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  • Pre Policy Medical Check Up in Health Insurance

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    With the rising cost of medical care and a higher susceptibility to disease, today’s professionals are looking at investing in health insurance as a way to ensure quality medical care without the heavy cost. With a slew of insurance companies offering various types of health insurance schemes to suit every budget and need, there is no dearth of options when it comes to picking a health insurance policy.

    Most health insurance policies mandate a health check-up before the policy is issued. So what exactly is this pre-policy health check-up and why is it mandatory?

    What is a Pre-Policy Medical Check-up?

    A pre-policy medical examination or check-up is a battery of tests and procedures that the prospective policyholder is required to undergo before the policy is accepted by the insurance company and health cover extended to him/her. These tests are required if the policyholder is above 40 or 45 years of age, so that the insurer is aware of the policyholder’s current medical fitness and if there are any pre-existing medical conditions.

    Another reason for the pre-policy check-ups could be if the policyholder chooses a Sum Assured above the average amount, thereby increasing the risk of the insurer. Policyholders who opt for health cover above Rs.10 lakhs are generally required to undergo a battery of medical tests before the health cover is extended to them.

    Why is a Pre Policy Medical Test Important?

    Pre-policy medical tests are compulsory for the majority of health insurance policies available today. These tests are important because they act as a benchmark against which the insurance company can measure the policyholder’s health. Any pre-existing medical conditions and illnesses would come to light through such a test, allowing the company to make a decision on appropriate cover for the particular individual.

    The tests are also important when it comes to filing claims. If the policyholder files a claim and the company can prove that the illness was caused by a pre-existing medical condition that was not disclosed or proves that the policyholders deliberately withheld information regarding his/her medical health, the claim could be repudiated. By undergoing a pre-policy test, the policyholder’s medical health will be on file, making it easier for both the insurance company as well as the policyholder to investigate and file a claim, respectively.

    Pre-Policy-Medical-Checkup-in-Health-Insurance

    What are the Tests Usually Conducted?

    Each insurer has a different risk assessment policy, based on which a life assured’s medical risk is measured. The risk is measured by a grid, with the policyholder’s age and coverage amount being the parameters of the grid. Based on these two factors, the type of tests would be administered to the policyholder. The usual tests administered are measurement of blood pressure, ECG, lipid profile test, blood serum test, complete blood count, blood sugar etc.

    Who Pays for the Tests?

    According to rules laid down by the Insurance Regulatory and Development Authority of India (IRDAI), at least half of the costs of the tests is to be borne by the insurance company, and the balance is to be paid by the policyholder. With the high competition in the market and to reduce the burden on policyholders, a number of insurers choose to cover the cost of the tests themselves.

    Some health insurance policies stipulate that the policyholder would have to cover the costs of the pre policy testing, with the amount being reimbursed after the cover has been granted.

    What Happens After the Tests are Conducted?

    Once the results are received, the company will take a decision on whether to cover the policyholder under the terms mentioned in the policy proposal. This is generally the case. If the tests show an illness or medical condition, the company can opt for any of the following:

    • Higher premium: the company could issue the policy and extend cover to the individual but at a higher premium to cover the cost of expenses due to the condition/illness detected. The increase in premium would depend on the severity of the illness and the policyholder’s age.
    • Permanent exclusions: the company could choose to issue the policy but exclude cover for the condition/illness detected. This is done if the company’s underwriters deem the illness too risky to be covered. In such a case, if the policyholder receives any medical treatment due to the excluded illness, he/she will not be able to file a claim of recompense.
    • Rejection: in cases where the illness is very high risk or would require frequent treatment, the insurer could choose to reject the policy proposal.

    While there are policies that do not mandate pre-policy medical examinations, it is advisable to undergo the tests as they pay dividends in the long run and help avoid the possibility of a rejected claim at a later date.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Pre Policy Medical Check Up in Health Insurance Reviews

  • Page 1 of 50 1 2 3 4 5
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with HDFC ERGO from last 2 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance policy. A premium of Rs 6000 has to be paid for this insurance and the coverage value is Rs 3-4 lacs.
      Was this review helpful? 0
      , vadodara
      Reviewed on Sep 17, 2018
    • Star Health Health Insurance
      "Average Service"
      0.5 3.0/5 "Satisfactory"
      I was using the health insurance policy with the Star Health. I am paying a premium of 35K per year. On one occasion I claimed the policy and they were able to reimburse only 75% of the amount claimed which wasn't satisfactory.
      Was this review helpful? 3
      , hyderabad
      Reviewed on Sep 15, 2018
    • Reliance General Health Insurance
      "Average Service"
      0.5 3.0/5 "Satisfactory"
      I've a health insurance policy with the Reliance General Insurance. I am paying a premium of 27000 per year. It is for the entire family. There hasn't been any claim experience so far. I will have to wait and see how they respond to my requests in future if I will have any.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 15, 2018
    • New India Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      My health insurance is with New India Assurance from last 1 year, i am not aware of the premium amount as my company pays it. I have no claim experience so far with this insurance policy and the coverage value is Rs 2 lacs for individual.
      Was this review helpful? 1
      , bangalore
      Reviewed on Sep 14, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 7-8 years, i have no claim experience so far with this insurance policy. I pay a premium of Rs 12000 for this insurance policy and the coverage value is Rs 5 lacs for this policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 12, 2018
    • Cigna TTK Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with CIGNA TTK from last 2 years, i am happy with the coverage value of this insurance policy. I pay a premium of Rs 12000 for this insurance policy. I have no claim experience so far with this insurance and the coverage value of Rs 4.5 lacs.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 12, 2018
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with MAX BUPA from last 6 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance and i get no claim bonus every year. The coverage value for this insurance is Rs 15-20 lacs.
      Was this review helpful? 0
      , faridabad
      Reviewed on Sep 12, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 3.0/5 "Satisfactory"
      I have recently taken a health insurance policy with ICICI LOMBARD. I have to pay a premium of Rs 15000 on yearly basis. This policy i got it along with the personal loan taken from Fullerton. They gave a coverage of Rs 3 lacs for this insurance policy.
      Was this review helpful? 1
      , rajahmundry
      Reviewed on Sep 12, 2018
    • Star Health Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      My health is insured with STAR health from last 1year and it is a good policy to use. It is a family policy where the coverage value is Rs 3 lacs per individual. I do not have claim experience with this insurance and i pay a premium of Rs 15000 for this insurance.
      Was this review helpful? 1
      , coimbatore
      Reviewed on Sep 12, 2018
    • Religare Health Insurance
      "Best policy"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with Religare from last 1.5 years, a premium of Rs 14000 has to be paid for this insurance policy and it is a family coverage. My claim experience was very good and they covered 100%. Coverage value is Rs 5 lacs +5 lacs (auto refill) for this insurance.
      Was this review helpful? 0
      , ahmedabad
      Reviewed on Sep 12, 2018
    • Reliance General Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Reliance general insurance from last 3 months, i pay a premium of Rs 10000 for 2 individuals and each one has the coverage value of Rs 5 lacs. It is a good policy to use and i have not claimed anything so far from this insurance.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 12, 2018
    • National Insurance Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I hold an Individual health insurance policy with National insurance from last 4 years, i have not claimed anything so far from this insurance policy. I pay a premium of Rs 3000 for this insurance policy and the coverage value is Rs 1.5 lacs for this insurance.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Sep 12, 2018
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with HDFC ERGO from last 1.5 months, i am happy with the coverage value of this insurance policy. A premium of Rs 6000 has to be paid for this insurance policy. I have no claim experience with this insurance the coverage value is Rs 5 lacs.
      Was this review helpful? 0
      , palanpur
      Reviewed on Sep 12, 2018
    • ICICI Lombard Health Insurance
      "Normal Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy with the ICICI Lombard. I am paying low premium, there hasn't been any claim experience with the policy so far. Considering the premium I pay it has been a normal experience with the policy so far.
      Was this review helpful? 1
      , udaipur
      Reviewed on Sep 11, 2018
    • ICICI Lombard Health Insurance
      "Good Service"
      0.5 5.0/5 "Blown Away!"
      I've a health insurance policy with the ICICI Lombard, I am paying the premium and I do not have any claim experience with the policy so far. I'll have to wait and see how they respond to my claim requests in future. It has been a hassle free experience so far.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 11, 2018
    • Star Health Health Insurance
      "Start Health Insurance Fraud"
      0.5 0.5/5 "Unacceptable"
      My father purchased Star health insurance for family safety and was paying premium from last 2 years but when time came insurer refused to give claim stating that throughout the hospitalization and all investigation reports are within normal limits. My brother was admitted in family hospital delhi for 24 hours, doctors diagnosed him and billed approx 13500.
      Was this review helpful? 3
      , new delhi
      Reviewed on Sep 08, 2018
    • Chola Ms Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with Cholamandalam health insurance from last 2 years, i am happy with the coverage value of this insurance policy. I am not aware of the premium amount as my company pays it. It is a family coverage and they cover up to Rs 5 lacs for this insurance.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 08, 2018
    • Apollo Munich Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with Apollo Munich from last 3 months, i am happy with the coverage value of this insurance. I am not aware of the premium amount as my company pays it. The coverage value is Rs 10 lacs for accidental policy and Rs 10 lacs for death policy.
      Was this review helpful? 0
      , pune
      Reviewed on Sep 08, 2018
    • National Insurance Health Insurance
      "Very Good Service"
      0.5 4.0/5 "Great!"
      I had taken this insurance policy almost ten years back and the premium had been paying online. The premium amount has not been higher and it was nominal. Their customer support and their staff responses also had been good as well. They also covers most of the hospitals in our locality.
      Was this review helpful? 0
      , coimbatore
      Reviewed on Sep 07, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have an Individual health insurance policy with ICICI Lombard from last 4 years, i pay a premium of Rs 6500 for this insurance policy. I have not claimed anything so far from this insurance policy. The coverage value for this policy is 7 lacs.
      Was this review helpful? 1
      , faridabad
      Reviewed on Sep 06, 2018
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