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Pre Policy Medical Check Up in Health Insurance

Pre-policy medical examination refers to the medical examination requested by health insurers before providing coverage to a person. This is to minimise their risk in covering a person. This is required only for applicants over a specific age.
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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

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  • ICICI Lombard Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with ICICI Lombard general insurance, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me was nominal,i use to pay on yearly basis.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I took my medi claim with HDFC ERGO, they have tie up with many hospital,and they have shared me the location regarding this,they have mention the location on excel,and the premium amount they have charged me is nominal,they have charged me on yearly basis.overall service is good.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Apollo Munich Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    My organization has given me a health insurance from Apollo Munich. I have not gone through about the documents and hospital list. My entire family has been covered in this policy. They have given me a satisfied coverage value. I have not contact the customer care so far.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    I have purchased the health insurance from HDFC Ergo. For some enquiry, i have called the customer care service and they have resolved my query immediately. I have not made any claim experience so far. I pay the premium amount of Rs. 37000 and myself has been covered in this policy.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 20, 2019
  • Star Health Health Insurance
    "Less premium with Extra benefits"
    0.5 3.0/5 "Satisfactory"
    Taken my health insurance policy recently from Star. Till now i have not spoke with the customer care. Since my age is above 50, i made the premium amount of Rs. 17000. Myself, my wife and child has been covered in this policy. They have given me a coverage value of Rs. 4 lakhs. Almost major hospital has been covered in this list.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Reliance General Health Insurance
    "Overall Experience is good"
    0.5 4.0/5 "Great!"
    I'm using the health insurance from Reliance last 5 years. Since I'm the in charge of corporate insurance the customer care service is really fine. I made many claim from Reliance for other employee. As per the policy, they are fulfilling the customer needs. They are providing good cashless treatment facility. They used to send a updation on a regular basis.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • Apollo Munich Health Insurance
    "Very Good Policy"
    0.5 5.0/5 "Blown Away!"
    I have a corporate covered health insurance policy from Apollo Munich. They have given me a coverage value of Rs. 4 lakhs. My entire family has been covered in this policy. This policy covers all the major hospitals in all over India. I have not made any claim so far.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 20, 2019
  • ICICI Lombard Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    My health insurance was purchased from ICICI Lombard. To apply the claim, its a lengthy process. I had a claim experience and they have given the claim upto 80%. I pay the premium amount of Rs. 12500 every year. My entire family has been covered in this policy.
    Was this review helpful? 0
    , indore
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I experience my health insurance with HDFC Ergo,they have tie up many hospital ,i have not have claim experience yet,there is cashless treatment option available,the premium they have charged me on monthly basis,they have charged me up to 700 which is nominal , i pay premium through on line.
    Was this review helpful? 0
    , kolkata
    Reviewed on Jan 20, 2019
  • ICICI Lombard Health Insurance
    "Bad experience"
    0.5 1.0/5 "Really Bad"
    I hold health insurance with ICICI lombard,they have tie up with many hospital , and even they have shared me the location in pdf form, and i pay previously premium on yearly basis, but now it is flexible pay option is available, and i use to pay on monthly basis, up to 878 rupees ,it is bit high compare to market value,there is cashless treatment available.
    Was this review helpful? 0
    , ahmedabad
    Reviewed on Jan 19, 2019
  • Max Bupa Health Insurance
    "Good Policy"
    0.5 4.0/5 "Great!"
    I have chosen this MAX BUPA insurance mainly because of convincing premium benefits . This policy covers Cashless hospitalization. , pre diseases coverage . Overall am satisfied with customer care and service. Am getting income tax benefits and the premium amount which am paying is satisfied , Am making the payment through online .
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 19, 2019
  • Star Health Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using health insurance with Star health insurance, the agent had clearly explain me amount the claim policy, and they have tie up with my hospital, and they have charged me location regarding to hospital location, there premium amount is on yearly basis, and it use to get auto debited from my account.
    Was this review helpful? 0
    , thane
    Reviewed on Jan 19, 2019
  • HDFC Ergo Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken Health insurance from Hdfc ergo insurance . Am satisfied with the premium amount which am making the payment for every 2 years . This policy gives good coverage with cashless hospitalization and pre disease cover . Even they have given network list of hospitals . While taking the policy they have explained very well about policy and claim .
    Was this review helpful? 0
    , bhubaneshwar
    Reviewed on Jan 19, 2019
  • United India Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my mediclaim insurance with United state of India,the premium i use to pay on yearly basis,i need to pay through on line,they have tie up with many hospital , i no doing much important is that they have share the location,i have no claim experience yet,till now no issue ,any changes they use to notify and use to send hard copy.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 19, 2019
  • United India Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I have mediclaim policy with United India Insurance, My wife got surgery, it was there in the listed hospitals. I paid only for the medical , remaining all taken care by the insurer gave me the cash less treatment. My total coverage value is Rs. 3.5 lakhs including my family its good.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 19, 2019
  • United India Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I got group insurance from company, on time I got policy. My father was not good at the time I have used the policy. I got the reimbursement around Rs. 23,000 the total value is Rs. 33,000. I went to shobha hospital they don't have tie up with United India, hence I got the reimbursement.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 18, 2019
  • Max Bupa Health Insurance
    "Good Claim Experience"
    0.5 5.0/5 "Blown Away!"
    I have medical cover with Max bupa, they gave me the coverage value of Rs. 5 lakhs its covers for entire family. One time I claimed for my mother for the eye surgery, I got the reimbursed within 30 days with 90% of amount, the total experience was good.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Jan 18, 2019
  • New India Health Insurance
    "Yet to experience the policy"
    0.5 5.0/5 "Blown Away!"
    My company has provided me a health insurance policy from new India. As per company norms, they have given me a coverage value of Rs. 5 lakhs. My entire family has been covered in this policy. They are offering a cashless treatment facility.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 18, 2019
  • United India Health Insurance
    "Very Good Service"
    0.5 4.0/5 "Great!"
    I had taken this insurance policy in the year of 2018 and the the premium has been deducting from my salary. The premium amount has not been too high and there has been many hospitals collaborated within my locality. There has also been some cashless treatment available with this policy as well.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 17, 2019
  • Star Health Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have my health insurance with Star health insurance, i had claim experience with it, my experience was good, they have good tie up with my hospital and they have mailed me about the location of it, and i am happy with there service, they have charged me premium amount on yearly basis, and the premium amount is nominal for me, and i use to pay through on line mode.
    Was this review helpful? 2
    , chennai
    Reviewed on Jan 17, 2019
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