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All About Pre Policy Medical Check-Up in Health Insurance

It doesn’t come as a surprise, but a large percentage of people in India are physically inactive. This finding comes from the study by the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB). 

This inactiveness makes us prone to lifestyle diseases like diabetes, hypertension and more. Is that why some insurers insist on a pre-medical test before making medical insurance online application? 

But is that the only reason? Read along to find out.

Why do Insurers Conduct a Pre-Policy Medical Check-Up for Medical Insurance Application?

Insurers need to quantify the health risk associated with an insured person before issuing a policy. 

And they consider these factors as you apply for health insurance:

  1. Age and Health Risk

Age is an important factor in assessing the health risk of a person. Health risk increases with age. While younger people carry a minimal health risk, older people carry the most.

  1. Increasing Incidence of Lifestyle Diseases

However, young people are increasingly prone to lifestyle diseases. That’s another reason why insurers conduct a pre-policy medical checkup for health insurance.

  1. Pre-Existing Conditions

The insurers assess whether the insured person already suffers from certain diseases or conditions. These may be cardiac conditions, hypertension, diabetes etc. If the insured person has them before purchasing the policy, they are known as pre-existing conditions.

  1. Critical Illnesses

Diseases or ailments like cancer, certain cardiac conditions, stroke etc., are called critical illnesses. A pre-policy medical test before you apply for medical insurance helps to identify critical illnesses.

The insurer gets to know more about the insured person’s health condition and associated health risks.

Are there any benefits of pre-policy medical tests for the insured person? 

Read along to know what they are.

Benefits of Pre-Policy Medical Tests to the Insured Person

The insured person, too, stands to gain from a pre-policy medical checkup in health insurance. 

Here are some of the benefits to the insured person.

  • Selection of Policy Best Suited to the Insured Person

The medical checkup may identify certain health issues or conditions the insured person may be prone to. This may result in the selection of the policy best suited to the insured person.

  • Chances of getting Certain Pre-Existing Conditions Covered

The medical checkup may identify certain conditions which were not yet known to the insured person. The insurer may decide to cover these conditions with certain terms, conditions and limits.

  • Discounts on Insurance Premium for clearing Certain Tests

If the insured person clears certain tests, the insurer may offer discounts on insurance premiums. This is because the health risk associated with the insured person is now reduced.

  • Less Possibility of Claim Denial

In some cases, insurers may deny certain claims citing undisclosed pre-existing conditions. This possibility is completely removed by conducting a pre-policy medical checkup. This results in reducing the chances of claim denial by the insurer.

Conducting a pre-policy medical checkup may also be beneficial to the insured person.

Are you wondering what kind of tests are conducted in a pre-policy medical checkup? Read along to know more.

Types of Medical Tests Conducted During a medical Checkup for medical insurance application

Here are a few common types of medical tests conducted.

  1. Complete Blood Count (CBC)
  2. Fasting Blood Sugar
  3. Blood Pressure
  4. Heart Rate
  5. Respiratory Rate
  6. Electrocardiogram
  7. Urine Analysis
  8. Lipid Profile
  9. Blood Serum

Who covers the expenses for the pre-policy medical checkup in health insurance? Find out in the next section.

Expenses for the Medical Check-Up

Insurance Regulatory and Development Authority (IRDAI) is the insurance regulator in India. IRDAI mandates that the insurance company should bear at least 50% of the pre-medical checkup expenses. 

However, most insurers bear the expenses if it is performed at an empanelled diagnostic centre. 

You may conduct a medical test at a non-empanelled diagnostic centre. The insurer will most probably reimburse the expenses after the policy is issued. 

Thus the costs of medical checkups for health insurance are significantly less for the insured person.

Want to know what happens after the medical checkup? Read along.

What Happens after a Medical Check-Up for Health Insurance?

Insurers use the results of the medical to assess the medical condition of the insured person. They also consider the health risk associated with the insured person. Insurers use the data collected during a medical checkup to make decisions such as:

  • Issue a health insurance policy to the insured person at a calculated premium. 
  • Identify certain pre-existing conditions that they may choose not to cover or with certain terms, conditions, waiting periods, and limits.
  • Identify critical illnesses that they may choose not to cover or cover at an additional premium with terms, conditions, and limits.
  • In rare and extreme cases, refuse to issue a policy.
Better Informed and Empowered after a Pre-Policy Medical Checkup

The insurer and insured person are better informed after a medical checkup in health insurance. This information empowers them to make decisions to suit them both better.


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