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Why Are Pre-Policy Medical Check-Ups Important in Health Insurance?

Today’s professionals are considering purchasing health insurance as a method to guarantee high-quality medical care without paying a high price due to the rising expense of medical care and an increased vulnerability to sickness. There are many options when choosing a health insurance policy, with a plethora of insurance firms offering various forms of health insurance benefits to meet every budget and need.

The majority of health insurance policies demand a physical before issuing the coverage. Then what is this pre-policy health checkup exactly, and why is it required?

Pre-policy medical checkup: what is it?

Prior to the insurance company accepting the health insurance plans and extending health coverage to the potential policyholder, a pre-policy medical examination or check-up is a series of tests and procedures that must be completed. In order for the insurer to be informed of the policyholder’s current medical fitness and whether there are any pre-existing diseases, these tests are necessary if the policyholder is over 40 or 45 years old.

If the policyholder selects a sum assured over the average amount, increasing the risk to the insurer, this could be another cause for the pre-policy checks. Policyholders who choose health coverage that costs more than Rs. 10 lakhs typically have to go through a series of medical exams before being approved. *

The importance of a pre-policy medical test

The majority of current health insurance policies require pre-policy medical exams. These tests are crucial because they serve as a standard by which the insurance provider may assess the health of the policyholder. Such a test would reveal any pre-existing diseases and illnesses, enabling the business to choose the best type of coverage for the specific applicant. *

When submitting claims, the tests are also crucial. The claim may be rejected if the policyholder makes a claim and the insurer can show that the illness was brought on by a pre-existing condition that wasn’t reported or that the policyholder knowingly omitted information about his or her medical condition. The policyholder’s medical history will be recorded by taking a pre-policy test, making it simpler for the insurance provider to conduct an investigation and for the policyholder to submit a claim, respectively.

Who covers the test costs?

The Insurance Regulatory and Development Authority of India (IRDAI) has established regulations that require the insurance provider to cover at least half of the cost of the tests while the policyholder is responsible for the remaining balance. #

Some health insurance policies state that the policyholder is responsible for the pre-policy testing fees; the policyholder will be repaid for these costs when the coverage has been approved.

What takes place following the tests?

Following receipt of the results, the insurer will decide whether or not to provide coverage for the policyholder under the conditions outlined in the health insurance plan. The following options are available to the employer if the testing reveals a disease or medical condition:

  • Higher premium: To cover the cost of expenses incurred as a result of the ailment or illness discovered, the company may issue the policy and extend coverage to the individual. The severity of the disease and the age of the insured would both affect the premium rise. *
  • Permanent exclusions: The insurance provider may decide to issue the policy but not include coverage for the identified ailment or illness. If the company’s underwriters determine that the sickness is too hazardous to be covered, this is done. If the excluded sickness is treated medically in this situation, the policyholder will not be eligible to submit a claim for compensation. *
  • Rejection: The insurer may decide to reject the coverage proposal if the sickness has a very high risk or would demand regular treatment. *

* Standard T&C Apply

# Visit the official website of IRDAI for further details.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

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