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Are Pre-Medical Tests Necessary?

Pre-medical exams are necessary for obtaining health insurance because they play a significant role in establishing your eligibility for coverage.

  • 17 Apr 2023
  • 3 min read

Many reputable insurance companies require you to undergo certain medical tests when you seek health insurance coverage. These pre-medical exams are necessary for obtaining health insurance because they play a significant role in establishing your eligibility for coverage. However, it does not entail that you cannot get health insurance without a medical test. 'Insurance providers that require you to take a health insurance test are the most accommodating when filing a claim.

However, it is crucial to remember that even if the insurance company has not requested that you undergo these tests, this does not suggest that you conceal a pre-existing medical condition. Fraud is intentionally misrepresenting facts, resulting in the insurer denying or rejecting your claim. Therefore, before your insurance provider determines your premium amount, you must declare any pre-existing medical condition to avoid the chances of your claim being denied or rejected in the future.

What are the Pre-Medical Tests?

Pre-medical inspections, or pre-medical tests, are a set of medical assessments performed by licenced medical professionals to determine the applicant's current health status. Before issuing a healthcare policy, most insurers insist on pre-medical tests as they want to assess the prospective policyholder’s medical condition. Also, the premium for a policy depends on the results of the pre-medical tests that you have to undergo.

In most cases, the insurance provider's coverage and the number of tests doctors perform are correlated. Additionally, most testing is done based on the applicant's age and the plan's benefits. According to the general tendency, most people seek insurance without medical exams.

The age of a potential customer and the scope of the insurance coverage determines how many pre-policy medical examinations are required. For example, if the beneficiary is older than 45, most health insurance firms demand a pre-policy medical assessment, including several parameters.

The world has seen one of the most dreadful pandemics in human history. As a result, how people generally live their lives in the present has undergone a complete transformation due to COVID-19. In addition, many sectors, along with the health insurance sector, have been impacted by this pandemic. As a result, how the health insurance market works has undergone considerable change.

Nowadays, most insurers insist on a pre-medical investigation for prospective policyholders. Although it is not mandatory, pre-policy medical tests are gaining popularity.

Is Pre-Medical Examination Compulsory for Buying Health Insurance?

A prospective policyholder with a pre-existing condition views medical exams as a barrier as they can lead to higher premiums or even coverage denial. However, most individuals over 45 undergo regular medical examinations to be aware of any dormant health issues. Insurance providers advise them to give accurate information when applying for insurance to guarantee a smooth claims procedure. Furthermore, most policies have a waiting period for pre-existing conditions. Insurance providers usually reject claims related to pre-existing health issues made during this tenure.

Regular medical exams are always advisable because they give you an update on your health condition and act as a benchmark for medical professionals. Without medical exams, disputes over whether policyholders concealed or misrepresented their illnesses could arise when claims get settled. Your insurer can reject your claim if the insurance provider finds you have concealed information about a pre-existing illness.

The premiums for plans that cover pre-existing ailments are comparatively high than a standard policy. They also have more stringent restrictions than plans with standard coverage. However, you will still have to give detailed information even though buying a policy without a medical exam may seem simple.

A comprehensive medical evaluation will establish your actual degree of fitness. If there are any possible health problems, you will be in a position to opt for medical intervention and timely treatment.

Although it is not mandatory, you should go for a medical examination before buying health insurance coverage.

Also read:

Importance of Undergoing Pre-Medical Examination

For a variety of reasons, the beneficiary must submit the results of the medical exams he/she undergoes.

Numerous companies issue Mediclaim policies without requiring you to undergo medical tests. This might initially seem alluring, but it can cause significant problems when submitting a claim. Buying a health insurance plan without undergoing a pre-medical examination means the candidate is responsible for disclosing any existing medical conditions. Before a health insurance plan is approved, applicants who opt for pre-medical exams have a financial advantage in the shape of a discount. Candidates who perform well on the medical examination may be eligible for reductions in the premium because their chances of filing a claim greatly diminish.

Pre-existing condition coverage is a significant advantage of selecting health insurance policies that subject candidates to pre-medical examinations before Mediclaim approval. After a predetermined waiting period, the provider will typically give coverage against pre-existing conditions. Unfortunately, when we least anticipate it, illnesses often strike, causing financial and emotional hardship. But having a pre-medical exam guarantees that the applicant is fully conscious of their ailments and state of health, making it easier for them to get the appropriate care when needed.

Pre-medical exams are a crucial instrument for assisting applicants in selecting an appropriate level of coverage depending on their present state of health. With this, the applicant and their family members can ensure they receive the relevant health insurance policy benefits.

Benefits of Buying Medical Insurance with Pre-Policy Medical Tests

People purchase medical insurance plans to protect their funds against potential medical costs. Hence, taking proper steps when buying a health insurance policy is crucial.  

The insurance provider may sometimes deny your claim by claiming that a previously unreported pre-existing medical condition caused the sickness. Your pre-policy test findings, however, might avoid such rejections by clearly stating that you did not suffer from the illness before purchasing the policy.

Some insurance providers give applicants who pass particular tests — such as those that measure their body's amount of nicotine — discounts on their premiums. Likewise, you might be entitled to a discount on your health insurance premium if there are no signs of this substance in your blood.

If you come to know about a medical condition during the Pre-Policy Check-up, you can opt for a policy that covers it rather than being refused coverage due to non-disclosure. Depending on the examination results, the health insurance provider may even give a specific coverage level for the policyholder's circumstance or offer waiting period exclusions. However, the likelihood of being underpaid gets nearly eliminated by seeking a Pre-Policy Medical Check-up. In addition, the policyholder's chance of getting adequate coverage as per his/her medical condition increases with the timely submission of the medical test results.

Common Tests Include:

Pre-medical examinations required for a healthcare insurance policy depend on the insurer and the proposer's medical history and disclosure. However, the following are some pre-medical tests that all insurance providers assess.

The BMI test determines your body mass index, which assesses your weight and height (BMI). This aids the insurance company in determining whether you are at a good weight, an unhealthy weight, or somewhere in between. The urine analysis test helps insurers decide whether or not you suffer from elevated blood sugar levels or other conditions.

The RBC examination assesses the body’s red and white blood cells. This enables the insurance provider to verify that you don't have any undiagnosed health issues.

Diabetes is a severe illness that harms one's health. Insurers use blood sugar levels as a crucial metric to determine whether you have type I or type II diabetes.

The kidney function test reveals whether your kidneys are functioning normally. The liver function test evaluates the liver's condition to determine whether any problems exist.

The lipid profile evaluates your body’s blood cholesterol levels to eliminate any issues and their impacts on your health. Next, TMT examines your heart's health and performance. It measures the capability of your heart under conditions of high stress. Echocardiography shows whether you have cardiovascular issues or your heart is functioning properly. There are several procedures involved, including 3D and stress echocardiography.

What are the charges for these tests?

Medical exams ascertain a potential policyholder's present health status. Considering the health status enables the insurance provider to offer greater coverage and lowers the likelihood of a claim’s denial or rejection. The insurance company will cover half of the pre-medical check-up expenses, and the policyholder will cover the other half, following IRDAI regulations.

  • The costs of these pre-medical tests vary as different diagnostic centres and hospitals have various charges.
  • Many diagnostic facilities and hospitals provide pre-medical check-up packages in different Indian cities, and costs may differ.
  • Most simple tests start with a doctor’s visit and physical examination. These health exam packages are affordable, and most clinics can customise them to meet needs. Some insurance providers cover the complete expense of the pre-medical exams to lessen their obligations to policyholders.
  • Some health insurance providers advise their customers to cover the cost of the pre-policy medical assessment themselves. The insurer refunds the customer after he/she purchases the plan.

If any pre-existing health condition is detected, paying a slightly higher premium will widen the scope of your healthcare policy’s coverage. You can talk to your prospective insurance provider to figure out the percentage of the costs the insurer will reimburse, as well as the charges for undergoing the evaluation.

Pre-policy medical examinations can identify any potential future problems. Packages for pre-medical check-ups provide a complete assessment of your current state of health. Therefore, a good first move is to choose packages that, at the very least, include the fundamental exams.

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