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In India, securing Health Insurance without medical exams is challenging. Most insurance companies mandate a pre-medical examination at an approved hospital. They do this to gauge rates accurately and prevent potential losses if they overlook a severe illness when issuing the policy. This article can help guide you through all aspects of these examinations.
Also read: What Is Health Insurance – Types, Features & Benefits
What is a Pre-policy checkup?
A pre-medical checkup comprises a set of medical examinations and tests that a prospective policyholder must undergo before the insurer approves their policy application. Typically, these tests are necessary for policyholders aged over 40. The tests help insurers understand the applicant's medical health and whether they have any existing conditions. Always choose the insurance plan before you opt for a pre-policy test.
Inclusions and exclusions in your policy
No matter which Health Insurance plan you finalise, exclusions in the plan are inevitable. No plan covers everything in the health domain, and as a policy buyer, you'll have to make tradeoffs. Certain items like knee replacement surgery might be non-negotiable for you, so search for such inclusions while looking for policies.
Before you finalise any Health Insurance policy, understand the treatments included in the plan and those excluded. Many insurance policies now also cover convalescence benefits. If your plan excludes many treatments and does not include coverage for days spent in recovery after hospitalisation, choose a better plan.
Lock-in period and solvency of the insurance provider
Some Health Insurance policies come with a lock-in period. Even though you are paying premiums, you cannot raise any claims during this lock-in period. Some insurance providers enforce a one or two-year lock-in period where claims are limited. Once that period lapses, you can raise claims. Employers offer group medical coverage plans that often don't have a lock-in period.
Additionally, before purchasing a policy, you should check the solvency of the insurance provider. Though the IRDA has strict norms for insurance policies, you should check the lock-in period and solvency of the insurance provider to ensure that you will get a payout or claim when you need it the most.
Total sum insured and payment modes
People often miss out on some of the most important things to check in a policy. Remember to check the total sum insured in your Health Insurance, as that is the maximum amount you can claim. Additionally, you should review payment modes and frequency. If you feel your Health Insurance premium is too high, consider choosing flexible payment options.
Tests Conducted before Health Insurance
You should be familiar with the medical exam for Life Insurance and what it tests for. For Health Insurance, applicants must compulsorily undergo certain pre-medical checkups.
As required, you'll need to undergo mandatory pre-policy medical checkups, which often include common tests such as
1. Fasting Blood Sugar Test
2. BP, Heart rate
3. ECG
4. Lipid Profile Test
5. Blood Serum Test
6. Urine Test
7. Complete Blood Count (CBC)
Do not worry about who will pay for the pre-medical checkup expenses. According to IRDA rules, Health Insurance companies must pay the policy buyer at least 50% for pre-policy medical checkup expenses.
While there are insurance companies that provide an option to buy Health Insurance plans without any medical test for Term Insurance , it is always a better choice to get it done. Such policies will provide more advantages to help you find the right Health Insurance plan.
Medical checkup in Term Insurance
A pre-policy medical checkup is essential whether you seek Health Insurance or a Term Insurance plan. Before any insurance company can provide you with a Term Insurance policy, the company needs to know about your present health situation. They get to know this with the help of your medical reports. The buyer must undergo mandatory health checkups per the Term Insurance medical test list. After the medical checkup, the insurance company determines the premium and the maximum coverage they can offer you when you purchase the Term Insurance plan.
Cat5 medical test
CAT 5 is a specific set of medical tests that a Health Insurance applicant may be required to undergo to avail of life and Health Insurance policies as part of the application process.
The tests which are included under CAT 5 are:
(i) MER (Medical Examination Report): The MER is a review of an applicant's medical history, physical examination and an assessment of vitals.
(ii) Blood Profile: This test provides vital information about the applicant's blood, including complete blood count, liver function, kidney function, lipid profiles, and glucose levels.
(iii) ECG (Electrocardiogram): The ECG test measures the electrical activity of the applicant's heart. It helps evaluate the heart's rhythm, detect abnormalities, and assess cardiac health.
(iv) CBC (Complete Blood Count): It measures the various components of blood, including red and white blood cells, haemoglobin, haematocrit, and platelet count.
(v) MSU (Midstream Urine): It helps detect urinary tract infections, kidney problems, and other urinary system disorders.
These tests are essential for life insurance companies to assess the applicant's overall health, determine the insurance premium, and suggest suitable insurance plans.
Also read: What Are The Non-Medical Expenses in Health Insurance?
Conclusion
A pre-medical checkup lets you know about your medical condition; you can understand the underlying condition that may eventually become serious. Staying aware of your health issues can help you get the right coverage to cover the treatment expenses you may incur later. If you pass the pre-medical test, the insurer may consider you a low-risk customer and offer an attractive discount on the premium.
If a pre-medical checkup reveals an illness, many experts advise paying a higher premium to secure additional coverage rather than risking claim rejection and bearing the bills yourself.
Thus, it is evident that pre-policy medical checkups are always beneficial before buying Health Insurance.
FAQS – FREQUENTLY ASKED QUESTIONS
When can I expect results for PPMC ?
Pre-policy medical checkup (PPMC) is vital in getting the right coverage. Therefore, you shouldn't rush the process; instead, allow things to progress naturally. Typically, the outcomes of reports depend on their complexity, calculation methods, and the quantity of reports. If you undergo more tests, it will naturally take longer to get results. If a specific calculation method mandates waiting for a certain period before using the sample, you'll have no choice but to wait. Generally, for straightforward tests, you can receive results the same day. However, as tests become more complex, the time needed for results will extend.
Is it a good idea to avoid pre-policy tests ?
Pre-policy tests are essential. Although many insurance companies require them, some still bypass these tests. When shopping for a policy, always choose those that conduct a pre-policy test. Doing so lets you understand your health status better and select the most suitable plans. Moreover, the insurance provider can also provide accurate coverage. Pre-policy tests also help you support your future medical claims and decrease the chances of rejection.
How do you check medical reports online ?
Most insurance providers have a standardised list of approved medical examination centres, and they accept reports from them only. If you have done the reports from such a centre, you can get the medical reports online before getting the printed reports. To access those reports, you should log in to the medical centre’s patient portal, and you can easily find your reports there if they have already been published. You can also request the centre to send you a soft copy via email or WhatsApp.
Does insurance cover medical checkup ?
Insurance has various categories and coverage. Today, there are insurance policies that can cover your medical checkups and OPD visits. When buying insurance, you have to check whether there is OPD coverage or whether you can add it to the existing policy. While the premium may be a bit higher than regular insurance, it can help you save significantly on doctor visits and get more minor treatments from qualified doctors. Additionally, if your policy includes such coverage, it ensures that any daycare treatments you undergo are covered.
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
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