Do undergo medical test for hassle free health insurance claim settlement

Health Insurances 199 views

While buying health insurance policy, make sure you reveal each and every health related details to the insurer in order to prevent a situation where you may get denied the coverage for any pre-existing conditions or diseases. Health insurance companies often tell you to undergo medical tests. But many a times, it has been observed that people tend to get wary and hesitate to go for medical test in anticipation of the fear of losing the coverage on disclosure of health conditions from the test. By skipping the medical test and not revealing the health related details, you make the extent of your health coverage extremely shorter. Let's understand in detail about medical test and its role in health insurance policy.

What is pre-policy medical test?

Health insurers do ask you to undergo a medical test before granting you the cover. The medical check-up is required if the customer attains a certain age of say 40-45 years. Also, when an individual opts for a higher cover amount of above 10 lacs, the need for medical test becomes extremely important for the insurer as its risk gets multiplied with such amount.

How Insurers Decide the Tests to be Conducted?

Health insurance companies have varied underwriting policies to decide the medical risk that the prospective insured faces. With the help of a grid, health insurers are able to know the required tests to be conducted on the individual. The grid works on two parameters- age and amount of cover. The higher the coverage amount and the age, more the tests will be conducted on the individual.

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Tests to be Conducted

As a prospective insured individual, you will have to go through common tests including blood pressure, fasting blood sugar, complete blood count, lipid profile test, blood serum test, urine test, ECG, etc.

Who Takes Stock of Medical Test Costs?

As per the guidelines of the Insurance Regulatory and Development Authority of India (IRDAI), the health insurance providers are expected to bear at least 50% of the medical test costs. But now, some insurance companies have lowered the financial burden on the customer by taking stocks of the entire cost related to medical check ups. While some insurers keep a criteria where the individual has to first bear the check-up costs, which will be then reimbursed about 50% or 100% subsequent to the approval of the policy.

What Next Post Test Completion?

The test reports are sent by the clinical laboratory to the company where the review of the same is made by an underwriting department. Upon satisfactory test results, the insurance proposal is accepted at the normal premium rates. Just in case the ailment comes out in the test results, one may have to go through below mentioned situations.

  • If the ailment is common and its severity is not high, then the insurance proposal will be accepted with a higher premium. On major illnesses, the premium amount could go up further.
  • If the underwriters of the health insurers consider the detected ailment to be dangerous with a high degree of occurrence, then the proposal may get accepted with some exclusions. The insurers will not have any liability to pay for the medical bills on treatment of any excluded ailment.
  • If the individual is found to have an ailment with a very high risk of occurrence at frequent intervals, then the insurer may reject the insurance proposal.
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How Insurers Intimate the Decision?

  • If the proposal gets the acceptance without any condition, then the insurer intimates the customer by sending him/her the policy document showing normal premium rates giving maximum coverage.
  • If the test results come out to be adverse, the health insurer sends the prospective policy holder the letter and tells him/her the conditions for the insurance proposal. For the proposal to be accepted, the customer has to accept the conditions, signs the letter and returns the same to the insurer.
  • The health insurance companies do send the letter stating the reasons for the rejection of the insurance proposal if so is the case.

Now that you have understood the importance of medical tests before taking health insurance policy, ensure you undergo the same. Don't go by the thought to reduce premium amount by not going through the check up because you are aware of the ailments you may have. Neglecting medical tests in this scenario could lead to the rejection of your claims. The higher premium amount, on being found ailment in the tests, will actually help you get the claim settlement.