Medical costs are increasing by leaps and bounds as modern-day medicine has become advanced and technology-driven. At the same time illnesses are rising as lifestyle changes have made people prone to health risks. In this scenario, affording quality healthcare has become difficult and challenging for many because of financial constraints. That is why people invest in health insurance plans to protect against the financial strain of a medical emergency.
When it comes to health insurance plans, buying them is easy as the plans can be bought online. However, there is a concept of pre-entrance health check-up under many policies before the coverage is granted. Let’s understand what this check-up is all about –
What is pre-entrance health check-up?
When you buy a health insurance plan, the insurance company insures the risk of diseases and injuries. While injuries cannot be predicted, it is easy to predict the occurrence of diseases based on your medical health. That is why many insurance companies ask you to undergo specific medical check-ups before you can avail coverage. These check-ups are called pre-entrance health check-ups as they are required before buying the policy.
Why such medical check-ups are required?
Insurance companies want to assess the probability of claims in the policies that they issue. To assess this probability they insist on pre-entrance medical check-ups. The medical check-ups help insurers understand the present medical condition of the insured and to find out if there are any pre-existing illnesses or medical complication. If the medical reports are found to be favourable, insurance companies can easily offer coverage to the insured. If, however, the medical reports show some medical complications, health insurance companies can do one or more of the following –
- Increase the premium to compensate for the higher health risk that they are undertaking by issuing the policy
- Restrict the amount of coverage available
- Put restrictive coverage terms on coverage of specific illnesses which might arise due to the medical complication found in the report
- Reject the proposal for insurance altogether if there is a very high health risk
The requirement of medical check-ups in health insurance plans
Now that you know why medical check-ups are required by health insurance companies, you should know that not all health insurance plans need you to undergo pre-entrance health check-ups. The requirement of pre-entrance medical check-ups occur in one or more of the following instances –
If your age is high
Usually, health insurance plans require pre-entrance health check-ups if you are aged 46 years and above. It is believed that individuals up to 45 years of age are comparatively healthy and as the age advances, medical complications set in. So, under many plans, you would find the requirement of pre-entrance health check-ups if you are aged above 45 years. Some plans, however, do not need pre-entrance health check-ups till 55 or even 60 years of age.
If you opt for a high sum insured
If you choose a sum insured which is high, the risk for the insurance company increases as the claim amount increases. As such, for high levels of the sum insured, pre-entrance health check-ups are needed even when you are young. Generally, the sum insured level above which pre-entrance medical check-ups are required is INR 10 lakhs while some plans might even allow coverage up to INR 20 lakhs without medical check-ups. However, if you choose a higher limit of sum insured, medical check-ups would become mandatory even when you are young.
If you declare an adverse medical condition in the proposal form
When filling up the proposal form you are required to divulge your medical history and present medical condition to the best of your knowledge. So, when filling up the proposal form if you mention that you suffer from an adverse medical complication or condition, the insurance company might ask you to undergo a medical check-up before issuing the policy irrespective of your age and the sum insured that you choose.
Health insurance without medical check-up in India
When it comes to undergoing pre-entrance health check-ups, many individuals tend to avoid buying the health insurance plan altogether. The reasons for such avoidance are as follows –
- They are averse to the idea of pre-entrance medical check-ups even when such check-ups can help them know about their health.
- Many also fear the detection of a medical condition which might increase the premium charged and avoid buying plans with medical tests.
- People find it inconvenient to undergo health check-ups before buying the policy
- The insurer bears the cost of pre-entrance health check-ups only if the policy is issued. If the policy is rejected, the cost falls on the shoulders of the policyholder which is an added expense
- Many companies pay only 50% of the cost of health check-ups making policyholders pay the remaining 50%. This is an added expense which many individuals do not like to undertake
Whether it is a mental aversion to health check-ups, the costs involved or the inconvenience of undergoing the test, pre-entrance medical tests are not favoured by all. That is why many people look for health insurance plans which do not require medical check-ups. Are there such plans available?
The answer is ‘Yes’. There are health insurance plans which do not require pre-entrance health check-ups up to a certain age and/or sum insured limit. Let’s have a look at such health insurance plans without medical check-ups –
|Name of the health plan
|The need for medical check-ups
|Star Health Family Health Optima
|No medical check-ups needed till 50 years of age. However, if an adverse medical history is mentioned in the proposal form, medical check-ups would be needed
|HDFC Ergo Health Easy Health Plan
|Pre-entrance medical check-ups depend on the entry age and the sum insured opted. If the tests are required, 100% of the cost of the tests would be borne by the insurance company
|Universal Sompo Complete Healthcare Insurance Plan
|Pre-entrance medical check-ups are not needed till 55 years of age. However, if there is a medical complication disclosed in the proposal form, medical check-ups might be required even if you are below 55 years of age
|Care Health Insurance Plan
|Pre-entrance medical check-ups are not required till 45 years of age if the sum insured is below INR 15 lakhs. For higher sum insured levels and/or higher ages, medical check-ups would be compulsory
|Manipal Cigna ProHealth Plus
|No pre-entrance medical check-ups would be required till 45 years of age if the sum insured is up to INR 50 lakhs. For higher ages and/or sum insured, pre-entrance health check-ups would be needed
Disclosures at the time of buying health insurance
Even if you are young or you choose a low level of sum insured, you might be required to undergo pre-entrance health check-ups if you disclose about any adverse medical condition in the proposal form when you apply for a health insurance policy. Fearing this many individuals try to hide important medical information when buying a health insurance policy. This is a mistake because of the following reasons –
- If you hide material information which directly impacts the risk undertaken by the insurance company, you breach the principle of utmost good faith. If the insurance company finds about your non-disclosure, the policy would be cancelled and it would become null and void. You would not only lose coverage but also the premium paid under the policy
- At the time of claims, if the insurance company finds out that you did not disclose about your medical condition when buying the policy, it might reject your claim
To avoid claim rejections and termination of coverage, you should always disclose about your medical condition when buying a health insurance plan. In case of an adverse medical complication, the company might increase your premium or limit the coverage but your claims would be honoured when the time comes and even your policy would not become null and void. So, complete disclosure at the time of buying a health insurance policy is a must.
While there are health insurance plans which do not require medical check-ups, remember that such plans would allow only limited coverage without health check-ups. So, if you are looking for a higher sum insured and want comprehensive protection, do not avoid medical check-ups. Undergo the required medical tests and get comprehensive coverage.