How Do Insurance Companies Know If You Have a Pre-existing Condition?

Health insurance plans are necessary for people who have pre existing diseases, but how do insurance companies know about them? A pre-existing illness is any health issue that you have been facing before buying a health insurance plan. Pre existing conditions can be – high blood pressure, thyroid, diabetes, asthma, etc. So whether you are aware of your pre existing condition or not, Health Insurance Companies organize a pre-medical check-up to find out which illness you are suffering from. Read this post further and know about health insurance pre-medical checkups in detail.

What is Pre Policy Medical Check-Up?

A medical test or a pre-medical check-up is conducted by the insurance company to do a medical examination of the insured person. And this test is conducted by the health insurance companies before they provide approval for the policy. The general tests that are suggested to you are as follows –

1. ECG
2. Measurement of blood pressure
3. Blood serum test
4. Lipid profile
5. Blood sugar test
6. Complete blood count

Who Pays for the Pre Policy Medical Check-Up?

According to the Insurance Regulatory and Development Authority of India (IRDAI), the proposer should bear at least 50% of the pre-medical test cost while the remaining cost will be borne by the insurance company. And as there is a wide range of companies, there are some insurance companies that cover 100% of the cost of the medical check-up. Other than this, some insurance companies reimburse the pre-policy medical check-up cost once the policy is approved.

What Happens Post Pre Policy Medical Check-Up?

When your test results are received, and there is no sign or symptom of an illness, the insurance company will decide your policy coverage, premium amount, terms and conditions. In case, the test results show any sign or symptom pre-existing illness or medical conditions, the insurance company will proceed to any of the following:

1. Policy Application Rejection – If your pre existing illness is of higher risk and there are fewer chances of survival, the insurance company will decide to reject your policy proposal
2. Higher Premium Amount – The insurance provider will approve your insurance plan request but at a higher premium amount. The increase in the premium amount would be based upon the severeness of the pre-existing illness and the age of the insured.

Exclusions Due to Pre existing Conditions

If the insurance provider issues the insurance policy knowing your pre existing health condition, there are some terms and conditions that will apply to your policy:

1. You can’t file a claim during the initial policy period
2. No claims are valid for pre existing condition treatment until the waiting period expiry
3. Your pre-existing condition shall not be covered throughout the policy tenure, this condition may vary from insurer to insurer.

Do All Insurance Companies Offer Pre Policy Medical Check-Up?

The following are the insurance companies that don’t require pre policy medical check-up for a health insurance plan –

Oriental Health Insurance

Oriental Insurance provides you a Happy Family Floater Plan where you do not need to go through a medical check-up if your age is less than 60 years at the time of policy purchase.

Care Health Insurance

Another insurer that provides you the benefit of no medical check-up under its health plans is Care Health Insurance. If you apply for Care health insurance and have a pre existing condition like Diabetes, High BP & High BMI, you don’t need to go through a medical screening if you have disclosed the same in the proposal form.

Star Health Insurance

If you purchase the following health insurance plans from Star Health, you don’t need to go through medical screening till the age of 50 or 65 years –

1. Star Family Health Optima (till the age of 50 years)
2. Star Medi Classic (till the age of 50 years)
3. Star Health Gain (till the age of 50 years)
4. Star Comprehensive (till the age of 50 years)
5. Star Family Delite (till the age of 50 years)
6. Senior Citizen Red Carpet (till the age of 65 years)