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Pre-Policy Medical Check-Up (PPMC) and Tests Under Health Insurance Coverage

Team AckoJun 8, 2022

Having comprehensive health insurance coverage is becoming the need of the hour for almost all individuals these days. This is due to the rising cost of medical care and the equally rising incidences of lifestyle diseases. However, many are unaware of various features of health insurance policies, particularly Pre-Policy Medical Check-up (PPMC). This article will give an insight into all you need to know about tests that are conducted before you get health insurance.

Pre-Policy Medical Check-Up and Tests Under Health Insurance Coverage

What is Pre-Policy Medical Check-Up (PPMC) in Health Insurance? 

Pre-Policy Medical Check-up (PPMC) consists of a set of medical investigations that are mandated by health insurance companies before accepting and providing coverage to a potential policyholder. This check-up is meant to determine the applicant’s medical fitness before providing coverage. Besides, it also helps the insurer decide the most suitable health plan that the applicant might require. 

The number of pre-policy medical tests that are prescribed, depend on two factors – the age of an applicant and the coverage of the policy. Most of the health insurance companies request a Pre-Policy Medical Check-up (PPMC) if the policyholder’s age is more than 45 years. Also, higher the coverage more might be the number of tests required. 

Importance of Choosing Health Insurance Policy with a Pre-Policy Medical Test:

Pre-policy medical tests are becoming increasingly popular and have become a compulsory procedure for many health insurance companies nowadays. These tests are important in many ways, for example:

  1. They act as a standard against which the insurance company can measure the policyholder’s health. 

  2. They will reveal any pre-existing medical condition or illness that the applicant might be unaware of.

  3. The reports of these tests serve as important documents that can be presented as proof during filing claims. 

Generally, people have a tendency to try and escape these medical check-ups. But if the benefits of pre-policy tests are known, people wouldn’t hate this idea so much.

Benefits of Buying Medical Insurance Coverage with Pre-Policy Health Check-Up (PPHC):

We buy insurance policies to secure our savings against any future expenses related to health issues. That’s why it is absolutely necessary to ensure that the policies are bought by following the correct procedures. Let us now uncover some benefits that you can enjoy if you buy health insurance coverage with Pre-Policy Medical Check-up (PPMC):

  • Avoid the possibility of claim denial

    Many a time, when the policyholder files a claim, the insurance company rejects it by stating that the illness was caused by a pre-existing medical condition. And this condition was not disclosed by the policyholder before buying the policy. But when your pre-policy test results are on record, such unfortunate events can be easily avoided.

  • Clearing certain tests can make you eligible for discounts

    Some insurance companies offer discounts on the premium to applicants who clear certain tests. For example, testing the level of nicotine in the body. If no traces of this substance are found in your blood, you may be eligible for a discount on health insurance premium.

  • Possibility of getting coverage for some pre-existing conditions

    Sometimes, It might be a good thing to be aware of a pre-existing condition during the Pre-Policy Check-up than to be denied coverage due to non-disclosure of the pre-existing condition. In fact, the health insurance company might even provide a certain level of coverage for the policyholder’s condition or offer specific exclusions or waiting periods. These options are much safer than getting a claim denied completely when in need. 

Learn more about waiting period for health insurance.

  • Selection of the best policy as per the policyholder’s health condition

    Getting a Pre-Policy Medical Check-up (PPMC) almost always rules out the possibility of being under insured. Duly submitting the medical test reports increases the policyholder’s chance of receiving a higher coverage as per his/her medical condition. 

What Kind of Tests are Usually Conducted? 

The tests that are usually done during the check-up are simple yet efficient. Below are some basic investigations that are performed: 

  1. Complete Blood Count (CBC)

  2. Fasting blood sugar

  3. Vital signs such as blood pressure measurement, heart rate, and respiratory rate 

  4. ECG

  5. Urinalysis

  6. Lipid profile

  7. Serology or blood serum test, etc.

Who Will be Paying for The Medical Tests?

As per the Insurance Regulatory and Development Authority (IRDAI), the insurance company should bear at least 50% of the cost associated with the pre-medical check-up. But the majority of health insurance companies bear the entire expense of such tests, especially if they are done at an enlisted diagnostic center, to whom the insurer will pay an agreed rate upon the completion of check-up. 

In cases where health insurers request policyholders to pay the cost of the medical tests, or if the tests are not done at a listed center, then the amount is reimbursed to the policyholder once the cover has been granted. So, the medical check-up cost varies according to company policies. However, for the policyholder, these costs are minimal.

Also, read: Pre-Hospitalisation and Post-Hospitalisation Expenses

List of Procedures After the Tests Are Done:

What happens after the Pre-Policy Medical Check-up (PPMC), is dependent on the test results. Basically, the results will be reviewed by the insurer to decide whether to grant or deny the insurance policy. Below is a list of procedures according to what the medical test results show:

  1. If your test results are negative for any medical illness, the health insurer will accept the coverage and inform the policyholder. 

  2. If an illness is detected in the check-up, the insurer may grant the coverage under the condition that the policyholder pays a higher premium amount according to his/her age and the severity of illness. 

  3. The health insurer may accept the proposal, but the policy will not cover the pre-existing illness. This is called permanent exclusion.

  4. The insurance company can reject an application if a specific illness requires expensive medical attention.

How to Avail of Medical Check-Up under your Health Insurance Cover?

It is commonly seen that insurance companies allow free medical tests only after the policyholder has remained claim-free for a predetermined number of years. However, there are some companies that offer medical check-ups to their policyholders every year or every three to five years, irrespective of the claims made. The policyholder can avail this feature at any diagnostic center that is enlisted under the insurer’s network by using the insurance company’s health card.

Why Choose ACKO Pre-Policy Health Check-Up (PPHC)?

ACKO offers a seamless process right from buying a health insurance policy to claim settlement. When you choose ACKO Health insurance, you can avail adequate coverage for a low premium. The policy will also come with a host of additional features that are not commonly available in the market. One such feature is Pre-Policy Health Check-Up. 

When you apply for a health insurance policy at ACKO, the expenses of Pre-Policy Health Check-Up will be completely borne by the company. You do not have to spend money for undergoing such tests. ACKO will bear these expenses without you burning a hole in your pocket even before spending money on the insurance policy. Thus, choosing ACKO health insurance will enable free Pre-Policy Health Check-Up

Things to Remember:

Let’s revisit the important facts to brush off the fear of Pre-Policy Medical Check-ups and enjoy the best coverage according to your needs:

  1. Pre-Policy tests are a set of procedures that the policyholders need to fulfil before being accepted for coverage. 

  2. Although not advertised much by the insurance companies, pre-policy tests offer a bunch of attractive benefits.

  3. Do not underestimate Pre-Policy Checkup as a non-essential procedure.

  4. It is easy to fall for policies without a Pre-Policy Check-up due to the faster approval time and lesser premium amount. 

  5. Skipping these tests can lead you to pay a heavier price later i.e. during a medical emergency.

Frequently Asked Questions:

Here are few questions related to the above article:

1) Why are medical tests required before buying a policy?

Medical tests are conducted to determine the current health status for a potential policyholder. Knowing the health status helps the insurance company to provide better coverage and reduce the chances of claim rejection. Thus, medical tests are required.

2) How to check medical reports online?

When your application is accepted, the insurance company will provide the reports of your medical tests either online or by sending the hard copies of the documents. You can log in to the insurance company’s website and check the reports in your account.

3) Is it a good idea to avoid pre-policy tests?

No, if you avoid undergoing medical screening before buying the policy, you will be unaware of your current medical status. This can prove to be bad in the long run, both for your health and in terms of claim rejection.

4) Is it mandatory by law to buy health insurance?

No, it is not mandatory by law to buy a health insurance policy, however, buying a good health insurance plan is the most logical thing to do. A health insurance policy will provide the necessary financial backup in case of a medical issue. Thus, you do not have to worry about the finances when suffering from an illness.

5) How to check the list of tests under annual check-up?

If you have the option to undergo annual check-ups, the tests listed under the plan will be available on your insurance company’s website. You can check the policy wordings of the health insurance plan. If you cannot find what you are looking for, you can get in touch with the insurance company via their helpline number.

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