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

Team AckoJan 17, 2024

Comprehensive health insurance coverage, is the need of the hour for almost all individuals. This is primarily due to the rising cost of medical care and the increasing incidences of lifestyle diseases. In such a scenario, being aware of various health insurance features, particularly Pre-Policy Medical Check-up (PPMC) is crucial. This article will give an insight into all you need to know about tests that are conducted before you are insured.




What is Pre-policy Medical Check-up in health insurance? 

Pre-policy Medical Check-up consists of; a set of medical investigations that health insurance companies might mandate before accepting and providing coverage to a potential policyholder. This checkup determines the applicant’s medical fitness before providing coverage and helps the insurer decide if the person qualifies for the policy. It also plays a crucial role in deciding the payable premium. 

The number of prescribed pre-policy medical tests depends on two factors — the age of an applicant and the policy coverage. Most health insurance companies request a Pre-policy Medical Check-up if the policyholder is older than 45 years. 

Importance of choosing a health insurance policy with a pre-policy medical test 

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

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

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

  3. The reports of these tests serve as important documents during claim settlement. 

Generally, knowingly or unknowingly, people might try and evade these medical checkups. 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

People buy medical insurance policies to secure their savings against any future expenses related to health issues. But due process needs to be followed to ensure smooth claim settlement. That’s why it is necessary to ensure that policies are purchased 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.

  • Reduce the risk of claim denial: In some situations, the insurance company might reject your claim by stating that a non-disclosed pre-existing medical condition caused the illness. But your pre-policy test results might prevent such rejections by providing clarity to the insurer about the illness so that apt premium can be charged and non-disclosure won’t be an issue.. 

  • Discounts as per tests results: Some insurance companies offer discounts on the premium to applicants who clear specific 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 premiums.

  • Extra coverage for pre-existing conditions: It might be better 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. The health insurance company might even provide a certain level of coverage for the policyholder’s condition or offer specific exclusions on waiting periods based on the check-up.. These options are much safer than getting a claim denied when in need. 

  • Coverage as per health status: Getting a Pre-Policy Medical Check-up almost always rules out the possibility of being underinsured. Duly submitting the medical test reports increases the policyholder’s chance of receiving adequate coverage as per their medical condition.

Learn more about the waiting period for health insurance.

What kind of tests are usually conducted for pre-policy medical check-ups? 

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 pre-medical tests?

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

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 centre, the amount is usually 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 or free depending upon the terms of the health plan.

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 depends on the test results. 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 medical test results. 

  1. If the results of your pre-medical test for health insurance 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 checkup, the insurer may grant coverage provided the policyholder pays a higher premium according to their age and severity of the illness.  

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

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, some companies offer medical checkups to their policyholders every year or every three to five years, irrespective of the claims made. 

Therefore, based on the terms of the policy, the policyholder can avail of this feature at any enlisted diagnostic centre under the insurer’s network by using the insurance company’s health card.

Things to remember

Let’s revisit the critical facts to brush off the fear of Pre-policy Medical Check-ups and avail of 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 health insurance pre-medical check-ups 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) due to claim rejection.

Frequently asked questions

Here are a few questions related to PPMC.

Why are medical tests required before buying a policy?


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

How to check medical reports online?


When your application is accepted, the insurance company will provide the reports of your medical tests online. You can log in to the insurance company’s website and check the reports from your account. Alternatively, you can collect the test results directly from the lab. Note that different insurers might follow different processes in this regard.

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 counterproductive in the long run, both for your health and in terms of claim rejection.

Is it mandatory by law to buy health insurance?


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

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 policy will be available on your insurance company’s website. You can check the policy wordings also. If you cannot find what you are looking for, you can get in touch with the insurance company via their helpline number.

What is the PPMC process in health insurance


The PPMC process in health insurance refers to undergoing a health check-up before issuing the policy. The insurance company can approve or reject the application based on the reports of this health check-up.

What does PPMC mean in health insurance?


PPMC in health insurance means Pre-policy Medical Check-up. Under ACKO Health Insurance Policy (Rs. 1 cr. plan) all people aged 45 years and above must undergo PPMC before the policy can be issued.

Why does an insurance company ask for PPMC?


An insurance company asks for PPMC to determine the current health status of a person. This can also help understand if the person suffers from any pre-existing diseases.

When can I expect results for PPMC?


You can expect the results for PPMC within 1 or 2 days of undergoing medical tests. However, this largely depends upon the nature of the tests and the turnaround time of the lab.

What can cause a delay in PPMC or policy issuance?


Usually, there is no significant delay in PPMC reports or policy issuance. But sometimes, technical issues can cause a slight delay in policy issuance.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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