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Understanding the Importance of Medical Tests in Health Insurance

By Vikas Chandra Das
13 October 2022, 6:18 PM

Before buying health insurance, the majority of individuals detest the thought of having to undergo tests and examinations for medical reasons. Many times, if the insurance provider wants them to undertake specific medical tests before approval, consumers may cancel buying a particular policy. 

Many insurance companies run deceptive commercials in which they guarantee to offer health insurance without requiring a medical exam, and a considerable number of consumers fall for them. It appears preferable that there may not be a medical examination required only to get a health insurance policy. But is buying medical test-free health insurance plans worthwhile? Does it cause a problem later on and put you in a difficult situation where there is nothing you can do?

A Mediclaim Policy Without Medical Tests: Doesn't it Sound Fishy?

Health insurance policies that advertise not requiring medical exams for insurance can appear simple and straightforward. However, the catch is that, in order to calculate premium payments, insurance firms often classify people as high-risk or low-risk. A healthy person with good medical test results will be classified as low-risk and receive discounts on premium payments, whereas people with subpar medical exam results will be classified as high-risk and will need to pay higher premiums. All policyholders of a medical insurance policy without a medical examination will be labelled as high-risk individuals, regardless of their health. Therefore, a healthy person ends up paying a large premium.

Furthermore, it is a terrible bargain for people who already have health issues because they would have to disclose such concerns upfront. So, because insurance providers do not authenticate the declarations being made, their claims may be denied.

Why Do Some Health Insurance Providers Don’t Approve Health Policies Without Undergoing Medical Examinations?

The underwriting team is often responsible for assessing the policyholder's risk potential. The underwriting department examines your risk factors and human life value when you request a health insurance policy. The sum is determined by your underwriting in terms of finances and health. There is a potential that your health insurance will not be as valuable as you would want if your coverage lacks these procedures.

The insurance company eliminates the duty of their underwriting teams by requiring you to have a medical test or check up done, which is not the scenario with a health insurance policy without medical testing. 

There is a good likelihood that an insurance company may increase your premium if they provide inexpensive medical testing. The reason for this is that the premium payment is dependent on the alleged health risk factor that the policyholder is exposed to. If any tests are absent, it is presumed that the policyholder is hiding one or more medical issues and a higher premium is applied.

In retrospect, it is possible that you will only pay a "Preferred Rate" if your tests show you are healthy when you do the full range of medical tests recommended by the insurance provider. If you choose to get health insurance without having any tests done, you will be subject to the following rates that are set by the majority of insurance providers.

  • Standard Rate
  • Sub-standard Rate
  • Smoker Rate

"Preferred Rate" refers to a lower premium rate granted to policyholders who are deemed healthy by medical checkups and tests as required by the insurance provider and is not applicable if you purchase health insurance without medical exams.

The Significance of A Medical Exam for Health Insurance

1. Less Expensive Premium Payments

There will be hefty premium payments for a medical insurance policy without medical exams. On the other hand, if you are a healthy person and ace the pre-medical exams, you will be rewarded with savings and alluring offers for premium payments. The reason for this is that the person is considered to be low-risk.

2. Ward off Claim Rejection

Even in the worst-case scenarios, an insurance policy's medical examination will offer coverage. Let's say your medical test results validate any existing health issues you may have. After that, you'll have to endure the required waiting period and pay a noticeably higher premium. The insurance provider will also inform you whether there is any exclusion relating to your existing medical condition. However, in the long run, it will be beneficial to purchase health insurance that includes a medical examination even if you have pre-existing conditions because you won't run the risk of having your claims denied. You will continue to be covered and safeguarded in the event of an unexpected medical emergency.

3. Understand Your Current Health Condition

You can determine your present health state by taking a medical examination for your insurance coverage. There is a chance that you may not be aware that you have a health condition. Following a medical examination, you can start taking preventative steps and taking your health more seriously. For instance, if you have a lifestyle condition, you can enhance your immunity and avoid further difficulties by eating the correct foods. You can prevent health dangers by choosing to engage in regular workouts and activities after learning the results of the medical examination.

Read more - 5 Main Reasons Why a Health Insurance Policy is Important

Conclusion

The majority of insurance companies request you to undergo medical testing if your age is more than 40/50 years hence have won the argument here. The cost of health insurance premiums without medical exams is higher. Therefore, it is advised to carefully assess non-medical test policies before purchasing them. Only purchase them if they fit your needs, tastes, and price range.

Instead of opting for health insurance that doesn't need medical testing, we advise you to get coverage that does. The tests are inexpensive, and a comprehensive report includes fasting blood sugar, blood pressure, a blood count, an ECG, and occasionally even liver and kidney testing. The exams won't cause you too much trouble and will ultimately be beneficial to you.

Read more - Benefits of Getting Annual Health Checkups Under Your Health Insurance

FAQs

1. What does a medical exam mean for health insurance?

Medical exams are performed to ascertain a potential policyholder's current health status. Knowing the health state enables the insurance provider to offer better coverage and decreases the likelihood that a claim will be denied.

2. Can we submit insurance claims for medical tests?

Yes. Health insurance policies typically cover the cost of diagnostic testing including X-rays, blood tests, MRIs, etc. However, these are only reimbursed if they are related to the insured patient's hospital stay.

3. What kind of examinations are conducted for health insurance?

A standard health insurance medical exam may check your height, weight, blood pressure, pulse rate, urine, blood sample, etc.

4. Can someone with high blood pressure purchase health insurance?

In general, a person with high blood pressure can be approved for health insurance as long as no other more significant medical concerns exist and as long as they can show they are treating their blood pressure according to their doctor's recommendations.However,the same is considered as an existing condition, a waiting period of 2 years would be applicable here.

5. Does having a high cholesterol level impact health insurance?

If you have high cholesterol and require health insurance right away, you should be prepared to pay a greater premium than you would otherwise.

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