Medical Health Check Ups In Health insurance

Say your friend has a car or a bike that is being used everyday, but he mentions to you that he hasn’t serviced the car for months together. What would be your reaction? What would be your advice?

Not taking regular checks of vehicles, not servicing them, can result in a sudden and major breakdown that could cost a fortune to repair.

Similar is the case with our bodies, if we don’t take care of them, get them regularly checked, we are risking a sudden breakdown in the form of a disease or a health condition.

Look around, talk to people, and you will hear about folks getting affected by hypertension, diabetes at an early age. Diseases which were only detected at age 40-50 are now observed in early 30s!

Regular health check ups can be that hack to identify any early signs of health issues, and take timely action.

But, health check ups cost money too and can be pretty expensive if done in a good hospital or a lab. But what if your health insurance covers a preventive health checkup every year for you and all other family members? Sounds too good to be true?

Yes, many health insurance plans offer preventive health check ups to people covered under the plan. But what are the benefits, conditions, and how does the process work? Read on.

exclusion of health insurance plans

Not Covered In Health Insurance

  1. Pre-existing Deceases for a Fixed Term
  2. Cosmetic Surgeries
  3. Injuries caused due to suicide attempts

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What Are The Conditions Associated For Coverage Of Health Check Up Expenses?

  • Limit On Coverage

    Yes, while insurers cover medical checkups, you cannot spend on medical checks solely based on your preferences, there are certain restrictions. While some insurers will only cover a specific list of tests, some policies may stipulate a limit on the amount that you can claim for health check up expenses. The limit or the list of tests you are eligible for will be stated in your policy document or the insurers website. If your health check up expenses exceed your policy's limit, you'll have to pay the remaining amount out of your pocket.

    For instance, take Bhavana's case, her base sum insured is INR 10 Lakhs, and her policy has a limit of INR 10,000 for health check up expenses. Her routine check up tests including complete blood count, kidney function test, urine test, fasting blood glucose, uric acid and lipid profile test costs around Rs 3,000, which will be covered by her health insurance.

    Please note that these limits may vary across insurance companies.

  • Some May Be Cashless And Others Could Be Reimbursement Based

    Some health insurance policies offer health check up benefits only on a cashless basis. If you need to get a health check up, you need to contact your insurer beforehand, book the test through them, and get an approval in advance.

    Once your request is approved by the insurer they will send you details of the booking. You don’t have to make the payment, as they will make the payment directly to the hospital or the lab where your tests were done.

    The ones that offer on a reimbursement basis would usually have a limit. You can simply go and get medical tests up to this limit from any lab listed on their website, and then send the original reports (you can keep a copy), and payment proof (receipt/invoice) to the insurer for a claim. You may be required to fill a claim form and attach along with the other documents.

  • Limited To Insurer’s Network List

    Some health insurance policies cover health check ups only if they are undertaken in a hospital or medical lab that is enlisted with the insurance company. You need to contact your insurer, and set up an appointment with this network of labs. If you get your check-up done in a hospital or health centre that is not listed with your insurance company, then the insurer will not cover such expenses.

  • How Often Can You Get Tests Done?

    Insurers will have conditions on how often you can get such medical tests done.

    A few insurers, such as Max Bupa Reassure, Aditya Birla Active Assure and Active Health, allow you to get a medical test done, as soon as you have bought the policy, and every year thereon. Insurers like Care Insurance, Max Bupa Health Companion give you the option of using the health check up benefit on every renewal, which means you can claim this benefit every year from Year 2 , while there are many other insurers like Bajaj Health Guard-Gold plan, Manipal Cigna Pro-Health who may cover medical checks once in three or four years.

  • Age Restriction

    Some policies may cover only adult members for this benefit while others offer this benefit to both adults and children.

  • Report Collection

    Some insurers may allow you to collect the report from the laboratory yourself, some may send it directly to you through email. In case of reimbursement claims, explained above, you may be required to submit the original (including films) and keep copies with you.

  • Other Constraints

    Some policies have a clause that you can claim for health check ups only if you haven't filed any claims in the past year. Some health insurance plans, however, allow you to claim for health check ups from the moment you purchase the policy.

    Note: These conditions might vary across insurers. Make sure you read the T&Cs of the health insurance policy before buying it.

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Summing Up!

So, this is all about health check up benefits offered under health insurance policies. The scope of coverage and the associated conditions may vary from insurer to insurer. Hence, make sure you go through the policy wordings so you’re aware of whether health check ups are covered and the limitations associated with the coverage.

Preventive checkups are mutually beneficial for you and the insurer. Taking regular health check-ups is meant to help you to be proactive about illnesses before they get out of hand. The result is fewer hospitalisation claims, thus benefiting insurers.

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