Are Medical Tests Mandatory When Buying a Health Insurance Plan meant to Cover Critical Illness?


Are Medical Tests Mandatory When Buying a Health Insurance Plan meant to Cover Critical Illness?
According to a World Health Organisation (WHO) projection, non-communicable maladies such as cardiovascular diseases, diabetes and cancer will claim 55 million lives globally by 2030. One in every four Indians risks dying from critical illnesses even before reaching the age of 70 in the absence of timely medical intervention. Hence, proper and prompt (timely) diagnosis and treatment of these diseases are very important. However, owing to the surge in healthcare costs in India, medical expenses for these critical ailments could cost you an arm and a leg. This is where a critical illness health insurance plan comes to your rescue.

A health insurance plan catering to critical illness extends cover to the insured members and protects them against debilitating health ailments. Most insurers extend health insurance cover towards critical illnesses ranging from eight to twenty such conditions as cancer, heart attack, stroke, organ transplant, etc. Many regular health insurance plans offer coverage for critical illnesses treatment costs via add-on riders which are optional covers that can be chosen as per personal requirement for extra premium.

People who are either undergoing treatment or who show a tendency to contract such illnesses owing to predisposition are generally considered as high-risk profiles by insurers. Given the sensitive nature of such cases, many insurance companies ask the applicants to undergo certain health checks and pre-acceptance medical screening as a prerequisite to applying for health insurance.

When is pre-policy medical screening mandatory?

A lot of health insurance companies need you to go through a pre-policy medical screening mandatorily in order for you to get a health insurance plan, particularly for critical illness. Your service provider may either ask you to consult / visit a medical practitioner recognised by them or get a medical examination done, as mentioned in the policy, depending on the declaration you make on your application. It is a means by which the health insurance companies evaluate the severity of the applicant’s health condition. It also helps assess the extent and the kind of risk the applicant puts forward for the insurer.

  • Insurers follow a Medical Grid for standard pre-issuance medical policies. On many occasions, applicants above the age of 45 are asked to undergo necessary medical tests as a norm.
  • If you opt for a higher Sum Insured, the insurer may require you to undergo tests as a standard policy (even for younger applicants).
  • Some may require applicants who are regularly consuming habit-forming substances such as tobacco and / or alcohol to mandatorily undergo medical tests.
  • Few other insurance firms may ask people who are on the extreme spectrum of weight or Body Mass Index (BMI) figures to do some tests to assess their health.
  • Insurers may ask applicants who are diagnosed with and being treated for conditions that are tagged by the company as pre-existing diseases or PED to get themselves tested further for health reports.
  • Underwriters of Insurance companies may seek medical reports as and when required depending upon the profile of the applicant.
  • Yet others may not accept applications from people who are being treated for an ongoing critical disease.

Eventually, it is up to the insurer to decide whether or not you are required to go for a pre-policy medical screening before you buy critical illness cover. Some insist on it being mandatory prior to the purchase and some don’t. The requirements are, however, specified by the insurer of the health insurance plan prior to purchase.

Applicants are required to fill in a questionnaire at the time of the purchase of the health insurance plan for critical illness. If a pre-policy medical examination is mandatory under the lists of conditions of the insurance company you have approached, you will have to undergo the required tests. On completion of the medical screening, you need to submit the reports along with other required documents if any. You will be informed whether your application has been accepted or turned down based on factors such as smoking, involvement in an occupation that is hazardous, etc. to name a few. Based on your reports, the insurer will also let you know about the nitty-gritties—which includes the premium amount also—of a suitable plan.


These diseases take a toll both on your mind and finances, in addition to affecting your physical wellbeing. Since these ailments call for extensive care and treatment, they require a sizable insurance amount. A health insurance plan that allows you to customize the features by means of add-on covers for critical illness will be a good option and it will ease the financial burden from hefty medical expenses to a large extent.

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