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 policy catering to critical illness extends cover to the insured members and protects them against debilitating health ailments. Most insurers (example HDFC Ergo (erstwhile Apollo Munich), ICICI Lombard, Max Bupa (now Niva Bupa) etc.) 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. One such rider or a combination of few riders that can be opted for to customize the policy according to your healthcare needs and make it more comprehensive.

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 policy, 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 policy 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 policy.


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 or riders for critical illness will be a good option and it will ease the financial burden from hefty medical expenses to a large extent.

About SANA.Insure

SANA.Insure provides personalised guidance to help you with your health insurance decision. Through you get to choose the right insurance and protection plan for yourself in 3 simple steps. You can comfortably select multiple health insurance plans, compare them for features, sort them by basic premium amount (auto-populated by our system-enabled premium calculator) and purchase the option that suits your personal health requirements the best. We also help you decide on the best rider or riders to add on to your base policy to make it comprehensive enough to take care of your and your family’s medical needs.

Our Health Insurance Experts are happy to help you should you need any assistance along the way. Please get in touch with us over WhatsApp chat on 8278271818 or call us on 18002028118 for more information.

Wish you a healthy and happy life!


Q : What qualifies as a critical illness?

Ans : Critical illness is a disease or an ailment that has long-term and serious conditions affecting one or multiple organs, thus requiring special medical attention and treatment. Some examples of critical illness are heart attack, stroke, renal (kidney) failure, cancer etc.

Q : Do I really need critical illness cover?

Ans : Life truly is unpredictable. All of us have issues of work-related stress, irregular sleep, lack of physical activity, poor diet, genetic predisposition and/or some lifestyle health concerns, One or more of these problems could have long-term and life threatening implications in the form of a critical illness that could impact when least expected. And the costs of treatment of these illnesses are ever increasing. Having ample critical illness cover will ensure that you get the right treatment at the right time without having to worry about financial strain and dipping into your personal savings.

Q : Are critical illness policies worth it?

Ans : Critical illness policies are worthwhile for everyone. Especially for people whose families have a prior history of a critical condition, having such a policy makes a lot of sense. Millennials in their 30’s should definitely consider buying critical illness as they are more prone to lifestyle health concerns and work-related stress. Also, if you are the primary earning member of your family, it would be wise for you to opt for critical illness as it would mean protection for your loved ones who are dependent on you without dipping into the family’s finances.

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