Can I ask insurers to get my medical check-up done?

I hear many claims are rejected due to non-disclosure of pre-existing diseases. What if I insist on the insurance company doing my medical check-up? Do they accept such a request?

—Name withheld on request 

When it comes to health insurance, non-disclosure of pre-existing diseases is a leading cause of claim rejections. Understandably, you should ensure transparency by insisting on a medical check-up conducted by the insurance company. However, it’s important to note that you cannot insist on this.

Insurance companies have their underwriting processes. While some policies might include a mandatory medical check-up based on age, sum insured, or other factors, the insurer, not the customer, generally determines whether one is required.

However, you can take proactive steps. You can undergo a medical check-up at your own cost before applying for the policy. This check-up can provide you with a clear understanding of your health status. You can then use the results to declare any pre-existing conditions accurately on the proposal form. This ensures that you are transparent with the insurer, potentially minimising the risk of claim rejections due to non-disclosure.

Even with a medical report, it’s crucial to answer all the questions on the proposal form carefully. Insurers rely heavily on the information you provide. Misstatements or omissions can lead to complications, including claim denials. Be thorough and honest when declaring your medical history, medications, surgeries, and other relevant health information.

In summary, while you cannot insist on an insurance company conducting a medical check-up, you can certainly take one yourself to ensure full disclosure. Remember, the key to minimising claim rejection risks lies in wholly and accurately filling out the proposal form, backed by any relevant medical reports you may have. This transparency fosters trust and helps ensure smooth claim processing in the future.

I am 36 years old from Karnataka (one of the districts where Aditi Insurance is available). I heard about this plan which offers ₹1 crore coverage at ₹10,000. I’m aware that non-network coverage is restricted, but I hardly travel. Should I buy this plan or consider any other comparative plan?

—Name withheld on request

Aditi Insurance, Narayana Health Insurance’s first product, has attracted considerable attention due to its affordable price point and high sum assured. The policy offers coverage of ₹1 crore for surgeries and ₹5 lakh for medical management.

However, this coverage is available only in Narayana Health’s network of hospitals. This plan also comes with several restrictions such as room coverage only for the general ward, coverage of only 280 listed daycare treatments, daily deductible of ₹2,000 and a 10% co-payment if you get treated at non-network hospitals. 

Given these limitations, it’s important to consider whether this plan aligns with your healthcare needs and lifestyle. The restrictions on room type, daily deductibles, and co-pays for non-network hospitals can lead to significant out-of-pocket expenses, especially during emergencies or if you require specialized care not available at Narayana Health hospitals.

In my view, it would be prudent to consider a comprehensive health insurance plan with an adequate sum insured and without these financial restrictions.

Look for policies with:

No Room Rent Limit: Ensures you have the flexibility to choose the room type based on your preference and availability.

No Co-Pay: Reduces your financial burden during hospitalization.

No Deductible: Eliminates the need to pay a certain amount before the insurer covers the rest.

Extensive Network Hospitals: Provides you with a wider range of hospitals for treatment, enhancing accessibility and convenience.

Additionally, when comparing premiums, it’s important to note that comprehensive base health insurance with a super top-up combo, with similar coverage, can cost around ₹10,000 to ₹16,000 annually (including GST). This indicates that you can find plans offering broader coverage and no/fewer restrictions at a similar price point to Aditi’s plan.

By opting for a more comprehensive health insurance plan, you can ensure better coverage and peace of mind, knowing that you and your family are protected without the worry of financial limitations and additional costs during medical emergencies.

Aayush Dubey is co-founder and research head of Beshak.org.