HDFC Ergo Optima - Medical Test

21 Dec, 2021 | by Shashank S Kumar

Hello Community,

After my research, I purchased HDFCO Optima Restore policy online. While I thankfully do not have any major ped, I did have Covid19 and a couple of hairline fractures.

HDFC says there's no need of a medical test for people under 45 years of age. Is there any way that I can insist to get a test done and use that for policy underwriting?

My policy is in the free-look period, so I can cancel it and restart the process if I have to.

Thank you

Health Insurance

Purchase

3 Answer

Post

21 Dec, 2021

Gurleen Kaur Tikku

4.2

Hello Shashank,

Pre policy medical checkup (PPMC) is currently not being done by most of the insurance companies.

Earlier when PPMC was done, then also they were very basic tests and did not give true picture of one's health conditions or determine whether there is a PED or not.

There is no way where you can ask them to conduct PPMC if it not required for.

The only factor for underwriting by insurance companies is the proposal form and tele underwriting. If proposal form is filled truthfully and all the questions are answered diligently, then nothing to worry as medical underwriting team review the same thoroughly before issuing the health insurance policy.

If everything that you mentioned above is well documented, then freelook cancellation is not required.

Thanks

Gurleen Kaur Tikku

1 Comments

22 Dec, 2021

Shashank S Kumar

Thank you so much for responding, appreciate it! Your answer is re-assuring.

Is there any specific reason why insurers have moved away from medical tests?

22 Dec, 2021

Satish Kumar

4.4

Dear Mr.Shashank,

Please note that Insurance Policies are issued primarily on the basis of PRINCIPLE OF UTMOST GOOD FAITH. Which means declaration of all the material facts related to your current & past medical / surgical history (other than common cold & fever) is absolutely necessary.

Check if the information related to Covid19 and hairline fractures was mentioned in your proposal. Most insurance companies have moved away from the Pre-Policy medical tests and are now inclined towards tele verification. If you have disclosed your medical history details during this process, you do not have to worry about cancelling your policy. However if you missed mentioning about these details in your application you must get back to the insurer & make sure that these details have been taken a note of to ensure that you do not breach the utmost good faith clause.

Hope this answers your query.

Best Wishes,

Satish Kumar H

2 Comments

22 Dec, 2021

Shashank S Kumar

Thanks for taking the time to respond to my question. Curious why insurers have moved away from medical tests?

22 Dec, 2021

Satish Kumar

4.4

Hi Shashank,

Traditionally, Insurance companies have been issuing polices for less than 45 Yrs age groups without medical checkups unless the member had any health related history in the past. Even for the other group who needed medical screening, only a very basic health checkups were performed. Accessing the complete health status of an individual requires a very comprehensive health screening which turns out to be a costly affair making it unviable or not a feasible option for the insurer & even the customer. Hence it's the self declaration of the member which is given more importance rather than the medical screening.

The primary reason why Health Insurance Companies have started preferring Tele Verification over Pre-Policy Medical Examination is to facilitate easier & quick processing of the Health Insurance applications. Added to this during the Pandemic Period most customers were reluctant to attend medical tests due to then prevailing circumstances. Insurance companies therefore have started focusing more on verification through a phone / video call as the best alternative. All vital details pertaining to the medical & lifestyle of the member are asked & the call is recorded for future reference. A confirmation copy of the details declared is shared with the policyholder to avoid any dispute in future. The onus therefore lies on the proposer of the policy to be very transparent in declaring all material facts.

Hope this information helps...

Satish Kumar H

Reply |

22 Dec, 2021

Shailesh Kumar

CEO, Insurance Samadhan

Dear Shashank

Trust you had declared your Covid and Hairline fracture .

HdFC optima offers free annual medical.check up faciity .

Go for a medical under annual check up and this will be your evidence of good health . Insurance company would receive your medical report automatically.

Hope this clarifies

1 Comments

22 Dec, 2021

Shashank S Kumar

Thank you for your response, Sir. Will make sure to avail the annual health checkup option.

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