Health check up expenses in Health Insurance: Covered or not?

When you are diagnosed with a chronic illness, the emotional and financial impact on you and your family can be huge. From visiting the hospital for doctor consultation, checkups/tests to spending a large sum of money on the treatment and hospitalisation, a huge financial strain befalls you and your family. The best way for you to overcome such a stressful situation is by buying a good health insurance plan.

A health insurance policy helps you cover all hospitalisation-related expenses including coverage of inpatient expenses, organ donor expenses, pre and post-hospitalization benefits, etc. Additionally, most health insurance policies also provide reimbursement of preventive health check up expenses for family members once a year. But is the health checkup included in the insurance policy? Do all policies cover health check up expenses?

In this article, let us take a look at how health insurance helps in covering your health checkup expenses.

What are Health Check up Expenses? Are they covered under Health Insurance?

A lot of health insurance plans provide preventive annual health check ups to insured members. It’s a win-win proposition for insurers and the insured alike. The idea is to encourage insured people to take regular health check ups and be aware of any possible illnesses before they take an ugly shape. This also helps the insurers in keeping the hospitalisation claims in check. Expenses incurred on such preventive health check ups are covered under annual health check up expenses in health insurance.

For instance, suppose you were diagnosed with a heart ailment a few years back which is now treated. The doctor may have advised you specific health checks to ensure good health & preempt any further deterioration of health. Such health checks may be covered under the annual health check expense reimbursement given by your Insurer.

The extent of coverage, however, will vary from insurer to insurer. Some insurers will offer to cover all your health checkup expenses, while others might put certain restrictions. There will also be specific conditions you’ll have to fulfil in order to claim the health check up benefit under your policy.

Let’s learn about these conditions in detail.

Conditions for Coverage of Health Check up Expenses

👉 Specific limit

Some insurers will provide a health check up package, i.e., a test list - and only those tests that are mentioned in the list will be covered by your policy. A few insurers might give specific limits up to which your health check up expenses will be covered under the policy.

For instance, if your base sum insured is INR 5 Lakhs, the insurer could give a limit of INR 2000 for health check up expenses. Similarly, if your base sum insured is INR 10 Lakhs, the insurer might give a limit of INR 4000 for health check up expenses, and so on (numbers are hypothetical).

These limits will be mentioned in your policy document. If your health check up expenses are above the limit specified in your policy, you’ll have to pay the excess amount out of your pocket.

👉 Age-related limit

Some policies have a condition that the insured person who needs to undergo the health checkup should be at least 18 years old. Further, in a few floater plans, there is a condition that only adults can avail health check up benefit, whereas some floater plans allow both adults and children to avail this benefit.

👉 Cap on the number of times you can avail the benefit

How often you can use the health check up benefit under your health insurance policy will depend on the insurer and the type of policy you hold. While some insurers like Max Bupa, Aditya Birla, and Care Insurance allow you to use the health check up benefit only once in a policy year, there are insurers who don’t put any cap on the number of times you can use this benefit.

👉 Cashless Service

Some insurers allow you to make a claim under this benefit on a cashless basis only. Meaning, if you undergo any health check up, you will have to inform your insurer in advance and get an early approval from them - that they will honour your claim and pay it to the hospital directly. If your request is approved, the insurer will directly pay for the health check up expenses to the respective hospital or the lab where you undergo the tests.

👉 Insurer’s network provider

Some insurers impose a condition that they will provide you a cover for your health checkup only if you visit the hospital or a lab with whom they have tie-ups. If you get your check ups done at a hospital/ lab of your choice, and it is not on the insurer’s list of network providers - they will not cover the expenses.

👉 Other conditions

Some insurers allow you to claim under the health checkup benefit from day one of buying the health insurance plan. And, in some policies, there is a condition that the benefit can only be availed if you’ve not made any claims in the previous year.

Please Note: These conditions might vary from insurer to insurer. So, before you purchase a health insurance policy, ensure you go through the terms and conditions of the policy.

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Health insurance policies provide you with the benefit of covering the expenses you’ll incur during a health check up.
Some insurers offer you this benefit on a cashless basis.
There’s a specific limit until which you can claim for your health check up expenses - which is over above your base sum insured.
To avail of this benefit, you need to be above the age of 18 years old.
Some insurers will only help you cover the health checkup expenses if you get the tests done through their network provider.
Some insurers provide this benefit only once every policy year.
Under some policies (like floaters), if one person claims for the expenses the remaining members cannot avail of this benefit.
There are also some insurers that do not provide you the health checkup expenses to help you cover additional costs like transportation.