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21 Feb, 2023 | Health Insurance

How To Utilize The Medical Check-up Benefit Available Under Your Health Insurance?

Aakansha Jain
By Aakansha Jain
Research & Content Ninja at Beshak
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In the past, we used to visit doctors only when we were sick. But, times are changing now. The rise in the prevalence of diseases as well as an increase in lifespan due to advances in medical care facilities has led to a shift in our mindset towards health. We are now becoming more educated and empowered about our own health. And, preventative health care is becoming more common. We seek medical advice ahead of time on how to live a healthy lifestyle, and how to lower the risk of various conditions by maintaining a healthy diet, weight, etc. Doctors, too, advise us to undergo health check-ups on a regular basis. 

Regular health check-ups can help detect any early signs of health problems before they become a major issue. They can, however, be costly if performed in a good hospital or laboratory. What if your health insurance paid for these expenses?

Well, many health insurance policies today include a medical check-up benefit. The insurer will cover the costs of your medical check-ups under this benefit, subject to certain terms and conditions. In this article, we’ll learn about these conditions as well as how to use the medical check-up benefit available under your health insurance policy.  

Let’s dive right in!

How to utilize the Medical Check-up Benefit under Health Insurance?

Here’s how - 

👉🏻Check when the benefit can be availed

Health insurance policies have conditions on when and how often you can get the medical check-up done. These conditions will differ across policies. 

  • Some insurers may have a condition that you can use the benefit immediately after purchasing the policy, while others may have a clause that you can claim for health check-ups from the second policy year, or from the third policy year, and so on. 
  • Some insurers may allow you to get the tests done regardless of any claims you make, while others may have a condition that you can get the tests done only if you haven't filed any claims for one or more consecutive policy years.

So, the very first thing you should do is check your policy document and understand the conditions. You can either do this by yourself or consult your financial advisor

👉🏻Check for any list/limits for the tests

Next, you should check the coverage-related conditions. Generally, the limits will vary depending on your policy's sum insured - 

  • Some policies may place a cap on how much you can claim for the health check-up expenses, while some policies like Niva Bupa's ReAssure Plan, only cover a predefined list of tests (such as a routine urine test, fasting blood sugar test, lipid profile test, kidney function test, ECG, etc.) 
  • As per the insights provided by one of our expert advisors, Mr. Avinash Sonee, a few policies like Star Health’s Women Care Plan offers medical check-up benefit to female insured members starting from the age of 13. And, only a predefined list of gynecology-related tests is covered. 
  • He also says that the coverage may differ for disease-specific policies, like Star Health’s Diabetes Safe Plan and HDFC Ergo’s Energy Plan which come in multiple variants. For instance, one variant of the plan may provide coverage for HbA1c tests up to a certain limit, while another variant may include coverage for additional tests besides HbA1c testing.

It is important to be aware of such conditions because the insurer will not cover any tests you undergo that are not on the list, or any expenses you incur that exceed the specified limit.

👉🏻Undergoing the medical check-up 

Some insurers allow you to claim only on a cashless basis, some allow you to claim only on a reimbursement basis, while some may allow both. You should go with cashless if it is available under your policy - because there will be fewer hassles, and you won’t have to pay upfront or submit any documents to the insurer. 

The process involved in availing of the medical check-up benefit is different for both cashless and reimbursement. And, the process may also vary across insurance companies. 

⏩For cashless:

  • You can contact your insurance company via toll-free or email, and inform them that you need to get a medical check-up. Once you provide the necessary details, the insurer will check your eligibility, approve and then send you a date and time slot. 
  • According to Mr. Satish Kumar H, one of our expert advisors, some insurers also allow you to book a slot on their mobile apps. If your insurer provides this option, you can easily book a slot by logging into the app, entering your details, and selecting the desired date and time. And, if you have purchased a policy through a financial advisor, you can inform them of your intent to avail of the medical check-up benefit. Your advisor will then contact the insurance company and book a slot on your behalf.
  • On the day of your scheduled medical check-up, all you need to do is visit the hospital or laboratory, carry documents like your health card and policy copy, and undergo the necessary check-up. 
  • Some insurers, like Star Health Insurance Company, also provide a home pick-up service via a third-party provider like Thyrocare. With this service, your medical samples are collected from your home, and you do not need to visit the hospital or laboratory in person.

⏩For reimbursement:

  • If your health insurance policy allows you to claim medical check-up expenses on a reimbursement basis, you have the flexibility to choose any hospital or laboratory for the check-up. Additionally, you can select a medical test package of your choice as long as it falls within the limit specified in your policy.
  • You must, however, note that some insurers may have specific requirements for where you can undergo the medical tests. For instance, Star Health Insurance Company has a condition that you can undergo the tests only at hospitals or laboratories listed on their website. Therefore, if you are only able to claim medical check-up expenses through reimbursement, it is important to check with your insurer to see if you can go to any hospital or laboratory or only some specific providers.

👉🏻Collecting the test results

⏩For cashless:

  • In the case of cashless, the hospital or laboratory where you took the test will send the test results directly to the insurance company. And, your insurer will send a soft copy of the results to you. 

⏩For reimbursement: 

  • You will need to collect the original test reports from the laboratory or hospital. 
  • You may also need to submit the original reports to the insurance company when you apply for the reimbursement claim. So, before submitting the reports to the insurer, make sure you keep a copy for your future reference.

👉🏻Making the payment

⏩For cashless:

  • The insurance company will make the payment directly to the hospital or laboratory where you undergo the medical check-up. As long as you undergo the tests from the list mentioned in your policy document or the cost of the check-up is under the limit stipulated by the insurer, you do not have to pay anything from your pocket. 

⏩For reimbursement: 

  • After you undergo the medical tests, you will need to pay for the expenses out of your pocket - and then get them reimbursed from the insurance company later. 
  • You will have to fill out a claim form and submit documents such as the original test report, payment proof (receipt/invoice), etc., along with it. The insurer will then evaluate and reimburse the expenses up to the limit specified in your policy. They will credit the amount to the bank account you provided while submitting the claim. 

Now, let's compare the medical check-up benefit available under some leading health insurance policies.

Comparison Of The Medical Check-up Benefit Provided By Some Top Health Insurance Companies 

 HDFC Ergo - Optima SecureICICI Lombard - Health AdvantEdgeNiva Bupa - ReassureTata AIG - Medicare
How can you claim?On a reimbursement basisOn a cashless basisOn a cashless basisOn a reimbursement basis
From when can you claim?From the 2nd policy yearFrom the 1st policy yearFrom the 1st policy yearFrom the 3rd policy year
How often can the benefit be availed?Once every policy year Once every policy year Once every policy year Once every 3rd policy year
Which tests can you undergo? Preventive tests Preventive tests Preventive tests, Diagnostic tests as per the predefined listPreventive tests 
Condition for availing of the benefitOnly when no claim is made in the previous policy year Only when no claim is made in the previous policy yearIrrespective of whether a claim is made in the previous policy year or notOnly when no claim is made in 2 continuous previous policy years
Who can avail of the benefit?Children and AdultsOnly AdultsOnly AdultsChildren and Adults

What are the coverage limits?

Individual - Up to ₹2,000 per insured person

Family - Up to ₹5,000 per policy

Up to 0.5% of SI or up to a maximum of ₹10,000

Up to ₹500 for every ₹1 Lakh SI

(Maximum limits: Individual - Up to ₹5,000 per insured person. Family - Up to ₹10,000 per policy)

1% of previous SI up to a maximum of ₹10,000 per policy

Is there a predefined test list?NoNoYesNo

Note: The data in the table is for health insurance policies with a sum insured of ₹10 Lakhs, as of 14.02.2023.

So, that is all about how you can utilize the medical check-up benefit offered by your health insurance policy. Remember, the limitations and conditions associated with the medical check-up benefit may vary across policies. So, ensure that you go through them carefully before availing of this benefit.

Found this overwhelming? 

Talk to professional advisors at Beshak, who will make it all easier for you! :)

Key takeaways
  1. Many health insurance policies offer a medical check-up benefit that will cover the cost of the medical check-ups you undergo.
  2. While some insurers allow you to use the benefit immediately after buying the policy, others have a clause that you can use it after renewing the policy, etc.
  3. Under some plans, you can undergo the tests regardless of any claims made, while others have a condition that you can get the tests done only if you haven't filed any claims for two consecutive policy years.
  4. Some policies allow you to claim only on a cashless or reimbursement basis, while some may allow both.
  5. Under cashless, the insurer will make the payment directly to the hospital/laboratory where you undergo the medical check-up - you won’t have to pay anything from your pocket.
  6. Under reimbursement, you’ll need to pay the expenses out of your pocket - and then get them reimbursed from the insurer later. You’ll have to fill out a claim form and submit some documents, payment proof, etc. along with it to the insurer. 
  7. The insurer will only cover tests that are on their list or expenses that are within the policy's limit
Aakansha Jain
Written by,
Aakansha Jain, Research & Content Ninja at Beshak

Aakansha is a Content Ideator and Writer at Beshak. With her easy-to-understand content, she makes insurance simple for everyone. She comes with a strong background in finance and commerce and wants to help families make positive insurance decisions that are good for a lifetime.

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