If you have recently started paying attention to the coverage of medical insurance, or are preparing to get a medical card for yourself and your family, you may have this question in mind: “Do I need to do a Body Check Up (medical examination) before buying a medical card?” Many people worry that if they haven’t done a check-up before, or have some minor health issues, the insurer will require complicated medical examinations, or even affect the approval of their medical card. The following points about pre-application medical check-ups, buying insurance with pre-existing conditions, and the serious consequences of concealing medical history are worth understanding clearly before signing the policy.
Do you definitely need a Body Check Up to buy a medical card?
Simply put, buying a medical card does not necessarily require a mandatory medical examination. For generally young and healthy applicants, purchasing a basic-sum medical card usually only requires passing a health questionnaire for underwriting.
The insurer’s underwriting process mainly relies on the principle of utmost good faith. When applying, applicants must truthfully fill in their height, weight, past medical history, family medical history, and lifestyle habits (such as smoking or drinking) in the health questionnaire. As long as all health indicators in the questionnaire show normal results and do not trigger other underwriting risks, the insurer will usually approve the application directly without requiring the applicant to go for blood or urine tests at a clinic or hospital.
In what situations will the insurer require a medical examination?
Although most ordinary applications can skip the medical examination step, insurers will still issue a Medical Requirement letter in specific situations, requiring the applicant to complete the specified medical checks. Common factors that trigger mandatory medical examinations include:
- Higher application age: Many insurers set mandatory medical examination thresholds for older applicants (e.g., over 50 or 55 years old, depending on each insurer’s policy) to assess potential health risks that increase with age.
- Excessively high sum assured: When the coverage amount for medical cards, life insurance, or critical illness policies exceeds the insurer’s non-medical limit, insurers will require a comprehensive medical examination to control risk.
- Abnormal health declaration: If the applicant declares past medical history (such as high blood pressure or pre-diabetes), obvious family genetic history, or belongs to a high-risk lifestyle (such as severely high BMI or heavy daily smoking) in the health questionnaire, underwriters will usually require further blood tests or specialist examinations.
- Random system sampling: Some insurers’ underwriting systems will randomly select a proportion of routine applicants for medical examinations to ensure the quality of the overall risk pool.
How does the medical report affect the medical card application result?
If the insurer requires you to undergo a medical examination, there is no need to panic. The examination is mainly to allow underwriters to assess risks more accurately. After the medical report is issued, insurers usually make one of the following 4 underwriting decisions:
- Standard Acceptance (Standard Rate): If all indicators in the examination results are normal, or there are only extremely minor and insignificant fluctuations, the insurer will approve the policy at normal premium rates with full coverage.
- Premium Loading: If minor health issues are found (such as mildly elevated cholesterol or being slightly overweight), the insurer is willing to accept the risk but the applicant must pay a higher premium than healthy peers of the same age.
- Specific Disease Exclusion: For specific existing health problems (e.g., benign nodules or certain old joint injuries found during examination), the insurer will exclude that organ or disease from coverage, but this does not affect normal coverage for other parts of the body.
- Postponement or Decline: If the examination reveals unstable health conditions (such as certain indices abnormally high requiring treatment and observation first), the insurer may postpone the application; if a serious illness results in excessively high future claim risk, the insurer will directly decline coverage.
Can people with existing diseases (such as high blood pressure) still buy a medical card?
Many people mistakenly think that having high blood pressure or diabetes means they absolutely cannot buy a medical card. This is not entirely true. Having a medical history does not necessarily mean automatic rejection. The key lies in the degree of disease control and each insurer’s specific underwriting guidelines.
Taking high blood pressure as an example, if the patient has been taking medication on time for a long period, blood pressure data remains consistently within the doctor’s recommended range, and has not caused complications such as heart or kidney issues, insurers will usually still consider approving the policy after review, possibly with premium loading or by applying an exclusion clause for cardiovascular diseases. If you have an existing condition, it is recommended to proactively provide recent specialist consultation reports, blood test reports, or daily medication records when applying. These complete medical details can help underwriters make a more favourable and accurate assessment.
What happens if you conceal your medical history when buying MHIT? Never take this risk
According to the guidelines of Bank Negara Malaysia (BNM), the main function of Medical and Health Insurance and Takaful (MHIT) is to help consumers cope with sudden medical expenses. Some applicants, in order to obtain a “standard rate” premium or fearing rejection, deliberately conceal past consultation records or existing health issues when purchasing MHIT. This kind of opportunistic behaviour has extremely serious consequences.
In Malaysia, purchasing insurance must strictly comply with the Financial Services Act 2013. Schedule 9 of this Act clearly stipulates the consumer’s pre-contractual duty of disclosure. If an applicant conceals medical history (Non-disclosure) at the time of application, even if the system initially auto-approved the policy, they will still face serious legal and claims consequences in the future:
- Claim Rejected: When you are hospitalised and need to make a claim, the insurer has the right to obtain past clinic and hospital records. Once concealment of facts is discovered, the insurer will reject the claim on the grounds of breaching the principle of utmost good faith.
- Policy Voided: In addition to rejecting the claim, the insurer will usually immediately void the policy. This means you must bear all medical expenses yourself, and the premiums paid over many years may not be fully refunded, ultimately resulting in loss of both money and coverage.
Frequently Asked Questions
Who pays for the medical examination if the insurer requires it?
This depends on the reason for the requirement. If it is because the sum assured you purchased exceeds the non-medical limit, the cost of a routine medical examination is usually borne by the insurer. However, if it is due to you declaring an existing medical history (such as high blood pressure or diabetes) in the health questionnaire, and the insurer requires specific specialist tests for further assessment, this cost is generally paid by the applicant first.
If a new disease I didn’t know about is discovered during the medical examination, will the insurance still be approved?
It is not always declined; it mainly depends on the severity of the newly discovered condition. For minor issues, the underwriting department may propose premium loading or specific disease exclusion as alternatives. Only in cases of serious and extremely high-risk conditions may the application face postponement or decline.
If I already have specialist reports from a few months ago, do I still need to do the insurer’s medical examination?
If you have detailed specialist consultation records and complete blood test reports from the past six months, it is recommended to submit them directly to the insurer for review when applying. As long as the report data is sufficiently comprehensive and meets underwriting requirements, the insurer is very likely to accept these reports and waive additional medical examinations.
If I proactively go to the hospital for a full medical check-up before buying a medical card, will it be easier to get approved?
Not necessarily. If you proactively do a check-up and discover previously unknown health issues, you must declare them truthfully when applying according to the principle of utmost good faith. This may instead lead to premium loading or additional exclusion clauses on your policy. It is generally recommended to declare your current known true health status honestly, and let the insurer’s underwriting department decide whether further medical examination is needed.
Information Sources
- fenetwork.my
- bnm.gov.my
