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Is a physical exam required for health insurance?

“To sum it up…”

  • Physical exam requirements vary among insurance providers
  • It is more common to have to get a physical with a plan offered through an employer
  • You should keep yourself informed by reading your policy documents and contacting your insurer if necessary

In days past, nearly all health insurance plans required their policyholders to take physical exams before their policies became active. This has become less common in recent years, but many health insurance plans still require this.

Mandatory physical exams for health insurance is especially true for health insurance plans offered as part of a benefits package for a job. This is because the employers who are offering these benefits want to limit the cost of offering health insurance to their employees.

In the past, people could actually get declined for health insurance based on the results of their physical. This is no longer legal due to the Affordable Care Act. However, it is common for insurers now to raise premiums sharply if problems are found at the physical.

To learn more about physical exams for health insurance, read on. Also, enter your health insurance above to get free health insurance quotes and find the right provider for you!

Physical Exams for Health Insurance in the Past


As previously mentioned, nearly all health insurance policies required policyholders to have physical exams in times past. However, this is not as common right now. This is because many people were turned away by health insurance companies for failing physical exams, and they publicly criticized these companies.

Seniors were especially active in this criticism. These days, it is less common for an insurer to require an exam than to not require an exam.

Physical Exams for Modern Health Insurance

While physicals are less commonly required by health insurance companies, a significant minority of insurers do require physicals for their policies. If you are reluctant to get a physical for health insurance policy, you can no doubt compare insurance quotes online and find a policy that does not require you to get a physical.

However, the insurer will still strongly encourage that you get a physical immediately following your enrolling in their health insurance.

If the physician that does your physical finds that you have pre-existing conditions, you no longer have to worry that the insurance company will cancel your policy.

However, they may greatly raise the rates on your insurance policy. To learn more about that, see below.

What the Exam (If You Need to Get One) Involves


A physical exam for health insurance purposes is very similar, if not exactly the same, as a standard annual physical. Generally, the doctor will check your reflexes, blood pressure, and draw blood for routine testing. Of course, you can always contact your insurer and ask them if their requirements for a physical exam are more specialized.

How to Find Health Insurance That Doesn’t Require an Exam

In this day and age, finding health insurance that doesn’t require an annual physical should be fairly easy. Just do your research into the plans you considering when you compare insurance quotes online. Many times, the information about the plan will state up front whether or not a physical is required.

If this information is not included up front, you can always contact the insurance yourself and ask them. Do not purchase a plan without figuring out whether a physical is required or not.

The outcome of the physical, if necessary, could change the cost your health insurance coverage and you want to be prepared for this.

When You Should Get a Required Physical Exam


If your insurer requires you to get a physical exam, it will be right at the beginning of your coverage. There is also a good chance that they will require you to get a physical every year.

If you do not have this physical exam performed as required, the insurer may have grounds to cancel your insurance.

Check your policy documents to see if this is the case. Either way, it is important to do the physical as your insurance requires. This will help you establish a positive relationship with your insurer, which will be important in the future.

How to Set Up Your Exam


An insurer that requires that you get a physical will no doubt make it easy for you to set up this appointment. Often, whether your insurer requires a physical or not, they will automatically assign you a primary care doctor. This doctor is usually the nearest general practitioner in their network to your home address.

Your health insurance company may even set up the appointment for you, but most likely you’ll have to call the doctor and set up the appointment yourself. Getting an appointment for a physical with a general practitioner should be easier than getting in with a specialist.

Denial of Health Insurance Due to the Results of the Exam

As previously mentioned, it is now not legal for an insurer to deny you coverage because of the results of a physical. This was previously common, but it became illegal with a passage of the Affordable Care Act, also known as Obamacare.

There seems to be a good chance that the Affordable Care Act may be repealed in the near future, but for the time being you do not have to worry about a health insurance company refusing to cover you because of the results of your physical.

Higher Health Insurance Premiums Due to the Exam


While you don’t have to worry about a health insurance company refusing to cover you, it is common for your insurer to raise their premiums significantly based on any pre-existing conditions found in the physical. These conditions can be quite minor, such as acne, but still result in noticeably higher premiums.

There have been suggestions that there should be limitations on how high an insurer can raise their premiums that are more strict than the current limitations. However, with the current health insurance legal situation in flux, it remains to be seen what sort of laws will actually be enacted.

Getting a Physical Exam for Health Insurance


In conclusion, your health insurance may or may not require you to get a physical. This requirement is different for every health insurance company, and often is different for various plans provided by the same company. It is more common to have to do an exam when you have a plan administered by your employer.

If you do have to get a physical, you do not have to worry about your health insurance being canceled or denied because of the results of the physical. It may become more expensive if any pre-existing conditions are found at the exam.

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  1. http://www.wikihow.com/Prepare-for-a-Health-Insurance-Physical
  2. http://www.healthline.com/health/physical-examination#overview1
  3. http://www.webmd.com/a-to-z-guides/getting-the-most-from-your-doctors-appointment
  4. https://www.hhs.gov/healthcare/about-the-aca/pre-existing-conditions/index.html
  5. https://www.healthcare.gov/coverage/pre-existing-conditions/