Medical underwriting
Medical underwriting is a process where insurers evaluate an applicant’s health status, medical history, and related risk factors to determine eligibility and premium rates for health or life insurance. Insurers use data points like chronic conditions (e.g. diabetes), prescription drug use, past surgeries, and family disease history to assess risk.
Companies frequently request medical exams, blood tests, or physician statements for applicants over certain age thresholds, such as 50. Underwriters commonly decline coverage for applicants with recent cancer diagnoses, organ transplants, or severe heart disease within the last five years.
Medical underwriting directly impacts premium costs; individuals with high-risk profiles (e.g. smokers, obese applicants) often face rate increases of 25–100%. HIPAA regulations restrict insurers from disclosing applicants’ medical details without written consent, protecting privacy during the review process.
State laws in places like New York and California ban individual health insurance medical underwriting but allow it for some life insurance products. Insurers may offer modified plans or policy exclusions (such as excluding pre-existing back injuries) when underwriting identifies specific risks.
Insurers typically complete full medical underwriting for traditional term and permanent life policies while using simplified versions–no exam required–for final expense plans. Medical underwriting delays approval by an average of four to six weeks compared to guaranteed issue policies that do not require it, per YourInsurance.info.
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See also Medical visit costs.