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The lowdown on life insurance medical exams

If you're shopping for coverage, you'll probably be subjected to some health tests. Here's what insurers are looking for and how they'll find it.

You will probably be asked to have a medical examination when you apply for life insurance, depending on your age and the amount of insurance you're buying. This can include a basic physical exam, urine specimen, blood work, EKG and X-ray. For high amounts of life insurance, such as $2.5 million or more, treadmill EKGs are usually required, too.

You generally will not be subject to medical underwriting (meaning the exam requirements) if you're under 40 years old and are applying for less than $100,000 of life insurance. However, the older you are, the less insurance you can buy without an exam. For instance, you may be able to buy $50,000 without an exam if you're 45, but by age 50 that amount could drop to $10,000. It really depends upon your health and insurance company guidelines.

Forget about fudging your medical history a bit in order to get a better insurance rate. Insurance companies will track down your medical dossier through the results of your exam or through the Medical Information Bureau (MIB), a clearinghouse of medical information that insurers share.Even if you're buying life insurance through the Internet, there's still no way to avoid the medical requirements of an insurance company.

Tips for a better exam
Certain health conditions simply cannot be masked, but to obtain the best possible results, here are some recommendations.
  • Get a good night's rest the night before your exam.
  • Don't drink for at least eight hours before the exam.
  • Don't smoke or chew tobacco for at least an hour before the exam.
  • Avoid coffee, tea or other caffeinated drinks like cola for at least one hour prior to the exam.
  • Limit salt intake and high-cholesterol food 24 hours before your exam.
  • Don't engage in strenuous physical activities 24 hours before the exam.

Typically, insurance medical exams are done by paramedicals who are licensed health professionals and who are often independent contractors hired by the insurance company. Paramedicals also can perform employment physicals and drug screening. They're quick at what they do -- you'll usually get a call within a day and are examined within three days.

What you'll need done
Here's how it works. There are medical questions on Part I (some insurers call it Part A) of a life insurance application that usually are completed by your agent in your presence; Part II (or Part B) is the medical form and is used whether the exam is performed by a paramedical or a doctor.

In a basic exam, the paramedical will take your medical history, physical measurements and diagnostic specimens. Nearly all exams can be done on a mobile basis, since many paramedicals carry their own supplies and have centrifuges for blood sampling.

If you're a 35-year-old who is applying for $250,000 of insurance, most life insurers want a paramedical exam, a urine specimen and a blood profile. Although the company might order what is called an attending physician's statement (APS) from your doctor, you cannot have the exam done by your own physician.

After taking your application for life insurance, your agent (or someone in the agent's office) will call one of several paramedical services that specialize in mobile exams to give them information on you and on the amount of insurance for which you're applying and the name of the insurance company. Most paramedical professionals stay current on insurers' underwriting requirements (every insurer has a chart that lists medical requirements based on your age and the amount of insurance for which you're applying).

A paramedical will call you to schedule your appointment, either at your home or your office, and might even see you in the evening. If you can't schedule this appointment, you'll usually have the option of going to a clinic. The exam isn't optional -- you must have it or your application won't go through. Declining to take a test isn't an option and will only send red flags to the insurer. The insurance company pays the paramedical directly, so you're not financially responsible for the exam or any lab work.

Medical underwriting differs slightly from company to company. For instance, an insurer might require the collection of saliva from a person age 16 to 40 who is applying for a policy between $50,000 and $149,999. A 60-year-old who is applying for $200,000 might have to undergo a basic exam, give urine and blood samples, and have an EKG. Insurance companies are particularly interested in using your blood work to confirm your smoking status, for obvious reasons.

Obesity may require you to have a medical exam, even if you fall below the age and amount guidelines, because being overweight may cause a coronary risk. If you're overweight and smoke, have diabetes, family history of coronary artery disease, high cholesterol or high blood pressure, MetLife, for example, will require a treadmill or exercise test.

What are they looking for? The insurance company is checking to see if you have any health condition that could eventually affect your mortality -- and, hence, their risk. When samples of blood, urine and oral fluid are taken from you, the insurer will test for the presence of antibodies or antigens to the HIV virus, cholesterol and related lipids, liver or kidney disorder, diabetes, antibodies to hepatitis, prostate specific antigen (PSA) and immune disorders. The urine sample may go through routine analysis, plus screening for certain medications, cocaine and other drugs.

There are two ways your blood can be drawn: through a finger prick or via a needle. A younger person may be asked for a finger-prick blood sample; however, if you're looking to buy a large amount of life insurance, you may have to submit to a full blood profile.

Results are sent directly to the home office for the underwriter to review. You can usually send a written request if you want a copy of the results. Jane Fore, assistant vice president of life, new business at The Horace-Mann Cos. in Illinois, says, "It's common to ask for results of a [medical] profile. We'll release the results to the person or their doctor."

An underwriter, usually located at the insurer's home office, then reviews your life insurance application and the results of your medical exam. They have the option to order whatever additional medical tests they deem necessary -- and they will if their suspicions are raised for any reason.

In the rare event you are unknowingly quite ill -- chronically or terminally -- you'd probably be turned down for coverage and would have to look for a high-risk carrier or one that offers guarantee issue life insurance.

Don't let your premiums go up in smoke
Smokers are penalized by the insurance industry because of their higher mortality rate. Julie Possner, a paramedical examiner with Exam & Profile Services in Wisconsin says, "Cigarettes [nicotine] will show up many days or even weeks after use in somebody's urine. It will probably still show up if someone has refrained from smoking for a short time prior to the exam." If any nicotine does show up, you'll be considered a smoker. And the test even detects nicotine that is delivered through a transdermal patch.

What if you're a cigar smoker? "You can have 12 cigars per year, but not one cigarette. If certain levels of nicotine show up in a cigar smoker, they will also be considered a smoker," explains Possner.

The more you want, the more they want
If you're applying for a very large amount of life insurance -- say, $1,000,000 to $5,000,000 -- underwriting criteria become more stringent. An insurer could request a doctor's exam if you're over 41 and applying for $2,500,000 of coverage for example. But since most of us aren't interested in getting a $5,000,000 life insurance policy, those requirements don't necessarily apply to the masses.

If you ace your medical exam, you should have no problem getting your life insurance issued at the rate quoted. However, if a medical problem is discovered, you may be offered a rated, or substandard, premium, meaning you won't be declined but you'll have to pay a higher premium if you want the life insurance.

There are two types of risk ratings: "flat ratings" and "table ratings." Underwriters assess health conditions based on a tightly defined, industrywide underwriting manual to determine how to rate certain health conditions. For instance, an underwriter might apply a flat rating for short period of time for a person who has just had surgery. Conversely, a person with high-blood pressure would likely receive a table rating (i.e., Table A, Table B, etc.). Table ratings are based on a percentage of the premium, so Table A might be 120% of the regular premium.

If you disagree with a rating you receive, get your agent involved. Agents can argue the rating, although it might mean submitting to additional medical tests to prove you qualify for a better rating.

Even if you decline the policy, this becomes part of your permanent record in the MIB. So, if you go shopping around for other insurance, keep in mind this information remains at every insurer's fingertips.

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