Medical Underwriting
What is Medical Underwriting?
Medical underwriting is a common term found in life and health insurance industries. Underwriters use your medical information to offer coverage, to decide how much coverage you qualify for, deny your coverage, or to set your coverage rates. They use one or more of the five types of medical underwriting. In some insurance markets, the use of medical underwriting is illegal for denying, delaying, or offering coverage due to pre-existing conditions. However, for example, if you were to disclose that you’re a tobacco user, a medical underwriter can use that in determining your rates and apply a higher rate for your coverage.
Prior to changes in the acceptance of pre-existing conditions in 2010, medical underwriters determined whether you had a deniable condition(s) or if you had been symptom-free long enough to qualify for coverage. Today, the medical underwriting process is no longer about denial and acceptance for pre-existing conditions. Companies still use underwriting to stop patients from only purchasing insurance because they’re sick or injured.
Medical Underwriting Process
After you submit an application to an insurance company, the company will make certain you’ve completed all parts and contact you if additional information is required. Please keep in mind that each company will have their own methods, but the steps are generally the same up until underwriting begins. Some applicants won’t require underwriting and can by step that process altogether.
If a company decides you require underwriting, they will contact you for permission to access your medical records if they haven’t already. Your assigned medical underwriter will contact your previous doctors and review your history to see if it meets the company or policy’s guidelines for coverage. In some cases, an underwriter will recommend a different policy or assess your risk as higher than average and request a higher premium.
How in depth the process will vary on your medical history and the company’s available resources. From start to finish, a medical underwriter can take 72 hours to a week to complete the underwritten portion of your application. For extensive medical backgrounds, the process can take longer.
Considered Factors
Each company and plan will have its own criteria, but when applying for an underwritten plan make sure you meet their non-medical requirements. Non-medical factors: • Eligibility based on location or your occupation—many policies state that you must reside in a certain area to qualify.
- Age limitations — Many plans have age caps or you need to be older than a certain age to qualify
- Dependent limitations — Many plans have criteria for dependents, including spouses or domestic partners.
- Non-medical declinable conditions — You qualify for another plan or for full coverage with a state-based insurance.
5 Types of Medical Underwriting
- Full Medical Underwriting
- Moratorium
- Continued Personal Medical Exclusions
- Continued Moratorium
- Medical History Disregarded
Full Medical Underwriting
Full medical underwriting (FMU) is an analysis of your complete medical history. This often includes contact with your past doctors and past insurance companies. With the mandatory inclusion of pre-existing conditions, companies don’t use or require full medical underwriting as much as they used to before the law changes. However, if you want a truly customized insurance plan, full medical underwriting helps insurance companies find the best coverage for you.
Moratorium
In this type of underwriting, you don’t take a medical questionnaire or have an extensive medical background check. Acceptance is typically automatic or instant. The company has automatic exclusions in place that are usually certain pre-existing conditions—or any condition that you’ve received treatment for in the past five years. Some companies apply a symptom-free period to excluded conditions, which is usually two years. However, you cannot have asked for advice, received treatment, or had symptoms of the condition to qualify for coverage for that condition.
Continued Personal Medical Exclusion
If you already have an FMU and are under 70 years old (65 in some states), a medical underwriter can set your new policy to mirror your current one. They won’t add new exclusions.
Continued moratorium
If you’re under 70 years old (65 in some states), and already have or had this type of policy written, your medical underwriter might extend your current, or previous, coverage.
Medical history disregarded
This is generally a corporate policy for people under 70 years old that receive coverage despite pre-existing conditions or medical exclusions.