Have you ever had a life insurance medical exam? It can be a little unsettling to have someone unfamiliar come into your home or office and ask you a seemingly endless series of personal health questions, weigh you, have you provide a urine sample, and jab you to get a blood sample.
Jump ahead to these sections:
- Why Do Some Life Insurance Policies Require a Medical Exam?
- What Are Life Insurance Companies Looking to Find in a Medical Exam?
- Who’s Typically Responsible for Paying for the Medical Exam?
- Is It Possible to Get Life Insurance Without a Medical Exam?
- What Happens During a Life Insurance Medical Exam?
- How Can You Prepare For a Life Insurance Medical Exam?
- Who Gets to See the Results of My Medical Exam?
- What To Do If You’re Declined Coverage
Is all this really necessary? Why do some life insurance policies require a medical exam, and some don’t? What is the life insurance company looking for? Who gets to see the results of my medical exam? This article is going to answer all of those questions and more.
Why Do Some Life Insurance Policies Require a Medical Exam?
Answering this question can be summed up in one word: risk.
Life insurance companies are risk-averse when issuing a policy. They calculate their numbers and statistics almost as frequently as casinos in Las Vegas count their money. They’re not about to risk losing $1 million on a life insurance claim without closely examining an applicant's lifestyle and medical condition, past and present.
Life insurance companies prefer to spread the risk around to protect their bottom line. They would much rather sell twenty $50,000 policies than sell one $1 million policy. There is much less risk involved for them by pooling together a group of people they’ve deemed healthy after the applicants have had a life insurance medical exam.
They know that eventually, they’ll have to pay some death claims, but in the meantime, they’re collecting premiums every month and investing them. They also know that a good percentage of their insured will let their policy lapse, and they’ll never have to pay a claim on that policy even though they had collected premiums for years.
Age is also a factor. Life insurance companies require a medical exam for older individuals. For example, depending upon the company, they may not require a 21-year old to have a medical exam for a $50,000 policy, but they would for a 61-year old. There is a much lower risk of them paying a death claim anytime soon on the 21-year old than paying one on the older individual.
So, what’s the 61-year old supposed to do if they have pre-existing medical conditions and know that they’ll fail a medical exam? They have an option called “guaranteed issue life insurance.” These policies are usually issued to people over 40 years of age who can’t qualify for a standard life insurance policy.
A medical exam is not required, nor are any medical questions asked. Many older individuals with pre-existing medical conditions buy guaranteed issue policies to pay for funeral expenses.
How can a life insurance company do this and stay strong financially? They can do it by keeping the face amounts low and the premiums higher than those of a standard policy. Most guaranteed issue policies cap the death benefit at $25,000, and premiums can be 5-10 times higher than those for a standard policy.
What Are Life Insurance Companies Looking to Find in a Medical Exam?
When a life insurance company sends your blood and urine samples off to the lab, they’re looking for a variety of health alerts that would indicate that you are either a sub-standard risk or someone they don’t want to insure. They look for things like:
- Elevated blood sugar levels
- Conditions indicating the possibility of heart disease, diabetes, and certain types of cancers
- Abnormal liver and kidney functions
- Cocaine, cotinine, and the substance indicating nicotine use
In addition to the results of your lab work, life insurance companies also evaluate your height, weight, pulse rate, and blood pressure obtained during the exam to gauge your insurability. For example, an obese individual with high blood pressure will be charged a higher monthly premium because of the increased risk to the insurer, or they may be declined coverage altogether.
Individuals age 50 or over that are applying for a large amount of life insurance may not only have to have a medical exam by a paramedical, they may also need to have an electrocardiogram and treadmill stress test completed.
Who’s Typically Responsible for Paying for the Medical Exam?
The life insurance company will pay to have your exam completed. To them, it’s worth the investment of a few hundred dollars to protect against the possible loss of tens of thousands of dollars or more.
However, you may disagree with the results of your medical exam and can have another exam to verify the validity of the exam. The applicant typically pays for this second exam. The life insurance company may, however, pay for a second exam if the results were marginally negative and the policy’s premium would be very high.
Is It Possible to Get Life Insurance Without a Medical Exam?
Yes, it’s possible to get life insurance without a medical exam.
Some people won’t do the exam because they’re afraid of needles and won’t let their blood be drawn. Others are sometimes afraid of what the exam will reveal about their health and would rather not know if they have an illness. And some people will find life insurance available without a medical exam because they’ve been declined for standard policies because of pre-existing medical conditions.
There are several ways to still get a life insurance policy issued without a medical exam:
Apply for a lower face amount. Some life insurance companies will issue a policy if the face amount is below a certain amount and if you’re younger than a certain age. For example, ABC Life may have guidelines that allow policies to be issued for people under age 40 with a face amount of $50,000 or less.
Apply for a guaranteed issue policy. As mentioned previously, there is no medical exam required to qualify for a guaranteed issue policy and no medical questions to answer. However, you usually have to be over age 40, and the face amount can’t be higher than $25,000 (some companies do approve guaranteed issue policies with face amounts up to $50,000).
Get life insurance at work. Group life insurance where you work, if it’s offered as an employee benefit, doesn’t require a medical exam. The life insurance company is willing to take on the group's risk if it’s a certain size, such as 50 or more employees.
Typically, for the first $50,000 of group life insurance, you also are guaranteed to be issued a standard policy. Any face amount exceeding that amount will require you to answer medical questions, and you can be denied coverage.
What Happens During a Life Insurance Medical Exam?
During the short 15-45 minutes of your medical exam, quite a bit happens. It typically looks like this:
- You’ll be asked many questions concerning your past and present health status. It’s important to answer truthfully—any misstatements could cause the policy to be voided when it comes time to pay a death claim.
- Your height, weight, blood pressure, and pulse will be recorded.
- You’ll provide blood and urine samples
- If you’re over age 50, you may be asked to have an EKG done, depending upon your past heart health history and the amount of life insurance you’re applying for.
- Dependent upon multiple factors (age, health, face amount), you may be required to have an x-ray or perform a stress test.
- Applicants over age 70 will sometimes be required to take a test measuring their cognitive ability.
How Can You Prepare For a Life Insurance Medical Exam?
Your rates for life insurance depend, in part, on the results of your medical exam, so being prepared can save you a substantial amount of money over the years you’ll be paying premiums for your policy.
Here’s the best way to prepare so you can get the best results possible:
- 24 hours before the exam: Limit high-cholesterol foods, like red meat; avoid any over-the-counter medications like decongestants and antihistamines.
- 12 hours before your exam: Limit strenuous exercise and abstain from alcohol consumption. Both of these can raise your blood pressure levels.
- One hour before the exam: Avoid nicotine and caffeine; drink a glass of water (being hydrated helps with the blood draw and helps with urination for your specimen).
- At the exam: Have a photo ID with you, and wear short sleeves or sleeves that can be rolled up to make it easy for the nurse or phlebotomist to draw blood and measure your blood pressure.
When you schedule your exam, ask the scheduler if you need to fast before the exam. You may need to avoid drinking (except water) and eating anything for 12 hours before your exam.
Who Gets to See the Results of My Medical Exam?
The person who will spend the most amount of time reviewing your exam results is the underwriter assigned to evaluate your application and the exam results. They will then ultimately be the person who accepts or declines your application for coverage.
The underwriter is going to review all of the results of your blood and urine tests. They’ll be looking for:
- HIV and AIDS
- Sexually transmitted diseases
- Cholesterol, including LDL and HDL, and triglycerides (poor levels correlate with heart disease)
- Hemoglobin A1C, fructosamine, and glucose levels (checking for diabetes)
- Creatinine, hemoglobin, and proteins (checking for kidney disease)
- Urine acidity (can signal diabetes or kidney issues)
All of the insurance company’s findings will be reported to the Medical Information Bureau, which is a central database where other insurance companies can view your medical records and your exam results. They’ll also be able to tell if you have been approved or declined for any additional life insurance policies.
What To Do If You’re Declined Coverage
If your exam results indicate you have/may have a medical condition with a moderate to low impact on your activity levels (like prediabetes), you should speak with an independent life insurance agent and see if they represent any life insurers that issue policies to individuals with similar exam results. The agent can also give you guidance on finding the best life insurance policy and how much life insurance you may need.
There’s No Need to Worry
Companies that specialize in performing medical exams for life insurance companies employ professional nurses or parameds who have been trained to ask the medical questions in a way that isn’t embarrassing or uncomfortable for anyone. They have also been well-trained in phlebotomy (drawing blood). Their livelihood depends on treating you well and performing as a professional. You’ll be in good hands.