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What Are the Medical Requirements for Life Insurance?

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When you apply for life insurance, you'll likely be asked several questions regarding your health. Questions such as if you smoke and whether you have a chronic disease are used to decide your eligibility and help set your rates.

In many cases, a medical exam is required to not only verify your current health status but determine if you're at risk for any issues in the future. Undergoing the exam might sound overwhelming, especially if you know that your health isn't great. But understanding what to expect and how to get the best results can make the process a whole lot easier.

Why Life Insurance Companies Require Medical Exams

Companies that offer financial products such as life insurance often assess the risk of each potential customer who applies. Just like banks review your credit report before extending you a loan, or auto insurance companies examine your driving record before deciding your rate, life insurance companies want to get a complete picture of your health before offering you coverage. 

Life insurance is designed to provide your beneficiary with financial support in the event that you pass away. People with longer life expectancies are less likely to cost the insurance company money, while those with shorter expectancies provide a much greater risk.

For example, if a person takes out a 30-year policy set at $750,000, but dies after only paying a few years of premiums, the company takes a large loss on what they end up paying out. However, if someone with the same policy lives to the end of their term, the company pockets the premiums they've collected.  

This is why a person who's younger and in good health will pay a much lower rate for the same policy as someone who's older or in poor health.

A medical exam helps insurance companies determine your risk and decide what rates you qualify for based on that risk

Health Categories & Rates

Depending on your risk level, your insurance company will assign you to a health category. Categories vary slightly by company, but take into account the same basic requirements and premium ranges. The 5 most common categories used by insurance companies are:

Also referred to as select preferred or extra preferred, this top-tier category is for people in excellent health who have long life expectancies. You'll need to be a nonsmoker with extremely good cholesterol, blood pressure, and other medical readings. You'll also need to be within a healthy BMI range and have no immediate family history of diseases such as cancer. You'll get the lowest rates if you qualify for this category.

This is the second highest category offered by most insurance providers. This is also for those who are in excellent health with long life expectancies but may be in a slightly wider range when it comes to their medical readings. don't quite meet the requirements for preferred plus. You might also fall into this category if you have a condition that's well-managed and being treated with medication. This category also qualifies for low rates.

Sometimes labeled as standard select, this category is for people who are in above-average health but might be receiving treatment for a non-serious condition, fall slightly outside the healthy BMI range, or have a family history of certain diseases. Falling into this category will qualify you for lower than average rates.

As the name implies, this is the most common life insurance category. People who are in average health, taking multiple medications, are overweight, and/or have a family history of certain conditions will likely fall into this category. This qualifies you to receive the company's base rates.

People who fall into the substandard category are in below-average health and might not qualify for insurance with all providers.

Some companies also have separate categories for smokers and nonsmokers, so you might come across labels such as preferred nonsmoker or standard smoker. Other companies don't separate out smokers but won't assign them to any category higher than standard plus, even if they're otherwise in excellent health.  

What to Expect During Your Medical Exam

To determine what category you're in, your life insurance company will request and pay for a medical exam. You'll likely have a choice of local spots to take the exam, and some companies might even send a medical professional to your workplace or home. You can expect the exam to take around 20–30 minutes.

Most exams start with the medical professional asking you a series of questions. You'll talk about topics such as:

  • Your medical history, including any conditions you have (physical or mental health), medications you're taking, procedures you've had, and if you've ever been hospitalized
  • Your family's medical history
  • Your lifestyle habits, including your exercise routine, how much you drink, whether you smoke, and if you engage in any high-risk activities like extreme sports
  • How much life insurance you're looking to purchase

The next step will be a series of procedures, including:

  • Measuring your height and weight
  • Taking your blood pressure
  • Drawing your blood
  • Gathering a urine sample

Depending on your age and medical history, you might also need to have an electrocardiogram or other tests for cognition or mobility. Some insurance companies also ask for X-rays and saliva samples, though this is fairly rare.

Different life insurance companies look for slightly different things, but in most cases, the health category you're assigned to you will based on your:

  • BMI
  • Blood pressure
  • Cholesterol levels
  • Lipid levels
  • Blood sugar levels
  • Liver function
  • Kidney function

They'll also use your results to look for the presence, or warning signs, of diseases such as:

  • HIV and other immune disorders
  • Diabetes
  • Hepatitis
  • Prostate and other cancers

Your blood and urine will also be tested for the presence of nicotine or any illegal drugs.

What You Can Do to Get Better Results

Getting better results on your exam can result in much lower premiums. While you can't change your medical history or any preexisting conditions, there are some things you can do a few days or weeks beforehand to ensure you get the best results you can.

Giving up smoking can make a big difference in your results. Nicotine can be detected in your blood for up to 10 days, so ditching the cigarettes, even for just a couple of weeks, can move you into a better health category. Plus, nicotine can raise both your blood pressure and your pulse, so avoiding it before your test will help those results, too.

Like nicotine, caffeine can raise your blood pressure and your pulse. Going a couple of days without coffee, or at least reducing how much you drink, can improve your results. Coffee also dehydrates you, making it more difficult to get blood and urine samples.

Not only can alcohol negatively affect your results and dehydrate you but having alcohol in your system might make you look riskier to insurance underwriters, resulting in a higher rate.

Anything that could raise your blood pressure or blood sugar should be avoided for a few days before your exam. Instead, try eating foods such as avocados, nuts, and leafy greens, which can stabilize your cholesterol and blood pressure levels.

It might not make sense to skip on something that's good for you, but an intense workout can affect your cholesterol readings and the levels of protein in your urine. It's best to skip the gym for a day or 2 before your exam.

Some common substances can cause false positives in your drug test results. These include things such as:
  • Poppy seeds (opiates)
  • Over-the-counter cold medicine (amphetamines)
  • Ibuprofen (marijuana)
  • Sleeping pills (barbiturates)
  • Tonic water (cocaine)

You can also test positive for drugs if you're currently on antibiotics or HIV medication. You shouldn't stop those before your exam, but you should let your examiner know.

Being well-hydrated can help your blood pressure, make it easier to draw your blood, help you produce a urine sample, and flush toxins out of your system.

Being as calm and well-rested as possible will also help you get the best results. You should try to get a good night's sleep and avoid anything stressful before the exam.

What Happens After the Exam?

It could take up to a few months for your information and samples to be fully processed. Depending on your insurance company and whether you paid a premium upfront, you might be covered during the period of time that it takes to verify your results. Other companies wait to begin coverage until you've been officially accepted, so it's best to speak to an agent to understand the terms of your plan.

What to Do If You're Denied Coverage

Unfortunately, you could be denied coverage based on the results of your exam.

If your insurance company denies you, your first step should be to get a copy of the results to show to your doctor.

If your vitals have always been normal, your doctor could help determine if something was off on the day of the exam. You could request to have a secondary test run or submit verification from your doctor that the results were wrong.

If the exam shows you have a condition you didn't know about, work with your doctor on a treatment plan. They might be able to help you manage the condition well enough that you could qualify for life insurance later.

If working with your doctor doesn't help, you might need to look for an insurance company that offers plans specifically for people in below-average health. Contacting an insurance broker who can access several types of plans can help you find one that fits your situation or offers add-on and rider policies. Keep in mind you'll likely pay a lot more for a substandard policy.

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