Find out what you need to know about life insurance medical exams

So you've done your research and decided that it's high time you got yourself a life insurance policy - that's great! Life insurance is an important way you can protect your loved ones from the unexpected. But making the decision might very well be the easiest part - what can you expect when applying for life insurance?

If you've never applied before, you might have heard that a detailed life insurance medical exam is required, but is that always the case? What sorts of questions or medical tests are involved in the process? How can you make sure that you're prepared for a medical exam? 

That's the subject of our blog today, so read on as we tell you everything you need to know about life insurance medical evaluations

Applying for life insurance

As you fill out your life insurance application, you'll likely answer a variety of questions about your medical history, family medical history, and lifestyle. These are preliminary questions designed to help the underwriters know where to start and helps inform the rest of the application process. 

Depending on the product you are applying for and your answers to the initial application questions, the insurance provider may need to gather more information from you. Sometimes, this results in additional questionnaires to better understand your lifestyle (such as your occupation and your hobbies), but they may also request that you undergo a medical evaluation.

Life insurance medical evaluations

Before we discuss what's involved in the evaluation, let's take a look at some common questions and concerns you may have about the process itself.

How do you take a medical exam for life insurance? What's the process like?

This medical evaluation includes a variety of lab tests, or a paramedical exam, and a review of your personal medical history. But don't worry, you're not responsible for setting this up on your own.

After an agent reviews your initial application, they'll help you organize the exam with an approved medical provider. Most insurance companies use one of several large third party providers, such as Exam One, American Para Professionals Systems (APPS), and/or Milliman. This exam is 100% paid for by the provider, and you can get a copy of the results at no charge.

Paramedical exams are performed by a licensed examiner, and the third-party provider presents both the exam results and lab results to the insurance underwriters for review. If medical records are needed to help the underwriter better understand your health status and health conditions, the insurance provider will request your medical records, also known as an Attending Physician's Statement (APS). Again, the third party partner will assist the underwriter in obtaining these records from your doctor's office at no cost to you.

Why are medical exams often required for life insurance?

At this point, you might feel like this is an awful lot of personal information and wonder why exactly it's important, or what exactly it is being used for - that's completely understandable! Life insurance exams are detailed and personal, but are important for both you and the insurance company all the same. 

Like property and auto insurance, life insurance underwriters have a responsibility to evaluate risk for the insurance carrier while providing the best possible price for the customer. Of course, unlike auto and property, life insurance underwriters have the unique and somewhat challenging task of evaluating a person rather than a car or a building.

Checking for medical markers of health is the primary way that insurance companies evaluate whether or not they are able to insure a person, and if so, how to price the policy and give the best coverage at a fair cost. If providers decided not to perform medical exams and instead offer policies at a flat rate, chances are the cost would be much, much higher for everyone.

Are life insurance medical evaluations always required?

No, medical exams are not always required. While common, insurance providers often offer policies without the need for a medical exam in certain circumstances. Generally speaking, it depends on the type of policy, the coverage amount being sought, and the applicant's age.

For example, if you are 30 years old and you apply for a $100,000 term life policy, many carriers can issue that policy without a medical exam. However, the longer in life you wait to get a policy and the more coverage you apply for, the more likely it is that they will require a medical exam.

Of course, these requirements will vary between providers, so it's always a good idea to check with your agent.

The paramedical exam

Essentially, the exam can be thought of in two different parts. The first part is a look at your personal medical history and the second is a a series of lab tests.

Your medical history

During your evaluation, you'll be asked for thorough information about your medical history. They'll want to know about any medications you take regularly, substances you may use and how often, whether or not you're a smoker, any past procedures, and any ongoing or chronic conditions.

As mentioned, some of these questions might have appeared in some form on the application itself. However, this portion of the evaluation is designed to go into greater depth.

Expect that they will ask questions about these items and be prepared to give specific details about the following:

• Alcoholism
• Cancer (multiple varieties, including leukemia, melanoma, etc.)
• Diabetes
• Disabilities
• Drug use
• High blood pressure
• High cholesterol
• HIV
• Mental health, depression, anxiety
• Obesity
• Pregnancy
• Sleep apnea
• Weight loss
• Chest pain
• Ulcer
• Anemia
• Immune deficiency
• Asthma
• Anorexia or bulimia
• Obsessive compulsive disorder

It's important to note that having one or more of these conditions does not necessarily exclude you from life insurance, but they absolutely can have an impact on the purchasing process.

Lab work and tests

The paramedical exam also includes items such as your height, weigh, blood pressure, and general wellness questions, as well as a panel of lab tests collected through blood and urine samples. Depending on your age, you may also be asked to have an electrocardiogram (ECG or EKG).

The following are some of the medical markers and tests measured in the lab work using blood samples:

• Glucose is a real time look at a person’s blood sugar level. It is recommended that that proposed insured’s fast before a paramedical exam, which typically provides a more favorable glucose result.
• Hemoglobin A1C is an average measurement of the glycated form of hemoglobin or blood sugar. An elevated A1C is a maker for diabetes and will show the underwriter the level of control a diabetic individual has on the condition.
• Blood Urea Nitrogen is a lab that reflect the level of health kidney function. If the BUN is elevated, the underwriter will likely request medical records to determine if there is a risk associated with kidney health in the client.
• Creatinine is a product found in blood that is considered a waste product of muscle breakdown. Creatinine results that are higher typically lead the underwriter to thinking there may be a concern of kidney function in the body.
• Alkaline phosphate is a blood enzyme found in the bile ducts, bone, intestine, placenta and sometimes tumors. When alkaline phosphate is elevated, the underwriter will likely question the client about any infection, bone breaks or undiagnosed tumors that they may have. Medical records are almost always required for any elevation in alkaline phosphate due to the number of illness that can be associated with the abnormality.
• Bilirubin measures the liver’s ability to breakdown hemoglobin or blood in the urine. Any abnormality in bilirubin indicates a liver function failure. Underwriters take bilirubin levels into consideration for all ages of proposed insured’s but especially for younger aged clients and our most mature clients.
• Aspartate Aminotransferase (AST), Gamma-glutamyl Transferase (GGT) and Alanine Aminotransferase (ALT) are all liver function tests. Abnormalities in liver function are indicators of liver damage, liver diseases, hepatitis or cirrhosis. Underwriters are hyper aware of these elevations and critically consider them when evaluating risk.
• Carbohydrate Deficient Transferrin is an indicator of heavy ethanol consumption by an individual. Often times, the CDT is elevated when one or more of the AST, ALT or GGT is also elevated. Underwriters will typically request an Alcohol Questionnaire if the CDT is positive in the serum results.
• Total Protein also known as Serum Protein, is an estimate of the number of proteins present in the plasma of the blood. Women who are pregnant could have elevations in total protein because of the bone development of the fetus, which is an interesting underwriting consideration.
• Albumin is measured in both the blood and the urine; however, life underwriters only evaluate the blood albumin level. Elevations typically point to liver function and could be a concern of the liver’s ability to absorb nutrients properly. Elderly applicants often times have abnormalities in albumin, which could indicate malnutrition or frailty.
• Cholesterol is measured in two parts, HDL and LDL and the two are combined to make up the HDL/LDL ratio. Individuals should seek to have a high HDL and a low LDL to have the best overall all ratio of healthy cholesterol. Cholesterol that is well controlled with medications or a healthy diet is favorable from an underwriting standpoint.
• Globulin is another measure of blood protein. Globulin is rarely abnormal in the serum results, but if it is, other protein markers would be considered as well to determine overall protein.
• Triglycerides are essential in evaluating an individual for their risk of a cardiac event or stroke. Increases in triglycerides are indicators of clogged arteries which could lead to such events.

They'll also screen for the following using a urine sample:

• Drug Profiles are collected on all individuals who are seeking life insurance and who require a paramedical exam with labs. Drugs that are tested for on an insurance paramedical exam include, amphetamines, methamphetamines, barbiturates, benzodiazepines, cocaine, marijuana, methadone and opiates. Any positive drug result would prompt the underwriter to request a Drug Questionnaire and/or order medical records for the case. Clients with a positive drug screening are highly underwritten and likely declined if not explained and backed up with a doctor’s explanation.
• Cotinine is found in tobacco and is present in urine when an individual uses tobacco products of any kind. The cotinine lab test is highly sensitive meaning that a client who even occasionally uses tobacco products will likely come back with a positive result. Second-hand exposure to tobacco will not produce a positive cotinine result.
• A Hepatitis Test is a profile available in the urine sample as well. The frequency of positive results is low on Hep A and Hep B, but is becoming more prevalent in Hep C. If Hep C is positive, the underwriter will obtain medical records and could request a liver ultrasound on the proposed insured.
• Urine Glucose unlike the serum glucose, is not used to measures the body’s ability to process sugar but more over is a test that represents kidney function.
• Proteinuria is a common urine lab result that can be abnormal because abnormalities can be caused by so many different factors. Dehydration, stress, exposure to cold weather, fever or even exercise can cause protein to appear in the urine. If proteinuria occurs, often times the underwriter will order two additional urinalyses to see if the abnormality is persistent or if the abnormality was situational and otherwise should be considered normal.
• White Blood Cells (WBC), also called leukocytes, when present are an indicator of infection in the body. Extremely high WBC levels could be an indicator of tumors, cancers or other serious illness and are highly underwritten on life insurance applications.
• Red Blood Cells (RBC) evidence of RBC in the urine, could be caused by a number of conditions which range from common and not serious to life threatening. Some medications can even cause RBC presence in the urine so the underwriter may question the applicant extensively if there is evidence of RBC on the labs.
• Protein/Creatinine Ratio is an extremely important measurement in the urine that indicates chronic kidney disease (CKD). Chronic kidney disease is very serious and would result in a declined life insurance application

Your family's medical history

Lastly, a life insurance medical evaluation includes questions about your family medical history. Learning about your family's medical history can give underwriters insight into what sort of medical conditions you may be susceptible to in the future, or may be genetically predisposed to. Generally, underwriters want to discuss close family members, such as your mother, father, and siblings.

Application questions often times ask about parent or siblings’ illnesses or deaths that occur at ages younger than 60. Family histories that include cardiovascular disease, diabetes or cancer are considered higher risk depending on the circumstances.

When discussing your family's medical history, they'll likely ask if family members have a history of:

• Cancers (breast, lung, prostate, etc.)
• Cardiovascular disease
• Diabetes
• Alzheimer's disease
• ALS
• MS
• Aneurysm
• Mental illness, attempted suicide
• Cardiomyopathy
• Huntington's disease
• Porphyria
• Sickle cell anemia
• Strokes

Again, just because you have a family member with a certain condition in their medical history doesn't mean your application will be automatically declined. If a member of your family has been treated for or diagnosed with a condition, the underwriter will likely ask for more information, like whether the person is deceased and what age they were when the diagnosis was given.

Withholding information

As you can see, these are often extensive exams, and people know that their answers can have an impact on their coverage. At times, this can lead to an applicant concluding that it is in their best interest to omit or otherwise withhold information, either out of fear that their rates may be too high or that their application will be denied altogether. This is not advisable, however, and can lead to disastrous consequences for a policyholder and their beneficiaries (i.e. their family).

Life insurance providers have what is known as a "contestability period" following the beginning of a policy. If a death occurs within this two-year period of time, it is meticulously investigated to determine if anything was omitted that could have potentially changed the underwriting decision. In the event that something is found, it could lead to the claim being denied, which means no claim would be paid to the beneficiaries.

This is yet another reason why it is important to be open, honest, and thorough when answering these questions.

Privacy and security

The medical portion of the life insurance application clearly involves a lot of sensitive personal information - information that most people would prefer be kept confidential. This is why underwriters and the providers they work for take great care to keep this information under lock and key.

Fortunately, these exams, tests, and the results are protected by HIPAA, or the Health Insurance Portability and Accountability Act. This is a series of federal laws and national standards that protect sensitive patient health information from being disclosed without the patient's knowledge.

Although you are required to sign a waiver giving the life insurance company access to your medical information, by law they are not allowed to share it with anyone and they may not use it for any other purpose apart from evaluating your life insurance rates and eligibility.

Preparing for a medical exam

Preparing for the medical exam is relatively straightforward. To make sure that the tests provide the best results and generally make the process issue-free, take a look at this list of things you should and should not do.

You should: 

• Get a good night's sleep
• Stay hydrated
• Document all current medications
• Have a photo ID and wear a short sleeve shirt for the day of for blood draws and checking blood pressure

You should not: 

• Consume salt or high cholesterol foods up to 24 hours prior to your exam
• Engage in strenuous activity or exercise 12 hours prior
• Drink alcoholic beverages up to 12 hours prior
• Use nicotine or caffeine up to one hour prior

Non-medical evaluation

So, now you have a good idea of what to expect from the medical evaluation portion of your life insurance application! This evaluation is an important tool that helps underwriters review your application, but they also must consider non-medical factors. 

In our next blog, we'll discuss how a life insurance company reviews the non-medical aspects of an application, such as your occupation and hobbies. Stay tuned!


Germania Life offers a variety of life insurance products, and some applicants may not even require a medical exam! Get a fast and free online quote today!