The lowdown on life insurance medical exams

By Insure.com

There's a good chance you will need to undergo a medical exam if you are buying life insurance, whether it's term or whole life. Typically, insurance medical exams are done by paramedicals, who are licensed health professionals. Paramedicals are often independent contractors hired by the insurance company who come to your home.

There are medical questions on Part I (some insurers call it Part A) of a life insurance application that are usually completed by your agent in your presence, or online by you. Part II (or Part B) is the medical form that is completed by a paramedical or a physician.

After receiving your application for life insurance, your agent or life insurer will call one of several paramedical services that specialize in mobile exams. They'll give the paramedical service information on you, the amount of insurance you're applying for, and the name of the insurance company. Most paramedical professionals stay current on insurers' underwriting requirements.

What's involved in the exam

Nearly all exams can take place at your home or office, since many paramedicals carry their own supplies and have centrifuges for blood sampling. Although the insurer might order what is called an attending physician's statement (APS) from your doctor, you cannot have the life insurance medical exam done by your own physician.

A paramedical professional will call you to schedule your appointment. If you can't schedule an appointment, you'll usually have the option of going to a clinic specified by the insurer. The exam isn't optional -- you must have it or your application won't be processed. The insurance company pays the paramedical service or examining physician directly, so you're not financially responsible for the exam or any lab work.In a basic exam, the paramedical will take your medical history, physical measurements of height and weight, blood pressure and pulse, as well as blood and urine samples. Beyond that, tests vary based on your age and policy amount.

For example, MetLife will order an in-home EKG for applicants age 50 and older who are applying for face amounts of at least $1 million. For applicants age 70 and older who are applying for $2 million policies and higher, MetLife forgoes the paramedical exam and requires an exam by an M.D. chosen by MetLife (not your own doctor). The doctor will ask the same medical questions as a paramedical and get your height, weight, blood pressure and pulse, plus do a brief medical exam such as listening to your heart.

As age and face amounts get higher, a treadmill test may be required. MetLife requires treadmill tests for applicants who are at least 50 and applying for more than $10 million in insurance or applicants 76 and older applying for $5 million or more.

If you're applying for a low face value policy, you may not even be asked to do a paramedical exam. For example, if you're age 40 and applying for $50,000 of life insurance, MetLife requires no specific tests or measurements. And for some cases MetLife asks for a "simple paramed" exam, encompassing the basic measurements and blood and urine work but without the paramedical question list. Guidelines for tests will vary among life insurers.

What are they looking for?

The insurance company wants to know if you have any health condition that could shorten your life -- and increase the company's risk. When samples of blood and urine are collected, the insurer tests for the presence of antibodies or antigens to HIV; cholesterol and related lipids; liver or kidney disorder; diabetes; antibodies to hepatitis; prostate specific antigen (PSA); and immune disorders. The urine sample might 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 with a needle.

Continued: After the results

Results are sent directly to the life insurer's home office for the underwriter to review. You can usually send a written request if you want a copy of the results, and some insurers will automatically send you a copy of your lab work. If there's anything of concern about the lab results, you would need to consult your own doctor. Goldstein says, "It's not uncommon to have abnormalities that don't mean anything."

An insurance underwriter then reviews your life insurance application and the results of your medical exam. He or she then decides your insurance rating, which sets your premium. If there are lingering questions about your health, they may request additional information or medical tests. In the very rare event you are unknowingly quite ill -- chronically or terminally -- your application would be declined and you would have to look for a high-risk carrier or one that offers guaranteed issue life insurance.

Smokers pay higher premiums for life insurance because of their higher mortality rate. If any nicotine does show up in your results, you'll be considered a smoker. The test can even detect nicotine that is delivered through a transdermal patch.

After the results

If your test results correlate with the classification used when your premium rate was originally quoted, you'll have no problem getting that rate. If a medical problem is discovered, you might be offered a policy with a higher premium.

There are two types of risk ratings: "flat" ratings, sometimes called temporary flat extras, and "table" ratings. Underwriters assess health conditions based on a tightly defined underwriting manual to determine how to rate certain health conditions.For instance, an underwriter might apply a flat rating for a 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. Table ratings increase premiums by a set amount, depending on the medical condition and your age. 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 end up declining the life insurance policy, your test results become part of your record in MIB Group's database (formerly the Medical Information Bureau), a clearinghouse of medical information that insurers share which stores information for seven years after you apply for a life, health, disability income, long term care or critical illness insurance policy.

MIB is jointly owned by about 470 insurance companies. So if you go shopping around for other life insurance, keep in mind your medical information remains at every insurer's fingertips for the near future. Note that MIB's database does not contain actual medical records but rather codes that represent medical conditions and tests, hazardous hobbies and even your bad driving record.

If you want to check your MIB file, or dispute information in it, you can obtain one free report annually at the MIB Group Web site.

Avoiding the exam

Life insurance medical exams are really quite routine. But if you want to avoid a medical exam at all costs, you could buy a simplified issue policy, which requires only that you answer a few medical questions, or a guaranteed issue policy, which requires neither an exam nor questions.

Keep in mind, though, that if you're in general good health, or even have a history of some health issues, you'll likely get a much better rate by buying the underwritten policy that requires a medical exam. That's because simplified issue and guaranteed issue policy rates assume you are a riskier applicant.

Tips on 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.
• Avoid coffee, tea or other caffeinated drinks such as soda for at least one hour prior to the exam.
• Limit salt intake and high-cholesterol foods for the 24 hours before your exam.
• Don't engage in strenuous physical activities in the 24 hours before the exam.

Updated March 7, 2008