Is a medical exam required to get critical illness insurance?
Critical Illness Policy Application Process:
- Submit the critical illness policy application.
- Submit to a medical exam, if warranted.
- The provider evaluates your application. Further medical information may be required during this time.
- When the application is approved, premiums will be set.
- Pay the premiums.
- The policy is issued and you receive the policy document.
What the underwriter looks into:
- Your health
- Your physical condition (height, weight and age)
- Your medical history, including that of your family’s
- Your occupation, lifestyle and hobbies (including smoking habits and dangerous sports or past times)
- Your location
Medical exams are often used as an underwriting tool – not just for critical illness insurance, but also for other insurance products such as life insurance and disability insurance. It gives the insurer an indicator of what kind of risk you present.
After all, your health status will indicate whether you may claim against your policy any time soon. Insurance companies are loath to provide insurance coverage to those who have a high medical risk – for obvious reasons.
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Medical Exams
There are some insurance companies selling critical illness insurance that will require you to get a medical exam before they will issue the policy to you. Depending on the company, it may either require you to have a conversation with their accredited doctor (especially if the policy is issued over the Internet), or to submit to urine and blood tests.
This may depend on the declaration you made on your application. For instance, if you declared that you already have diabetes, the insurance company may require you to test for blood sugar and other related tests. This is to check whether your condition is still manageable and that with medications, you may still ward off the possibility of your condition being worse in the near future.
The doctor will also look into your family history to check the medical condition of first-degree relatives to determine if there is a tendency for you to develop a serious illness. The doctor may ask about the medical condition of your parents and siblings. Depending on the initial assessment, the underwriter may also ask for further tests.
Some tests that may be requested during the medical exam include:
- Blood tests, to check for cholesterol level or indicators with regards to the function of your kidney or liver, as well as to determine the existence of certain diseases (i.e. HIV or hepatitis).
- Urinalysis, to check for abnormalities or the presence of infections.
- Smoker test
- Exercise Electrocardiogram, to check for the presence of heart disease
- HIV test
No-Medical Policies
If you’re worried about the medical exams (or scared of needles and blood tests), you don’t need to fret. You can still buy a critical illness insurance policy since there are some companies that issue the policy even without a medical exam. You will still need to answer a few medical questions, though.
One drawback with this policy is that the coverage is limited – some companies will only issue this up to $250,000 (some even less). Anything above that amount will need a medical exam.
The Importance of Full Disclosure
What is important, particularly if you’re getting a no-medical policy, is that you answer the medical questions completely. This is to avoid any problems when it is time to make a claim.
The insurance company may take issue on areas you failed to disclose. For instance, if you failed to inform the insurance company about a heart problem and you make a claim because you need a heart bypass, the insurance company may deny your claim.
How a Critical Illness Provider Decides on Your Application
Reasons why a policy application is denied:
- High BMI or blood pressure, compounded by negative health habits such as smoking
- Existence of medical conditions that is linked with life-threatening illnesses (i.e. hypertension that can lead to a stroke)
- Occupation or past times that are dangerous
After assessing the kind of risk you present, the underwriter representing the company will give one of the four decisions:
- The policy is issued on standard terms. This means you pay the standard premiums will no additional charges or exclusions.
- The policy is issued on non-standard terms. This means that the policy can be issued, but with additional premiums (starting from an additional 25% to 150%) or exclusions.
- The application is put on hold. The company may be awaiting further information or can wait after a treatment is begun and is proven successful.
- The application is denied. This means that the provider cannot issue the policy due to your medical condition.
How Your Answers to the Policy Application Can Affect Underwriting Decisions
As said before, you need to disclose any conditions or symptoms. Of course, this also has an impact on how the underwriter will act and decide upon the application.
| Illness or Symptom | How this will affect the underwriting decision |
|---|---|
|
Difficulty in breathing, wheezing or coughing |
The underwriter will evaluate the presence of bronchitis or asthma. He may ask questions like, “How frequent are your asthma attacks?”, “When did your difficulty in breathing start?” Depending on the severity of the asthma, coupled with additional risk factors such as age, weight and smoking habit, your policy application may be denied or accepted but with a higher premium. |
|
Diabetes or indicators of high blood sugar |
The underwriter will consider this with other factors such as:
In most cases, those with diabetes may be denied cover or issued cover only with additional premiums. |
|
High BMI that may indicate being overweight or obese |
Risk factors will be evaluated along with the high BMI. The policy may be issued on non-standard terms. |
|
High cholesterol or blood pressure |
The underwriter will evaluate this based on the applicant’s age, weight and other risk factors. The policy may be issued on non-standard terms. |
|
Pain in the joints or muscles |
The underwriter may check the reason behind the aches and pains. |
|
Recent heart attack |
The application is put on hold until the applicant has recovered fully and is able to go back to work or perform normal duties for at least six months. The underwriter will look into risk factors such as a smoking habit, weight, high cholesterol or blood pressure. Underwriting will also evaluate the applicant’s age and the severity of the heart attack. This may result in the denial of the application. |
Last updated on: 18.1.2013
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Recommended useful information to read:
- Dos and Don’ts when making critical illness insurance claims
- What you should know about your critical illness cover: the exclusions to your policy
- Things to consider before getting a critical illness insurance policy
- Are you at risk? Critical illnesses you may be susceptible to
- Save up on premiums: factors that affect your critical illness insurance premiums