Are there questionnaires that may be used to gather information about and to get a better understanding of various medical and nonmedical issues for pre application underwriting purposes?

Are there things you can do to prep for an exam?


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  • No exercise regimen within 12 hours of the exam, including a morning jog or trip to the gym
  • No extensive exercise (marathon, bike racing, etc) within 7 days of exam
  • There is no need to “fast”, but avoid salty, sugary, creamy and fatty foods
  • No tobacco within 1 hour; ideally, none the day of the exam
  • No excessive caffeinated coffee
  • No “energy drinks” the day of the exam
  • Refrain from drinking alcoholic beverages for at least 12 hours prior to the exam
  • Make sure a big blood pressure cuff is used if the client has a thick arm
  • Make sure urine is collected before blood pressure is taken
  • No talking during blood pressure; it should be done while sitting and in a quiet room
  • Men age 50 plus, no prostate massage or digital rectal exam within 3 days if a PSA is being done
  • Ideally, no breakfast before a morning exam- and try to schedule the exam in the morning hours
  • Get a good night’s sleep, no exam on 5 hours or less of rest
  • No exam if under undue stress.
  • No exam if in pain or symptomatic with acute illness
  • No exam within 7 days of being in the hospital for any reason
  • Dress light and remove shoes (for build purposes)
  • Provide a list of all medications taken, prescription and non-prescription, and a list of all medical professionals seen within the past 5 years and the reason for the visit
  • For applicants 70 and above, carriers may require a Senior Supplement. This involves a variety of tests involving timed movement, memory recall, activities of daily living and drawing. These results can have a major impact upon insurability, it is important your client is prepared and knows what to expect

What amount of daily alcohol use causes concern for carriers?

Typically carriers will be fine with up to 2-3 alcohol related drinks per day, 14-21 per week on average, If there is no criticism of driving such as, DUI or reckless/careless driving, no criticism of alcohol use in the medical records, no history of alcohol treatment, and no abnormal lab findings due to, or thought to be caused by, alcohol in the client’s medical records or on the insurance lab.

How long will a carrier use an insurance exam?

While this may vary somewhat by company, up to age 70 most carriers will accept insurance exam results on a standard or better risk for up to 12 months. At age 70 plus, results are typically valid for up to 6 months.

What special lab tests are insurance carriers doing today?

All carriers request several routine blood and urine results, but there a number of “special” tests that are becoming more common:

  1. Blood alcohol content-not widely used by carriers today
  2. CDT-an alcohol marker used to determine if alcohol is drank in excess on a routine basis. Usually, this test is done on request, or when other labs are irregular. If you routinely drink 4 or more alcohol beverages daily this test will show positive
  3. Hemoglobin A1C-widely used by carries today. Measures blood sugar control over a 90-120 day period and is used to screen for diabetes and prediabetes, as well as diabetes control for persons with a diagnosis of diabetes
  4. NT-proBNP-becoming widely used by carriers today, especially in the age 60-70 plus age groups. Measures cardiac health and vitality and is sometimes used in place of an EKG at age groups below 60
  5. PSA-widely used by carriers today. Screens for prostate cancer in the age 50 plus age category
  6. Hepatitis B & C- used by several carriers today. The test is usually done on request or when other labs are irregular. May indicate an applicant has an active infection of the Hepatitis B or C virus
  7. Marijuana & Opioids-becoming more widely used by carriers today. A urine screen to test for the presence of marijuana & opioids
  8. Cystatin C-this is an alternative to the more traditional kidney function test. It screens for kidney dysfunction and may also be used to measure health and vitality in the 70 plus age group
  9. CEA-this is a tumor marker test to detect cancer.  It is typically completed when amount of coverage applied for is substantial and/or the applicant is age 70 or greater

Can someone with sleep apnea, type 2 diabetes, and certain cancers get preferred?

Yes, there are instances where any of these impairments may be considered preferred.

  1. For sleep apnea-a preferred offer depends on how long the applicant has had the condition, ongoing treatment, control of the problem, and personal risk factors. In fact, sleep apnea MAY be considered preferred best by a few carriers if all factors are favorable.
  2. For diabetes-if the onset is age 70 or older, and control is excellent without cardiac or other complications, preferred may be possible with some carriers
  3. For cancers-preferred may be possible for thyroid, uterine/cervical, testicular and other cancers if the tumor was totally localized/confined, in early to moderate stage, surgically removed without the need for radiation or chemotherapy, and at least 10 years has elapsed since last treatment

Are there any programs where an applicant may be issued coverage without the need for an insurance exam or fluids, with non-loaded products and full compensation?

Yes. There are programs, often called accelerated underwriting programs, which offer the opportunity for an applicant to be underwritten without the need for an exam or bodily fluids, without an additional mortality rating and at normal compensation. For carriers that offer these programs, typically age ranges are 30 to 60 with, for many carriers, face amounts up to $1 million.  However, some carriers will go as high as $2-$5 million.  In most programs today, the applicant must either do a tele-interview with a carrier representative or complete an on-line part 1& 2 and various databases are checked. Also, the person must typically qualify for coverage on a standard to preferred best basis. It must be stressed that these programs offer the opportunity—but not a promise--to be issued coverage without routine exam requirements. It is important that diligent prequalification be done and proper expectations be set with the applicant prior to submitting an application through this process

What do I need to know about foreign travel and its impact on underwriting?

Foreign travel may impact a carrier’s risk assessment of an applicant. Most all carrier applications have some type of foreign travel question, where details to an applicant’s purpose of travel, length of time one may stay at a destination, cities, accommodations and other things are requested. As a general rule, countries with characteristics similar to those of the United States—Europe, Canada, Hong Kong, Israel (excluding the West Bank and Gaza Strip) Japan, Australia, New Zealand, and others—are not a foreign travel concern and represent no additional underwriting risk. However, countries such as Afghanistan, Botswana, Congo, Haiti, and other similarly situated countries where political instability, military occupation/control, crime, social unrest and poor health conditions may be present represent a significant underwriting risk where an applicant may not be accepted for coverage. In addition, the length of time an applicant resides in a foreign country may cause carriers to view them as a foreign resident, with risk factors similar to those of a foreign national. See Foreign National section for more information

Retention, Auto Bind & Jumbo limits- what are the differences?

What is a company’s Retention Limit?

The retention limit, also referred to as internal carrier capacity, is the amount of coverage a carrier may retain itself on an applicant for life insurance coverage. Maximum retention limits vary by carrier and are typically adjusted for age of insured, assessed rate class, whether the insured participates in a hazardous activity or sport, foreign travel, and plan of coverage.

What is a company’s Auto Bind Limit

The auto bind limit is the amount of coverage or capacity a carrier may cede or pass on to its reinsurance partners on the life of an insured without reinsurance review of a direct carrier’s underwriting information. A carrier may use their auto bind as long as a case is not jumbo (see below). Auto bind limits vary by carrier and are typically adjusted for age of insured, assessed rate class, whether the insured participates in a hazardous activity or sport, foreign travel, and other things such as plan of coverage.

What is a company’s Jumbo Limit

The jumbo limit is defined as the total amount of insurance applied for and in force on an applicant with all carriers. Carrier jumbo limits range from $35 to 75 million, with the largest carriers typically having the greatest jumbo limits. These limits are typically adjusted for age of insured, assessed rate class, whether the insured participates in a hazardous activity or sport, foreign travel, and other things such as plan of coverage. In addition, for permanent to permanent coverage 1035 replacements, some carriers may allow their jumbo limit to be adjusted or offset by the amount of in force coverage to be exchanged—where the 1035 amount to be replaced will not be included for jumbo limit purposes.