What is medical underwriting for health insurance?

Answer 1

Medical underwriting investigates your medical history and determines your eligibility for coverage. They enforce the guidelines established by the insurance company. Underwriting may also play an important role in determining the payment of claims. They can decline your ability to be covered by their policy, or they can place a "rider" on a condition meaning they would not cover anything having to do with a certain medical condition, but possibly cover the medication that is prescribed for the condition. For instance if you had back problems, they would not cover any future back problems but may cover your pain medication. They can also give you a "rate-up" meaning if you got a quote from an agent and the underwriters found a specific reason to increase your premiums, they would notify you that your original quote was going to be a given percentage higher because of a certain medical condition. For instance, height and weight restrictions could cause your rate to increase from the original quote. These guidlines vary between the companies.

Answer 2

Medical underwriting is the process by which an insurer evaluates the past health history and the present state of an applicant's health. Its purpose is to determine if the applicant comes within "underwriting guidelines" that it has established. The guidelines essentially set the parameters of the risks that the insurer is willing to undertake. In turn, they have a bearing upon the ultimate premium for the coverage, as the premium is the amount paid by the insured to the insurer for undertaking the risk of loss.

Underwriting guidelines are a function both of industry standards and of the law. Because insurers are regulated by State insurance departments of the States in which they do business, they are required to adhere to each State's law. One of the areas of regulatory involvement is to approve (or disapprove) proposed underwriting guidelines for the insurer's product(s) before the insurer can market the product in the State.