The life insurance medical exam: what to expect

The life insurance medical exam, usually called a paramedical exam, is a short health screening done at your home, workplace or a clinic by a nurse or technician hired by the insurer. It typically takes 20 to 40 minutes, includes a few measurements and a blood and urine sample, and costs you nothing because the insurer pays for it. Results go to the underwriter, who uses them to set your rate class.

Not everyone needs one. Many younger or healthier applicants buying modest coverage can be approved without an exam (see accelerated underwriting: approval without an exam and no-medical-exam term life insurance: how it works), but a full exam is still common for larger amounts, older applicants and complicated histories.

What happens at the exam

The examiner is usually not a doctor and does not diagnose anything. Exact steps vary by insurer and by the amount of coverage, but a typical visit includes:

1. Identity check. Bring a photo ID. The examiner confirms who you are.
2. Health history questions. The examiner goes through your application answers again, often asking about medications, doctors seen, hospital stays and family history, and records your answers. These should match your application.
3. Height and weight. Your build is compared with the insurer's build chart.
4. Blood pressure and pulse. Often taken seated, sometimes more than once.
5. Blood sample. A few vials are drawn for lab testing.
6. Urine sample. Used to test for nicotine, drugs and kidney-related markers.
7. Extras for some applications. Larger policies or older ages may add an electrocardiogram (ECG), a cognitive screen, a chest measurement or a longer questionnaire. Some insurers also ask for an oral fluid sample in place of or in addition to urine.
8. Signatures. You may sign authorizations that let the insurer request your medical records.

What the labs look for is covered in what a life insurance blood and urine test looks for.

How to prepare

Most advice is ordinary common sense, because the point is a representative reading of your health, not a lucky one.

• Schedule it sensibly. Morning appointments are common. Many exams ask for fasting for 8 to 12 hours beforehand, so read the instructions you are given and follow them.
• Drink water. Being hydrated helps with the blood draw and the urine sample.
• Skip heavy exercise the day before. Hard workouts can temporarily alter some lab values, such as muscle enzymes and protein in urine.
• Go easy on salt, caffeine and alcohol. Caffeine and a salty meal can push blood pressure up, and alcohol can affect liver readings. Avoid alcohol for a day or two before.
• Do not use nicotine and avoid it before the test. Nicotine shows up on tests regardless, and the insurer will price you accordingly. See tobacco rate class.
• Take your usual medications unless your doctor says otherwise, and bring a list of what you take, with doses and the prescribing doctor.
• Bring your ID and have your doctors' names ready. The examiner may ask for contact details.
• Be accurate. Answers that contradict your medical records can slow the file or lead to a denied claim later. See what happens if you lie on a life insurance application.

What you can and cannot control

You cannot, and should not try to, change who you are in a day. But a few things are within your control in the weeks before an application: a blood pressure reading is more reliable when you are rested and calm, so give yourself extra time to arrive and sit quietly for a few minutes before the cuff goes on. If you have a known condition such as high blood pressure, mention that you are on treatment; a controlled reading on medication is evaluated differently from an untreated one.

Honest disclosure is far safer than hoping something goes unnoticed. The underwriter may also order your doctors' records through an attending physician statement.

After the exam

The examiner sends the samples to a lab and the paperwork to the insurer. Results typically reach the underwriter in days. If something unusual appears, such as elevated liver enzymes or sugar in the urine, the underwriter may ask for more information or doctors' records. This is normal and not a rejection; many abnormal results prove to be temporary or explainable.

The insurer then issues a decision (see how life insurance underwriting works). Your rate class may not be the one you applied for, and the next step if you disagree is to ask the agent which finding caused it. Some results can be improved with time and treatment, and you may later ask for reconsideration (see asking for a better rate class later).

Your privacy

Lab results and exam findings are sensitive health data. Insurers must handle them under state privacy law and, for HIV tests, special consent and disclosure rules that vary by state. Information may be shared with the MIB if it has underwriting significance, which is why you may later find coded entries in your MIB file (see The MIB report: what insurers know about your history).

When you can skip the exam

Insurers waive exams in several situations: accelerated underwriting for qualified applicants, simplified issue policies that use only health questions, and guaranteed issue policies with no questions at all. The trade-offs are usually a lower maximum amount, a higher price for the same health, or both. A fully underwritten exam can earn the lowest rates for people in good health, which is why healthy applicants sometimes choose it over a no-exam route.

Key takeaways

• The exam is a 20 to 40 minute screening by a nurse or technician, paid for by the insurer.
• It includes health questions, height and weight, blood pressure, and blood and urine samples; older or larger applications may add an ECG.
• Prepare by following fasting instructions, staying hydrated, avoiding hard exercise, alcohol and nicotine, and bringing a medication list and ID.
• Abnormal results lead to follow-up questions or records requests more often than to an outright decline.
• Some applicants can skip the exam, usually with limits on amount or price trade-offs.