How does the life insurance underwriting process work?

Underwriting is designed to give insurers a clearer look at your health history and background.

Zack SigelAmanda Shih author photo

Zack Sigel & Amanda Shih

Published June 15, 2020


  • The underwriting process determines your monthly life insurance rates using information about your health and lifestyle

  • The process usually involves a medical exam and review of your prescriptions, hobbies, and driving record

  • An underwriter may give you a credit for better rates if you are actively working to improve your health

Applying for life insurance is easy. It takes only a few minutes. Once you have life insurance, if you die during the policy’s term then your loved ones will receive a death benefit to help pay for the expenses you paid for while alive.

But to determine how much your life insurance policy costs, an underwriter will give you an insurance classification. The underwriter works on behalf of or for the life insurance company to look at your health information and figure out if you should actually get the rate you were originally quoted. They will determine how likely you are to die before the end of your policy’s term and offer you a premium based on that.

Going through this process is called underwriting. All insurance products involve some degree of underwriting, which is used to get a picture of who you are based on your characteristics and how they relate to the kind of insurance you’re purchasing. For life insurance, the underwriter looks at data like your health and medical history as well as lifestyle information like your hobbies and driving ability.

Some parts of the underwriting process require action on your part, while others require the input of someone else, such as your doctor. Although underwriting can take several weeks and potentially even longer, an insurance broker can make the process easier by shopping around your underwriting results to different carriers to get you the best rate.



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The underwriting manual

Every carrier has its own underwriting manual. This defines the guidelines that an individual carrier will use to determine your final premium rates.

An underwriting manual will state things like what service a carrier’s underwriters should use for ordering an attending physician statement (APS)online, when they require a prescription history report, how height and weight correlate to health classifications, and more.

Of course, since each carrier has their own guidelines, that means that the other steps of the underwriting process — which tests are ordered, what tools are used, and what all of this ultimately means for your final life insurance rates — varies, too. Everything that follows is a pretty standard set of tools and tasks for an underwriter, but the specifics of what’s used, when, and how won’t be the same across companies.

Step 1: Application quality check

Before life insurance underwriting even begins, the carrier will go through your application to make sure all of the correct information is there. Your application is the first step in actually getting life insurance, so it’s something you want to get right.

It’s not uncommon for applications to be accidentally incomplete. The carrier is looking to make sure that all of the information is accurate and completely filled out. Fortunately, unless the missing information is related to medical history, most changes that need to be made to an application won’t slow down the underwriting process.

Depending on the carrier, you may need to do a phone interview as well. You’ll usually need to do this if you only gave the most basic information on your application, like your date of birth, address, and coverage needs, and the carrier needs to dig a little deeper into things like your hobbies.

After that, you’ll go into the official underwriting process. Each of the following checks can add some time to your application, but it’s worth it to getyou the premium price you’ll need to pay over the life of your policy.

Step 2: Paramedical exam

One of the first steps of the underwriting process involves looking at the results of your paramedical exam.

The medical exam is like a checkup with your doctor, except it’s free to you. A medical technician will perform the exam at a lab or your home or work.

After the paramedical exam, the results will be sent to the underwriter. The information an underwriter uses falls into three main categories:

  • Basic measurements. Height, weight, blood pressure — the boring things that you get a report on at a typical physical. Your height-to-weight ratio plays a big role in how you’ll be classified and, ultimately, what you’ll pay for your life insurance policy. High blood pressure, which becomes a particular concern as you get older, is also required for setting your rates.
  • Blood test. You can get a lot of information on potentially risky health concerns with a simple blood test. Heart disease, stroke, diabetes, blood-borne illnesses, and more can all be found out with a few vials of blood.
  • Drug test. A urine test for a full drug panel will alert the carrier to the use of drugs like amphetamines, cocaine, barbiturates, and more. Generally speaking, drug use makes you riskier to insure and raises your premiums (unless it’s marijuana, which is in a legal, social, and insurance grey area at the moment).

You can reuse the results of your paramedical exam to apply for other types of insurance, like disability insurance, or even for life insurance from another carrier. You’re under no obligation to go with a particular life insurance company just because they paid for your medical exam.

Step 3: Attending physician statement

If there are red flags coming out of your paramedical exam, the underwriter will order an APS to answer some remaining questions.

An APS is a summary of your medical history from your doctor’s point of view. It provides the status of each condition your doctor is treating and information about the condition, such as how long you’ve been treating it, how long symptoms have been present, and your prognosis.

Say you’re showing signs of high blood pressure. An APS can let an underwriter know that the high blood pressure is a temporary side effect of medication you’re taking and not necessarily indicative of a larger problem. In that way, it complements the paramedical exam by getting into the finer details of your health.

This step can skew the timeline for the life insurance underwriting process, adding anywhere from a few days to a few months, depending on how long it takes for a doctor’s office to comply with the request.

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Step 4: Medical Information Bureau check

The Medical Information Bureau (MIB) is a trade group that helps insurers share medical data, which helps a carrier fend off fraud by seeing where and when you’ve previously applied for life insurance in a general window of six months.

It’s not a bad thing if you’ve applied for life insurance with different carriers in the past, but the MIB will let carriers see what sort of information you’ve been disclosing on some applications that you may have accidentally left off others. Tested positive for drug use on a previous test but failed to disclose it on your current application? They’ll find out.

Step 5: Prescription check

The underwriter will check all the medication prescribed to you over the past five to seven years. As with the paramedical exam and APS, the prescription check will confirm the information in your application: the prescriptions you say you’re on or if you’ve omitted any medication up to this point.

Whether your underwriter requires this step depends on what they find in other areas of investigation. Life insurance policies with higher coverage amounts may also require a prescription check.

Step 6: Motor vehicle report

The underwriter will receive a motor vehicle report, or MVR, detailing your driving history. Just like your health history, your driving history plays a role in your life insurance rates because it helps determine how risky you are to insure.

An MVR notes driving violations like traffic citations (think speeding or reckless driving tickets), vehicular crimes, accident reports, driving record points, and DUI convictions. It can look as far back as five to seven years.

If you have a tendency to speed, drink and drive, or engage in other dangerous driving habits, you’re riskier, and your rates will be higher than someone who’s not.

You can request to see your MVR from your state. It’s also used when determining your auto insurance rates, so a copy of your MVR can be nice to have.

Step 7: Actuarial tables

Underwriters use a number of different actuarial tables to determine what risk you pose to the insurer and how much the insurer needs to charge to offset that risk.

  • Mortality table. This table shows the mortality probability for a given population, usually based on age and gender and assuming all other things being equal. Think of it as a baseline for when, statistically speaking, you’re most likely to die.
  • Build table. This table takes your body mass index (BMI) based on your height and weight and translates it into information that’s relevant to setting your insurance classification. A poor build can automatically set your classification to Standard, meaning you’ll pay more for your life insurance policy than someone with a Preferred classification.

Step 8: Credit system

After the underwriter has gone through all of the tests, tools, and checks needed to set your insurance classification, the last thing he or she may do is use a credit system to give you a little bump to help you get better rates.

If a chronic illness results in a Standard (substandard) classification, the underwriter’s credit system can make your premium more affordable if you’re actively taking steps to improve your health and undergoing preventative care.

The APS and prescription check will let an underwriter know what you’re doing to keep health problems from getting worse, which can be a boost to both your health and your wallet.

Step 9: Your final rating

Once underwriting is complete, you’re now the proud owner of a life insurance policy. The whole process can take anywhere from three to eight weeks, and relying on outside sources — like a doctor’s office for an APS — can add time. All that’s left is to confirm the premium rate, sign the policy to put it in force, and your family is protected.

If that was a lot to digest, you could consider getting simplified-issue life insurance, which skips the paramedical exam and the attending physician statement. But simplified-issue offers lower coverage amounts and isn’t available to people with certain health profiles.

About the authors

Managing Editor

Zack Sigel

Managing Editor

Zack Sigel is a SEO managing editor at Policygenius. He covers personal finance, comprising mortgages, investing, deposit accounts, and more. His previous work included writing about film and music.

Insurance Expert

Amanda Shih

Insurance Expert

Amanda Shih is an insurance editor at Policygenius in New York City. Previously, she worked in nonfiction book publishing and freelance content marketing. Amanda has a B.A. in literature and communication from New York University.

Policygenius’ editorial content is not written by an insurance agent. It’s intended for informational purposes and should not be considered legal or financial advice. Consult a professional to learn what financial products are right for you.

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