Conditions and Medications


In medical underwriting, one of the most important parts of the process for determining eligibility used to be assessing an applicant’s medical history and their ability to receive coverage. Many applicants may not be aware that they have had a condition that will disqualify them entirely from receiving coverage before health reform. While each carrier in every state had their own set of guidelines, the list of declinable conditions was fairly similar from one insurance company to another.

Serious and chronic illnesses were a definitive red flag for health insurers when writing a plan. They mean costly medical bills, constant treatment, pricey medications and supplies, and therefore were unappealing to health insurers. Until the health care law made pre-existing conditions of all types acceptable and insurable in 2014, there were strict rules prohibiting certain individuals from getting insured. Though some people who knew they are uninsurable may have been aware that their medical history had deemed them as such, others may not have known what to expect.

Depending on the medications a person took, they may also be declined coverage, as certain prescriptions are expensive to cover or the related condition is also. Medications can become so expensive that insurers had designated a list in for their underwriters to follow in order to determine eligibility or decline an applicant.

Many other medications and conditions may have made an individual’s rates increase though they may not have been declined completely. These are referred to as risks, and each company had a specific percentage they rate up based on the condition, when they were diagnosed, and the current state of their health. Another case of inquiry for health insurers are conditions which require additional information. If an individual had an illness or diagnosis within a certain time frame, they may also have been rated up.

Below is a list of declinable conditions and medications from a national insurer’s underwriting guidelines prior to the Affordable Care Act’s changes in 2014.

 

Conditions Subject to Decline

 

Medications Subject to Decline

 

 

Conditions Requiring More Detail