In medical underwriting, one of the most important parts of the process for determining eligibility is 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. While each carrier in every state has their own set of guidelines, the list of declinable conditions is fairly similar from one insurance company to another.
Serious and chronic illnesses are a definitive red flag for health insurers when writing a plan. They mean costly medical bills, constant treatment, pricey medications and supplies, and therefore are unappealing to health insurers. Until the health care law makes pre-existing conditions of all types acceptable and insurable in 2014, there will still be strict rules prohibiting certain individuals from getting insured for the next year. Though some people who know they are uninsurable may be aware that their medical history has deemed them as such, others may not know what to expect.
Depending on the medications a person takes, they may also be declined coverage, as the prescription is expensive to cover or the related condition is also. Medications can become so expensive that insurers have designated a list in for their underwriters to follow in order to determine eligibility or decline an applicant.
Many other medications and conditions may make an individual’s rates increase though they may not be declined completely. These are referred to as risks, and each company has 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 has had an illness or diagnosis within a certain time frame, they may also be rated up.
Below is a list of declinable conditions and medications from a national insurer’s current underwriting guidelines.
Conditions Subject to Decline
Medications Subject to Decline
Conditions Requiring More Detail