Can I Get Major Medical Insurance Without an Exam?

In many states, you must undergo a brief physical examination before you can get a medical insurance policy. The insurance industry is regulated at the state level, and each state sets its own policies and procedures regarding how carriers handle new health insurance applications and the requirements they place on consumers. Health insurance companies have rationalized and justified the need for physical exams on all new applicants, and many state insurance departments have sided with carriers. However, this does not preclude you from obtaining major medical insurance without an exam.

What is Underwriting?

• Underwriting is the process of evaluating a new insurance applicant in an attempt to determine the level of risk posed by that individual, and the appropriate premium to charge to offset that risk. Health insurance underwriting consists of an examination of prior medical history, current health status and anticipated future treatment. The more information and data health insurance underwriters possess, the more accurate the final decision will be regarding insurability and appropriate price.

Purpose of an Exam

• Since health insurance directly involves benefits that pay for your major medical services, it is not surprising that the companies providing those benefits have a desire to more closely examine the consumers they may agree to insure. The purpose of the physical examination required by health insurance carriers prior to the issuance of coverage is to allow underwriters an opportunity to more closely evaluate both your current medical ailments and the most likely future course of treatment. If the exam reveals disorders, or symptoms of disorders, that typically require lengthy and expensive treatment, underwriters may issue a policy with a more expensive monthly premium.

Guaranteed Issue

• Some states, like New Jersey, have banned medically underwritten health insurance policies. Additionally, some health insurance carriers, even in states that allow medical underwriting, offer health insurance products that do not require consumers to submit to a physical examination. These "guaranteed issue" policies are available to everyone regardless of past, present or expected future medical treatment.

Pros & Cons

• For individuals with serious health problems, guaranteed issue products are advantageous because their ailments do not result in an increased monthly premium. However, in guaranteed issue states, the opposite also applies, and extremely healthy individuals end up paying significantly higher premiums.