Health Insurance Underwriting Overview

There are many aspects of your health and habits that must be taken into consideration when you have a health insurance policy underwritten. These things work together to create the general risk that you life presents to the insurance company. It is not until all these factors are considered that your insurance agency can determine whether or not to issue your policy and what premiums to charge. Here are some of the main factors that health insurance underwriters consider when reviewing your health insurance application for approval.

Your medications: The medications you take give a tremendous insight not only on the prior events of your health history, but also on what your doctor thinks might be in the future. For instance, you might not have had a heart attack yet but if your doctor has you on a cholesterol medication, then it is likely that he or she thinks you may be at risk for one in the future. That indicates to a health insurance underwriter that you could be a risky bet.

Your actual health history: The events that comprise your health history give an insight not only into what your health future might hold but also in how you treat and respect yourself. For instance, Type 2 diabetes is often caused by obesity and poor eating choices. If you have Type 2 diabetes then it is unlikely that you eat well or exercise, which puts you at risk for a whole host of additional health problems.

Your family history: DNA ruins a lot of things health wise. If heart disease runs in your family then you are much more likely to suffer from it eventually. The same can be said for cancer, obesity, diabetes and certain mental illnesses. Knowing that someone in your family has suffered with these issues could change how a health insurance underwriter views your application for coverage-even if you are in perfect health.

Your weight and height: Your weight and height indicate how well-proportioned you are. Someone who weighs 300 pounds and is 5’3″ is much more likely to be considered obese than someone who is 6’5″ and weights the same.

Smoking status: If you are a smoker-even an occasional lighter upper-then you are putting your body at risk for cancer, lung disease, emphysema and more. This will not be looked upon favorably by the underwriters reviewing your health insurance application.

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Health Insurance Terminology

You cannot be sure that you’ve gotten the best health insurance coverage unless you understand health insurance terminology. Here are some of the most commonly used terms in the health insurance industry.

COBRA: The Act that allows for continuation of group coverage for a limited time after you leave the group.

Co-insurance: The amount you must pay for treatment after copayments and deductibles.

Copayment: The fixed amount that you must pay out-of-pocket for physician visits, medical procedures and prescription medications.

Deductible: The out-of-pocket amount you must pay before your policy benefits start kicking in.

Exclusions: Any medical conditions or illnesses whose expenses are not covered by your insurance policy.

HIPAA: A health insurance Act that sets privacy standards in an electronic world and guarantees portability of coverage and new policy issue after COBRA benefits run out, as long as there has not been a significant break in coverage (varies by state but usually at least 63 days).

HMO: A type of insurance policy that allows only treatment within a set network of physicians and facilities.

Lifetime limit: The maximum amount your insurer will pay out in benefits.

PPO: The type of insurance policy that has a network of physicians but still allows you to visit physicians and facilities outside the network for a reduced benefit.

Pre-certification: Some insurance companies require that you get preapproval from them before you have surgery or other medical procedures. This is called a pre-certification.

Pre-existing conditions: Any illness, injury or chronic disease you suffered from before you took out your insurance policy is considered a pre-existing condition.

Premiums: The fee that you pay to your insurance company monthly, annually or quarterly is your premium.

Underwriting: The process of reviewing and evaluating the risk you pose to the insurance company based on your medical history.

Waiting period: The amount of time you must wait before your pre-existing conditions are covered by your policy.

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