What happens after I submit my application?
Once your application is deemed complete and legible, it is sent to the underwriting department for processing. During this medical underwriting process, the underwriter will first review your response to all of the questions on the application. Since you are legally bound to provide correct responses to the questions, the underwriter will most likely assume that you have been honest in your answers. On an application from a very healthy applicant, with no pre-existing medical conditions or medications, the application may receive a quick approval. For applications with a more complicated health history that includes current medications and pre-existing conditions, the underwriter may request medical records to get a clearer understanding of the risk to the insurance company in providing you with coverage. Some pre-existing conditions may result in an immediate decline of your application, in which case the decision will be quick and medical records will not be requested. If you have previously been insured with the insurance company with whom you are applying, they will request your claims history from the claims department. This will give them immediate access to any concerns they have and may cause a request for medical records from the attending physician. Your claims history may also be requested from the Medical Information Bureau, which will expose any claims you had with other health insurance carriers. Once all of your medical records are received by the underwriter, they will review these records to make sure that any previous medical conditions have been resolved. For conditions that still exist, the underwriter will estimate the cost of maintaining your health condition, including doctor’s visits and prescription drugs. Depending on the regulations in your state, the insurance underwriter may decide to offer you coverage, but request the signing of an elimination rider that excludes coverage for a specific pre-existing medical condition. Once your application is approved, you will receive notification of approval, followed later by a copy of your policy and insurance ID cards. This may arrive after your effective date of coverage, but you still have time to review your policy details and address and concerns during the 10-day free look period. 1 CommentLeave a comment |
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What happens after I submit my application?
Once your application is sent to the insurance company, it is usually reviewed for completeness before it goes to an underwriter. This may be the responsibility of the health insurance agent or the insurance company itself may perform this initial review. If the application is incomplete or not legible, it may be returned to you for completion. In some cases, the insurance agent or insurance company employee may contact you by phone to obtain the missing information. Since the addition of information is part of your application, which is a legal document, you may be required to send this missing information in writing, along with a signature. Your health insurance agent does not have the legal right to make amendments to your application without your written approval.
I have 15 years of combined experience in medical underwriting, so I am often asked questions from friends and associates when they are considering buying health insurance. Probably the question I have heard most is if all insurance companies have the same underwriting guidelines. The answer is that they don’t. Each individual health insurance company have their own internal guidelines which are usually kept private. But states require insurance companies, that are selling health insurance, to file their guidelines with the different departments regulating the industry. So even if there can be difference within the industry, their overall guidelines are usually similar. In my experience there are three cases where an insurance company will automatically deny your application. These are important to know if you are considering buying health insurance.
They are:
Health issues that you have not consulted a doctor for.
Health issues and problems that a doctor is unable to explain.
Health problems that you have at present but which you have not completed any treatment for.
Besides those, there may be specific health conditions that will always result in a denial of application, but they are too many to list here.
Comment by John — May 25, 2009 @ 6:55 am