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Life insurance is a contract between you and the life insurance company. You pay premiums (monthly or annually) for a payout that your living relatives will receive, known as the death benefit. Should you die, the insurance company pays the death benefit to your chosen beneficiary.
There are two main types of life insurance policies to choose from: permanent life and term life. Both require applicants go through the underwriting process. If you have a chronic illness or certain pre-existing conditions, you may be asked to have your doctor submit an attending physician statement (APS) as part of this process.
What is an attending physician statement?
The underwriting process is how the life insurance company determines your insurability — deciding how much of a risk you are and how much of a death benefit you qualify for. The company collects information about your health, job, income, finances, and other personal information to determine how much it will insure you and what your premium will be. Underwriting can take 4-6 weeks.
If you have health issues like high blood pressure, cholesterol, diabetes, or a family history of cancer or heart disease, the insurance company may request your health records from your attending or primary care physician, known as an attending physician statement (APS).
In the attending physician statement, your doctor may be asked to explain your health condition, prescriptions, and prognosis depending on your medical condition and the insurance provider. This will make the underwriting process longer, as the insurance company waits to receive your medical records from your doctor and review them.
The attending physician statement better helps underwriting understand your medical condition so they can determine your risk.
An attending physician statement is different from a life insurance paramedical exam
Traditional life insurance policies require a medical exam, which includes a blood test and urine sample, as part of the underwriting process.
The insurance company sends a paramedical professional to your home or business to perform the exam. The medical exam, also known as a paramedical exam, can take up to 30 minutes and usually includes a blood and urine sample, weight, and blood pressure screening.
The attending physician statements are forms sent to your doctor from the life insurance company, usually as a result of the paramedical exam or due to your answers on the life insurance application.
Life insurance premiums are based on your health risk
Based on your medical exam and underwriting, you are assigned a risk assessment category. Once your risk is assessed, your life insurance premiums are calculated based on your risk and you are issued a policy.
Here's an overview of the different risk classifications used by insurance companies:
| Risk Classification | Definition |
| Preferred Plus/Elite | Excellent health without any big risk factors for coverage will most likely end up rated at Preferred Plus, giving them the lowest possible premium payment. Only available on certain types of skin cancer. |
| Preferred | Excellent health but may have some subtle red flags, but will enjoy low premiums. Only available on certain types of skin cancer. |
| Standard Plus | Above-average health, but some things may be outside the ideal range. You will have low premiums just not as low as Preferred or Preferred Plus. Available depending on type and date of onset of cancer. |
| Standard | Normal risk and insurable at standard rates. Available depending on type and date of onset of cancer. |
| Substandard | Impaired risk deemed undesirable due to medical condition or hazardous occupation requiring a higher premium charge. |
| Smoker | Higher risk because nicotine negatively affects health and impacts life expectancy. Will pay more than non-smokers. Some companies separate cannabis users from tobacco users. |
Data sourced from NAIC and Quotacy
No medical exam life insurance is another option
Mark Williams, CEO of Brokers International, told Insider that people with pre-existing conditions or chronic illnesses, like cancer, should use independent agents while shopping for life insurance because companies underwrite differently and agents will know which ones are more flexible and liberal.
If you are ineligible for traditional life insurance due to your health history, no medical exam life insurance is an option.
Not knowing your medical history means the insurance company is taking a gamble on your health. The benefit of no medical exam life insurance is that acceptance is typically guaranteed. The drawbacks are limited coverage amounts — usually up to $100,000 — and there may be a waiting period for death benefits to payout.
There are two types of no medical exam life insurance: guaranteed issue and simplified issue.
Guaranteed issue life insurance has no medical exam or medical questions. It is sometimes referred to as "final expense" insurance because the coverage amounts are so low that they basically only cover funeral and burial expenses. Most coverage is limited to $25,000 and you must be 50 years old or older to qualify.
Simplified issue life insurance doesn't have any age restrictions or a medical exam, but there is usually a health questionnaire. The questionnaire will not be as extensive as traditional life insurance. However, if you fail to disclose a condition on the health questionnaire and die, the insurance company can withhold death benefits to your beneficiaries. Also, death benefit amounts are up to $100,000.
Some guaranteed and simplified issue no medical exam life insurance policies have a two-year waiting period — meaning if the policyholder dies within the first two years of coverage, the policy won't pay out.
Having a traditional life insurance policy with underwriting — even if an attending physician statement is required — is worth the extra time because your premiums will be cheaper than a no medical exam policy (because the company knows your risk). Also, you will be able to get more in death benefits, whereas no medical exam life insurance policies are usually less than $100,000 in benefits.