Why Your Medication History Affects The Outcome Of A Life Insurance Application
Life insurance is a contract that requires the insurer to pay a specified death benefit upon the insured’s death. For this reason, the relevant question the insurer must ask is: how long will the insured live?
While nobody can truly know the answer to this question, it can be estimated. Remember, all insurance is the practice of determining the probability of a qualifying event occurring. In this case, the insurer needs to estimate the insured’s life expectancy to accurately measure and price the risk it is assuming.
Aside from the applicant’s current age, health history is the strongest predictor of their average life expectancy. Health history includes diagnoses, dates of diagnosis, and treatments, which include medications.
Prescriptions in and of themselves don’t give the full picture of your health history. However, they do give the insurer deep insight into what pre-existing health issues you’ve been dealing with. This, in turn, allows them to develop a reasonably accurate estimate of life expectancy.
Bear in mind that insurers know which ailments medications can treat (many prescription medications treat multiple conditions). Furthermore, they consider the timing of medication prescriptions and the type of physician who prescribed them.
For example, an opioid pain medication prescribed five years ago for two months by a rheumatologist will be of much less concern than that same medication being prescribed every month for the last five years by a pain management doctor.
Please note that all life insurance policies will request your prescription history except for guaranteed acceptance life insurance policies.
How Insurers Know Your Past Medications
When you apply for life insurance, the application requires you to sign various authorizations. One such authorization is a HIPAA release, which grants the insurer the right to obtain your protected health information.
Once the release has been signed, the insurer will obtain your pharmaceutical report from a company called Milliman Intelliscript. They will provide the insurance company with a detailed report that includes:
- Names of medications and dosages you’ve been prescribed.
- The physician who prescribed them.
- Diagnoses and which physician ascribed to said diagnosis.
In general, the report will provide data for the prior seven years.
Which Prescription Medications Can Cause a Life Insurance Application To Be Declined?
According to Drugs.com, there are over 24,000 prescription medications. Given this extremely large number, there is no way to detail all of them that may cause a declined life insurance application.
However, medications that cause a decline usually fall under these categories:
- Blood thinners: Drugs such as Xarelto or Coumadin are often prescribed for serious events such as heart attack, stroke, irregular heartbeat, or blood clots. Given the serious nature of these issues, blood thinners often cause a decline.
- Cognitive issues: This class of drugs will cause an automatic decline. Furthermore, if you have these drugs in your history, your only path to obtaining a new policy is via guaranteed acceptance life insurance.
- Opiate pain medications: Powerful opiate pain medications such as fentanyl, morphine, or oxycodone will result in a near-certain decline. Less powerful opiate pain medications, such as Vicodin, are of less concern but can also cause a decline.
- Highly ambiguous: Hundreds of medications treat a wide spectrum of conditions. In particular, drugs that have a treatment spectrum that includes high-risk and low-risk health conditions will often cause a decline because the insurer is unable to determine which specific health condition they were prescribed to treat. For example, gabapentin can be used for basic pain management, or it can be used for neuropathy. General pain is not of much concern, but neuropathy is.
- Weight gain: Drugs used to help you gain weight are of great concern, as they nearly always cause a decline. It’s because the inability to maintain weight is often caused by very serious health issues, such as cancer.
- Immune suppressants: Drugs to repress your immune system can be used to treat a wide variety of health conditions. Some of these issues, such as rheumatoid arthritis, are generally not a problem. However, they can be used to treat far more serious health issues, such as lupus or an organ transplant. Since the insurer cannot know why these drugs were given (unless you apply for a fully underwrittenFully Underwritten
A type of life insurance underwriting that requires the applicant to undergo a medical exam. In addition, the insurer will formally request copies of all your medical records from every physician you've seen in the last decade. Once all of this data is compiled, the insurer will determine whether you're approved and, if so, which rate classification you're eligible for. These rate classifications typically include: Preferred-Plus, Preferred, Standard, and various Sub-Standard ratings. The better the rating, the lower your premiums will be. policy), they often result in a declined application. - Seizures: The drugs themselves don’t tell the insurer how serious your seizure condition may be. This results in an unknown level of risk for them, which is why it’s common for this class of prescriptions to cause a decline.
- Diuretics: Commonly known as “water pills“, diuretics are often given for very serious health issues such as CHF or liver cirrhosis. For this reason, expect a decline if you’ve been given medications such as Lasix, Bumex, or Spironolactone. Less powerful diuretics, such as Hydrochlorothiazide (HCTZ), are far less serious, which may or may not cause a decline.
- HIV: Any medication used to treat or prevent HIV will result in an automatic decline for any kind of simplified issue life insurance policy (no exam). If you have any of these drugs in your history, you should either explore a fully underwritten life insurance policy (Guardian Life offers this) or one without health questions and guaranteed approval.
- Powerful respiratory drugs: Medications specifically intended to treat COPD or other lung diseases (excluding asthma) are likely to cause a decline. Less serious inhalers used to treat asthma or acute bronchitis are unlikely to cause a decline.
- Insulin: Given that insulin-dependent diabetes is a spectrum regarding severity, expect a decline. You may need to opt for a burial insurance policy or some type of coverage with full underwriting.
Keep in mind that this list is not exhaustive, but does cover most drug categories that cause a decline for a no-exam life insurance product. Also, there is significant nuance in the underwriting process. It’s just the name of the medication.
Insurers take into account: the type of physician who prescribed the drug, when it was last prescribed, and the dosage.
What You Can Do If Your Medication Report Has Errors
If you believe your pharmaceutical report contains errors, you have the right to fix it. Your medical reports fall under the jurisdiction of the Fair Credit Reporting Act, which gives you the right to obtain a copy of your report free of charge and fix any errors within the report.
The first step to fixing your medication report is to order it on Milliman IntelliScript’s website. Once you obtain the report, you can then identify the mistakes and which physician(s) are responsible for informing Milliman of said errors.
You will then need to contact the offending physicians to inform them of the errors. Those physicians would need to provide you with a signed letter that disputes the erroneous information in your report. Once you have those letters, you can email them to Milliman Intelliscript at intelliscriptsupport@milliman.com.
At that point, you must wait for them to process your request. If they amend your report, they will notify you in writing.
If you had a life insurance application denied due to an erroneous entry on your medication report, and you fix it, you can then reapply and should get approved.
How To Obtain Life Insurance When You Were Previously Declined Due To Your Prescription History
If you’ve been denied for a life insurance policy due to prior medications, there are multiple ways to work around this issue:
- Full underwriting: Fully underwritten life insurance policies require you to take a medical exam, and the insurer obtains all your medical records. Given all of this data, they know with great detail everything there is to know about your health. Normally, this will allow them to offer coverage even though a medication causes a decline for no-exam life insurance policy.
- Different insurance companies: Insurers all have unique underwriting. For that reason, if one company declined you for a medication, another may not.
- Different products: Not all types of life insurance carry the same level of risk. For example, term life insurance policies carry far more risk for the insurer than whole life insurance. If you were denied for one type of policy, it may work out if you apply for a different type (with the same or a different company).
- Final expense insurance: Final expense life insurance is a type of small whole life policy designed to cover your end-of-life costs. However, the death benefit money that is paid out upon death can be used for anything. These policies have very lenient underwriting, to the point that nearly everyone qualifies (even with high-risk health issues). It’s unlikely you’ll be declined for a final expense policy, even if your medication history led to a decline for a prior product.
- Guaranteed issue coverage: As a last resort, you can opt for a guaranteed issue final expense policy. These have no underwiring of any kind. That means there is no medical exam, and the insurer does not obtain your prescription history. Because approval is guaranteed, there is a two-year waiting period. During this first two-year period, the insurer will only refund your premiums. Also, these policies generally have a maximum coverage of $25,000.
It’s highly beneficial to speak with an experienced licensed insurance agent. They should be able to analyze your case to determine viable options for you.
The Medical Information Bureau Does Not Have Prescription Data About You
The Medical Information Bureau is a unique consumer reporting agency that provides insurance companies with health data. Nearly all life insurance companies will obtain a copy of your MIB file when you apply for a policy with them.
What makes MIB unique is how they get their data. Let it be clear that MIB does not have any of your prescription history information. Furthermore, they don’t have your medical records.
MIB gets its data exclusively from insurance applications.
Whenever someone applies for life, health, or disability insurance, the insurer will report to MIB the following information:
- Health information the applicant voluntarily reveals about themself. For example, if you proclaim that you’re 5’10 and weigh 210 pounds, smoke tobacco, and have diabetes, all of that data will be reported to MIB because you revealed it.
- Lab results derived from a medical exam. If you apply for a fully underwritten life insurance policy, you will be required to take a medical exam. When the insurer receives the results of your lab work, that data is sent to MIB. For example, if your lab results show that you have low-functioning kidneys, indicating kidney disease, that will appear in your MIB file now.
- The name of the insurance company applied to and the date of application.
The purpose of MIB is that when you apply for coverage with a company, they will obtain your file to see what data exists about you in prior insurance applications.
For example, let’s say you apply for a life insurance policy with company A and deny having lung disease. When they pull your MIB file and see that a prior application with company B shows that you declared that you have COPD, that is going to be a big issue.
Company A will see this discrepancy and may withdraw your application, as they cannot be sure you’re being honest about your health history. On the flip side, they may require you to provide a physician’s statement proving that you don’t have COPD.
Ultimately, MIB is a consumer reporting agency, so you have the right to obtain your file and correct any errors.
- Nationally licensed life insurance agent with over 16 years of experience.
- Personal annual production that puts him in the top .001% out of all life insurance agents in the nation.
Anthony Martin is a nationally licensed insurance expert with over 16 years of experience and has personally served over 10,000 clients with their life insurance needs. He frequently authors entrepreneurial and life insurance content for Forbes, Inc.com, Newsweek, Kiplinger, and Entreprenuer.com. Anthony has been consulted as an expert life insurance source for dozens of high-profile websites such as Forbes, Bankrate, Reuters, Fox Business, CNBC, Investopedia, Insurance.com, Yahoo Finance, and many more.
- Nationally licensed life insurance agent with over 20 years of experience
- Best selling Amazon author.
Jeff Root is a nationally licensed life insurance expert with over 20 years of experience. He has personally helped over 3000 clients with their life insurance needs. Jeff is a best-selling Amazon author and the managing partner of a highly successful insurance brokerage that manages over 2,500 licensed insurance agents across the USA. He has been a featured life insurance source for prestigious websites such as Forbes, Bloomberg, MarketWatch, Nerdwallet, and many more.
- Nationally licensed life insurance agent with over 15 years of experience
- Best selling Amazon author of five insurance sales books.
David Duford is a nationally licensed insurance expert with over 15 years of experience. He has personally helped more than 15,000 clients buy life insurance. David has been featured as an expert source for highly authoritative publications such as A.M. Best and Insurancenewsnet. He also runs one of the largest Youtube channels to help aspiring insurance agents serve their clients better.
- Nationally licensed life insurance agent with over 20 years of experience
- Best selling Amazon author.
Jeff Root is a nationally licensed life insurance expert with over 20 years of experience. He has personally helped over 3000 clients with their life insurance needs. Jeff is a best-selling Amazon author and the managing partner of a highly successful insurance brokerage that manages over 2,500 licensed insurance agents across the USA. He has been a featured life insurance source for prestigious websites such as Forbes, Bloomberg, MarketWatch, Nerdwallet, and many more.
- Nationally licensed life insurance agent with over 15 years of experience
- Best selling Amazon author of five insurance sales books.
David Duford is a nationally licensed insurance expert with over 15 years of experience. He has personally helped more than 15,000 clients buy life insurance. David has been featured as an expert source for highly authoritative publications such as A.M. Best and Insurancenewsnet. He also runs one of the largest Youtube channels to help aspiring insurance agents serve their clients better.
Choice Mutual often cites third-party websites to provide context and verification for specific claims made in our work. We only link to authoritative websites that provide accurate information. You can learn more about our editorial standards, which guide our mission of delivering factual and impartial content.
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HIPAA. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
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Milliman Intelliscript. https://www.rxhistories.com/our-company/
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Fair Credit Reporting Act. https://www.ftc.gov/legal-library/browse/statutes/fair-credit-reporting-act
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Milliman IntelliScript’s website. https://www.rxhistories.com/contact/#report
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Drugs.com. https://www.drugs.com/drug_information.html
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Xarelto. https://www.xarelto-us.com/
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Coumadin. https://my.clevelandclinic.org/health/treatments/16182-warfarin-a-blood-thinning-drug-what-you-need-to-know
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fentanyl. https://www.drugs.com/fentanyl.html
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morphine. https://medlineplus.gov/druginfo/meds/a682133.html
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oxycodone. https://medlineplus.gov/druginfo/meds/a682132.html
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Vicodin. http://Vicodin
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gabapentin. https://my.clevelandclinic.org/health/drugs/21561-gabapentin
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water pills. https://my.clevelandclinic.org/health/treatments/21826-diuretics
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Lasix. https://www.drugs.com/lasix.html
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Bumex. https://my.clevelandclinic.org/health/drugs/20111-bumetanide-oral-tablets
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Spironolactone. https://www.mayoclinic.org/drugs-supplements/spironolactone-oral-route/description/drg-20071534
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Hydrochlorothiazide. https://www.mayoclinic.org/drugs-supplements/hydrochlorothiazide-oral-route/description/drg-20071841
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Guardian Life. https://www.guardianlife.com/life-insurance/hiv
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Medical Information Bureau. https://www.mibgroup.com/
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MIB is a consumer reporting agency. https://www.consumerfinance.gov/consumer-tools/credit-reports-and-scores/consumer-reporting-companies/companies-list/mib-inc/
