Health information can affect whether an insurer will give you coverage, your premium class and whether they’ll ask for more information.
We reviewed Ontario’s health-information consent guidance to understand life insurers’ ability to access your health information. In general, a life insurer can’t just look through your OHIP file. They need your consent and legal permission. We reviewed MIB’s Canadian consumer-file process to learn more. We also looked at the Financial Consumer Agency of Canada’s life-insurance guide for more underwriting information. We reviewed Canada’s Genetic Non-Discrimination Act to learn about insurers’ abilities to use genetic tests.
How Do Health Records Affect Life Insurance Premiums?
Health records back up or clarify what you disclose on the application.
Based on your medical history, a company can offer insurance at a standard or preferred rate; offer coverage but charge more; make a limited offer; defer its decision; or decline coverage.
The severity and stability of any medical condition, treatments, follow-up care, the type and amount of insurance sought, and each insurer’s guidelines can affect an application.
Having a certain medical condition or disease does not mean you’ll be offered a specific premium. Two people with the same diagnosis can have different outcomes based on treatment, test results, complications, or how long it’s been since diagnosis.
Why Health Records Matter In Life Insurance
An insurance company needs your medical history to determine the risk of insuring you. They may request that you fill out a health questionnaire or submit to a medical exam.
Depending on the amount of coverage requested, your age and the complexity of your medical history, insurers may ask for varying levels of evidence. Evidence may include interviews, physical measurements, lab work and/or an attending physician statement.
What Insurers Actually Look At
| Possible source | What it may help confirm | What you should check |
|---|---|---|
| Application or interview | Symptoms/diagnoses, treatment, medication, and nicotine/tobacco use along with the dates pertaining to these. | Answer the exact question and correct an error promptly |
| Doctor or clinic records | Consultations, test results, referrals, treatment and follow-up | What information you authorized and whether follow-up care is documented. |
| Attending physician statement | A focused report requested from a treating clinician | Who is responsible for paying: insurer or applicant? Is anything outstanding? |
| MIB consumer file | Information coded from earlier applications filed with MIB member companies | Canadian consumers can request their insurance report for free. Review what’s in your file. You can dispute the report if it contains incomplete or inaccurate information. |
| Medical exam or laboratory results | Current measurements or test results requested for this application | Follow any instructions about how to prepare. Ask how they’ll share the results. |
Each application is different. Different sources of information may be available for review. The application itself, along with the signed authorization for release of information, identifies what type of information the insurer can request.
MIB provides coded information to its member companies that may warrant a closer look. It doesn’t replace an insurer’s underwriting decision.
Read More: See What an Attending Physician Statement Contains
How Consent And Privacy Rules Apply
Health-information custodians, such as your doctor, clinic, or hospital, store health information. Life insurers can’t access a single chart through OHIP. OHIP pays for health-care services eligible in Ontario.
For your health-information custodian to share your personal health information with a third party, such as a life insurer, you must consent. Ontario’s privacy commissioner describes what constitutes express consent. Consent must relate to the information and be informed and voluntary. You can refuse or withdraw consent, but doing so may impact a life insurer’s ability to acquire information needed to evaluate your application.
Canadian federal law prohibits anyone from requiring an individual to provide the results of a genetic test, or requiring that they undergo a genetic test as a condition of providing goods or services, or entering or continuing a contract, subject to the Act’s exceptions. These rules refer specifically to genetic tests and do not absolve an individual from answering other questions in a life insurance application honestly.
How Health Classes Translate Into Premiums
Preferred, standard, rated: insurers use a variety of names for health classes. What qualifies as preferred or rated, etc., varies among insurers. Don’t assume all insurers use a six-class system or any other standard.
| Possible decision | What it means | Useful next question |
|---|---|---|
| Preferred or standard offer | Each insurer determines your health class and provides coverage at the corresponding pricing class. | Which disclosed factors prevented or supported a preferred class? |
| Rated offer | Health classes affect premiums. Coverage is offered in classes that have higher premiums than the insurer’s standard rating class. | Is the rating permanent, or can a review be requested after a stated period? |
| Modified offer | The amount or duration of insurance can be reduced from the amount or duration requested in the application, or other terms may be imposed. | What changed, and what alternatives are available? |
| Postponed | An insurer can require a later date, a completed medical test or a certain period of stability before reconsidering an application. | What evidence and date would support reconsideration? |
| Declined | If declined, that insurer will make no offer based on the application as it stands. | Can the reason be described in writing, and should incorrect source data be corrected? |
How Does Smoking Affect Your Life Insurance Rates?
Tobacco and nicotine use can change the premium class. There is no universal 12-month definition. Each company views tobacco or nicotine products differently. Cigars, vaping, nicotine replacement and cannabis are treated differently by companies, and time frames also vary.
Always follow the instructions in the questionnaire. Ask what evidence they require for a future non-smoker review.
What Are Table Ratings In Life Insurance Health Classification?
Some insurance companies assign higher-than-standard risks to lettered or numbered tables to determine rates. Table rating names, the number of tables used and the percentage increase in the rate at each table vary among insurers.
If you fall into a table-rated classification, ask for the premium in actual dollars, because the table rating name by itself has limited use. Ask whether the company reconsiders ratings later.
How Many Years Back Do Insurers Go To Check Your Records?
There is no set time frame for how far back insurers can look. Although a consumer’s MIB report in Canada will include coded information from member companies for the last seven years, that is not a seven-year limit on how far back an insurer may request medical information.
Some information is asked about within certain time frames, such as whether you have been hospitalized within the last few years, while other information covers your lifetime medical history. Some insurers may request medical records for certain conditions or follow-up appointments.
Read More: Review How to Prepare for a Life Insurance Medical Exam
Can You Say No To Insurers Checking Your Health Records?
Yes. But an insurer might decline to proceed without sufficient information.
Consider other options before refusing to give consent, such as suggesting other documents that answer their questions, asking whether a narrower records request is possible, or discussing other insurance products that don’t require as much information.
Jumping straight to guaranteed issue products isn’t necessarily in your best interest because you may pay more for less coverage.
What If Your Health Records Affect The Offer?
| Route | Typical evidence | Trade-off to examine |
|---|---|---|
| Fully underwritten | Detailed questions and possibly records, exam or tests | Can offer more pricing classes, but takes more evidence |
| Simplified issue | Your health records may affect the offer, but there may be options with a reduced health questionnaire, which is often exam-free. | Fewer questions do not mean every applicant qualifies |
| Guaranteed issue | No health questions for eligibility | Coverage amount, premium or benefits, especially during the initial phase of coverage, may be restricted. |
Never leave anything out of your disclosures to avoid having your health record investigated. Doing so may affect the validity of the policy or any future claim.
Read More: See What to Do After a Life Insurance Application Is Denied
Life Insurance Pre-Application Checklist
- Prepare a list of diagnoses, medications, diagnostic tests, treatment, etc. Include the date and doctor’s name for each item before the interview. Ask the doctor to correct any inaccurate information.
- If you’ve applied with MIB member insurers in the past and think there may be inaccurate information, consider requesting your MIB consumer reporting file.
- Get a copy of anything you sign. Keep a copy of any application and consent forms, as well as the final insurance policy. Fix any mistakes immediately.
- Carefully review offers from insurers. Look at premiums, coverage, exclusions and options to review your policy. Compare them side-by-side.