Best Rx before medical exam
By Paul Bannister • Bankrate.com

Your life insurance company says, yes, you can take out a big policy on your life and, yes, you can get it at the best possible premium.

Then comes the dreaded B-word: "But."

"But," your agent says, "you will first need to take a medical examination."

Your mind flashes with the uncertain fear of every little twinge and ache you've felt over the past decade. Even if you think you're in excellent shape, you wonder, "Am I really OK? How detailed is the test? Will they find something wrong? Will I pass?"

There's really nothing to worry about because if you do have a serious medical problem, it's pretty much beyond your control. And wouldn't you rather find out sooner than later?

Beyond that, here are positive steps you can take to cast yourself in the best medical light -- improving your results enough to qualify you for the best possible rating and premium -- along with what to expect, how to prepare and what the insurer is looking for.

Medical necessities
"The medical exam is a necessary part of the picture that the insurance company wants to see," says Gary Lardy, of California-based IntelliQuote.

"Some companies will sell you a life policy, typically worth $150,000 or below, without requiring a medical examination, but it doubles or triples the rate you'll pay because you'll be helping to carry people with undeclared health problems.

"If you're in good health, there's no reason to pay for others' problems. You just have to show your carrier you deserve a better premium, and the medical examination is the way to do it. In fact, for almost all policies, there is no way to avoid a medical examination."

Underwriters also check your medical history through the Medical Information Bureau, a shared clearinghouse of information, so you can't cover up your past records.

The company you're applying to will require you to provide your doctor's name and address and will often ask for your medical history, but they won't let your own physician carry out the examination.

Instead, they'll ask to perform a simple examination of their own. The call will come quickly -- within a few days -- and the exam is usually booked and carried out just a few days after that. It won't cost you a penny.

The 20-minute to 30-minute physical itself is normally performed by a licensed paramedical -- nationwide companies like Portamedic Inc. supply the staff -- at your home or at a medical office.

The examiner will ask questions about your medical history, including information about doctors or hospitals where you have been treated, surgeries you may have had, and medications you have taken. He will also conduct checks of your height and weight, blood pressure and pulse.

Have your medical records, health insurance and doctor's information handy. You should also have a photo ID available -- it's not unheard of for cheaters to ask someone else to take the exam for them.

Remember to tell the examiner about any medications you take, even nonprescription ones, because they could skew the test results against you.

The medic will take a blood sample from you for analysis. You won't have to undress, but you should wear a short-sleeved shirt or blouse, or one with sleeves that can easily be rolled up for the blood sample taking.

For a typical full-blood profile, less than an ounce of blood will be drawn from a vein into two or three vials in a sterile procedure (you can ask the examiner to let you see the seal on the needle to prove it is sterile).

Sometimes, for a younger person applying for a lower amount of life insurance, the examiner will only take a finger-prick blood sample.

You'll also be asked to provide saliva and urine samples, which will go with the blood to a testing laboratory, where analysts will look for evidence of a number of ailments.

What they're looking for
"Medical tests are to see if the applicant has any health condition that could eventually put him at risk -- and increase the insurer's risk," says Lardy. "The tests are for major conditions, not for a temporary cold or cough."

Analysis of saliva, urine and blood samples can reveal the presence of antigens or antibodies to the HIV virus. They can also reveal kidney or liver disorders, cholesterol problems, heart disease, antibodies to hepatitis, diabetes, immune system disorders or the prostate-specific antigen.

Analysis of a urine sample can also reveal drug, nicotine or medication use. The marker that the person being tested uses tobacco is especially important -- insurers believe that smoking increases the risk of premature death and often load premiums up to two or three times the rates they charge nonsmokers.

"The tests are confidential," says Lardy. "They are between you and the insurer, but they can be useful in confirming that you don't have some physical problems."

"In a few cases," says Lardy of IntelliQuote, "the carrier will ask for an EKG, an electrocardiogram, which is a recording of the heart's electrical impulses."

For the EKG, you will be asked to lie on your back with your shirt removed or unbuttoned so the leads can be placed on your chest. Women should remove tight stockings before the EKG is taken.

"All you have to do is lie calm and relaxed," says Lardy."This prevents false readings from muscle action."

Put on a healthy face
Apart from being relaxed during the exam, you can do some things to help it go more smoothly, and to present your health in its best light.

Remember, there's about 20 percent difference between preferred plus and preferred insurance rankings, and similar differences between each class down the tables, so it is well worthwhile to be at your best.

Try to schedule the exam for a morning, even if it's on the weekend, because your body is least stressed then. Don't eat for at least eight hours beforehand -- 12 hours is better -- and avoid salty, cholesterol-loaded or high-fat foods for a day or so before the exam.You should not undertake strenuous exercise the previous day, either, and do get a good night's rest.

It's OK to drink water, and you should have a glass or two an hour before the time you'll be asked to give a urine sample.

Stay off alcohol for at least 24 hours before the examination, and avoid caffeine-laced drinks like coffee, tea or soda for at least several hours before the exam. You should also avoid smoking or chewing tobacco and nasal decongestants for a similar amount of pretest time.

"I have come across high cholesterol levels, high blood pressure and elevated liver enzyme readings all caused by people eating or drinking excessively the day before an examination," says Larcher. "Be kind to your body; give it a chance to rest before the test!"

You won't be able to make significant changes to your weight in 24 hours, but you should know that the more you weigh, the more you pay.

Insurance companies use height and weight guidelines to determine what your premium category will be, and American Medical Association studies show that excess weight is linked to health problems, especially those of cholesterol and blood pressure.

In the long term, lose weight and stop smoking if you want to reduce your health insurance premiums by as much as two-thirds. Noncigarette smokers get better rates than do smokers, and if you smoke only one or two cigarettes a day, your insurer will lump you in the same high-priced category as a 20-a-day individual.

If you stop smoking, you may qualify for a nonsmoker's rate after a year and for a preferred nonsmoking rate after two years. Cigar smokers whose blood shows certain nicotine levels may be considered smokers by insurers, and even people on nicotine patches may earn that same tag.

After the examiner leaves, your blood, saliva and urine samples are analyzed and the results go to the underwriters. They review the results and have the option to order additional tests if they suspect a hidden condition or get an unusual reading.

Getting test results
You can request the test results. "That's common," says Jane Fore, a Horace-Mann Companies new business vice president in Illinois. "We will release the results to the person or their doctor."

"Request a copy either by including a letter with your application for insurance, or by writing directly to the insurance company after the exam. Be sure to include your name and address and sign and date the request," advises Lardy.

You might want the results if you've applied for a very large amount of coverage. MetLife, for example, requires a doctor's examination if you are aged 41 or older and are applying for more than $2.5 million in coverage.

Some of the higher-premium tests include a chest X-ray and treadmill EKG to monitor your heart under stress.

If you're declined by the insurer -- and the most common causes are signs of heart disease or cancer, says IntelliQuote's Lardy -- you should involve your agent, who can argue the rating.

"Usually that involves more tests and more information," says Lardy. "The agent can often make it happen, though."

Last word: Don't apply for a policy and then decline it. The information becomes part of the Medical Information Bureau's shared records. In the future, another insurer might red-flag your application, as soon as they see you've declined in the past.

-- Posted: July 28, 2004