Medical Underwriting

Before you can buy a policy you must give the insurance company information about your health. This process is called underwriting.

The company uses underwriting information to predict what the likelihood is that you will file claims against the policy. Each company has its own underwriting standards, which means one company could reject your application but another may be willing to accept it.

The insurance company will get most of its underwriting information from these sources:

  • Your application form
  • Your past medical history
  • The Medical Information Bureau (MIB, Inc.)

Underwriting Decisions

Insurance companies can accept your application and issue the policy as requested or they can do one of the following:

  • Issue the policy with full protection but charge a higher premium. This might occur if you have a chronic disease such as diabetes.
  • Modify the benefits, such as increase the deductible.
  • Exclude a specific medical problem from coverage by adding an exclusion rider.
  • Decide not to issue a policy--turn down your application for insurance.

If you are turned down or denied coverage:

  • Find out why you were denied coverage. The company is required to provide you with that information in writing. If it is due to your medical history, make sure the information the company received was correct.
  • Try several other insurance companies or health maintenance organizations. Every company has its own underwriting guidelines. Some may view your situation differently.
  • If you cannot find coverage from an insurance company, you may be eligible for benefits under the Wisconsin Health Insurance Risk-Sharing Plan.

Medical Information Bureau

When you sign the application form, you authorize the insurance company to obtain information about you from the Medical Information Bureau (MIB). The MIB is a private company that insurance companies use to share information about insurance applicants.

If you are denied coverage based on medical history, you may want to find out if you have an MIB file and if so, is it correct. If your file contains incorrect information, you have the right to ask the MIB to correct it. You may obtain a copy of your report by calling or writing to:

MIB, Inc.
50 Braintree Hill Park
Suite 400
Braintree, MA 02184-8734
(866) 692-6901
(866) 346-3642 TTY (for hearing impaired)