Example: Declinable Medications & Conditions

Conditions and medications that deem a health insurance applicant ineligible for coverage were essential to underwriting before health reform. Included is a sample from the underwriting guidelines of a major insurer from 2012, during the transitional period of the Affordable Care Act when health plans did not yet have to comply with nondiscrimination laws. A more comprehensive list than the previous articles we have already featured in our Underwriting section, this gives a clear picture of what one particular carrier required of its applicants in order to qualify at the time.

As underwriting was specific to each plan, the state in which it was issued, and its corresponding company, these lists can be used as a guide to what to expect from the underwriting process. Due to the high cost of treatment and medications associated with the following illnesses and conditions, insurers did not wish to accommodate certain individuals, but now they are required to by law. Once any of these conditions is discovered for an applicant, the company issuing this plan had the right to decline coverage without any further medical information for individuals age 19 and older.


Declinable Medical Conditions


Declinable Medications


Conditions Requiring Additional Information