Is it better to get disability insurance with OR without a medical exam?
This topic comes up all of the time when doctors are considering the question of, what is the best way to get disability insurance. Does it really matter? Does it affect the cost? How about what is included in the plan? Is there any difference?
First let’s discuss what is a medical exam in this setting? Just as with any individually owned insurance, in most cases you have to meet with a nurse where they get your physical measurements, ask your health history questions and usually get a blood and urine sample. A simple physical is really all it is. Insurance companies require this because they are trying to get an idea how they should rate you? Either at the best rates or somewhere down the list.
What are they evaluating in the samples? The first area they are checking is your heart and arteries: things like Cholesterol, HDL and LDL levels, ratios associated with them, triglycerides, diuretic screen, and beta screen. Then they look at your kidney and bladder by checking the blood urea nitrogen, creatinine, urine PH screen, protein, leukocyte screen, hemoglobin screen, urine creatinine and associated ratios. For liver they get into alkaline phosphatase, bilirubin, AST, ALT, GGT, total protein, albumin and globulin. For pancreas they check blood and urine glucose, and fructosamine. And of course they’ll be checking for HIV.
If you know that you fall in the normal range for any of these areas, your labs should not be a problem. We’ve had a cases where they were abnormally elevated and just had to re-test to get new labs and it worked out just fine. Another scenario we ran into was a client who ran a marathon the day before and threw his levels off so we had to re-test.
For height and weight each company varies a little but to give you an example, the maximum weight for someone to get the best rates would be
179 for 5’0”
204 for 5’5”
233 for 5’10” and
257 for 6’2”
If you are over these weights then the rates tend to go up. Once you hit a certain level, you do become uninsurable by normal standards. For anyone that would fall outside the blood/urine and height and weight ranges, or you have a significant health problem that you are currently in the middle of or even in the last 5 years, it might be best to pursue a program that does not have any medical exam requirements. These kind of programs allow anyone to sign up even if they are uninsurable as long as they haven’t missed any work in the last six months.
Is there a downside to a no medical exam policy? Yes they cost more and have less features than their peers because they are not screening anyone out. In a sense the healthy are subsidizing the rest. But, they are still worth it for those who wouldn’t be able to get any if a health screen was required.
What if you’re someone who is healthy but just doesn’t want to do a health exam? Is that possible? Before 2016 there wasn’t. But now it is. There are companies rolling out options where if you apply for a small enough level you can get a plan set up without the medical exam as long as your phone interview doesn’t report any significant health problems. They do reserve the right to require one based on a doctors health history but if yours is clear you shouldn’t have any issue. These plans are great because they allow you to increase them once your income goes up without a medical exam. Now this option is not available for everyone though. It’s designed specifically for residents and fellows so you’ve got to get it going when you are in a training program.