Paramedical Examination

Basic health screening by nurse/technician:

Includes:
- Height, weight (BMI calculation)
- Blood pressure (multiple readings)
- Pulse
- Blood sample (venipuncture)
- Urine sample
- Brief health questionnaire

Location: Applicant's home or office

Time: 30 minutes, fasting preferred (8-12 hours)

Results: Sent to lab, forwarded to insurer (3-5 days)

Laboratory Tests

Blood tests:
- Cholesterol: Total, HDL, LDL, triglycerides
- Glucose: Diabetes screening
- Liver enzymes: ALT, AST, GGT (alcohol abuse, hepatitis)
- Kidney function: BUN, creatinine
- CBC: Complete blood count
- A1C: Long-term glucose control (diabetes)
- HIV: Required for large amounts
- Nicotine/cotinine: Tobacco verification

Urine tests:
- Protein (kidney disease)
- Glucose (diabetes)
- Blood (kidney/bladder issues)
- Drugs (screening)
- Nicotine (smoking)

Attending Physician Statement (APS)

Medical records from applicant's physician:

When requested:
- Application discloses medical condition
- Abnormal exam/lab results
- Need detailed information

Includes:
- Complete medical records
- Diagnosis and ICD codes
- Treatment history
- Test results (labs, imaging)
- Prognosis
- Current status

Time: 2-4 weeks typically

Example:

Application: "Heart murmur - monitored"

APS reveals:
- Mild mitral valve prolapse
- No regurgitation
- Echo normal
- No treatment needed
- Excellent prognosis

Decision: Approve standard

Prescription Database

Shows prescriptions filled (5-7 years):
- Medication names
- Prescribing physician
- Fill dates

Reveals conditions:

Metformin → Diabetes
Nitroglycerin → Angina
Zoloft → Depression
Lipitor → High cholesterol

Inspection Report

Third-party investigation (large cases $1M+):
- Financial: Income, net worth, debts
- Reputation: Character, stability
- Lifestyle: Alcohol, hobbies
- Driving record: MVR, DUIs
- Employment: Job stability

Build (BMI)

Formula:

BMI = (Weight lbs × 703) ÷ (Height inches)²

Example: 5'10" (70"), 220 lbs
BMI = (220 × 703) ÷ 4,900 = 31.6

Classification:

Normal: 18.5-24.9 (standard)
Overweight: 25-29.9 (standard to slight rate)
Obese I: 30-34.9 (rated)
Obese II: 35-39.9 (substantial rating)
Obese III: ≥40 (likely declined)

Blood Pressure

Categories:

Normal: <120/80
Elevated: 120-129/<80
Stage 1: 130-139/80-89
Stage 2: ≥140/90 (rated)
Crisis: ≥180/120 (postpone/decline)

Cholesterol

Total cholesterol:
<200: Desirable
200-239: Borderline
≥240: High (may rate)

LDL (bad):
<100: Optimal
≥160: High (rating likely)

Glucose

Fasting:
<100: Normal
100-125: Pre-diabetes (may rate)
≥126: Diabetes (rated/declined)

A1C:
<5.7%: Normal
5.7-6.4%: Pre-diabetes
≥6.5%: Diabetes

Diabetes Underwriting

Type 2 (adult-onset):

Well-controlled (A1C<7), no complications:
Standard to Table B

Moderate control (A1C 7-8):
Table B-D (+50-100%)

Poor control (A1C>8.5) or complications:
Table F-H (+150-200%) or declined

Type 1 (juvenile):

Well-controlled: Table D-F (+100-150%)
Complications: Substantial rating or declined

Cardiovascular Disease

Heart attack:

Recent (<1 year): Declined/postponed
1-3 years, recovery: Table D-H (+100-200%)
5+ years, no issues: Table B-D (+50-100%)

Stroke: Recent declined; past TIA with recovery rated

Cancer

General approach:

Active: Declined
Recent (<1 year): Postponed  
1-3 years remission: Substantial rating
5+ years remission: Moderate rating
10+ years (type dependent): Standard

Varies by: Type, stage, treatment, prognosis

Mental Health

Depression:

Mild, controlled: Standard to slight rating
Moderate, stable: Table B-C
Severe, recent hospitalization: Postpone
Suicide attempt: Substantial rating or declined

Substance Use

Tobacco:

Cigarettes: Smoker rates (2-3x)
Quit <1 year: Smoker rates
Quit 1-3 years: Moderate rating
Quit 3-5 years: Slight rating
Quit 5+ years: Non-smoker rates

Alcohol:

Social (1-2/day): Standard
Heavy: Rated or declined
DUI: Rating
Multiple DUIs: Substantial rating/declined
Alcoholism: Declined or postpone 2-3 years sober

HIPAA

Privacy rule:
- Written authorization required
- Specific purposes listed
- Time limit (24-30 months)
- Right to revoke

FCRA

Fair Credit Reporting Act:
- Disclosure required
- Authorization needed
- Adverse action notice if declined
- Right to see report
- Can dispute errors

• Paramedical exam: Basic screening by nurse (vitals, blood, urine)
• APS: Attending Physician Statement - detailed records from doctor
• When APS ordered: Medical condition disclosed or abnormal results
• Blood tests: Cholesterol, glucose, liver enzymes, kidney function
• Prescription database: Shows medications past 5-7 years
• BMI ≥30: Obese - rated
• BP ≥140/90: Stage 2 hypertension - rated
• A1C: Hemoglobin A1C shows long-term glucose control
• Diabetes A1C <7: Well-controlled
• Tobacco: Must quit 12 months for non-smoker rates
• Cancer: Type, stage, time since treatment determine rating
• HIPAA: Privacy law; authorization required for medical records
• FCRA: Governs consumer reports; adverse action notice required
• Accelerated underwriting: No exam, uses data analytics