What is medical underwriting?
The process of selecting risks for insurance in respect of a Scheme and classifying members according to their degrees of insurability so that the appropriate premium may be charged and the terms offered may be reviewed. This process is performed in an insurance company by an underwriter.
What could be the underwriting requirements?
The process may involve the review of a Non Medical Questionnaire (NMQ),a Personal Medical Attendant’s Report (PMA), a Specialist Physician Medical Report (SMR), a full blood analysis, a laboratory urinalysis, an electrocardiogram (ECG), a chest x-ray or other specified tests as deemed necessary by the underwriter.
What is the Non Medical Questionnaire (NMQ)?
The NMQ is the first stage of the underwriting process. It primarily reviews the age, occupation, hazardous pursuits, general habits, personal medical history and family history of members. All fields of the NMQ must be completed in full, as delay in the process will be incurred if they are not. Should the form be incomplete, Global Alliance Life will contact the member directly at the contact address indicated on the NMQ (usually e-mail) to obtain future details. The NMQ relies on an element of utmost good faith in that we assume that the member has been honest and has declared any relevant personal details accurately. Failure to do so could result in any claim being reduced or refused. It is essential that the consent form on the NMQ is signed by the member to enable us to seek further medical evidence, if required. Please note an unsigned NMQ would be considered invalid.
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A NMQ is valid for 90 days from the date it is signed by the member. Therefore, failure to obtain all necessary additional medical information within that period would result in the member having to complete a new NMQ.
What is a Personal Medical Attendant’s Report (PMA)?
After review of the NMQ, our underwriter may request the completion of a PMA. This is a relatively short report that is completed by the applicant’s regular medical practitioner based on their medical history. It is often used to clarify an issue declared on the NMQ or to confirm past medical history. The PMA is requested through Global Alliance Life and sent directly to the doctor identified on the NMQ. The doctor completes the form, using their records of the member’s medical history and returns it.
What happens if the member’s doctor does not respond?
Where the member’s doctor is not responding to our requests and reminders, we may contact the member directly so they may stress to their doctor firsthand the importance of our request.
What happens if the member has no regular doctor?
In the event that the member has indicated on their NMQ that they do not have a regular doctor, we may request that the member attends a basic medical examination.
What is a Specialist Physician Medical Report (SMR)?
The SMR in an independent medical examination, which provides details of the applicant’s current state of health. (not the member’s own doctor).
How long does it take to get the results?
Once the member has attended the SMR, Global Alliance Life should receive the results between 4 and 6 weeks, although the exact period depends on the location and availability of facilities.
What if Global Alliance Life does not obtain the SMR or relevant medical information?
Where the member has attended the requested medical but the
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doctor’s surgery is not providing the evidence in a timely manner, we will contact the surgery and keep the employer informed of our progress. It should be noted that after a period of three months the test results will no longer be valid. It is therefore imperative that they are received within that time. Should the results have expired, the member would be required to attend repeat tests in order to obtain the missing information.
Where the member has not attended the requested medical?
In the event that the member has failed to undergo the arranged medical, underwriting will be suspended after a period of 120 days from the date of receipt of the NMQ or from the date of joining if no NMQ was submitted. In this case, the employer is advised in writing by our underwriter that the member’s cover is restricted or declined. The member may re-engage the underwriting process by completing a new NMQ.
Can Global Alliance Life use other medicals as evidence?
In the event that the member attended a pre-employment medical or a medical with another insurance company, this may be used for the purposes of underwriting, subject to receiving a letter of consent from the member. Additional evidence may remain necessary at the discretion of the underwriter.
What does restricted cover mean?
Depending on the policy conditions, restricted cover may mean acceptance:
- For accidental cover only – where there is no FCL.
- Up to Medical Free Cover Limit.
- Up to previously insured amount.
- With pre-existing medical condition exclusion.
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