Back to all terms

Medically Underwritten (MU)

Medically underwritten (MU) refers to the process used by insurers to evaluate an applicant’s health history before approving coverage and determining eligibility, premiums, and benefit limits. In a medically underwritten plan, you must answer health questions, disclose pre-existing conditions, and often complete a medical questionnaire or provide additional documentation

This underwriting allows the insurer to assess risk accurately and often results in more comprehensive coverage, higher benefit maximums, and lower premiums for individuals in good health. Because the plan is tailored based on medical history, approval is not guaranteed, and some conditions may be excluded or rated at a higher cost.

Medically underwritten plans are common in personal health insurance, life insurance, and disability coverage. They are often compared to guaranteed issue (GI) or guaranteed acceptance plans, which do not require medical questions but usually have lower coverage limits and higher premiums to offset risk.

Example:

If you apply for a medically underwritten health plan and disclose that you have asthma, the insurer may approve coverage but exclude expenses related to that condition or set a higher premium.

What to Watch For:

Answer all medical questions honestly and completely. Providing inaccurate or incomplete information can lead to denied claims or cancellation of coverage. If you are transitioning from a group plan, apply promptly while you are still eligible for simplified or guaranteed options in case a medically underwritten plan is not approved.

Related Terms

Major Restorative

Major restorative coverage includes complex dental procedures designed to restore the function and appearance of teeth. Examples include crowns, bridges, onlays, dentures, and sometimes implants. These treatments are more extensive and expensive than basic restorative services such as fillings.

Material Facts

Material facts are the pieces of information that are essential for an insurer to accurately assess risk and decide whether to approve an application, determine premiums, or apply exclusions. These facts include any details that could influence the insurer’s decision to issue coverage or the terms of that coverage. Examples include medical conditions, medications, family health history, lifestyle habits, and participation in hazardous activities.

Medical Condition

A medical condition refers to any illness, injury, disease, disorder, or ongoing health issue that affects a person’s physical or mental well-being. In the context of insurance, the term includes both acute and chronic conditions, whether diagnosed, treated, or undiagnosed at the time of application or claim. Examples include high blood pressure, diabetes, asthma, depression, or past surgeries.

Medical Emergency

A medical emergency is a sudden and unforeseen illness, injury, or medical condition that requires immediate medical attention to prevent serious harm, disability, or death. In the context of health and travel insurance, it refers to an unexpected situation where urgent care is needed while away from home or outside your province or territory of residence.

Medically Necessary

Medically necessary describes any service, treatment, or supply required to diagnose, treat, or manage a health condition, rather than for convenience, appearance, or personal preference. Insurers use this term to determine whether a claim qualifies for payment under your policy.

Have questions about your insurance coverage?

Our licensed advisors can help you understand your options and find the right plan for your needs.

Contact Us