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
How It Works
Canadian private health insurance plans are either medically underwritten or guaranteed issue, and a guaranteed issue plan is issued automatically with no medical questions to answer. With a medically underwritten plan, the applicant answers the medical questions on the application and gives the insurer permission to access their medical history and records, which can include the insurer writing to the applicant's physician for an attending physician's statement (APS). Once the insurer reviews this information, there are three possible outcomes: the application is accepted with no exclusions, the insurer makes a counter offer that excludes one or more pre-existing conditions, or the application is declined. Like all personal health insurance, a medically underwritten health and dental plan supplements provincial government coverage by paying for health and dental services the provincial plan does not include, and its annual maximums and coverage amounts, especially for prescription drugs, tend to be substantially higher than those of guaranteed issue plans.
Example:
Imagine a self-employed Canadian in good health applying for a medically underwritten personal health and dental plan to top up their provincial coverage. They fill out a medical questionnaire and authorize the insurer to request records from their family doctor. Because they disclose that they have asthma, the insurer responds with a counter offer: coverage is approved with higher prescription drug and paramedical maximums, but expenses related to the asthma are excluded.
What to Watch For:
Medically underwritten plans typically exclude coverage for pre-existing conditions, so applying earlier in life with fewer health issues tends to secure broader coverage and better value. Answer every medical question honestly and completely, because inaccurate or incomplete information can lead to denied claims or cancellation of coverage.
