What the medical exam actually looks at.
It's a 30-minute nurse visit at your kitchen table. Here's exactly what they measure and how each number moves your premium.
What happens.
A paramed — a licensed nurse contracted by the insurer — comes to your home or office at a time you pick. They take your height, weight, blood pressure, pulse, a blood draw, and a urine sample. They ask you a long list of health questions. It takes about half an hour and it is free to you.
For smaller policies (typically under $250k–$1M depending on the insurer and your age), many carriers now skip the exam entirely and rely on prescription and medical databases. This is called 'accelerated underwriting.'
What they're actually testing.
The blood and urine panel checks for:
- →Nicotine — even occasional cigars or vaping will land you in tobacco rates, which are 2–3× higher.
- →Cholesterol and blood glucose — elevated numbers suggest cardiovascular risk or undiagnosed diabetes.
- →Liver enzymes — flags heavy drinking and some medications.
- →Cotinine, HIV, hepatitis, cocaine metabolites, and a few prescription drugs.
- →Kidney function markers via urine.
What moves your rate.
Big movers: nicotine use, BMI, blood pressure, blood sugar, and family history of heart disease or cancer before age 60. A single one of these in a bad range can shift you from 'preferred plus' (the best rate) down two or three classes, which typically means 30–80% more expensive.
Smaller movers: cholesterol, a recent DUI, a hobby the insurer considers dangerous (skydiving, private aviation, scuba beyond recreational depths), and international travel to countries on their advisory list.
How to prepare, ethically.
The week before your exam:
- →Schedule it for early morning, and fast for 8–12 hours beforehand. Water is fine. This gives you your best cholesterol and glucose numbers.
- →Skip alcohol for 48 hours. It shows up in liver enzymes and blood pressure.
- →Skip heavy exercise for 24 hours before — it can spike protein in your urine and elevate certain enzymes.
- →Sleep. Actually sleep. Blood pressure is dramatically higher on 4 hours of sleep than 8.
- →Bring a list of every medication and supplement you take. Being forthcoming is faster and cheaper than being caught.
“You're not gaming the test. You're showing up in the best honest version of your health, which is exactly what the insurer is trying to measure.”
If your results come back bad.
You are allowed to get a copy of your lab results. Do it. If the insurer offers you a rate class you don't like, some findings (like a temporary blood pressure spike or a one-off high glucose) can be re-tested in 6–12 months and used to reclassify your policy to a better rate.
You can also shop the results. Different carriers weight the same conditions differently — a well-managed diabetic might get 'standard' rates at one insurer and 'preferred' at another. An independent broker can run your file past several without a new exam each time.