My Profile  |  Contact Us  |  Member Portal

American Gem Society Logo

What is a Medically Underwritten Plan?

By Jeremy McLendon,

Health insurance can be hard to understand and navigate. From terminology to the enrollment process, it can be easy to get lost along the way. Although there is a lot to take in, it is important to comprehend the health insurance basics as it may help to save you time and money. One of these perplexing aspects of health insurance is a “medically underwritten plan.”

So, what is a medically underwritten plan?

In short, a medically underwritten plan is healthcare coverage in which the insurance company reviews an applicant’s medical history. This is used to factor in how much the applicant will pay and what coverage they are eligible for.

Because of this process, these plans are often misunderstood and even overlooked. As with most things in life, there may be pros and cons for you and your team, and understanding these factors will help you decide if a medically underwritten plan will suit your needs.

Things to keep in mind when it comes to a medically underwritten plan:

  • Savings: A medically underwritten plan can impact how much or how little you are paying in premiums and deductibles.
  • Your history: Your medical history and lifestyle will be evaluated through a questionnaire(s) and possibly even a medical exam.
  • Healthy living: The healthier you and your team are, the more you could save.
  • It may not work for you: Depending on your team’s current and past medical history, you may not qualify for one of these plans.
It is easy to understand why a medically underwritten plan can feel a little intimidating. However, it is important to be able to grasp the process so that you can make an informed decision about your health insurance.
Reasons a medically underwritten plan is a good idea for your small business:
  1. Open enrollment: In most states, small groups can enroll their team in a medically underwritten plan at any point of the year (not just open enrollment). However, it is important to be aware that your employees may be limited if they decide to join later and may have to wait until enrollment season.
  2. Being healthy pays off: In addition to being able to enroll your team at any point of the year, this plan can help save you and your team money. The healthier everyone is, the easier it will be for the insurance company to work with you and give you a fair price. (With this in mind, supporting and fostering good health throughout the year is beneficial as it can continue to help you save.)
  3. Transparency: With these plans, you will have a good understanding of what your plan does and does not cover.
  4. Options: Typically, these plans are accepted by a larger number of providers, care centers, and hospitals.

Reasons a medically underwritten plan may not be for you:

  1. Post-claims underwriting: An insurer can go back later and use medical underwriting to determine if a pre-existing condition was involved in a claim. If they find this true, they may deny your claim, and you will have to pay out of pocket.
  2. Health concerns: If you know you or your team have a multitude of medical conditions, or even if your team is a little older, you may avoid this route altogether.

Stay ahead of costs.

If you choose to take the route of a medically underwritten plan, staying ahead of things throughout the year can be helpful. You can do this by promoting overall health and wellness for your whole team. Whether you choose to provide wellness incentives or non-insurance benefits, a healthier team can aid in keeping costs down.

By this point, you have done your research and have a better understanding of whether this type of health insurance plan is for you. To learn more about medically underwritten plans, visit