When purchasing insurance, it is essential to complete the health declaration accurately. However, few people explain what constitutes a proper health declaration.
Some individuals are overly cautious, reporting every minor abnormality in blood tests to the insurer, which may ultimately affect their ability to purchase insurance. Others are more relaxed, assuming they are healthy as long as they haven’t had cancer or surgery, leading to potential claim denials later. So, how should you approach health declaration? What steps should you take if there are abnormalities? This article explores the topic in detail, covering the following: 1. How to interpret health declaration and key considerations 2. How to handle underwriting if health declaration is required 3. Eight common questions about health declaration Note: This article is over 4,500 words, providing highly detailed and practical insights. After reading, you will learn: – Different approaches to health declaration and potential pitfalls – Underwriting techniques to increase approval chances despite health abnormalities Common questions addressed include: – What if you’ve purchased medication for family members? – Are pre-existing conditions covered? If you’re new to health declaration, this article will help you avoid 95% of common mistakes. 1. How to Complete Health Declaration Properly? Most protection-based insurance products require health declarations, especially critical illness and million-dollar medical insurance, which have stricter requirements. For example, the health declaration for “Blue Medical Insurance (Good Doctor & Medicine Edition)” includes four main categories: – Have you ever been denied insurance coverage? – Have you been hospitalized or undergone surgery? – Do you have any abnormal symptoms or diagnosed conditions? Let’s examine each category and its implications. 1.1 Past Insurance Purchases If you’ve never bought insurance or had no issues, you can skip this section. However, if you’ve faced difficulties, check whether the declaration requires disclosure. Common questions include: – Were you denied, excluded, or charged higher premiums for life insurance in the past two years? Disclosure is only required if all three conditions (within 2 years, life insurance, and abnormal underwriting outcomes) are met. Life insurance includes critical illness, accident, medical, and term life policies. Abnormal underwriting outcomes are explained in Part 2. Questions like “Was my accident insurance application flagged by risk control?” or “Did an automated underwriting system suggest exclusions?” may also arise.In fact, none of these are necessary.
Generally, you only need to disclose if you’ve received a loading or exclusion result and still successfully purchased the policy, or if you’ve undergone manual underwriting and received a formal rejection letter. Even if there’s a prior record, many insurers will base their decision on their own underwriting results as long as you disclose the specific condition that led to the record. For example, if Xiao Hong was denied coverage by Insurer A due to breast nodules but was approved by Insurer B after disclosing the same condition, the prior rejection would have no impact. 2. Past Medical History Insurers want to know about your surgical/hospitalization/medication history. Common questions fall into two categories: The first requires disclosure only if you’ve been hospitalized, undergone surgery, or taken medication continuously for over 30 days as prescribed by a doctor. The second is more lenient regarding medication but stricter about hospitalization/surgery: if a doctor noted a recommendation for hospitalization or surgery in your records—even if you didn’t proceed—it must be disclosed. Choose the product that suits your situation better. Note the time frame: most products only ask about the past 2 years, and earlier history need not be disclosed. Also, keywords like “or” mean you must disclose if any single condition applies. 3. Past Abnormalities This section helps insurers determine if you’ve had abnormal test results or concerning symptoms. For test abnormalities, there are three question styles, ranked from lenient to strict: The first appears lengthy but is the most lenient, as it specifies limited test items and requires disclosure only if further treatment was recommended. The second covers slightly broader test items but still doesn’t require disclosure if no further action was suggested. The third seems concise but is the strictest, as it mandates disclosure of all abnormal test results within the past year, increasing the risk of over-reporting. If you have minor abnormalities without follow-up recommendations, opt for products with the first two question styles. For symptoms, insurers typically list specific issues requiring disclosure. Some terms may be unfamiliar, such as: Cyanosis: A bluish discoloration of the skin or mucous membranes due to insufficient oxygen in the blood.Subcutaneous bleeding spots, also known as purpura, refer to reddish-purple spots under the skin that do not fade when pressed. Generally, such abnormalities should be diagnosed by a doctor rather than self-interpreted. If you are unsure how to proceed with health declaration after observing abnormalities, you may click the card below to consult a professional.
4. Past Medical History The next section of the health declaration questionnaire is the longest—past medical history. For example, if the question asks about “current or past” conditions, it means any history of the listed diseases from birth to the present, including cured cases. Some individuals may not recall childhood illnesses or have vague memories due to the distant past. In such cases, consulting elders or attempting to retrieve medical records from hospitals is advisable. Additionally, pay attention to how diseases are phrased in the questionnaire. For instance, if a product only inquires about malignant tumors, benign tumors need not be declared. However, if the question broadly asks about “tumors,” both benign and malignant must be disclosed. Some diseases may be broadly categorized. For example, “hepatitis and hepatitis virus carriers” includes conditions like hepatitis B (both large and small positive); “mental disorders” encompass depression, anxiety, etc. Some diseases may appear similar, such as cervicitis and cervical atypical hyperplasia, gastritis and gastric ulcers, hemorrhoidal bleeding and bloody stools. Careful distinction is necessary. 5. Exceptions The above four sections must be truthfully disclosed if applicable. However, certain exceptions exist, such as sterilization or childbirth surgeries, which many products do not require to be declared. For example, Blue Medical Insurance (Good Medicine Edition) includes the following note at the bottom of its health declaration: What does this mean? Suppose Xiao Ming previously underwent surgery and hospitalization, which would typically require disclosure. However, if the surgery was for acute appendicitis and has since been cured, it falls under one of the excluded conditions listed above. Thus, Xiao Ming need not declare this issue and may proceed with the purchase if no other abnormalities exist. In summary, while the health declaration may seem lengthy, breaking it down reveals it is not overly complex. Diligence can help avoid most pitfalls. Remember: answer what is asked, skip what is not, and consult professionals for uncertainties—avoid self-interpretation. II. Can You Still Buy Insurance If Health Declaration Questions Apply? After completing the health declaration, two options typically appear: If no issues are confirmed, you may proceed directly to purchase by selecting the right option. This section can be skipped. However, if you suspect involvement in any health declaration items, carefully review this section to significantly improve your chances of successfully purchasing insurance.First, click on the “Partial Issues” option in the image above. After clicking:
Some products may directly indicate they are unavailable for purchase, in which case you can simply switch to another product. However, most products will still offer an “underwriting” opportunity. Underwriting refers to the insurer’s further verification of any abnormalities to determine whether they affect the purchase of insurance. There are generally two types of underwriting: automated underwriting and manual underwriting. The differences are as follows: In most cases, it is recommended to prioritize automated underwriting for its efficiency and flexibility. Manual underwriting should only be considered for complex situations. How does underwriting work? For automated underwriting, the process is straightforward: Locate the condition requiring underwriting, answer the system’s questions truthfully, and submit to view the underwriting conclusion. For example, let’s demonstrate the automated underwriting process for unoperated Grade 2 thyroid nodules when applying for Blue Medical Insurance (Good Doctor Edition). Note: The image is for demonstration purposes only. Actual results depend on the product and individual circumstances. When answering questions, pay close attention to the specifics: For instance, are there time limits? Are the conditions connected by “or” or “and”? Do all criteria need to be met, or just one? Based on your answers, the system will provide a final underwriting conclusion, ranging from favorable to unfavorable: The manual underwriting process differs slightly, requiring the submission of various documents and explanations for human review. However, the final conclusions remain the same. Now that you understand the underwriting process and conclusions, are there any tips to improve the approval rate? Indeed, there are. First, try multiple products. Underwriting standards vary by product. For example, the case above resulted in coverage excluding thyroid diseases. Other products might offer standard coverage or only exclude thyroid malignancies, minimizing exclusions. Compare multiple options to find the most favorable product before purchasing. Second, if manual underwriting is required, prepare in advance to avoid unfavorable outcomes affecting future insurance purchases: Purchase lenient products like accident or term life insurance first, followed by medical or critical illness insurance, to avoid strict health declarations hindering other purchases. If dissatisfied with automated underwriting results but prefer a product requiring manual underwriting, first purchase a product with acceptable automated results, then attempt manual underwriting. If the manual result is favorable, cancel the previous policy; if not, you’re still covered. 3. Frequently Asked Questions While the above covers health declarations and underwriting, real-life scenarios may raise additional questions. The following eight questions address common concerns. Check if any apply to you:1. Do I need to disclose if the doctor says it’s fine?
If the health declaration asks about it, you must disclose. For example, if you have a breast nodule and the doctor says it’s fine with just dietary adjustments, but the health declaration asks about nodules, you still need to disclose and undergo underwriting. Doctors focus on the present, while insurers consider the future. 2. How to handle health declaration if I used my medical insurance card to buy medicine for others? It depends on how the medicine was purchased and what was bought. If it was through a shared medical account where you only paid but didn’t use your identity to purchase, there’s usually no issue. If you used your identity to buy over-the-counter drugs like cold medicine, it generally has no impact. However, if it’s prescription drugs like blood pressure medication and the health declaration involves related conditions, manual underwriting is recommended to explain the situation. Some products may not support underwriting for such cases, so check the specific policy. 3. Do I need to disclose prescription drugs purchased online? It depends. Online purchases of prescription drugs leave diagnostic records, and the prescribed usage may trigger health declaration questions about medication history. If these relate to the health declaration, disclose them truthfully. If the drugs were bought for family or friends, check whose identity was used by reviewing the platform’s medical records. 4. Should I proactively underwrite if a condition isn’t asked in the health declaration but appears in smart underwriting? No. Follow the health declaration questions. If a condition isn’t asked, ignore it. However, if the health declaration asks but the smart underwriting lacks the option, consider another product or manual underwriting. 5. Are pre-existing conditions that pass health declaration covered? It depends. For critical illness insurance or term life insurance, minor pre-existing conditions may be less strictly assessed. Consult a professional for details. 6. Should I get a medical exam before or after buying insurance? Avoid unnecessary exams before purchasing to prevent uncovering issues that could affect coverage.If possible, avoid medical examinations during the waiting period. Issues detected during this time may not be covered and could even affect future coverage.
For example, with critical illness insurance, problems found during the waiting period may result in exclusion of that specific condition or even policy cancellation, causing significant inconvenience. Additionally, note that results from private medical institutions must also be disclosed. 7. Some accident insurance policies do not require health disclosure but only “health requirements.” How to determine eligibility? It depends. Different products define “good health” differently. For instance: – Some only require the ability to work or live normally. – Others may require full civil capacity and complete self-care ability. – Some may exclude individuals with a history of major illnesses or strokes. If the product specifies requirements, follow them. If unclear, consult a professional before purchasing. 8. Will insurers always pay if all health disclosures are marked “No” after 2 years? Not necessarily. The notion that “claims are guaranteed after 2 years” is a common misconception, often misinterpreted from Article 16 of the Insurance Law, which states that insurers cannot terminate contracts after 2 years. However, the law also clarifies that claims can be denied for intentional or grossly negligent non-disclosure. Always complete health disclosures truthfully and avoid misinformation. If an agent promotes such misleading views, distance yourself from them. 4. Final Notes Huagui Life’s 2023 claims data shows that 76% of rejected cases were due to inadequate health disclosure. This is particularly concerning as their products, like term life insurance, typically have lenient disclosure requirements. For medical or critical illness insurance, the rejection rate could be even higher. Take health disclosure seriously, follow the guidelines step by step, and ensure peace of mind.
