“Medically underwritten health care plans” are health insurance policies where the premium rates, coverage terms, and eligibility are determined based on an individual’s health status, medical history, and other related factors. During the underwriting process, applicants may be required to provide medical records, and answer detailed health questionnaires. This information allows insurers to assess the risk of insuring the individual and to tailor the insurance policy accordingly. In Quebec, prescription drug coverage is compulsory: if you don’t have access to a private group plan, you must register with the public prescription drug insurance plan run by the Régie de l’assurance maladie du Québec (RAMQ).
Key characteristics of medically underwritten health care plans include:
Individual risk assessment
Unlike group insurance plans where risk is spread across all members of the group, medically underwritten plans assess the risk on an individual basis. This can lead to more personalized premium rates and coverage options.
Potential for lower premiums
For individuals in good health with minimal medical history, medically underwritten plans can offer lower premiums compared to health insurance plans that do not differentiate based on individual health.
Exclusions and limitations
Based on the underwriting process, the insurer may exclude certain pre-existing conditions from coverage or impose ratings (that is, charge additional premium) before covering such conditions. This is a way for insurers to manage their risk exposure.
Comprehensive coverage options
Medically underwritten plans often provide a range of coverage options that can be customized to the insured’s needs, including choices in deductibles, co-pays, and coverage limits at different price points.