Underwriting Guide

Can You Get Life Insurance With Diabetes, Cancer, Heart Disease, Obesity or High Blood Pressure?

Published by CentraLife · Updated October 19, 2026

The short answer

Often, yes. A diagnosis rarely decides the outcome on its own. Insurers weigh:

which condition you have and how well it's controlled;
any complications;
how long it has been since diagnosis or treatment;
your overall health.

Depending on those details, the result can be a standard offer, a higher "rated" premium or a decline. No one can promise approval before an insurer underwrites the application.

Who this guide is for, and who it isn't

For you if:

you have, or have had, diabetes, cancer, heart disease, obesity or high blood pressure, and you need coverage to protect a family, a mortgage, a business or an estate plan;
an insurer has declined or rated your application, and you want to know what happened and what to try next;
you're deciding between a fully underwritten application and a no-exam policy.

Not the right page if:

you want a price today. Pricing depends on underwriting, and no honest page can quote a rate class for a medical history it hasn't seen.
you're comparing products for retirement income or cash accumulation. Start with policy architecture instead.

How underwriting actually decides

What it is. Underwriting is how an insurer decides whether to offer a policy and at what price. It often involves health questions and may include a medical exam. An insurer can decline someone it considers too high a risk[1].

The usual outcomes[2]:

Standard or preferred. Standard is the class most policies are issued in. Applicants with more favorable characteristics may be placed in a preferred class.
Rated. The policy is issued with an additional premium for the extra risk of impaired health.
Declined.

What the underwriter sees. It's more than your answers. NAIC research lists the traditional sources an insurer may draw on[3]:

the application and a phone interview;
medical records from your doctors;
prescription-drug history;
the MIB database;
your driving record;
public records;
for some applicants, a paramedical exam with blood and urine tests.

Your rights to see that information:

MIB and the main prescription-history service are consumer reporting companies. You can request your own file from each[4].
If an insurer takes adverse action based on a consumer report, federal law requires it to tell you so and to name the reporting company. It must also explain your right to a free copy and your right to dispute anything inaccurate[5].

Answer every question accurately. Life policies generally have a contestable period, commonly two years from issue.

During that period, an insurer can review the application and may contest the policy or deny a claim if it finds a material misrepresentation: an untrue or missing answer about something that would have changed its decision to issue the policy[6][7].
What counts varies by state law and by the policy. Examples:
- New York's statute requires the misrepresentation to be material.
- California's regulator describes omissions and mistaken or untrue statements as potential grounds[2].
- Texas's regulator says payment can be denied even when the wrong information was unrelated to the cause of death or was given by mistake[1].
After the period, regulators describe the policy as generally incontestable while premiums are paid, subject to its terms[6].

A rated policy that pays out is worth more to your family than a better rate that can be contested.

Condition by condition: what underwriters weigh

How to read this section. For each condition there are:

the factors underwriting looks at;
what to have ready.

Limits. Insurers set their own guidelines, and the exact parameters vary by insurer[3]. The same history can produce different results at different companies. Nothing below is a cutoff, a rate or a prediction of an outcome.

Diabetes

Factors that move the decision. A 2023 global survey of insurers and reinsurers by the actuarial profession lists the rating factors used for type 1 and type 2 diabetes[8]:

age;
time since diagnosis;
HbA1c;
blood pressure;
cholesterol;
BMI;
smoking status.

Complications and other conditions also bear on the risk.

How control is measured. For people with diabetes, underwriters have long used the HbA1c blood test as a measure of blood-sugar control[9].

Have ready:

your diagnosis date and type;
your current medications and any changes;
your recent HbA1c results, with dates;
recent blood pressure and cholesterol results;
any eye, kidney, nerve or heart findings;
the name of the clinician who manages your care.

Cancer history

What the review covers. Expect the review to rely on your medical records[3]. Records that clearly document the cancer's type and stage, the treatment, its end date and the follow-up since make that review possible.

Why cancers are treated differently. Cancers differ in their risk of recurrence or later complications, so insurers don't assess all cancer histories alike[10].

Timing matters too. How long it has been since diagnosis and since the end of treatment is part of the picture. Insurers set their own guidelines on timing.

Have ready:

the pathology or diagnosis summary (type, stage, grade);
your treatment dates and their end date;
your surveillance results since treatment;
any recurrence history;
your oncologist's contact details.

Heart disease

Factors that move the decision. Industry underwriting tools for coronary artery disease weigh:[11]

the specific diagnosis;
your medical history;
the type of treatment;
other conditions you have.

So the details and their timing matter, not just the diagnosis label. Medical records are usually central to the review[3].

Have ready:

your diagnosis and the dates of any events or procedures;
your current medications;
recent cardiology follow-up results;
your cardiologist's contact details.

Obesity and build

BMI. Health agencies use body mass index (BMI) to screen weight categories, and in adults "obesity" is defined as a BMI of 30 or higher. But BMI is only a screening measure. It should be weighed with other health factors[12].

How insurers assess build:

Insurers assess build under their own guidelines.
Some underwriting tools assess it together with blood pressure, cholesterol and smoking status[13].
Others model how BMI and blood pressure interact, rather than scoring each separately[14].

Report height and weight accurately. In a 2024 reinsurer study comparing accelerated (no-exam) decisions with full underwriting, build was the most frequently cited reason the two decisions differed[15]. A self-reported number that's off can surface later.

Have ready:

your current measured height and weight;
recent blood pressure, cholesterol and glucose results;
any weight-loss treatment or surgery, with dates.

High blood pressure

The condition itself. High blood pressure usually has no symptoms. It's diagnosed when readings are consistently above normal, and many people control it with lifestyle changes or medication[16].

What underwriters see:

your blood-pressure values, from records or an exam;
your prescription history[3].

How it's weighed.

Blood pressure is commonly assessed alongside build and cholesterol[13].
In the 2024 reinsurer study above, it was among the conditions most often behind differences between accelerated and fully underwritten decisions[15].

Have ready:

when you were diagnosed;
your current medication and dose;
a log or summary of your recent readings;
any heart or kidney findings.

More than one condition

Conditions are weighed together. For example, diabetes with high blood pressure or a higher BMI is assessed as a combined picture. The diabetes rating factors above already include blood pressure, cholesterol and BMI[8].

Worked example: reading your own BMI before you apply

Assumptions. The applicant is hypothetical, not a client. They are 5 ft 10 in (70 inches) tall and weigh 240 pounds.

Formula. CDC formula for US units: BMI = weight (lb) ÷ height (in)² × 703[17].

Worked BMI example for a hypothetical applicant, 70 inches tall and 240 pounds
Step	Calculation	Result
Height squared	70 × 70	4,900
Weight × 703	240 × 703	168,720
BMI	168,720 ÷ 4,900	34.4 (CDC category: Class 1 obesity, 30 to under 35)

What the number does and doesn't tell you:

It tells you which CDC screening category you fall in. It does not tell you an underwriting class or whether you'll be approved.
Insurers apply their own build guidelines.
Many also consider blood pressure, cholesterol, glucose and tobacco alongside build.

The practical step: gather those results before applying. Then the underwriter sees the whole picture, not BMI alone.

Which path fits your health history?

Underwriting paths compared: how health is assessed, when each can fit, and what to watch for
Path	How health is assessed	Can fit	Watch for
Fully underwritten	Application, records, databases, often an exam[3]	Larger amounts; well-documented, controlled conditions	Takes longer; records may be requested
Accelerated (exam may be waived)	Application plus data checks; applicants who don't qualify are commonly routed to traditional underwriting[3]	Applicants who want speed and expect a clean data picture	Not everyone qualifies
Simplified issue	Short health questionnaire plus database checks; accept or decline[18]	Moderate needs when timing matters	Can still decline; generally lower amounts and higher cost per unit than fully underwritten coverage
Guaranteed issue	No health questions; non-health eligibility rules such as age limits still apply[19]	Small needs when other paths aren't available	Some use a graded death benefit; read the benefit terms
Group coverage at work	Usually no health questions for the basic amount, if you have access and are eligible[1]	A supplement	Amounts often limited; usually ends when you leave the job

What can change the answer

Time since diagnosis, an event or the end of treatment.
Control and complications.
Age.
Tobacco use.
Other conditions that interact with the main one.
The amount and product. Accelerated programs set age and amount limits that vary by insurer[19].
The insurer. Each sets its own guidelines and rate classes.
Where you live. Policy provisions, including how misstatements are treated, and some consumer-data rules depend on state law.

If you were declined or rated

Ask why, in writing.
- If a consumer report contributed, you're entitled to a notice that names the reporting company and explains your right to a free copy and to dispute it[5].
- NAIC regulatory guidance calls on insurers to be able to give the reasons for an adverse decision in language a typical consumer understands[3].
Check your files.
- Request your MIB file. MIB provides one free copy a year, plus another after an adverse decision it influenced[20].
- Request your prescription-history report[21].
- Dispute anything inaccurate.
- An MIB record shows reported conditions, not whether another insurer approved or declined you[22].
Don't cancel existing coverage. A new policy starts a new contestable period[6]. A new policy may also cost more because you're older[2].
Look at conversion. If you have term coverage with a conversion privilege, you may be able to move to permanent coverage without a medical exam or health questions, within the policy's time limits[1].
Ask whether a later application could be considered. Timing since diagnosis and treatment is one of the factors insurers weigh, so it may help to ask once something material changes: more time since treatment, documented control, or updated results.
Compare the alternatives honestly.
- Group coverage, if you have access.
- Simplified issue, which can also decline.
- Guaranteed-issue coverage, with its benefit terms understood.
- These can fill a gap, usually for smaller amounts. See No-Exam Life Insurance, Explained.

Questions to ask before you apply

Which underwriting path (full, accelerated, simplified or guaranteed issue) fits my history and the amount I need?
Which records or test results will the insurer probably request, and can I gather them first?
How are my conditions assessed together, not just one at a time?
If I'm rated, can the rating be reconsidered later with better results, and what does the policy say about that?
Should I keep my current coverage in force until a new policy is issued? (Almost always yes.)
If I have term coverage now, does it include a conversion privilege, and until when?

Talk it through before you apply

An application creates a record. It's worth knowing your likely path before you submit one.

In an assessment, CentraLife will:

review your health history and coverage goals with you;
explain which underwriting paths may fit;
tell you what to gather before you apply.

What we can't do: the insurer makes the underwriting decision, so we can't promise an approval, a rate class or a price.

Schedule an Assessment No-Exam Life Insurance, Explained

Related:

Frequently asked questions

Will a past decline show up when I apply somewhere else?

Insurers that belong to MIB may report conditions they found during underwriting.
MIB records do not show what another insurer decided (approval, decline or rating).
You can request your MIB file and dispute errors[22].

Should I leave a condition off the application to get a better rate?

No. During the contestable period (commonly two years), a material misrepresentation can lead to a contested policy or a denied claim. Depending on state law and the policy, even an unintentional error can matter[6][2].
Insurers can also check prescription history and MIB records[3].

Is a no-exam policy better if I have a health condition?

Not automatically.
No-exam does not mean no information: accelerated and simplified-issue insurers may still check databases.
Simplified-issue and guaranteed-issue policies generally offer lower amounts and can cost more per unit than fully underwritten coverage[18].
A fully underwritten application with good records can sometimes produce a better result.

Sources

1.Texas Department of Insurance: Life insurance (consumer guide)
2.California Department of Insurance: Life insurance and annuities consumer guide (with glossary)
3.National Association of Insurance Commissioners (NAIC): Accelerated underwriting regulatory guidance and educational report
4.Consumer Financial Protection Bureau: List of consumer reporting companies (2024)
5.U.S. Code (Cornell LII): 15 U.S.C. § 1681m: requirements on users of consumer reports
6.Vermont Department of Financial Regulation: Consumer guide: purchasing life insurance
7.New York State Senate: N.Y. Insurance Law § 3105: representations by the insured
8.Institute and Faculty of Actuaries: An analysis of diabetes mortality and morbidity risk (2023)
9.RGA: HbA1c levels: mortality biomarker or random fluctuation? (2020)
10.Swiss Re: The right to forget cancer (2021)
11.Insurance Business: Swiss Re upgrades underwriting calculator to better assess coronary artery disease risks (2024)
12.Centers for Disease Control and Prevention: Adult BMI categories
13.Munich Re: Medical risk research
14.Swiss Re: Life Guide cardiometabolic calculator
15.Swiss Re: Accelerated underwriting in focus (2024)
16.Centers for Disease Control and Prevention: About high blood pressure
17.Centers for Disease Control and Prevention: Calculating BMI using the English system
18.Society of Actuaries: Simplified issue underwriting (2020)
19.Society of Actuaries: Accelerated underwriting practices survey (2019)
20.MIB: Request your MIB consumer file
21.Milliman IntelliScript: For consumers
22.MIB: Who is MIB?

Sources accessed October 19, 2026. Underwriting guidelines differ by insurer and change over time.

Disclaimer

Educational information only:

Underwriting decisions, rate classes and pricing are made by each insurer under its own guidelines.
Policy terms and state law control.
Nothing here is medical advice or a promise of coverage.

CentraLife does not provide tax preparation or legal services. CentraLife LLC · NPN 21105331.