Life insurance blood and urine test

Most people assume the life insurance exam is a formality. It's not. The blood and urine results are the most objective data point in your underwriting file — and a single out-of-range marker can move you from Preferred Plus to Standard, adding hundreds of dollars a year to a premium that's then locked in for the life of the policy. Knowing what they're testing for, how underwriters interpret each result, and how to prepare can meaningfully affect the rate class you're placed in. At Insurance Geek, we work with applicants across 30+ A-rated carriers and match each health profile to the carrier whose underwriting guidelines fit before a formal application goes in — because the same lab result can produce a Preferred rating at one carrier and a table rating at another.

These results feed the broader underwriting process and your rate class. Drug metabolites are handled under the drug test rules. Exam-day logistics — scheduling, what to bring, what to expect — are covered in paramed exam tips.

Key Takeaways

What the standard lab panel tests for

Carriers run a comprehensive metabolic panel (CMP) plus specialized markers. Here's what each one screens for and how underwriters interpret results.

Cholesterol panel

The lipid panel measures four values: total cholesterol, LDL ("bad"), HDL ("good"), and triglycerides. Underwriters typically look at the total-to-HDL ratio more than any single number.

What moves your rate class:

• Preferred Plus typically requires a total cholesterol under 220 mg/dL and a total/HDL ratio under 4.5
• Preferred usually allows total cholesterol up to 245–260 mg/dL depending on the carrier, or a ratio up to 5.0–5.5
• Standard Plus / Standard — elevated LDL (160+ mg/dL) or a ratio above 6.0 will often land here
• Table rating or postponement — total cholesterol above 300 mg/dL or triglycerides above 500 mg/dL can push an application to Table B or worse

If you're on a statin, disclose it upfront. Many carriers will approve at Preferred if your levels are controlled and stable; some will still rate for the underlying diagnosis.

Glucose and A1C

Fasting glucose screens for diabetes and pre-diabetes. A1C gives underwriters a 90-day average blood sugar reading that a single glucose result can't fake.

What moves your rate class:

• Fasting glucose under 100 mg/dL: clean
• 100–125 mg/dL (pre-diabetes range): flag that often triggers Standard or table rating, especially if A1C is also elevated (5.7–6.4%)
• 126+ mg/dL (diagnostic for diabetes): rating depends heavily on control, duration, and whether there are complications. Well-controlled Type 2 with a low A1C (under 7.0%) can sometimes achieve Standard. See diabetes and life insurance underwriting for full detail.

A1C below 5.7% is preferred-clean. A1C above 7.0% on a diagnosed diabetic will typically result in a table rating of D or higher.

Kidney function — creatinine and eGFR

Creatinine is a waste product filtered by the kidneys. Elevated creatinine signals impaired kidney function; underwriters also look at eGFR (estimated glomerular filtration rate), derived from creatinine, age, and sex.

What moves your rate class:

• eGFR above 90 mL/min: normal, no impact
• eGFR 60–89 mL/min: mild reduction — often Preferred or Standard depending on other markers
• eGFR 45–59 mL/min: moderate reduction — likely Standard or table rating; carrier will often request an APS from your nephrologist
• eGFR below 45 mL/min: significant impairment — most carriers will decline or table rate heavily; a handful of specialty carriers will consider

Urine also screens for protein (proteinuria), an early indicator of kidney damage that can affect rate class even when creatinine is normal.

Liver enzymes — ALT and AST

ALT (alanine aminotransferase) and AST (aspartate aminotransferase) indicate liver inflammation or damage. Elevated values can flag fatty liver disease, alcohol use, hepatitis, or medication side effects.

What moves your rate class:

• ALT/AST 1–2× the upper limit of normal (ULN): often Standard, especially if the elevation is mild and unexplained
• ALT/AST 2–3× ULN: usually triggers an APS request; rating depends on diagnosis
• ALT/AST 3× ULN or higher: likely postponement or decline until the cause is identified and resolved. Active hepatitis B or C with elevated enzymes is typically a table rating at minimum

A single elevated reading can sometimes be dismissed as transient — intense exercise, OTC medication, or a heavy weekend. If your enzymes are borderline, scheduling the exam when your lifestyle is clean will help.

Cotinine (nicotine)

Cotinine is the metabolite of nicotine. It's present from cigarettes, cigars, vaping, nicotine patches, gum, and pouches. Most carriers test urine for cotinine.

• Below 50–100 ng/mL: non-smoker rates apply
• Above threshold: smoker rates apply — typically 2–3× non-smoker premium

Nicotine gum, patches, and vaping all produce cotinine. If you use nicotine replacement and want non-smoker rates, you need a carrier that makes an exception for cessation products — they exist, but it requires specific carrier selection.

If you've quit smoking, most carriers require 12 continuous months without nicotine before granting non-smoker rates. A handful require 24 months.

HIV

HIV testing is standard on most fully underwritten policies. A positive result no longer means automatic decline at every carrier — a small number of specialized carriers now offer coverage to well-managed HIV-positive applicants — but it requires working with an agent who knows which carriers to approach.

PSA (prostate-specific antigen)

PSA is tested for male applicants, typically over age 40. An elevated PSA can indicate prostate enlargement, inflammation, or prostate cancer.

• PSA at or below age-adjusted norms: no impact
• Mildly elevated PSA with a clean biopsy: typically Standard or slight table rating
• PSA elevation with no biopsy on record: underwriter will usually request one before deciding

If you've had a prior elevated PSA, flag it to your agent before applying — the underwriting outcome depends heavily on the follow-up record.

How lab results interact with your MIB record

The Medical Information Bureau (MIB) is a shared database that carriers report coded health information to. When you apply for new coverage, the underwriter pulls your MIB file and cross-references it against your application disclosures and the lab results.

If your current labs show elevated glucose — and your MIB record contains a prior code for diabetes that you didn't disclose — that inconsistency is a serious underwriting problem. It can result in rescission of an issued policy if discovered post-claim, not just a rating.

Lab results don't exist in isolation. They're read alongside your MIB file, any attending physician statement (APS) requested, and your Rx history from prescription databases. Accurate disclosure upfront is the only way to make sure your application survives that cross-check.

Accelerated underwriting — when the exam is waived

Many carriers now offer accelerated underwriting (AUW) tracks that skip the paramed exam entirely for applicants who meet specific criteria. Instead of lab work, they use algorithmic data: prescription history, MIB codes, MVR, and credit-based insurance scores.

Typical AUW eligibility requirements:

• Age 18–50 (some carriers extend to 60)
• Coverage at or below the carrier's AUW cap — commonly $1M–$3M
• Clean MIB and Rx history
• No major chronic conditions flagged on the application

If you qualify, you can receive a fully underwritten decision — often at Preferred or Preferred Plus — without any blood draw, typically within 24–72 hours. See no-exam life insurance for a full breakdown of how these tracks work and which carriers offer them. The tradeoff: the algorithm is unforgiving. A prescription in your Rx history that you didn't disclose, or an MIB code from a prior application, will kick you out of the AUW track immediately.

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How to prepare for the exam

Lab results are snapshots in time, but you can meaningfully influence that snapshot.

48–72 hours before:

• Avoid intense exercise — strenuous workouts elevate ALT, AST, creatinine, and glucose
• Avoid alcohol — even moderate drinking elevates liver enzymes for 24–48 hours
• Avoid foods high in saturated fat, which can push triglycerides up temporarily

The night before:

• Fast for 8–12 hours. Fasting is required for accurate glucose and triglyceride readings. Black coffee is generally fine; anything with calories is not
• Stay well hydrated — dehydration concentrates urine and can artificially elevate creatinine

The morning of:

• Schedule early — morning exams mean you've already completed the overnight fast
• Skip non-essential supplements (some affect liver enzymes or creatinine)
• Bring a list of all current medications

The paramedical examiner also records your height and weight at the same appointment — those measurements feed a separate build table that can affect your rate class independently of your labs. See the life insurance height and weight chart to see where you'd fall across carriers.

What you can't change in 48 hours: A1C reflects your last 90 days. Cholesterol trends over months. If you know those numbers are out of range, the better move is to get your levels under control first, then apply. Rushing an application when labs are borderline usually costs more in the long run.

What happens if results come back abnormal

The carrier will notify you (or your agent) explaining the finding. Depending on severity, they may:

1. Issue at a different rate class than quoted — Standard instead of Preferred, for example
2. Request an APS from your physician to get context on the abnormal value
3. Table rate the policy — adding a flat extra premium or a percentage rating (Table B = +50%, Table D = +100%); see high-risk life insurance underwriting for how table ratings work in practice
4. Postpone the application pending follow-up testing or treatment
5. Decline — typically reserved for severe findings or multiple compounding issues

An adverse result from one carrier doesn't mean all carriers will reach the same conclusion. Underwriting guidelines vary meaningfully — a Table D at one company might be Table B at another for the same lab result. If you receive a rating or decline, get a copy of the specific lab values. We shop those situations across our full carrier panel to find the most favorable guidelines for your profile — I've seen clients save 40–60% on their premium just by applying to the right carrier the first time.

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