Certified Employee Benefit Specialist (CEBS) – Group Benefits Associate (GBA) Retirement Plans Associate (RPA) Course 3 Practice Test

In health insurance underwriting, guaranteed issue means what?

The insurer may require medical underwriting to determine eligibility. Guaranteed issue means the insurer must offer coverage to applicants regardless of health status. Guaranteed issue only applies to short-term plans. The insurer can deny coverage based on income.

Correct Answer:

Guaranteed issue means the insurer must offer coverage to applicants regardless of health status.

Explanation:

Guaranteed issue means an insurer must offer coverage to applicants regardless of health status. This ensures that a person cannot be denied a policy or charged higher premiums solely because of medical conditions or a difficult health history. The price can still reflect allowed factors like age, tobacco use, and plan level, but health status cannot be used to deny coverage. This is different from medical underwriting, which would consider health history to decide eligibility or pricing. Short-term or non-guaranteed-issue products may not follow this rule, and income alone isn’t the basis for denial under guaranteed-issue protections.

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