Life insurance blood tests screen for cholesterol, glucose, liver function and nicotine. Results affect your health classification and your premium.
Find out if you're overpaying for life insurance below.
Updated: March 22, 2026
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Most traditional, fully underwritten life insurance policies require a blood test for coverage of $100,000 or more.
Blood test results help determine your health classification tiers (Preferred Plus, Preferred, Standard Plus, Standard and Substandard), which directly control your premium amount. Classification tiers and availability vary by insurer and state regulations.
Fasting eight to 12 hours before the draw, avoiding alcohol 24 to 48 hours beforehand and scheduling morning appointments can improve test results.
A life insurance blood test is a medical screening process done during underwriting to assess your health risk. Most insurers mandate a blood draw for applicants seeking coverage above $100,000 to $500,000, though the exact threshold varies by company.
A paramedical examiner draws the blood at no cost to the applicant and submits results directly to the insurer. Results determine a person's health classification tier, and that tier controls the premium you pay for coverage.
Life insurance blood tests screen for cholesterol levels, blood glucose and HbA1c, liver enzymes (ALT, AST), kidney function markers (creatinine, eGFR) and cotinine (a nicotine metabolite). Each marker shows a different aspect of your health risk to the underwriter.
Low-density lipoprotein (LDL), high-density lipoprotein (HDL) and total cholesterol ratios signal cardiovascular health to underwriters. Elevated LDL above the insurer's threshold triggers a rate-up. The underwriter reviews the LDL-to-HDL ratio and compares your results to risk tables that correlate cholesterol levels with mortality rates.
Elevated fasting glucose signals pre-diabetes or diabetes risk. A diagnosis results in a table rating (premium surcharge) or decline, depending on severity. HbA1c measures average blood sugar over three months, providing a longer-term view of glucose control than a single fasting test.
Elevated liver enzymes (ALT, AST) indicate potential liver disease or alcohol use. Insurers check the ratio and degree of elevation. A mildly elevated result may prompt follow-up questions, while a sharply elevated result will likely trigger a table rating or a request for additional medical records from your physician.
Creatinine and eGFR (estimated glomerular filtration rate) detect kidney disease, which affects mortality risk and can trigger a substandard classification. An eGFR below 60 mL/min/1.73 m² may indicate chronic kidney disease, with underwriting decisions based on severity, stability and underlying causes.
Cotinine is the nicotine metabolite detected in blood. Smoker rates are higher than nonsmoker rates across all health classifications. A positive cotinine result reclassifies you as a tobacco user, which increases the premium.
Most fully underwritten policies require a blood test for $100,000 or more in coverage, though some insurers set the threshold higher. Age factors in as well: older applicants face testing at lower coverage amounts, and younger applicants meeting specific health and lifestyle criteria qualify for accelerated underwriting without a blood draw.
No-exam life insurance skips the blood test but comes with a lower coverage ceiling and higher premiums. Accelerated underwriting programs pull algorithmic health data from medical records and prescription databases instead of a blood draw to qualify applicants who meet age and health requirements.
The life insurance blood test process takes 2 to 6 weeks from application submission to final underwriting decision. The process works like this:
The insurer or a third-party scheduling service contacts you within three to seven business days of receiving your application. The insurer pays for the medical exam. The scheduler offers morning, afternoon or evening appointment slots at your home, office or a local clinic.
Fasting is required for accurate glucose and cholesterol readings. The standard fasting window is 8 to 12 hours, and water is permitted throughout. Discuss any prescription medications with the examiner in advance. You can take most medications as scheduled, but some diabetes medications may need timing adjustments.
The examiner draws blood (one to three vials), measures height, weight, and blood pressure, and may collect a urine sample. The appointment takes 20 to 30 minutes. The examiner asks questions about your medical history and current medications, then completes
Lab results return within 1 to 2 weeks. Full underwriting decisions take 2 to 6 weeks, depending on the insurer and whether additional medical records are required. The underwriter reviews lab results alongside your application, medical history, prescription drug database reports and prior insurance activity from the Medical Information Bureau (MIB Group).
The insurer assigns a health classification tier based on results. If the tier is lower than expected, you may request a re-evaluation with updated medical records or seek a second opinion through another insurer.
Blood test results set your health classification tier, which sets your premium. Tiers run from best to worst: Preferred Plus, Preferred, Standard Plus, Standard and Substandard/Table-rated. Dropping from Preferred Plus to Standard raises premiums. The exact gap varies by insurer, coverage amount and age, but health classification is the largest single driver of premium differences between applicants of the same age and coverage amount.
Table ratings add a flat extra or percentage surcharge per risk factor above Standard. A borderline result doesn't automatically disqualify you, but expect requests for additional physician records.
Being denied life insurance by one insurer doesn't close the door. Cholesterol, glucose and liver enzyme thresholds vary by company, so the same results can produce different outcomes elsewhere. The factors affecting life insurance rates guide you in understanding how specific health markers move your premium.
A few steps before your blood draw improve both your results and your health classification.
Eating before the draw raises blood glucose and triglycerides, which may push results into a worse classification tier. Water is permitted during the fasting period. Black coffee without cream or sugar is generally acceptable, but verify with the examiner when you schedule. Continue taking prescription medications as directed unless your physician advises otherwise.
Alcohol temporarily elevates liver enzymes (ALT, AST), which can trigger a table rating even in otherwise healthy applicants. The standard recommendation is to avoid alcohol for 24 to 48 hours before the blood draw. Even moderate alcohol consumption the night before the exam can produce elevated enzyme readings that take several days to normalize.
Intense exercise temporarily raises creatinine and certain liver enzymes. Light walking is acceptable, but avoid weightlifting, running, cycling or other strenuous activity for 24 hours before the appointment. The enzyme elevation from intense exercise can persist for 12 to 24 hours and may be misread as a sign of liver or kidney dysfunction.
Some medications affect blood markers in ways the lab can flag as abnormal. The examiner submits a medication list alongside results so the underwriter can interpret readings in context. Statins, blood pressure medications and diabetes drugs all affect lab values, so disclosing them prevents misinterpretation of your results.
Morning exams are easier to fast for and may produce lower cortisol and glucose readings. Cortisol and blood glucose naturally fluctuate throughout the day, with lower readings typically occurring in the morning after an overnight fast. This is a practical tip, not a requirement.
An abnormal result in underwriting means a value outside the insurer's preferred range, not a medical emergency. The insurer may request physician records, order a follow-up test or assign a table rating based on the finding. You have the right to request your blood test results from the Medical Information Bureau (MIB Group) file and the attending physician statement the insurer obtains from your doctor.
We've answered common questions about life insurance blood tests:
The blood draw is a standard venipuncture procedure that takes a few minutes and draws one to three vials of blood from a vein in your arm. No physician visit or clinic appointment is required. It feels just like getting blood drawn at your doctor's office.
The test checks cholesterol (LDL, HDL, total cholesterol), blood glucose and HbA1c, liver enzymes (ALT, AST), kidney function markers (creatinine, eGFR), complete blood count and cotinine (nicotine metabolite). Results determine your health classification tier and directly affect your premium.
There's no pass or fail threshold in the clinical sense. Results are placed into classification tiers: Preferred Plus, Preferred, Standard Plus, Standard or Substandard/Table-rated. A result outside the Preferred range doesn’t disqualify an applicant but may result in a higher premium or a request for additional medical records.
Lab results typically return within one to two weeks. Full underwriting decisions vary by insurer and applicant health history. Simple cases with clean lab results may receive a decision within two weeks; cases requiring additional medical records may take four to six weeks.
Yes. No-exam life insurance policies skip the blood draw. The trade-off is lower coverage ceilings and premiums higher than fully underwritten policies. Some insurers offer accelerated underwriting for qualifying applicants who meet specific health and age criteria.
Standard panels test for cotinine (nicotine) and may include a urine screen for controlled substances, depending on the insurer and coverage amount. A positive result for nicotine moves you to smoker rates. A positive result for controlled substances doesn’t automatically disqualify you, but it’ll affect your health classification and may trigger a request for additional medical records.
About Mark Fitzpatrick
Mark Fitzpatrick, a Licensed Property and Casualty Insurance Producer, is MoneyGeek's resident Personal Finance Expert. He has analyzed the insurance market for over five years, conducting original research for insurance shoppers. His insights have been featured in CNBC, NBC News and Mashable.
Fitzpatrick holds a master’s degree in economics and international relations from Johns Hopkins University and a bachelor’s degree from Boston College. He's also a five-time Jeopardy champion!
He writes about economics and insurance, breaking down complex topics so people know what they're buying.
