Life insurance companies sort applicants into health classes, and those classes set your premium more than almost anything else. The best class — preferred plus or preferred best — costs the least. Standard sits in the middle. Substandard (also called table rated) costs the most, often 25% to 300% more than standard. You don’t pick your class; the insurer assigns it after reviewing your health, prescriptions, and lab results.
What health classes mean for premiums
Insurers use four broad tiers. Names vary by company, but the structure is similar everywhere.
| Health Class | Who Usually Fits | Typical Premium vs. Standard |
|---|---|---|
| Preferred Plus / Best | Excellent labs, normal build, no health history, no risky hobbies | Lowest — often 20-40% below standard |
| Preferred | Good labs, minor controlled issues (mild cholesterol) | 10-25% below standard |
| Standard | Average health, treated blood pressure or cholesterol | Baseline |
| Substandard / Table Rated | Diabetes, past heart event, higher build, or a treated condition | 25-300% above standard |
Some insurers add a “standard plus” tier between preferred and standard. A few also use table ratings — Table 1 through Table 16 — where each table adds roughly 25% to your base premium. A Table 4 rating, for example, means about 100% more than standard.
How Insurers Decide Your Class
There’s no single test. The underwriter looks at several things together.
- Lab work — blood and urine tests check cholesterol, liver and kidney function, blood sugar, and markers like cotinine (a nicotine byproduct).
- Medical records — your doctor’s notes, diagnoses, and how long a condition has been stable.
- Prescription history — a database check shows what you’ve been prescribed, even if you didn’t list it.
- Build — height and weight against insurer tables.
- Lifestyle and hobbies — smoking, scuba diving, private flying, and high-risk sports all move you down.
- Driving and legal record — DUIs and recent moving violations can push you into a lower class.
Tip: Request a copy of your own medical records and lab results before you apply. Errors in those files are one of the most common reasons people get a worse class than they deserve.
Can You Improve Your Health Class?
Sometimes, yes — but the timing matters. If you smoke, quitting for 12 months or more can move you from smoker rates to nonsmoker rates, which is often the single biggest jump available. Losing weight, getting blood pressure under control, and waiting for a recent surgery or accident to age off your record all help too.
If your labs came back borderline, ask the agent whether a different insurer would rate you better. Companies weigh conditions differently — one may penalize well-controlled diabetes less than another. A broker who works with many carriers can shop your case before you formally apply.
When the Class Isn’t the Whole Story
A lower class doesn’t always mean a bad deal. A substandard policy from one company can still cost less than a standard policy from another, because base rates differ. What matters is the final quoted premium, not the label.
So compare the actual quotes side by side before you accept a rating. A table 4 offer from a carrier with aggressive pricing can beat a table 2 offer from a cautious one. Ask each insurer for the total annual premium at your exact age and coverage amount, then line them up.
Also, if you’re declined or rated very low, guaranteed-issue policies exist — but they usually cap coverage at a modest amount, skip the medical exam, and charge much higher rates. They’re a fallback, not a first choice.
One caution: a low class often comes with exclusions for the very condition that caused it. Read what the policy won’t pay for, not just the price.
Frequently Asked Questions
What health class will I get if I have high blood pressure?
If it’s controlled with medication and your readings are stable, you’ll often land in standard or preferred. Uncontrolled or recently changed medication usually means a lower class. The insurer looks at your last several readings, not one number.
Does one bad lab result drop my class?
Not always. A single out-of-range value can trigger a re-test, and some insurers average results or ignore a one-time blip. Ongoing patterns across several tests carry more weight than one reading.
Can I appeal my health class?
Yes. You can ask the insurer to reconsider, send updated labs, or correct errors in your records. If they won’t budge, applying with a different company is often faster than fighting the first decision.
Conclusion
Then work with a broker who can quote several carriers side by side — the same health profile can land in different classes at different companies, and that gap is where your savings live.