Review Requests of Adverse Underwriting Decisions Rating and Underwriting

Review requests of adverse underwriting decisions (declinations, substandard ratings) are to be submitted in writing to:

Independence Blue Cross
Individual Medical Underwriting
P.O. Box 41474
Philadelphia, PA 19101-1474

Requests may also be faxed to 215-238-2280. Applicants or brokers seeking to obtain explanations of underwriting decisions by phone will be advised that for privacy reasons, such explanations will be addressed only in writing to the applicant at the address provided in the application.

Review requests will be handled as a priority and responded to within five working days. Should there be a delay in responding to the applicant, a letter acknowledging receipt of the request will be sent and will include the promise of a timely response.

The Independence Blue Cross Underwriting Department will review the file, secure additional management and medical review if appropriate, and provide the applicant with a written explanation of the reasons for the decision. If additional information or medical records might allow for further review, the underwriter will advise the applicant. Submission of medical records in an attempt to have a declination reversed or a rating reconsidered will be at the applicant’s expense.

Applicants whose enrollments were approved with a substandard rating must keep their insurance in force for one year before requesting a review for a rate reduction. We recommend that the insured member first inquire in writing whether a change in the rating would be considered. If the answer is yes, the underwriter will request that a new application be completed and that all past and interim medical history be reported. In determining whether a rating will be upgraded, we will review not only the medical history that caused the initial rating but also any medical history that occurred since the policy was issued.

If the underwriting decision is upheld, there is no additional review process. If reconsideration at a future date is possible, the underwriter will advise the applicant of when a new application may be submitted.