Life insurance underwriting classes are mortality risk tiers assigned to an applicant based on health history, laboratory results, build, tobacco use, family history, and occupation. The class determines the annual premium rate the applicant pays for a given face amount. From best to worst, the standard class hierarchy is Preferred Plus, Preferred, Standard Plus, Standard, and then substandard ratings expressed as table ratings or flat extras.
Key Takeaways
- Life insurance underwriting classes are mortality risk tiers that directly set the premium rate. The main classes from most to least favorable are Preferred Plus (or Super Preferred), Preferred, Standard Plus, and Standard. Applicants who do not qualify for Standard are placed in substandard categories using table ratings or flat extras.
- Each table rating step above Standard adds approximately 25 percent to the Standard annual premium. A client at Table 2 pays 150 percent of Standard; a client at Table 4 pays 200 percent. Tables A through D correspond to Tables 1 through 4, and carriers use either notation.
- A flat extra is a fixed additional premium per $1,000 of face amount, charged annually or for a temporary period. A flat extra of $5 per $1,000 on a $500,000 policy adds $2,500 per year to the premium — on top of whatever class rate the applicant otherwise qualifies for.
- Temporary flat extras expire after a set number of years, often three to five. A client whose condition is in remission or has resolved may see the flat extra drop, making the long-term cost lower than a permanent table rating for the same history.
- Carriers apply underwriting criteria differently for the same health history. A client with controlled Type 2 diabetes who rates Table 2 at one carrier may rate Standard Plus at another. Shopping substandard cases across carriers is more important than for preferred-risk applicants.
How the four standard classes are structured
Every fully underwritten life carrier uses some variation of the four standard classes, though the specific criteria, labels, and thresholds differ by carrier. Preferred Plus (sometimes called Super Preferred or Select Preferred) is the most competitive rate class and requires applicants who are essentially ideal risks: no chronic conditions requiring medication, optimal blood pressure and laboratory values, no tobacco use for five or more years, and a family history free of premature mortality in first-degree relatives.
Preferred accepts applicants with minor deviations from Preferred Plus criteria. A client on a single controlled blood pressure medication who otherwise meets Preferred Plus requirements will typically land at Preferred rather than fall all the way to Standard. Standard Plus is the class carriers use for above-average health profiles that don't clear Preferred criteria. Standard is the baseline: average mortality risk, no significant health impairments, but not the optimal profile the carrier's best rates require.
The premium gap between Preferred Plus and Standard can be 30 to 50 percent on a 20-year term policy for a 45-year-old. Quotit's life quoting integrations typically return rates for the class the agent specifies; the carrier's actual underwriting decision may result in a different class, which changes the final premium from what was quoted. Managing that expectation with clients before the application is submitted is a process issue, not a technology one.
Table ratings: what each step actually costs
When an applicant does not qualify for any standard class, the carrier places them in a substandard category using a table rating. The table system assigns a letter (A through P) or a number (1 through 16) depending on the carrier's notation. Each step above Standard adds approximately 25 percent to the Standard rate:
- Table 1 (A): Standard rate plus 25 percent
- Table 2 (B): Standard rate plus 50 percent
- Table 4 (D): Standard rate plus 100 percent (2x Standard)
- Table 8 (H): Standard rate plus 200 percent (3x Standard)
Example: A 50-year-old male quoting a $500,000 20-year term at Standard might pay $180 per month. At Table 2, that same client pays approximately $270 per month. At Table 4, the premium rises to roughly $360 per month. These are illustrative figures; actual premiums depend on the specific carrier, plan year, and state.
Most carriers cap their rated offers somewhere between Table 8 and Table 12. An applicant whose health profile places them above the carrier's maximum table receives a decline rather than an offered rate. A Table 10 outcome at one carrier may produce a decline at another whose manual is more conservative at high risk levels.
| Class | Description | Typical qualifiers | Rate vs Standard |
|---|---|---|---|
| Preferred Plus / Super Preferred | Optimal health, no conditions, ideal labs and family history | No medication, BP under 130/80, cholesterol ratio under 4.5, no tobacco past 5+ years, clean MVR | 20 to 40% below Standard |
| Preferred | Excellent health with minor deviations from Preferred Plus criteria | One controlled medication acceptable, minor MVR, acceptable family history with age thresholds | 10 to 25% below Standard |
| Standard Plus | Above-average health; common at many carriers | Well-controlled conditions, moderate build chart deviations, no significant cardiovascular risk | 5 to 15% below Standard |
| Standard | Average mortality risk; baseline rate for quoting purposes | Typical health profile without significant impairment | Baseline (1.0x) |
| Table 2 (Table B) | Mildly substandard; common for controlled chronic conditions | Well-controlled Type 2 diabetes, mild build chart elevation, resolved cardiac event with normal function | 50% above Standard |
| Table 4 (Table D) | Moderately substandard; serious condition history | Poorly controlled diabetes, recent cardiovascular event, certain cancer histories | 100% above Standard (2x) |
| Table 8 (Table H) | Severely substandard; near the outer limit of most fully underwritten products | Multiple significant conditions, recent serious diagnosis, high-risk combination of factors | 200% above Standard (3x) |
Illustrative examples. Exact criteria and surcharge percentages vary by carrier and underwriting manual. A client's actual class is determined by the carrier's underwriter after reviewing the full application and medical evidence.
Flat extras: what they cover and how they expire
A flat extra is an additional premium charge expressed as a dollar amount per $1,000 of face amount, applied annually. Unlike a table rating, a flat extra is not a percentage of the Standard rate — it is a fixed surcharge layered on top of whatever class rate the applicant qualifies for.
Example: An applicant qualifies at Standard but carries a $5 per $1,000 flat extra for a private pilot avocation. On a $500,000 policy, that flat extra adds $2,500 per year to the annual premium ($5 times 500 thousands). If the same applicant were at Table 2 and also had the flat extra, both charges would apply simultaneously.
Flat extras are common in two scenarios: occupational or avocational hazards (private aviation, commercial diving, high-altitude mountaineering, certain mining roles) and health conditions with a defined risk horizon (cancer in recent remission, a recent cardiovascular event that is now stable). The occupational flat extra often remains permanent for as long as the applicant continues the hazardous activity. The health-related flat extra may be temporary — a carrier may apply a $3 per $1,000 flat extra for three years on a client who completed cancer treatment 18 months ago, with the flat extra expiring if the client remains in remission at the three-year mark.
Temporary flat extras lower the long-term cost of coverage relative to a permanent table rating for the same condition. A client on a three-year temporary flat extra who clears the window will pay Standard rates from year four onward. A client placed at Table 2 permanently for the same condition pays the 50 percent surcharge for the life of the policy. When presenting options for a client with a recent health event, ask each carrier how they would structure the rating — table vs flat extra, temporary vs permanent.
Field underwriting: the conversation before the application
Field underwriting is the process of gathering enough health history from a client to estimate their likely underwriting class before submitting a formal application. The goal is to manage client expectations, select the right carriers, and avoid declined applications that show up in MIB data.
A broker who submits a full application for a client with Type 2 diabetes and no prior underwriting experience, expecting Standard rates, is setting up a client disappointment when the offer comes back at Table 4. The better workflow is to ask the right health questions before the app goes in, then run informal quotes with two or three carriers specifically known for favorable underwriting of that condition.
The non-obvious nuance here is that carriers specialize. A carrier whose underwriting manual treats controlled diabetes favorably may rate that client at Standard Plus while another carrier rates the same client at Table 2. The difference in annual premium on a $1,000,000 policy over 20 years can exceed $15,000. Quotit does not currently surface carrier-level underwriting reputation by condition as a comparison field — that knowledge lives in brokerage relationships and general agent networks.
Simplified issue and guaranteed issue: the alternative for uninsurable or highly rated clients
Clients who decline at multiple fully underwritten carriers, or whose table rating makes fully underwritten coverage financially impractical, have two structured alternatives. Simplified issue life insurance asks a short health questionnaire but skips the paramedical exam, the attending physician statement, and laboratory work. The tradeoff is a lower maximum face amount (typically $250,000 to $500,000 depending on the carrier and age) and a higher effective premium than what a healthy applicant would pay for a fully underwritten policy.
Guaranteed issue life insurance accepts applicants regardless of health status but imposes a graded benefit during the first two to three years: if the insured dies from a non-accidental cause during the graded period, the carrier returns premiums paid plus interest rather than the full face amount. Face amounts are usually capped at $25,000 to $50,000. For older clients with no other options, guaranteed issue fills a final expense function. It is not a replacement for a fully underwritten policy when the client qualifies.
The 1035 exchange rule allows a client to move from an existing underwritten policy to a new policy without triggering a taxable event on the gain in the old policy. A client with an old whole life policy who no longer needs the coverage level and is now a better risk than when originally underwritten can use a 1035 exchange to move to a new policy with a fresh underwriting review.
Life insurance underwriting classes: common questions
Clear answers on how class decisions are made and what they cost clients.
What is the difference between a table rating and a flat extra?
A table rating multiplies the Standard class mortality rate by a fixed factor at each table step. A Table 4 applicant has been assessed as having mortality risk equivalent to a Standard applicant who is several years older. The resulting premium is the Standard rate increased by 100 percent (4 steps times approximately 25 percent each). A flat extra is a fixed dollar surcharge per $1,000 of face amount, charged on top of whatever class rate the applicant otherwise qualifies for. A carrier uses a flat extra when the risk is specific and quantifiable but doesn't fit cleanly into the graduated table structure. An applicant may carry both a table rating and a flat extra simultaneously — for example, Table 2 for health history and a $3 per $1,000 flat extra for a hazardous occupation.
How do carriers decide which health conditions lead to table ratings vs flat extras vs declines?
Carriers maintain proprietary underwriting manuals that map specific conditions, laboratory values, and personal history to rating outcomes. Most carriers use build charts (height/weight tables) for BMI-based ratings, blood pressure and lipid thresholds for cardiovascular risk, and diagnosis plus treatment history for oncology and chronic conditions. Flat extras are typically used when the risk is occupation-related or tied to an activity (such as private aviation), or when a condition is temporary — a recent cancer in remission may carry a flat extra for three years that expires if the client remains cancer-free. Declines occur when the mortality risk at any table level exceeds what the carrier is willing to accept for that face amount, or when the condition is uninsurable under the carrier's current guidelines. Table 8 (200 percent surcharge) is roughly the limit for most fully underwritten products; carriers above that threshold often decline rather than rate further.
What does 'Preferred Plus' actually require?
Preferred Plus criteria vary by carrier but generally require an applicant who meets all preferred criteria and additionally has optimal laboratory results, no tobacco use in the past five years, a clean motor vehicle record (typically no more than one moving violation in three years), and a family history free of premature cardiovascular disease or cancer (first-degree relative diagnosed before age 60 or 65, depending on carrier). Blood pressure must usually be at or below 130/80 without medication, and total cholesterol to HDL ratio below 4.5. A single deviation from these thresholds — one controlled blood pressure medication, or a family history of a parent dying of a heart attack at 59 — typically drops the applicant to Preferred rather than Preferred Plus. The premium difference between Preferred Plus and Preferred is typically 10 to 20 percent.
Can a client improve their underwriting class after being rated?
Yes, through a reconsideration process, though it is not automatic. Most carriers allow a re-application or a formal request for reconsideration if the health condition that caused the rating has materially improved. A client who was rated Table 2 for elevated BMI and loses 40 pounds can request reconsideration with updated height/weight measurements and a current blood pressure reading. A client whose temporary flat extra was for a cancer treatment period can request removal when the agreed-upon term expires and the condition remains in remission. The carrier is not obligated to approve the reconsideration, and the underwriter reviews current health status at the time of the request. Some carriers require a new application rather than a reconsideration request, which triggers a full new underwriting review and potentially different results in either direction.
Does a substandard rating from one carrier follow a client to another carrier?
Not automatically. Life insurance underwriting decisions are carrier-specific, and there is no industry-wide database of individual underwriting decisions equivalent to CLUE reports in property insurance. However, the Medical Information Bureau (MIB) maintains a coded health data database that carriers query during underwriting. If a carrier reported a condition to MIB, subsequent carriers see the flag and investigate. The client is also required to disclose any prior declinations or ratings on most applications. Misrepresenting a prior rating is material misrepresentation, which gives the carrier grounds to contest a claim during the contestability period. The practical outcome is that a client rated Table 4 by one carrier who applies to another carrier will be re-underwritten from scratch, may receive a different rating, and must disclose the prior rating — but the specific dollar outcome is determined by the new carrier's guidelines, not copied from the prior decision.
