High-Value Life Insurance Underwriting: What High-Net-Worth Expats Need to Know
Applying for life insurance at sums of £1 million and above is a qualitatively different experience from a standard retail policy. The underwriting process is more thorough, the medical requirements more extensive, and the financial scrutiny more detailed. For high-net-worth expatriates — who may seek cover of £5 million, £10 million or more — understanding what to expect before the process begins reduces delays and improves the likelihood of a favourable outcome.
How High-Value Underwriting Differs from Standard Policies
For a standard retail life policy — say, £250,000 of term cover on a 35-year-old in good health — underwriting is relatively light. A short health questionnaire, a declaration of lifestyle habits, and the application is typically accepted at standard terms within days.
At £1 million and above, the underwriting process changes in two important respects:
- Medical underwriting becomes more comprehensive — the insurer requires detailed evidence of the applicant's current health, medical history and risk factors, not just a completed questionnaire.
- Financial underwriting is applied — the insurer assesses whether the sum assured is proportionate to the financial need and insurable interest.
Both elements must be satisfied before the insurer will offer terms.
Medical Underwriting for Large Sums: What Is Required
The specific medical requirements depend on the sum assured and the applicant's age. The following illustrates the typical progression:
Up to approximately £1–2 million (age-dependent): Full medical questionnaire plus a medical examination including blood panel, urine analysis and ECG. For younger applicants, the non-medical limit may be higher; for applicants in their 50s or 60s, medical examination may be required at lower sum thresholds.
£2–5 million: The above, plus typically a GP's or attending physician's report (APS — Attending Physician Statement). The APS is a structured report completed by the applicant's doctor, covering medical history, current conditions, medications, recent consultations and the doctor's assessment of the applicant's health status.
£5–10 million: All of the above, plus potentially specialist reports where the medical history includes a specific condition. A past cardiac event may require a cardiologist's report with recent ECG and imaging results. A history of cancer may require an oncologist's report confirming remission and most recent investigations. For applicants over 50, some insurers require an exercise ECG (treadmill test) or cardiac imaging.
Above £10 million: Full medical workup including all of the above, with reports from all treating specialists. Some insurers will require the examination to be conducted by a doctor of their choosing or by an approved medical examination service, rather than relying solely on the applicant's own physician.
Specific Tests Commonly Required
Full blood panel: Complete blood count (CBC), lipid profile including LDL and HDL cholesterol, blood glucose and HbA1c (for diabetes screening), liver function tests (LFTs), kidney function (creatinine and eGFR), thyroid function, and prostate-specific antigen (PSA) for male applicants above a certain age. At very high sums, additional markers may be required.
Urine analysis: Screening for protein, glucose, blood and other markers indicative of kidney disease, diabetes or other conditions.
ECG: A resting 12-lead ECG is standard above the medical examination threshold. An exercise ECG may be required at higher sums or where the medical history suggests cardiac risk.
HIV test: Required above a sum assured threshold that varies by insurer, typically in the range of US $1–2 million equivalent. Testing is conducted confidentially; a positive result results in a decline, not an exclusion, and is not reported to any authority without the applicant's consent.
Blood pressure: Recorded as part of the medical examination; readings above a certain threshold will be rated.
All medical examinations arranged for insurance purposes are paid for by the insurer. The applicant does not meet the cost of required tests.
Financial Underwriting: Insurable Interest and Proportionality
Financial underwriting applies at high sums because life insurance is intended to indemnify a financial loss, not to generate a profit. An insurer will not knowingly issue a policy for a sum that bears no reasonable relationship to the financial loss that would result from the policyholder's death.
For individuals seeking personal life cover — rather than business protection — financial underwriting typically considers:
- Income and earnings history — typically evidenced by recent tax returns or certified accounts.
- Net assets and liabilities — a summary of assets (property, investments, business interests) and liabilities (mortgages, loans, business borrowings).
- The stated purpose of the cover — estate planning, IHT provision, income replacement, business loan protection, or a combination.
- Existing life cover — the total life insurance the applicant already holds in force is taken into account. The insurer assesses aggregate cover across all policies.
Broadly, insurers apply a multiple of income or assets to establish the maximum sum they are prepared to offer. A common working rule is that personal life cover should not exceed approximately 20–25 times annual earnings, though this is not a fixed industry standard and is adjusted for age, assets and purpose. For estate planning purposes — where the sum assured is linked to a projected IHT liability rather than income — the calculation is different and can support larger sums.
The applicant's adviser should prepare a clear financial underwriting letter at the outset of the application, setting out the financial justification for the sum assured. A well-presented case reduces the risk of the insurer seeking additional information and extends the likelihood of a straightforward acceptance.
Business and Key Person Financial Underwriting
Where the sum assured is intended to protect a business — as key person cover, shareholder protection, or to secure a commercial loan — the financial underwriting process is adapted accordingly.
The insurer will assess:
- The size and financial position of the business.
- The applicant's role and contribution to the business's value.
- How the business would be financially impacted by the applicant's death.
- The commercial loan or buy-out arrangement the cover is intended to fund.
Business protection cases typically require recent company accounts, evidence of the commercial loan agreement or shareholder arrangement, and a financial justification letter from the adviser. Cases are assessed individually; there is no simple formula.
Reinsurance and Multiple-Policy Strategies
Insurers retain only a portion of large life risks on their own balance sheet. The remainder is reinsured — transferred to specialist reinsurance companies that bear a share of the risk in exchange for a portion of the premium. Reinsurance capacity influences the maximum sum any single insurer will offer and the terms on which they will offer it.
For very large cases — £5 million, £10 million or above — the dynamics of reinsurance become relevant to the client in two ways:
Single policy: The insurer approaches their reinsurer to support the case. If the reinsurer's appetite is limited — for example, because of the applicant's age, health history, or country of residence — the insurer may reduce the sum they are willing to offer, apply a loading, or impose exclusions.
Multiple policies across providers: Spreading a large sum across two or three insurers, each underwriting a portion, may produce more competitive aggregate terms than placing the entire sum with one provider. Each insurer underwrites within their own reinsurance treaty, and the total available capacity is effectively greater. For sums above £3–5 million, this approach is frequently used in practice.
An adviser who places large cases regularly will have a working understanding of the reinsurance appetite and limits of each major provider, allowing them to structure applications to maximise the likelihood of favourable terms.
Timescales for Large Cases
Applicants should expect high-value life insurance cases to take longer than standard applications.
A straightforward case — healthy applicant, clear financial position, sum in the £1–3 million range — typically takes four to eight weeks from submission of the completed application and medical forms to a decision. This allows time for the medical examination to be arranged, for the GP or treating doctor to complete the APS, and for the insurer's underwriters and medical officer to review the file.
More complex cases take longer:
- A case requiring specialist reports (cardiologist, oncologist, etc.) may take 10–14 weeks.
- Cases where the insurer's medical officer wants a further opinion or additional tests extend further.
- Very large cases requiring the insurer to approach reinsurers for capacity can add several weeks to the process.
The most common cause of delay is incomplete or late medical evidence. Ensuring that the applicant's GP and any specialists understand the urgency and provide reports promptly is part of the adviser's coordination role.
What Happens If an Insurer Declines
A decline at high sums does not necessarily mean that cover is unavailable. Several options remain:
- Second opinion within the same market — another mainstream provider may assess the same risk more favourably.
- Specialist underwriting markets — Lloyd's of London syndicates and specialist life insurers write risks that the mainstream market declines, typically at a higher premium or with specific exclusions.
- Reduced sum assured — if the full sum is not available at any provider, partial cover at a lower sum may be achievable.
- Deferred application — where a recent medical event has created uncertainty, waiting 12–24 months and reapplying once the position has stabilised may produce a better outcome.
An experienced adviser will consider the full range of options rather than treating a single decline as the end of the process.
This guide is for information purposes only and does not constitute financial advice. Underwriting decisions are made by individual insurers and reinsurers based on their own guidelines and capacities, which vary and may change. Always seek independent professional advice before applying for high-value life insurance.
How Global Investments Can Help
Global Investments has arranged high-value life insurance for high-net-worth expatriate clients for over 32 years. We have direct working relationships with the underwriting teams at RL360, Friends Provident International, Zurich International Life and other international providers, and access to specialist markets for cases that fall outside standard parameters.
For large sum cases, we prepare comprehensive application packages that include a structured financial underwriting letter, a medical history summary, and coordination of the medical examination and report process — reducing delays and presenting the strongest possible case to the insurer's underwriters.
Where one provider declines or offers unacceptable terms, we manage the search for alternative capacity, including specialist and reinsurance markets. We also advise on whether a single-insurer or multi-provider structure is more appropriate for your circumstances.
To discuss a high-value life insurance requirement in confidence, speak to one of our senior advisers.
Frequently Asked Questions
Why do insurers require financial underwriting for large life policies?
At high sums assured, insurers apply financial underwriting to confirm that the sum requested is proportionate to the policyholder's financial position and insurable interest. A policy that far exceeds the financial loss that would result from the policyholder's death raises concerns about over-insurance and, in extreme cases, moral hazard. Insurers typically ask for evidence of income, assets, liabilities, and the financial purpose of the cover.
What medical tests are required for a £5 million life policy?
For a sum in this range, a typical insurer would require a full blood panel (including cholesterol, blood glucose, liver and kidney function), an ECG, urine analysis, a resting blood pressure assessment, an HIV test, and a report from your GP or treating doctor. For applicants over 50, an exercise ECG or cardiac imaging may also be requested. The exact requirements depend on age and the insurer's guidelines.
How long does underwriting take for a high-value life policy?
A well-prepared application for a £1–5 million policy typically takes four to eight weeks from submission to a decision, assuming all medical requirements are met promptly. More complex cases — large sums, complex medical histories, or cases requiring specialist reports — can take twelve weeks or longer. Coordinating the medical process efficiently through an experienced adviser reduces delays.
Is it better to place a large sum with one insurer or split it across several?
Both approaches have merit. A single policy is simpler to administer. Splitting across two or three providers diversifies insurer counterparty risk and can sometimes be achieved at more competitive terms, because each provider underwrites a smaller sum within their own reinsurance treaties. For very large sums (£5 million+), spreading the risk is often necessary in practice, as few insurers will retain the entire sum on their own book.
If one insurer declines my application, does that affect my chances with others?
Technically no — each insurer underwrites independently. However, some application forms ask whether you have previously been declined. An experienced adviser manages this by assessing your risk profile in advance and approaching providers in a considered order, minimising the likelihood of an early decline that then has to be disclosed. Where a decline has occurred, specialist and reinsurance markets may still offer cover.
This guide is for general information only and does not constitute financial or insurance advice. Policy terms, premium rates, and insurer eligibility criteria change — always verify current terms with a qualified independent adviser before taking out any policy.