A1C Life Insurance Underwriting Chart: How Insurers Rate Diabetes and Blood Sugar Levels

A1C Life Insurance Underwriting Chart: What Insurers Look At

Life insurance companies use the A1C test — also called glycated hemoglobin — to gauge average blood sugar over two to three months. It is one of the most important health metrics in the underwriting process for applicants with diabetes or prediabetes. The A1C life insurance underwriting chart maps specific percentage ranges to rate classes, helping insurers decide whether to issue a policy, decline it, or offer standard, table-rated, or preferred pricing. Understanding this chart helps applicants know what to expect and how to prepare before the medical exam.

Insurers do not use a single universal A1C life insurance underwriting chart. Each carrier sets its own thresholds, but most follow a similar framework based on clinical guidelines from the American Diabetes Association. The chart below reflects the general ranges commonly used by major carriers when evaluating a life insurance application.

How A1C Fits Into the Full Underwriting Process

The A1C result is never the only factor. Insurers combine it with other data points — age, gender, type of diabetes, duration of diagnosis, BMI, blood pressure, cholesterol, medications, complications, and lifestyle habits — to build a full risk profile. An applicant with an A1C of 7.5% who has no complications, takes oral medication consistently, and has a clean family history may receive a better rate than someone with an A1C of 6.8% who has neuropathy and cardiovascular issues.

For type 1 diabetes, insurers tend to be more cautious because the condition typically requires insulin and carries a longer history of glucose management challenges. For type 2 diabetes, outcomes are often more favorable, especially if the condition is managed through diet, oral medication, or a single non-insulin injectable. Gestational diabetes usually has minimal long-term impact if it resolved after pregnancy and the applicant has not developed type 2 diabetes.

Rate Classes and What A1C Levels Unlock

Life insurance rate classes determine how much you pay. The standard tiers are Preferred Plus, Preferred, Standard Plus, Standard, and Table Ratings (Table 1 through Table 12 or higher, where each table point adds roughly 25% to the base premium). Here is how A1C levels commonly map to these classes across multiple carriers.

Preferred Plus and Preferred

To qualify for Preferred or Preferred Plus, most insurers want an A1C below 6.5% and no diabetes diagnosis. Some carriers will consider applicants with well-controlled type 2 diabetes (A1C 6.5%–7.0%) for Standard or Standard Plus, but Preferred rates are rare once diabetes is part of the medical history.

Standard and Standard Plus

This is where most controlled diabetics land. An A1C between 6.5% and 7.5%, combined with no major complications and a stable treatment plan, often qualifies for Standard or Standard Plus. The policy is issued at a flat extra rate or a moderate table rating.

Table-Rated and Substandard

An A1C above 7.5% signals to underwriters that glucose control is inconsistent or that management is challenging. Table ratings increase with each percentage point above 7.5%. Above 9.0%, some carriers decline outright, while others will still issue with significant surcharges or graded benefits.

Common Complications That Shift the Chart

Even with a favorable A1C, certain complications trigger more conservative underwriting. Insurers cross-reference A1C results with:

• Diabetic retinopathy or vision loss
• Nephropathy or impaired kidney function
• Neuropathy or peripheral vascular disease
• Cardiovascular events such as heart attack or stroke
• Diabetic foot ulcers or amputations
• History of diabetic ketoacidosis or frequent hospitalizations

Any of these conditions can push an applicant into a higher table rating regardless of A1C. Conversely, a slightly elevated A1C with no complications and no other risk factors may still receive a competitive offer.

Tips to Improve Your A1C Before Applying

If you are planning to apply for life insurance and know your A1C is above target, taking steps to lower it before the exam can meaningfully improve your rate class. Most changes need at least three months of consistent effort, since the A1C test reflects a rolling two- to three-month average.

• Work with your doctor to adjust medications or insulin dosing before the exam
• Adopt a lower-carbohydrate or Mediterranean-style diet for at least 90 days
• Add moderate aerobic exercise — 150 minutes per week — which directly lowers A1C
• Reduce stress and prioritize sleep, both of which affect glucose regulation
• Avoid significant weight fluctuations close to the exam date
• Bring records of consistent monitoring (logbooks, CGM data) to the exam

Applicants should also consider the timing of their application. An A1C taken two weeks after a major dietary change or illness may not reflect steady-state control. Underwriters often prefer results from the most recent exam but may request a repeat if the number looks unusually favorable or inconsistent with other health indicators.

What If You Are Declined or Rated Harshly

A decline or a high table rating is not the end of the process. Different carriers use different A1C life insurance underwriting charts, and one company's Table 10 may be another company's Standard. Working with an independent broker who specializes in impaired-risk or diabetes-friendly underwriting can help you identify carriers that are more lenient with your specific profile. Guaranteed-issue or simplified-issue policies are also options for applicants who cannot qualify medically, though they come with lower coverage amounts and higher costs per thousand dollars of benefit.

The Bottom Line

The A1C life insurance underwriting chart is a critical tool that shapes how insurers price coverage for people with diabetes or prediabetes. While A1C ranges provide a framework, every application is evaluated holistically. Knowing your number, understanding the chart, and taking proactive steps to improve control before the exam puts you in the strongest position to secure affordable coverage. Work with a broker who understands diabetes underwriting, keep your medical records organized, and apply to multiple carriers to find the best offer for your profile.