Part of our guide: Impaired Risk Life Insurance Underwriting by Condition →
A total cholesterol reading in the 260-275 range sounds like an automatic underwriting problem. In two recent cases, it wasn’t. Here’s what carriers actually look at beyond the headline number.
Key takeaways
- The cholesterol/HDL ratio is often more informative to underwriters than total cholesterol alone.
- Some carriers now overlook total cholesterol levels between 150 and 300 entirely.
- Two real cases with cholesterol in the 260-275 range both qualified for favorable rate classes.
A total cholesterol of 275 with a 6.0 cholesterol/HDL ratio still came back Preferred — because the ratio, not the headline number, is what matters most to today’s underwriters.
What the numbers actually mean
The liver produces all the cholesterol the body needs on its own; dietary cholesterol from food causes the liver to send even more into the bloodstream on top of that. High cholesterol can lead to fatty buildup in the arteries, raising the risk of heart disease and stroke. But “cholesterol” isn’t one number — HDL is the “good” cholesterol that helps clear out LDL, the “bad” cholesterol, and triglycerides are another form of fat in the blood. The cholesterol/HDL ratio, calculated by dividing total cholesterol by HDL, is often more informative than total cholesterol alone: the higher the HDL, the lower the ratio, and the better that looks to an underwriter.
Underwriting has gotten more nuanced
In the past, carriers looked strictly at total cholesterol levels when underwriting a case. Today, some carriers can overlook total cholesterol levels between 150 and 300 entirely, and Preferred classes are available with favorable cholesterol/HDL ratios even when the total cholesterol number looks high on paper.
Two cases that prove the point
One client had a total cholesterol of 275 with a cholesterol/HDL ratio of 6.0, and was taking a prescribed cholesterol medication. That case came back Preferred. A second client — a 52-year-old male, non-smoker, seeking $500,000 of term coverage — had a total cholesterol of 260 with a ratio of 7.0, also on medication. That case still came back Non-Smoker Plus, a strong outcome despite the elevated numbers.
The takeaway
A cholesterol number in the 260-300 range doesn’t automatically mean a lower rate class. The ratio, the medication response, and which carrier is underwriting the case all matter more than the total cholesterol figure alone. Our life underwriting department has a heart for finding the best possible outcomes on cholesterol cases. Give us a call.
Frequently asked questions
Can a client with high total cholesterol still get a Preferred rate?
Yes. Some carriers can overlook total cholesterol between 150 and 300, and Preferred classes are available with a favorable cholesterol/HDL ratio even when the total cholesterol number is elevated.
Why does the cholesterol/HDL ratio matter more than the total cholesterol number?
The ratio accounts for how much “good” HDL cholesterol a client has relative to their total cholesterol. A higher HDL lowers the ratio, which underwriters generally view more favorably than the total cholesterol number on its own.
Reviewed by Tim Fuller on 2026-09-23
Tim Fuller
President, SRS Inc.
Tim leads SRS Inc., a full-service IMO (Independent Marketing Organization) and BGA (Brokerage General Agency) connecting independent financial professionals with life, annuity, disability income, and long-term care solutions from 60+ carrier partners — with the impaired-risk and complex-case expertise to place business other IMOs and BGAs turn away.
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