Life Insurance Underwriting Strategies for Applicants with Diabetes
The common use of the term “diabetes” typically refers to diabetes mellitus, a group of metabolic disorders that cause increased blood sugar levels. High blood sugar levels cause damage to blood vessels, which in turn can lead to a eye damage, kidney damage, heart disease, and strokes among other conditions. From a life insurance underwriting perspective, the most important variables are the type of diabetes, the age of onset, the level of blood sugar control over time, and complications from the disease.
Two Common Types of Diabetes:
The two most common forms of diabetes are classified as Type 1 or Type 2. Type 1 diabetes refers to diabetes caused by the destruction of the insulin producing cells of the pancreas, often very early in a person’s life.
The far more common form of the disease is Type 2. This condition is caused by cellular changes that make the entry of insulin, and thus the normal processing of blood sugar levels, more difficult. Our increasingly sedentary lifestyle, excessive calorie consumption, and the resulting rise in obesity have led to a significant increase in Type 2 diabetes among increasingly younger life insurance applicants.
Type 1 diabetics require the administration of insulin, either via several injections per day, or, increasingly, via insulin pump. Type 2 diabetics usually control their condition with a combination of diet, exercise, weight loss, and oral medications – although insulin injections are sometimes necessary to control blood sugar levels even in Type 2 diabetics.
Expected Underwriting Outcomes:
Age at diagnosis for diabetes is important as the effects of diabetes are cumulative. In other words, the longer one has diabetes, the greater the impact. Developing Type 1 diabetes as a young child is substantially less favorable than the development of Type 2 diabetes in one’s late 60s.
Underwriting outcomes for both forms of diabetes depend heavily on good blood sugar level control as documented via periodic glycohemoglobin A1c tests. Medical records that show A1c levels close to 7.0 over recent years are highly favorable to underwriting both forms of diabetes.
Type 1 diabetics diagnosed in early childhood – assuming good blood sugar control – can often be insured at moderate to high table ratings.
Type 2 diabetics diagnosed in late adulthood with excellent control and exceptional medical compliance can often qualify for standard – sometimes preferred – underwriting. Type 2 diabetics diagnosed in mid-life with good control may qualify for low table ratings at some insurers. Moderate control and suboptimal medical follow-up leads to moderate ratings even at the most aggressive insurers. Diabetics who continue to smoke are very difficult to underwrite at any carrier.
Newly diagnosed diabetics – perhaps as a surprise result of an insurance company lab analysis – are usually postponed until a workup by an endocrinologist. Key to minimizing underwriting complications is the development of medical records that show the applicant consistently follows medical guidance and is managing the disease toward achieving the lowest possible A1c reading.
Insurer Selection is Key:
Several highly rated brand name insurers have developed specialized expertise in underwriting applicants with diabetes. Unfortunately, there is no one best insurer for all applicants. Therefore, it is best to gather a few key facts in advance of a formal application. Our underwriters can use that information to negotiate preliminary underwriting assessment from several insurers, identify the most aggressive carrier, and model approximate product pricing for you. You and your client can then make an informed decision on the best way forward. Answers to the questions below will enable us to identify our industry’s top solution(s) for your client.
Pre-Formal Underwriting Questions:
- What is your name?
- What is your gender? F ___ M ___
- Date of birth:
- Do you have Type 1 or Type 2 diabetes?
- At what age were you diagnosed with diabetes?
- What is your most recent A1c reading?
- Range of A1c readings over the past year?
- Do you use prescription medications to control your diabetes? If yes, which ones?
- Do you use insulin? If yes, please list type and quantity:
- Have you experienced any diabetic complications, e.g., retinopathy, nephropathy?
- What is your build (height/weight)? ___________ Change past 12 months: _________
- What regular exercise do you do?
- Do you use any form of tobacco or marijuana? If yes, please describe type & frequency of use:
- Please list all other prescription medications you are taking, and what each is treating:
- Are there any other medical conditions for which you are being treated? If so, please describe:
- How frequently do you follow-up with your healthcare provider?
- Can you think of any other information that might help us negotiate for a best possible offer?