(This is a hot subject getting global scrutiny in a teleunderwriting context. The article is well worth reading!)

Life underwriters may be missing the forest for the trees when they ignore the broader implications of lifestyle and economic status, says Tia Sawhney writing in the March issue of Contingencies.

Dr. J. Carl Holowaty MD, DBIM revists his September 2005 piece looking at the epidemiological trends relating to obesity, Weighing-In On Obesity, and explores three other important topics: Prostate Cancer and PSA, Viral Hepatitis B and C, and MRSA.

The Individual Life Experience Committee has completed their latest report on intercompany mortality experience by amount of insurance under standard individually underwritten issues. This study includes policy years 2005-07. Read the report and associated documents.

A proposal in the House and Senate healthcare reform bills, the CLASS Act, establishes a federal long-term care (LTC) program financed from participant premiums without any federal subsidy. The new LTC program is subject to guaranteed issue, and that, combined with its voluntary nature, subjects the CLASS Act to considerable adverse selection risk. This paper by Al Schmitz examines this risk while considering other likely consequences.

From Bob Pedigo's series discussing the benefits of using the Laser Underwriting Approach, which utilizes an agency-based staff underwriter.

Catch Hank's article on Rx Underwriting, a look at the genetics of Huntington's Disease, a piece on medical advances that affect the industry, and more.

With the need for quicker turnaround time and swifter issue of policies, the life insurance industry was faced with a dilemma. How could the industry achieve this target to satisfy its customers’ needs without compromising its strict underwriting practices and its risk profile? The answer was simplified underwriting.

The Marketing and Distribution and Product Development Sections along with the Committee on Life Insurance Research, are pleased to make the following report available. Authored by a Mike Batty and Alice Kroll of Deloitte Consulting, the report summarizes the results of a company survey on the utilization of life insurance automated underwriting systems.

Americans, at least as a group, may have reached their peak of obesity, according to data the Centers for Disease Control and Prevention released recently.

Lifestyle Based Analytics can be used for a variety of decision-making behaviors and events in healthcare.

The 10 leading causes of death were the same in 2006 and 2007. The rankings also remained the same, with one exception. In 2007, Alzheimer's disease was the sixth leading cause of death, and diabetes the seventh; the ranks were reversed in 2006. Age-adjusted death rates for six of the 10 leading causes of death declined from 2006 to 2007 (from a decline of 1.8% for malignant neoplasms to a decline of 8.4% for influenza and pneumonia). Only the rate for chronic lower respiratory diseases increased (up by 1.7%). No changes were observed in the rates for Alzheimer's disease; nephritis, nephrotic syndrome, and nephrosis; and septicemia.

This Gen Re Risk Matters issues describes the changes to the HbA1c measurement and how underwriters should interpret them.

The Foreign Travel Survey Subcommittee of the Society's Committee on Life Insurance Mortality & Underwriting Surveys has completed their report on the results of a survey on foreign travel underwriting practices of reinsurance companies.

The Society of Actuaries International Experience Study (IES) initiative is in its seventh year. During that period, considerable progress has been made expanding experience studies into less developed parts of the world. This article (from the SOA International Section's August newsletter) presents the most recent preliminary results from Argentina, the Caribbean, the Philippines, Poland and Vietnam.

This is the eighth article in a series of 12 discussing the benefits of using the Laser Underwriting Approach, which utilizes an agency-based staff underwriter. Each story in the series addresses one of the 10 preliminary questions that make this approach effective. (Earlier articles in the series can be accessed here.)

The September 2009 issue looks at:

• Life Reinsurance Data from The Munich American Survey By David M. Bruggeman
• What Reinsurers and Cedants Can Learn from Uncle Rex and the Bulls By Rick Flaspöhler
• Reinsurance Modernization – A New World ViewBy Daniel W. Krane and Elizabeth A. Diffley
• Life Reinsurance: Capacity and Concentration of Risk Survey Analysis By William J. Briggs, Gaetano Geretto and Robert B. Lau
• Enhancing the Benefit: How quality successful limited-benefit health plans answered the demand for a more robust product By Curt A. Wieden
• American Academy of Actuaries Stop Loss Risk-Based Capital Work Group is Reviewing the Potential Need for Changes in the RBC FactorsBy Michael L. Frank

When an underwriting historian looks at the subject of financial underwriting, they quickly come to the realization that the conflict/confusion/befuddlement in the different perspectives between underwriter and advisor has existed since days we could not agree on the value of the inventor of the wheel as key man.

Heritage Labs' newsletter eEnvoy discusses the mortality associated with albumin and globulin. Using our database of insurance applicants and the Social Security Death Master File, we can measure increases in mortality at levels of albumin and globulin that may surprise many of our readers. The risk rises even before the lowest 2.5th percentile which is the traditional level chosen for a “lower limit of normal”.. We also propose a unique formula to help discern the relationship between albumin and globulin better than the current A/G ratio.

Underwriters are seeing requests from clients to modify policy provisions in advance of anticipated layoffs. By Eric Swanson, Senior Marketing Underwriter, ING Reinsurance. Reprinted from May 2009 Best's Review.

Topics covered include:

• Arterial Hypertension - A Major Risk Factor
• Hypertension Management through Physical Exercise
• Blood Pressure and Stress
• A Look across the Fence - Underwriting in France
• An Exceptional Sport: Canoe Polo - A Mixture of Various Sports
• An Exceptional Profession: No False Movement - Sign Language Interpreting
• Hypertension - Case Examples
• Seminar Dates

The latest issue looks at:

• Underwriting the Elderly - Findings From a U.S. Survey
• Beyond Containment but Well Into the Guessing Game - The Novel A/H1N1 Influenza Pandemic
• Evidence-based Underwriting - Rheumatoid Arthritis

Obesity is associated with increased health-care costs, reduced quality of life, and increased risk for premature death. Common morbidities associated with obesity include coronary heart disease, hypertension and stroke, type 2 diabetes, and certain types of cancer. As of 2007, no state had met the Healthy People 2010 objective to reduce to 15% the prevalence of obesity among U.S. adults. An overarching goal of Healthy People 2010 is to eliminate health disparities among racial/ethnic populations. To assess differences in prevalence of obesity among non-Hispanic blacks, non-Hispanic whites, and Hispanics, CDC analyzed data from Behavioral Risk Factor Surveillance System (BRFSS) surveys conducted during 2006-2008.

Improving its private-label market for term life insurance gave Transamerica Reinsurance an entirely new perspective on automated underwriting.

This is the second part of a series on the uses and misuses of mortality metrics. Life table construction is beyond the scope of this article, but the reader will need some familiarity with life tables in order to understand the issues. See this related document which illustrates life table construction and the calculation of life expectancy.

To examine the relationship between alcohol and suicide among racial/ethnic populations, CDC analyzed data from the National Violent Death Reporting System (NVDRS) for the 2-year period 2005--2006 (the most recent data available).

In this special section, three insurance suppliers (ImageRight, MajescoMastek and PlanetSoft), discuss some current issues in underwriting.

The latest issue of Risk Matters takes a timely look at the possible impact of the current flu outbreak.

With the flowering of “financial services,” life insurers are now seriously questioning the appropriateness of cumbersome, time-consuming and blatantly customer-unfriendly screening tests.

The insurance industry is in the business of controlling threats to life. It has invented new mortality gadgets, and now it needs to control them properly despite today’s tough times.

As part of the recently released 2008 VBT mortality tables, the Society of Actuaries introduced a theoretical model of the mortality continuum for the insurable population. The model’s spectrum extends from the very best super-preferred risks to those who barely qualify for a residual-standard class. Also included in the theory are underlying distributions for each distinct level of mortality. So how does the SOA model hold up to real world empirical data? Transamerica Reinsurance’s mortality experience database provides an ideal vehicle for putting the theory to the test.

Willis Re: Reinsurers Outperformed Financial Services Community in 2008

To update 2006 state-specific estimates of cigarette smoking, CDC analyzed data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS) survey and examined trends in cigarette smoking from 1998--2007. Results of these analyses indicated substantial variation in current cigarette smoking during 2007.

Presentation by Transamerica Reinsurance's David Wylde at the 2009 MUD Group meeting.

Presentation by Rick Bergstrom and Anna Hart at the 2009 MUD Group meeting.

From the Morbidity and Mortality Weekly Review.

Hannover Life Re believes that we should all be looking to offer cover to as many individuals as we can and that as far as possible insurance should strive to be inclusive. The company also feels it is right to challenge ourselves to continue to change cultural attitudes and encourage inclusive behaviour.

From Gen Re's Risk Insights publication.

During a recent visit to an insurer’s offices, Heritage was asked “What reflex rules are being used by your clients regarding Hepatitis C? Our internal studies convinced our company to start reflex testing even when the LFT’s are highly normal.” -- February 2009 article by Danny Perkins.

Hank George has written a comprehensive research paper on a new test ideally suited for mortality and morbidity risk screening. It will serve well in tandem with NT-proBNP and other blood tests, as an alternative to treadmill ECGs and other slow, costly requirements we currently use.

Check out these articles on:

• Calibrating Mortality Estimates From Insurance Applicants Linked To Mortality Data: How Do We Measure Up?
• Lipemia, Hemolysis And Things That Go Bump In The Lab
• A1C And Mortality Implications
• Results Reported From Plasma

In the setting of a worldwide increase in obesity and diabetes, reviews the protective value of current testing strategies. In plausible scenarios, shows that choosing uniform testing with HbA1c produces mortality savings that recover testing costs within short durations.

Presentation at ReFocus 2009.

This Question of the Month came from a client visit where the lipid profile was discussed. The comment expressed was that sometimes all 4 components of the profile are not given, most often the LDL which is sometimes not provided in an APS. When a suggestion was made to use the “lipid formula,” the inquiring underwriter had no knowledge of the formula or how to use it.

'Risk' is a term that comes up frequently when people discuss medicine and health: What's my risk of heart attack? Breast cancer? What's my risk of dying from a complication of surgery? Or having a dangerous reaction to a drug?

But according to Mark V. Pauly, Wharton professor of health care systems, consumers don't necessarily use that term in the same way that medical and insurance experts do -- which is a potential pitfall that can lead to less than optimal health care decisions and faulty policymaking.

Life insurance underwriters are frequently faced with assessing the mortality of an impaired risk. There are two primary ways by which this increased mortality can manifest itself: as a multiple of standard mortality or as a constant addition to standard mortality.

When working with an older client in the planning process, the individual’s health may be a critical component of the underwriting equation. Right from the start, there are certain issues that should be taken into consideration.

Heart disease continues to be the leading cause of death for Americans, according to the Centers for Disease Control.1 Fair, inexpensive, and accurate assessment of health risk presents a challenge to all insurance companies. Research in clinical medicine is impacting insurance medicine in new and exciting ways and is transforming how companies assess the cardiac risk of a proposed insured. New laboratory testing evaluating insurance risk profiles will assist in more accurately classifying cardiac risk. It is important, therefore, to review the new and existing laboratory markers that are available in your clients’ cardiac mortality risk.

The UK insurance industry developed its first set of standardised critical illness definitions in 1999. This article describes the approach taken by the South African insurance industry when it recently developed its first set of standardised definitions.

http://www.towersperrin.com/tp/showdctmdoc.jsp?country=global&url=Tillin...

From the CDC's Morbidity and Mortality Weekly Report.

Homeostasis is either the equilibrium itself or the process through which equilibrium is maintained between various chemical compositions and/or physiologic function in the body. Homeostasis is achieved by what engineers call “negative feedback loops” – sensors detect deviation and trigger corrective forces to bring the system back into equilibrium. There are thousands of such equilibria in the body, and the condition known as frailty in the elderly is thought to result from impaired homeostatic processes. (David Wesley, Vice President, Medical Research and Development)

Building a bona fide mortality management solution is not easy, but the value-creating potential is too big to ignore. In the short run, a mortality management solution improves operational efficiencies and mortality results. In the long run, it captures data that provide essential insights for building competitive products and meeting evolving regulatory demands, according to Joanne Collins, Lead Consultant, Product Consulting & Development.

Recent articles in mainstream publications have raised questions on some quarters regarding the use of Rx (pharmacy) profiles in underwriting.

Does this work to the detriment of the best interests of insurance seekers? The short answer is absolutely not, says Hank George.

Presentation by Kathy Thomas at the SOA Individual and Small Group Health Insurance Underwriting Seminar, September 2008.

Presentation by Valerie Lendt at the SOA Individual and Small Group Health Insurance Underwriting Seminar, September 2008.

This paper highlights the menace of overweight and obesity which are on the rise. Health care systems and insurance industries are directly affected. Liability claims are on waiting. The food related damage claims are costly. Insurers are therefore driven to find a solution: classify overweight and obesity as a group, adjust their premium to reflect the cost, and justify the classification and the adjustments.

Presentation by Tia Sawhney at the September 2008 SOA Individual and Small Group Health Insurance Underwriting Seminar.

Presentation from SOA Annual Meeting in Orlando, October 2008.

• Underwriting and the Financial Services Concept, Presenter: Hank George, Hank George, Inc

• Canada Life's Teleunderwriting Operation, Presenter: Helga Hryb, Canada Life Assurance

• Emerging Value of New Underwriting Resources, Presenters: David Redpath, Hartford Life and Eric Hjerpe, Allstate

• Insights into Outsourced Teleinterviewing, Moderator: Hank George, Hank George, Inc., Presenters: Andrew Gething, MorganAshe, Carol Dineen, MRS Inc., and Rocco Salviola, RSA Medical

• Report of a Teleunderwriting Survey, Presenter: Hank George, Hank George, Inc.

• Beneficial Life's Teleunderwriting Operation, Presenter: Wally Taylor, Beneficial Financial Group

• American Enterprise's Teleunderwriting Operation, Presenter: Meg Brown, American Enterprise Group Insurance Company

A follow-up to the article originally published in the May 2006 edition of Product Matters!, the newsletter of the SOA Product Development Section.

• Life Reinsurance Data From The Munich American Survey
• Longevity: Mortality Improvement
• Solvency II—What It Means For Reinsurers
• Limited Medical Benefit Plans—What Insurance Companies, Employers And Reinsurers Need To Know
• Update In The Employer Stop Loss Medical Insurance Market
• Reinsurance Execs Predict Capital Channels Will Blur
• STOLI Poses Danger To Industry, Reinsurers Warned

...and more.

Daniel Perkins, JD, FALU writing in Heritage Labs' eNews, August 2008. Part II is at this link: http://www.hooperholmes.com/Skins/Image/HL_Cocaine_UnderwritingII.pdf.

Published in January, this issue covers:

• Measuring GFR
• A1c
• 21st Century Geriatric Medical Underwriting
• New Tools for Older Age Underwriting

...and more.

Presentation at the MUD Group meeting in January 2008 by Charles Levy, MD, Chief Medical Director, AIG American General Domestic Life Companies.

Presentation at the MUD Group meeting in January 2008 by Charlotte A. Lee, M.D., FLMI, 21st Services, LLC.

Presentation at the MUD Group meeting in New York, January, 2008 by Steve Bloom, Vice President & Chief Underwriter, New York Life Insurance Company and Joe Manczuk, Vice President & Chief Underwriter, RGA Reinsurance Company.

November 2008 GenRe Underwriting Focus looks at:
Gastrointestinal System - Stomach Disorders: Gastric and Duodenal Ulcer Disease / The ABC of Gastritis / Functional (Nonulcer) Dyspepsia / A Look Across the Fence - Underwriting in Singapore / An Exceptional Sport: Speedflying / An Exceptional Occupational Profile: Freefall Photography / Certified Medical Underwriting Specialist (CII) - Graduation 2008 / Seminar Dates / Stomach Disorders - Case Examples.

This article series continues to explore the evolving landscape of underwriting in the 21st century. In this installment we explore the impact of informal, or preliminary, applications on both the workfl ow of an underwriting department and on relationships with producers. We spoke with four leading carriers in this market about innovations they have implemented to improve these dynamics, and we also spoke with a reinsurer to gain additional perspective on this marketplace.

In the following article Hannover Life Re highlights results from one recent large medical study and outline their implications for coronary heart disease treatment options. In particular, the article considers how this type of medical information can inform decision-making on definitions and scope of cover for critical illness benefits.

Article on p. 19 of the newsletter of the Australian Life Underwriters and Claims Association.

Without underwriting, individual coverage applicants on average cost 40% more than applicants for small group coverage. While the individual market provides insurers more opportunities to take rating actions and to improve their competitive positions, it also presents more risks than group insurance since individual health insurance applicants are collectively less healthy and have greater variance in their claim costs than applicants in other markets. For these reasons, the individual market is especially susceptible to adverse selection.

http://www.genre.com/sharedfile/pdf/Topics16_FischerH-en.pdf

Looks at a possible tool for better differentiating prostate cancer.

Recaps some key findings from evidence based underwriting research Gen Re has completed into multiple sclerosis.

Hank George reviews patient noncompliance with routine medical screening and how this is a major risk-taking behavior. It is fully documented from the worldwide medical literature. In this article, Hank argues that both risk-taking behaviors and findings consistent with the "healthy adherer" effect should be included in teleinterviews and used in risk assessments.

An actuary uses his skills and develops some new tones to put a face on racial disparities in his hometown.

Presentation by Robert L. Stout, Ph D.

Presentation by F. Sestier, MD, PhD and A. Naslafkih, MD, PhD.

Some researchers now believe that certain diseases can be postponed simply by slowing down the aging process, says this piece in Contingencies.

What is old? That depends. In 2000, the majority of life underwriters responding to an older age survey said they considered people who are age 60-65 to be in the older age group. But since then, they've revised their definition—upward.

Profiles heart attack cover in critical illness insurance contracts, how wording has evolved in the clinical setting, and illustrates the practical challenges of assessing these insurance claims with a case study.

This article considers the benefits of managing hypertension with combination therapy and what under writers must consider in reviewing applicants that disclose such regimens.

Potential testing options in underwriting people over age 65 are on the move. (link updated)

Handouts from the Living to 100: Survival to Advanced Ages International Symposium for sessions such as:

• Distinguishing Health Status For Advanced Ages - Faye S. Albert, John M. Bragg, James C. Brooks, Dr. Bob Gleeson, Steven K. Holland, Ashely Thomas
• Demographic Implications of Aging Populations Internationally - Robert L. Brown, Roberto Ham–Chande, Steven G. Prus, N. V. Subramanyan
• Quality of Life of Elderly - Beverly J. Orth, Anna M. Rappaport,Eric Stallard
  

This Contingencies article says that from an actuarial point of view, it might be interesting to know whether it’s possible to predict the likelihood of a person living to 100 and beyond based on general personal data taken at some point in young adulthood.

The bane of pricing actuaries is thier desire for more and more data in a preferred risk environment that is designed to produce fewer and fewer deaths. Previous mortality experience can be a reliable indicator of the future performance as long as one understands the potential variability in these future results. To that end, David N.

Gen Re on Inflammatory Bowel Disease (IBD) / Irritable Bowel Syndrome (IBS) / The Concept of "Scarless" Abdominal Surgery / A Look Across the Fence - Underwriting in Mexico / An Exceptional Sport: Chessboxing - Involving Brains and Brawn / An Exceptional Occupational Profile: Perfumer - In a Frenzy of the Senses.

"The EU Gender Directive had to be implemented across the EU by 21 December 2007. This article looks at how a sample of EU countries are dealing with the Directive from a life insurance viewpoint."