Gen Re Risk Matters considers why research supports a cautious approach to underwriting those who use cannabis.

The objective of this report is to compare the prevalence of diagnosed and undiagnosed hypertension, hypercholesterolemia, and diabetes among three racial/ethnic groups and the prevalence of co-morbidity of these conditions for U.S. adults.

A study published in Archives of Neurology reports that a new spinal fluid test can predict with 100 percent accuracy those patients suffering memory loss who will eventually develop Alzheimer’s disease.

This breakthrough offers new hope to victims of the disease and their families, who heretofore could only know for sure that Alzheimer’s was the cause of their suffering after an autopsy was performed.

Risk Matters examines a potentially recognizable and modifiable factor in LTC risk.

As people seek ever more exotic locations for their holidays, the risk of contracting malaria, or indeed other infections that are not commonly found at home, poses a risk to the insurance industry. This edition of Risk Matters looks at the risks malaria poses.

Smoking, as most of us know, carries quite measurable health risks. The Surgeon General warning on every pack of cigarettes is virtually self-explanatory. The increased mortality risk of heart attack, stroke, worsening of diabetes, lung cancer, chronic pulmonary disease, and vascular disease is well studied, and even smokers without complications pay an increased premium for their policies.

Needless to say, there is a lot at stake for both the insurer and applicant in smoker and non-smoker classification.

Have you had a case declined because of a lack of insurable interest or insufficient financial justification? If you answered yes, you have experienced the other hurdle to getting your case issued—namely, meeting the financial underwriting factors established by the life insurance carrier.

Benign prostatic hypertrophy (BPH) is an inevitable result of aging in men. An overgrowth of the prostate gland with either benign enlarged tissue or small nodules, the prevalence of this condition goes from about 20 percent in men 40 years old to almost 90 percent when they reach their 70s.

BPH, while not cancer, can cause problems with both obtrusive symptoms for men as well as possibly even urinary blockage and chronic kidney disease in more extreme cases. It is a very common condition that is encountered while underwriting male lives.

Presentation from the SOA '10 Health Meeting, held on June 28–30, in Orlando, FL.

A large international study has found that 10 risk factors account for 90 percent of all the risk of stroke, with high blood pressure playing the most potent role.

Of that list, five risk factors usually related to lifestyle -- high blood pressure, smoking, abdominal obesity, diet and physical activity -- are responsible for a full 80 percent of all stroke risk, according to the researchers.

Members of some demographic groups in California can expect to live about 20 years longer than members of other demographic groups in that state.

The Cancer Prevention Institute of California (CPIC), Fremont, Calif., discovered the wide variations in average life expectancies while conducting a block-by-block study of the population of California to examine cancer survival rates across the state.

A ground-breaking medical-based approach to quantifying longevity risk that takes account of changing mortality phases was unveiled by Risk Management Solutions (RMS) today. The RMS® Longevity Risk Model examines expected future waves of mortality improvement that depend on changing social patterns, healthcare expenditure, and the development of new medical treatments, as well as historical phases of change. Exploring how transitions occur between the different phases provides companies with a better assessment of longevity risk than conventional models that use forward projections of past statistical trends.

Includes feature stories on “An Underwriting Solution For Chromosome 6P Duplication” and “Mental Health Claims, the GP and the Claims Professional.”

The slides from Comminsure CMO Dr. Bill Monday’s presentation on May 26, 2010.

The slides from a recent paper given by Dr Detloff Rump entitled "30 years of HIV/AIDS: lessons for the life insurance industry" posted at the ALUCA NSW website.

Applicants are expected to be classified as a “preferred” risk instead of a “standard” risk, saving some policyholders more than a $1,000 a year.

Metabolic syndrome is a group of obesity-related risk factors that increases your risk of heart disease, diabetes and stroke. A person with at least three of these five risk factors is considered to have metabolic syndrome: excess abdominal fat, high triglycerides, low HDL cholesterol, high blood pressure and high blood sugar according to the American Association for Long-Term Care Insurance which tracks health conditions impacting the aging American public.

Hank's article in NAILBA's Perspectives says if there is a definable subpopulation freely opting to hike their odds of early demise, this is cigarette smokers. Therefore, it made consummate good sense when several proactive insurers began offering “cigarette smoker vs. all others” pricing, sorting residents of Marlboro Country into a separate, higher premium risk class. (Article begins on p. 36.)

According to the American Association for Long-Term Care Insurance (AALTCI), there are about 24 million people in the world living with dementia, with 4.6 million new cases coming forward every year.he study by Boston University School of Medicine (BUSM) published online in the journal Annals of Neurology, confirms the inverse association of increasing BMI with lower brain volumes in older adults and with younger, middle-aged adults.

New research shows seniors with higher levels of vitamin D demonstrate more youth and vitality as they enjoy longer life spans. A limited number of studies have pointed to the possibility that optimal intake of vitamin D (the “sunshine” vitamin) might help keep our muscles strong and preserve physical function. To help understand this diet-health association, researchers at Wake Forest University studied the relationship between vitamin D status and physical function in a group of relatively healthy seniors living in Memphis, TN and Pittsburgh, PA.

As the number of seniors continues to grow, more and more surgical operations are being performed on this segment of the population. Johns Hopkins University reports that approximately half of all operations in this country are performed on patients 65 and older. For patients older than 80, the chance of death during the month following a surgical procedure increases by 26 percent.

Now Johns Hopkins is releasing a study conducted with the American College of Surgeons which assesses the frailty of surgical candidates and attempts to predict the likelihood of post-surgical complications, hospital stay length and need for post-operative nursing care.

Intensive sports and exercise at young age may be the cause, experts say.

While most of the regulations necessary to implement healthcare reform have yet to be issued, it is clear that the health insurance industry will face a new layer of regulatory complexity. Health plans will be more heavily scrutinized at both the state and federal levels.

This paper outlines the scope of the changes facing health insurers in the individual, small group, and large group markets.

From a series 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.

Technologies supporting automated underwriting processes are gathering momentum in the United States. New data-driven methodologies have emerged, and insurers have begun to sell insurance to the middle class, a group that has been underserved by insurers focused on selling to high-net-worth individuals.

Further research is needed to determine if treatments that improve sleep duration may help stabilize glucose levels in people with diabetes. The study will be published in the June issue of the Journal of Clinical Endocrinology & Metabolism.

A new survey charts the insurance industry's shift toward telephone interviews and away from more traditional underwriting techniques. (Article in Contingencies by Hank George and Susie Cour-Palais)

Presentations made in the period from 2007 through 2009 are available for viewing. Among the topics in 2009:

• Betsy Sears - Hepatitis B & C
• Dr. Robert Baird - Sleepless in Dallas
• Radford Diastolic Dysfunction
• Underwriting Crohn' Disease
  

We’ve all seen it—basic group life rates that look more like AD&D rates; rate guarantees periods that resemble a mortgage contract; liberal guarantee issue maximums; and plan maximums that are so high that no person in the group even comes close to qualifying for, and on and on.

In many situations insurance benefits are subject to complex tax treatments. Insurance underwriters in Australia should have an appreciation of the taxation issues for they are relevant to managing the expectations of and relationship with the policy owner. This article from Gen Re's April 2010 Oceania newsletter provides a guide to understanding the tax implications in relation to Key Person insurance.

New life underwriting technologies have gained ground during the last decade. Recent surveys sponsored by the Society of Actuaries and other industry groups show strong inroads and increased confidence in these new tools. More significantly, the focus of underwriting technology is moving beyond speed, ease of case submission and sales support to strategic business benefits, including product design, pricing and capital considerations. As we enter a new decade, the goal will be to take advantage of what’s available to improve efficiencies without losing sight of the big picture – risk management – and the analysis and understanding that is required to manage risk.

The secret to finding small business owners who are good disability insurance risks even in the middle of the Great Recession is that there is no secret, according to Ernest Smith in a breakout session on “financial underwriting” in turbulent times at a disability insurance conference organized by JHA, Portland, Maine, a unit of General Re Life Corp., Stamford, Conn.

An estimated 1.7 million deaths, hospitalizations, and emergency department visits related to traumatic brain injury (TBI) occur in the United States each year, according to a report released by the Centers for Disease Control and Prevention.

The report, “Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations, and Death,” is based on data from 2002-2006 and identifies the leading causes of TBI and incidence by age, race, and gender.

What are the characteristics of a good underwriter? A few of the more important traits are: one must be analytical, flexible and creative, a decision maker, and a good communicator. Let’s examine each of these qualities in more detail.

This paper concentrates on both the non-motor symptoms whose management can reduce the likelihood of claim and the length of claim and the recent research suggesting changing patterns of PD mortality.

This is the 12th and final article discussing the benefits of using the Laser Underwriting Approach for Trial Applications. We have addressed 10 of the top questions that can help make the approach effective, utilizing an agency-based staff underwriter.

(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.

U.S., Bermuda and large international reinsurance companies lost about 15% of their capacity in 2008 as measured by shareholders’ equity. But A.M. Best Co. believes that two excellent operating years preceding 2008, sizable capital increases after Hurricane Katrina and significantly improved loss reserves have enabled the reinsurance industry to withstand the barrage of investment charges and catastrophe losses.

The current economic crisis is challenging life insurers to look closely at all of the products in their portfolio and make adjustments as necessary. While much of the focus is on variable annuities and universal life with secondary guarantees, the performance of term life is also affected by market upheaval.

In this issue of The Forecaster, Jim McArdle, Senior Vice President of Sales and Marketing at Transamerica Rinsurance, discusses the impact of current market conditions on term life insurance with Keith Dall, Principal at Milliman, Inc. Keith sees companies responding in a variety of ways – looking for new financing solutions, tightening underwriting guidelines, monitoring products and rates more closely and more.

This article is the first of a two-part series by Transamerica Reinsurance Vice President, Medical Research and Development, David Wesley, on relative survival, life expectancy and expected mortality, with this section discussing relative survival and how it is misused. For tips on using SEER*Stat and examples of alternatives, please see the article's supplement.

In developing mortality rates, actuaries smoothly increase rates by age and duration. We accept that some anomalies appear in the early adult years; however, for the majority of issue ages, we have a rather strong notion of the shape of the mortality curve. As a result we build experience studies using smooth expected mortality rates that consequently reduce volatility.

This result is intuitive and may be correct. However, it may not be the best basis on which to set expected mortality.

With the difficulties in 2008's credit market providing the background, 2009 promises to be a challenging year for insurance underwriters. Interestingly, while the market will certainly be volatile, the work done in the last few years by some insurers will position them to leverage the current market conditions into significant market opportunity.

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.

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.

Presentation at ReFocus 2009.

Heritage Labs recently had an inquiry concerning the hepatitis B tests offered as part of their reflex panel and the apparent discrepancy with the requirements of certain reinsurers. The case involves a female applicant, age 27, with normal transaminases, and a positive result for hepatitis B surface antigen. Before getting into detail on this case, this technical bulletin recaps the nomenclature for several of the common hepatitis B markers.

This new article by Hank George lays waste to the so-called "advantages" of treadmill stress tests and shows why their use should end NOW. They welcome all comments!

Best's Review essay by Hank George argues that underwriting poses no obstacle to life insurance sold by banks, and that with today's rapid underwriting tools, banks should be using this opportunity to sell to the under-served middle market BECAUSE of the rapid, efficient underwriting.

Presentation at ReFocus 2009.

A small chunk of DNA linked to schizophrenia, mental retardation, and autism may change the way we think about disease.

'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.

The October website article by Hank 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.

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

Kip May, Sue Nelson, FLMI, HIA, Mindy Stadel, J.P. Wieske panel at the SOA Individual and Small Group Health Insurance Underwriting Seminar, September 2008.

This paper presents a model for analyzing the impact of underwriting cycles on an insurer’s surplus. The model allows the insurer to vary its security loading in response to the cycles, with a strategy parameter that indicates the extent to which the insurer follows the loading which prevails in the market. The insurer’s claim rate is also allowed to vary to reflect exposure changes that result from the insurer’s strategy.

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."