Posts filed under 'cholesterol'
Occasionally when I am doing an interview to determine what rate class a person will fall into and what company will be best for them, I am asked if they will look less critically at the health issues if they ask for a smaller amount.
This often comes as questions like, “What if I apply for two $250,000 policies with separate companies instead of $500,000 with one company?” The thinking, and it has some logic to it, is that if a company is exposed to less risk maybe they won’t look at the health history or another issue as critically. That could end up with this logic, rather than a large policy approved at a standard rate, two smaller policies might be approved at preferred rates.
Unfortunately for the life insurance shopper underwriting doesn’t work that way. The truth is that while a company may do more tests and more intensive scrutiny of medical records at higher amounts, if a person has elevated liver function, high cholesterol or problematic family history, the company will award the same rate class whether the face amount is $100,000 or $10,000,000. If that weren’t the case then everyone with health issues would be buying multiple small policies rather than the amount they need in one policy.
I mentioned that the underwriting requirements do get more stringent at higher amounts. Here is a standard table of requirements starting with A being children under 18 at lower face amounts to H, I, and J where the requirements are for older ages and high face amounts. Actually they aren’t in exact order as A, B and E are for applicants under age 18. Note that none of them require a full blood draw.
A Non-Medical
B Paramed, Urinalysis, Attending Physician Statement
C Paramed, Urinalysis, Blood Profile
D Paramed, Urinalysis, Blood Profile, EKG
E Paramed, Urinalysis, Attending Physician Statement, Dried Blood Spot
F Paramed, Urinalysis, Attending Physician Statement, Blood Profile, EKG
G Urinalysis, Blood Profile, EKG, Physician Exam
H Urinalysis, Attending Physician Statement, Blood Profile, Physician Exam, Treadmill EKG
I Urinalysis, Blood Profile, Physician Exam, Treadmill EKG
J Urinalysis, Attending Physician Statement, Blood Profile, Physician Exam
Bottom line. While the up front requirements may differ, the results are all measured the same. Again, high blood pressure is high blood pressure whether the applicant wants a modest amount of insurance or tens of millions.
August 25th, 2008
Virtually all life insurance companies take your immediate family health history into consideration at some level. They don’t all view it the same and they certainly don’t all treat it the same, but it is in their guidelines and they seldom waiver.
This probably ticks people off far more than finding out something is wrong with their own health picture such as having high cholesterol on the life insurance exam or perhaps high blood pressure. Probably one of the toughest for a client to swallow is when a company penalizes them because a parent who smoked dies prior to age 60 of lung cancer when the client, having watched that whole scene, has never touched a cigarette. Another that is just about as tough a pill is when their rate is effected because their father died of a heart attack at age 48 after drinking, smoking and eating their way into the obesity hall of fame when they don’t smoke, don’t drink and exercise regularly.
So, is it fair? Well, the way I see that is if it happens to me, then no, but if I’m a life insurance underwriter, then yes. I have discussed this at length with underwriters and they understand that taking a black and white stance on family history will be unfair to some. But, any underwriting guideline that is black and white and produces the same result for a rate class for everyone, is going to be unfair to some.
Just a few examples of the latter and then back to family history. All companies use build charts and approve rates based on your build. They know that plenty of people who are 5′10, 250# live to ripe old ages, but they also know that at that weight the chances are much greater of having diabetes, heart disease and cancer. All companies test for cholesterol and approve rates that reflect your cholesterol numbers. They know that plenty of people with high cholesterol never develop heart disease or have heart attacks, but they know that the chances are greater of that happening if you have high cholesterol.
So, family history. Even though your father appeared to have done himself in by smoking, drinking and eating doesn’t mean that you are not genetically predisposed to heart disease. And just because you don’t smoke like your parent who died from lung cancer doesn’t mean that you aren’t genetically predisposed to cancer.
The good news is that, as I mentioned up front, not all companies share the same beliefs, and a good independent agent can usually find a company that will take most of the sting, if not all of it, out of any family history issues.
Bottom line. Rather than taking offense or trying to justify family history, ask your agent how they can take what you have and make it work for you.
August 20th, 2008
Life insurance exams have stayed pretty much the same for as long as I’ve been in the business, about 150 years now. On the lab side, the blood and urine testing, an occasional new test has come along and a few have gone down in extraordinary flames.
The industry has been deservedly dealt a few black eyes with great new ideas. Quite some time ago the industry decided it would be a great thing to be able to tell if someone had cancer even though there were no symptoms or diagnosis from a doctor. A lab came up with a tumor marker, dubbed TAA. It’s touted value was that it would have a high reading if someone had even an undetected tumor. The insurance companies jumped on it without real proof of its’ accuracy and it turned out to be a fiasco. In the end the test proved to be, to put it kindly, inaccurate and it resulted in completely healthy life insurance applicants being told they might have cancer and having to undergo expensive tests to find out that they didn’t, much to their dismay and the dismay of their doctors.
It is these kinds of underwriting screening tools that need to be proven before their actual use for the sake of the clients and underwriting credibility. Recently a new tumor marker has been proposed but so far the insurance companies have steered clear of the CEA test (carcinoembryonic antigen).
Other tests have come along that appear to have passed the validity test. Probably the biggest breakthrough has been the NT-proBNP. This test has afforded underwriters the ability to pinpoint impaired circulatory function. While most commonly tied to some level of heart failure, the test has proven very accurate in bringing to light the presence of cardiac damage from all pathological causes.
This test, in combination with other cardiac impairment markers can be more accurate than the old standards of checking cholesterol and doing an ekg. While some of the associated marker tests are still being reviewed, proBNP is in use by most companies. The issue of heart disease has been and continues to be taken very seriously in life insurance underwriting.
Bottom line. These tests are a two edged sword for life insurance applicants. While they might very well lead to an increased rate or even decline, they can also alert the applicant to a health issue that might be looming.
August 16th, 2008
Life insurance agents don’t usually get paid unless they make a sale. This can sometimes cast us in a shady light if the application doesn’t go as planned and we start offering alternatives. People perceive us as doing what it takes to salvage some income out the whole deal.
I am not going to speak for all life insurance agents and claim that all of them take the moral high road and the client’s interests are always first and foremost, but as for me and my business that is absolutely the case. I want to share a story that happened last year and was brought full circle on Monday.
I was working with a couple in their 40’s, engaged to be married, and they wanted to take the step of getting life insurance. Everything went fine with her application. A picture of perfect health and no surprises. His application was another story.
We knew going in that he was overweight and had quoted the case based on build since there were no other health issues that he knew about. Once he completed the exam we found out, well, that it was a good thing he took an exam. His cholesterol was approaching the 300 mark and, based on his hbA1c, his glucose was elevated enough that he would be considered by most doctors to be diabetic. So, overweight, high cholesterol and diabetic led to an underwriting decision that raised the rate substantially.
He had originally applied for 20 year term insurance. My recommendation was to initially put a 10 year term in force to keep the price down. Once he made the changes to get his cholesterol and glucose and hopefully weight under control, we could apply again and get a better rate class and a longer term. Even the 10 year term price was more than he had expected to pay and he really just wanted to put it all off until he got things under control. He didn’t have other life insurance in force, so I made my best case for the logic of having insurance in force when you are doing battle with health issues, and especially potentially serious health issues. He finally conceded that it probably really was a good idea. We put the 10 year term in force for just over $800 per year.
His fiancee called me Monday, almost a year after we put his coverage in force, to let me know that he had died suddenly the day before. There is an autopsy pending, but I suspect what will be found is that all of those risk factors, obesity, high cholesterol and diabetes, led to a heart attack.
Bottom line. The good news is that we are now talking about processing a claim versus what he should have done. It really wasn’t about me and my next paycheck. It honestly is a real concern for those who would joust with health issues without insurance. This story is tragic, but there is something of a good ending. Over the years I have seen far too many that were tragic and ended with no insurance in place.
August 6th, 2008
Guys, we’ve talked about this before, an area where women don’t even have to struggle at all to make us look like morons. Unfortunately far too many men find out the value of an annual physical, a regular checkup, when they discover that they have a serious health issue that might have been avoided or at least discovered earlier if they had a relationship with their primary care doctor.
I don’t have to search far to find the truth in this. In just the last 10 years, the number of men who have applied for life insurance through me only to get declined because of medical information they should have known has been, well, larger than most men would guess. The medical exam and lab tests that come with applying for life insurance are quite often the first thorough workup men have had in years. To their dismay it often answers the question about why they haven’t been feeling up to par lately.
All of these things are simple and relatively inexpensive to test for when you consider the high expense of treating the aftermath when things get out of control. Probably the most common thing that pops up is high cholesterol, a leading cause of heart disease. Caught early, minor lifestyle changes can usually turn the problem around. When the problem is discovered after things are out of control, it is often a far more serious matter.
Diabetes is a fairly common discovery on insurance exams. Again, any kind of regular checkup would have revealed a level of pre diabetes that could have been treated with lifestyle changes. It is not an unusual occurrence for men to discover that they have prostate cancer due to an elevated PSA on their insurance exam.
One issue that pops up with regularity that doesn’t even require an exam is the discovery that both men and women find out that they weigh significantly more than they thought they did.
All of that is to say that having regular visits to your doctor, for obvious reasons, is something that insurance companies like to see. It is safe to say that the majority of life insurance companies, if you are over age 50, would prefer not to even consider your application if you haven’t seen the doctor in the last 2 years. There is only one company I know of who will consider your application under those conditions if you are over 60.
Bottom line. Guys would prefer not to see doctors unless they are dying. This really presents a poor risk to insurance companies. Since insurance companies aren’t likely to change, men, maybe we should consider conceding to women that they are right on this issue.
August 4th, 2008
For a long time in the medical and life insurance communities there has been a definition of when someone has diabetes as opposed to being pre-diabetic. The problem has been that doctors had clear courses of action they could take when confronted with a diagnosis of diabetes, but the whole idea of pre-diabetes has never been clearly defined and there has really never been any clear direction about what should be done about it.
Now the diabetes docs, the American Association of Clinical Endocrinologists, have come up with guidelines
for both diagnosing and treating pre-diabetes. This can have huge implications as virtually everyone is pre before they are, and in essence what they are talking about is a plan to keep more millions of people from being added to the type 2 diabetes epidemic.
The whole idea from the diabetes docs is that really anyone that sees a doctor on a regular basis should find out that diabetes is in their future in time to keep it from coming to fruition. Little (or big) clues like being treated for high blood pressure and having “a big waist circumference” (code for obesity). If a persons labs show too little HDL, bad cholesterol or triglycerides that are too high.
At that juncture, in combination with high, but not quite diabetic, glucose levels the docs agreed that it’s time to have a serious talk with patients. Most agreed that in the pre stage of things medical intervention in the form of diabetes medication should not be the first line of attack. This is the point where they need to talk serious lifestyle change and put the fear of full blown diabetes and all of the collateral health issues into the train of thought.
If you think about it, no one in their right mind that knows that they will become diabetic if they don’t make some changes is going to ignore the warning. I know there is a large membership in the You Just Can’t Fix Stupid Club, but most of those are guys and maybe the endocrinologists could at least save a large percentage of women from suffering what they don’t need to.
It will be interesting to see how life insurance companies will treat this situation. Up until now being pre diabetic wasn’t an issue because in their mind you either are or you aren’t. But if people’s medical records clearly show that they are being treated, even if it’s only lifestyle counseling and monitoring, I suspect some companies will reward pro activity with higher rates. One company, Banner, has already stated that they will still offer best rate classes to someone who is actively addressing pre-diabetes. That’s the kind of reaction we should see and a good independent agent will be able to seek out those companies for you.
Bottom line. With the epidemic of type 2 diabetes in our country growing more rampant by the day, it’s good to see a more proactive approach.
August 1st, 2008
There aren’t many weeks that go by without hearing from someone who has finally figured out that they should have life insurance…..because their own mortality has been flashed before their eyes. This can come in the form of losing a friend or loved one or perhaps being in an accident and coming out with that thought in your head that, “Oh my God, I’m alive and probably shouldn’t be”.
Those are the easy ones to deal with. A wake up call with no harm done. But all too often the wake up call is because of some dramatic change in our health. People who have been diagnosed with cancer or who have had a heart attack tend to have a sudden, often fervent desire to look into the life insurance that they have been ignoring for years. They realize that they have blown the chance at getting good rates on the protection they now want and are desperately hoping that somehow this one health scare will be looked at by life insurance underwriters the way one speeding ticket would be looked at by an auto insurance company.
We all look for those second chances in life. Unfortunately, when it comes to the best rates that a life insurance company offers, with serious health issues there really are no second chances out there. If you are easily jolted into action by something minor like your cholesterol being a little too high, or with a few companies, your slightly high blood pressure needing a little medical nudge to get back to normal, you’re still in the running. Just about anything more serious than that will bump you at least one rate class, if not more.
So, and this is what all Americans really want to know, how do you beat the system? First and foremost you need to have a serious talk with yourself about your responsibilities and how, even though you are young and healthy, if something happens you will have failed to take care of those who depend on you. Second, you need to get over (we’ve all been here) that young, healthy feeling of immortality. You may live to be 120 and you may die tomorrow or be diagnosed with a terminal illness next month.
That’s the bad news. The good news is that for healthy people life insurance is probably the least expensive insurance you will have in your portfolio. Get it while you’re healthy. Get it while you’re still a good deal.
Having said all of that, should people with health issues give up on owning life insurance? No! It will cost more than your completely, disgustingly healthy cousin, but for almost everyone it is still available and with the help of a good independent agent, you can get the job done.
Bottom line. Life insurance is a good deal for family protection even when you don’t qualify for the best rates. Where else can $50 or $100 a month buy your family hundreds of thousands of dollars worth of peace of mind? Look into it today.
July 9th, 2008
It is a common belief that a life insurance agent’s offer of an annual review of your policy is nothing more than a ploy to try to get you to buy more insurance. I know from experience with my own clients that many are so sales phobic that their honest belief is that any contact from us, including birthday greetings, is a sales pitch attempt in the making.
In spite of the fact that my clients were never “sold” to start with and in spite of the fact that I tell them I will stay in touch during the life of their policy, at least on an annual basis, I can tell from their reaction that they think I am up to something when I call and ask if any questions have come up or if there is any way I can be of assistance (change of beneficiary, payment plan, etc).
I’m not naive enough to believe that all agents are calling simply out of a desire to be of service, and I won’t tell you that, if asked, I won’t provide up to date quotes and provide a better policy given their current situation or additional insurance if they feel that is a prudent thing to look at. But the annual review or annual service call has importance even if nothing happens.
There are plenty of agents and agencies out there who will gladly sell you life insurance and never talk to you again, so if that is what you want, it’s available. But, just for a minute, let me suggest that there is truly a value added to your product when an agent is willing to stay in touch.
I generally send out a letter to my clients about six weeks before the anniversary of their policy. Attached is a sample. annual-review-sample-letter
This contains information that may prompt questions. Suppose, unlike the sample, the letter explained that you were in the 9th year of a 10 year term. It’s time to give some thought to what happens at the end of the 10th year and possibly will lead to questions about what options are available.
This letter is followed up about 10 days later with a call from me simply asking if they received the letter (if they didn’t, it could be that their address has changed and they forgot to inform me or more importantly the company), if any questions came up after reading the letter (like what is the conversion option?) or if there is any way I can be of assistance. Usually in the 5th year or so of the policy I ask if they are still comfortable with the amount of insurance and the term length.
It is not a rare occasion, even with annual review calls, that a client will kind of forget what they have and the reminder helps remind them of why they bought what they bought. I have a substantial block of private pilot clients and it’s amazing how many will forget that the reason they purchased the policy they did and the reason they purchased it through us, is that it covered their aviation practicies at a fair rate.
I also review each client’s situation annually before calling to see if there are ways to save them money. If, for instance, they were approved initially at a higher rate than expected due to elevated cholesterol on their exam, I bring that up. If they’ve worked on getting their cholesterol down to normal limits, it’s possible in many cases to get a new policy at a lower rate. If someone has indicated that they are trying to quit smoking, I make a note of that because if they do there is substantial money to be saved. For some, an improvement in health or a change in habit may mean that they can now afford a longer term without raising their premium.
Bottom line. Service has earned a bad reputation, probably from unscrupulous agents that want to sell you something new every year whether it is warranted or not. That is called “churning” and is illegal. Don’t be afraid to participate in an annual review. If it feels like a sales call you might want to chastise your agent for that. If it feels like service and value added, that’s exactly what it is.
July 3rd, 2008
I know at times I pour it on pretty thick about the whole lifestyle thing, but lifestyle simply cannot be overstated when it comes to its’ impact on life insurance underwriting.
As posts go this one is short and to the point. Through diabeticconnect.com I found a review of a book
that really puts the spotlight on the impact of lifestyle on health. Again, I would like to recommend Diabetic Connect as a resource. I mentioned in a post a few days ago that I believe they will be the new best advocate on the block for those with diabetes.
Bottom line. Positive lifestyle changes increase your chances of avoiding or controlling issues like type 2 diabetes, high blood pressure, obesity or cholesterol. Avoiding or controlling those types of issues can only have one type of impact on life insurance rates….positive!
May 20th, 2008
Much has been made about cholesterol over the years. It went from an unknown quantity to a household word that carried with it the weight of heart disease and heart attacks. Who of has not seen a TV commercial with little pieces of plaque sticking together in an artery and we all know where that story is headed.
When you apply for life insurance and complete your exam, one of the lab results is your total cholesterol. Most companies want to see that number below 220 for consideration for the best rate class. Some want to see it below 205. The most lenient of the big companies has their standard set at 240.
In the whole scheme of things this would appear to be all over the map with nearly at 15% difference between the most conservative and most liberal underwriting. Where it is all brought back together is when HDL and LDL are considered, good cholesterol and bad cholesterol if you will. It is generally accepted that good cholesterol, in adequate quantities, trumps total cholesterol. A ratio of 5.0 or better is considered optimal from an underwriting standpoint, while there are a few companies that follow a more conservative 4.5. Putting that in context, if your total cholesterol is 200, a ratio of 5.0 would be accomplished with HDL of 40. In the attached labs from 2006 from one of my health fair visits, you see a total cholesterol of 156 with HDL of 44, for a 3.1 ratio.
hinerman-labs
A lower ratio like this can allow an underwriter to consider, for instance, a total cholesterol that would be over the normal guidelines. While they aren’t going to stretch those boundaries too far, a good independent agent will generally find an underwriter that understands the offsetting value of high HDL.
Bottom line. We’ve all heard that knowledge is power. Awareness of your health profile is power. Knowing where you stand with risk factors gives you the upper hand in beating the odds.
May 20th, 2008
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