Posts filed under 'heart disease'
We’ve blogged long and hard for years about the obesity epidemic in our country and the high cost the participants are paying in added health problems, shorter life spans and higher life insurance premiums. So, not that we had anything to do with it, but hats off to those New York restaurants that are now posting calories along with price on their menus.
Our country has worked long and hard figuring out how to market fat and calories under cute names and making quick and easy a dietary choice that seems to have sucked the common sense out of our nation’s health consciousness. That is not to say that there weren’t poor choices to be made 40 or 50 years ago, but with today’s marketing machines in full gear, fit as a fiddle may have to be updated to a cello.
So what’s the big deal about obesity? Clearly, with a few exceptions, it’s a lifestyle choice that’s been made and you make your bed and lie in it, right? If obesity was the end result, from a life insurance perspective it wouldn’t be such a tough hit. Weight alone will keep you away from the best rates, but it still leaves you affordably insurable.
The problem is that the weight, the obesity, is the start of an almost certain downhill health slide and studies seem to indicate that unchecked obesity doesn’t leave you in a place where you wonder if you’ll have health problems, but rather how bad will they be.
Bottom line. If you’re tipping the scales in the wrong direction, you may want to consider purchasing adequate life insurance before the health problems start happening. Once you come face to face with diabetes, heart disease or cancer, the task becomes much harder.
July 21st, 2008
This is an area involving life insurance that is receiving more and more attention and a topic where the troops (life insurance agents) are definitely divided. A life settlement involves the sale of your policy to a third party. The third party takes over ownership, future premium payments and becomes the beneficiary of the policy.
Why would a person consider a life settlement? Two reasons really. This generally involves term insurance and a person may simply not need the policy anymore. If a policy was, for instance, purchased to cover a key person in a company and that person has retired, the company may wish to recoup some of their premium payments through the sale of the policy.
The other reason is simply that the owner of the policy needs money and sees the sale of the policy as an easy way to get cash. This can be an unfortunate choice when long term family protection is bagged for a short term cash fix.
A few things about life settlements. First, the policy has to be within the conversion period. The new owner needs to be able to convert the policy in order to keep in force until your death. Second. You really need to be sick to get any significant amount of money out of a policy. A healthy 65 year old, if they are offered anything at all, won’t be offered much. I have seen this process of elimination work and the companies who do life settlements evaluate a case and determine, at least to the satisfaction, how long they believe you will live, down to the year and month. They then base their offer to you on the face amount, minus what they will have to pay in premiums on the converted policy, minus a healthy (very healthy) profit.
In most cases, in my opinion which happens to coincide with a large number of financial advisers, if you are sick enough to get a worthwhile life settlement, you are better off converting and keeping the policy yourself. Your family will net more benefit almost every time.
Then there is my own bit of discomfort with life settlements. Life insurance is all about mortality assumptions based on statistics that have been built up over long periods. Underwriters use assumptions when deciding rates for people with heart disease, diabetes or a history of cancer. My discomfort with life settlements is that there are no mortality studies that I’ve been able to find for people who sell their life insurance policies to a third party.
This country harbors one of the greediest corporate mindsets on the planet. If a life settlement group has a large block of business and profits aren’t where they need them to be, who’s to say, especially in today’s unemployment situation, that $500 here and $500 there might not hasten the mortality experience a bit. I’ve had plenty of viatical and life settlement agents tell me that assumption is hog wash and I would suggest that they allowing their greed for the sale to overwhelm their common sense. People get rubbed out in this country all the time for a lot less than hundreds of thousands or millions of dollars.
Bottom line. As for me and my agency, we will not recommend or participate in life settlement business.
July 17th, 2008
To a guy this makes perfect sense. From my own experience I can tell you that most women, especially those married to guys that feel fine, don’t share that philosophy. Unlike us guys, they think doctors are serious about the importance of annual physicals and things like colonoscopies after age 50.
Well gentlemen, life insurance underwriters are from the same planet as our wives. Most companies, even though they do a full blood and urine analysis as part of the application process, will postpone an approval if you are over age 50 and haven’t seen a doctor in the last two years. There are a handful of companies that will hang in there and allow you to get by on your own medical advice up to age 60, and only one that I know of that will go to 65.
Let’s get real for a minute. We all (every one of us) knows someone who died too young and felt fine right up to the time they had a heart attack, or felt fine right up to the time they were diagnosed with colon cancer. Heart disease and colon cancer are a couple of good examples of the kinds of things that can be discovered early enough to save your life if you follow the standard doctor recommendations. It simply doesn’t take that much time or money to keep track of your health.
I had a potential client recently who refused to have a life insurance exam because “people find out bad things when they have exams”. So I explained guaranteed issue life insurance and that was more than she wanted to pay (yes guys, I said she). She wanted the best rate but didn’t want the insurance company to have a clue what her health was and even worse, she didn’t want to know what her health was. How stupid is that?
I’ve touched before on how underwriters feel about not following doctor’s orders. If a doctor has recommended that you have a test or a procedure and that hasn’t been done, expect your application for insurance to be postponed until you successfully define and do the word compliant. Maybe you’re not real keen on having a blood test or a colonoscopy or a digital rectal exam, but when your doctor orders it and hands you that slip to make arrangements to get it done, or simply asks you to drop your pants and bend over, it’s because he expects you will follow through. Underwriters have that same expectation.
Bottom line. The more you care about your health, the more likely you are to impress life insurance underwriters.
July 1st, 2008
A lot has been made over the years about diet and exercise being key components of a successful battle with hypertension or high blood pressure. But from the fringes we keep hearing snippets about drinking a glass of wine a day, eating dark chocolate and other things that seem oddly out of place.
Diet and dark chocolate! Diet and dark chocolate! Almost seems oxymoronic. I know from my experience that when I’m munching down dark chocolate, the word diet is secretly deleted from my brain during that moment. Maybe that is the power of antioxidants. Maybe they aren’t really good for you, they just erase guilt from your mind so, a little wine, a truffle….life is good.
But such is not the conclusion of studies that show that antioxidants actually do lower high blood pressure. This happens through a process of antioxidants inhibiting something called free radicals (sounds like something out of the 60’s).
This ability to inhibit free radicals can have far reaching effects, staving off high blood pressure which can prevent strokes and helping to prevent some of the big boys like heart disease and cancer.
So, will you get lower life insurance rates if you explain on your application that you eat blueberries or dark chocolate or (yum), dark chocolate covered blueberries from Harry and Davids, daily? Well, not from the mere mention of the fact you won’t, but a healthier you is a better life insurance risk and that should lead to lower rates.
Bottom line. Do what your mom told you. Eat chocolate and drink wine….and eat your vegetables. Science is on her side.
June 24th, 2008
There is a real tendency in our society to brand the morbidly obese as taking the easy way out of the problem they’ve created by considering gastric bypass surgery.
Gastric bypass reduces the size of the stomach by stapling off the majority. This causes massive weight loss due to the inability to take in enough food to amount to significant calories and simply curbing appetite. Saying that gastric bypass is the easy way out is a bit like saying heart bypass surgery is the easy way out of having a heart attack.
The truth is that chronic morbid obesity can lead to diabetes, cancer and heart disease. Studies have shown that diabetes can actually be cured by the forced weight loss that comes with gastric bypass. And as much as those of us who have never been obese would like to think it’s no big deal to drop 100+ pounds, get a grip. It is a big deal and it is not easy. Dropping large amounts of weight and keeping it off is a mental and physical battle. Just like being a life insurance agent, if it was easy everyone would be doing it.
From a life insurance perspective gastric bypass is a good thing….after some time. The rule of thumb with the best of companies will be a year to two years after weight loss stabilizes. It can take one to two years to reach that point, so post gastric bypass it can take three to four years before companies will consider you at rates commensurate with your actual weight. Why the caution? There can be post surgical complications such as infection or intestinal leakage. Weight loss can be reversed in some cases where the new, smaller stomach stretches. Underwriters want to know that everything has worked out and generally, given those timetables, they can be pretty confident that the issue is gone.
Bottom line. Any stigma that gastric bypass has should be stuffed away. It is a life saving procedure, not an easy way out.
June 23rd, 2008
I have written in the past about life insurance underwriting on type 2 diabetes and also on heart disease. I think I have been very clear about the fact that life insurance underwriters are adamant about good control of diabetes and also we’ve discussed the problematic underwriting of the combination of diabetes and heart disease.
We’ll see where current studies guide diabetics and how underwriters react, but one recent studysuggests that type 2 diabetes, well controlled or not, results in a high occurrence of heart disease.
Heart attacks and strokes are the leading cause of death among type 2 diabetics and the ADA suggests that the rate of death among diabetics due to heart disease is possibly as high as 75%.
All of that is to say that perhaps life insurance underwriters are putting to much emphasis on driving glucose numbers down, possibly putting too high an emphasis on a low hbA1c. Current studies would indicate that may be the case, but don’t look for underwriters to jump on the bandwagon until more conclusive results are brought forward to back up the initial findings. I can see any changes going one or two ways. They may become less stringent about glucose levels, but may adjust mortality tables to reflect the high occurrence of heart disease in diabetics.
Currently the most critical underwriting factors for diabetes are age of onset, level of control as measured by the hbA1c, and any complications that have manifested themselves due to the diabetes such as neuropathy, retinopathy and heart disease. The best underwriting and rates would go to late onset (after age 50), an hbA1c of 6.5 or under and no complications.
Bottom line. The studies throw out some pretty sobering news and also, I think, some very useful news for those who have been battling to drive down their glucose levels. I’ll keep you posted as to any changes we see in underwriting guidelines, but as I said, I suspect those changes will be slow in coming.
June 7th, 2008
There is a common misconception that has floated around for the past 100 years or so of my life that if a person has cardiac problems, a heart attack, or coronary artery disease (CAD) requiring heart bypass surgery or an angioplasty, they are irreparably damaged in their ability to get life insurance, especially affordable life insurance.
This isn’t a simple thumbs up or down issue, but generally speaking in the absence of severe damage caused by a heart attack or chronic CAD requiring multiple procedures, insurability is not an issue. It will absolutely be at higher rates than someone who hasn’t had any cardiac issues, but affordable in most cases.
Some of the things that underwriters look for in heart attack cases would be:
1. Age of occurrence (better after age 50 than before)
2. Risk factors (obesity, high cholesterol levels, family history, high blood pressure, etc)
3. The amount of damage (usually measured on a stress test by the left ventricular ejection fraction (LVEF). Over 50% is insurable. Under 50% generally not, but would be weighed against offsetting factors.
In the case of CAD in the absence of a heart attack underwriters look at:
1. Age of onset (again, better after 50, not so good before 50, very challenging before 40)
2. Number of vessels effected (blocked). A single vessel blockage is better than what would be considered a more aggressive or pervasive multiple vessel blockage.
3. Again, risk factors. What underwriters are looking for here is whether your risk factors will tend to push you toward chronic CAD. If you have a good build and get plenty of exercise and do what it takes to control cholesterol and blood pressure, that’s a good thing. If you are overweight, don’t exercise and don’t get your cholesterol and blood pressure under control, the risk you pose to an insurance underwriter is much greater.
4. Underwriters will want to see a stress test usually at least 6 months to a year post procedure to determine the extent of any damage and how well the repair job went.
In spite of the myth, heart issues are insurable and usually at affordable rates. If you are applying for insurance, be prepared to answer the questions posed above. Know your cholesterol. Know your blood pressure. Know what meds you are taking. Know the date of your last stress test and get a copy of it. It is much easier for an independent agent to successfully shop for you armed with facts than being armed with generalities (the doctor says I’m doing fine). It would be a rare person who would know and a rare doctor who would discuss your LVEF. Underwriters have to know it in order to assess your application correctly.
Bottom line. If you’ve had a cardiac event, don’t throw in the life insurance towel. First and foremost, don’t go to your local State Farm or Farmers agent with your desire for life insurance unless you have a fondness for rejection. An independent agent will have access to companies that understand the underwriting of heart issues and provide your best possibility of success.
June 6th, 2008
Everyone believes they should get the preferred plus rates that are advertised everywhere. “Di you know that John can have $500,000 of term life insurance for just $12 per month?”. The truth is that many qualify for those rates and get them, but for the average person with average health issues, we don’t.
Probably the quickest group to rebuff anything but a best rate approval on life insurance are those folks that are overweight and know they’re overweight, but simply don’t see it as an issue. It has been my experience that this group, more than any other, seems to have a firmer grasp on denial than most. They, inspite of knowing the link between obesity and other health issues, don’t believe it is fair for them to be charged more for life insurance than someone who is fit and taking care of themselves.
Now let me be clear about this. Using a body mass index calculator I appear to fall into the overweight category at 5′10 and 175#’s. But insurance companies aren’t abusive about the build issue. With most companies, even though I am clearly in the overweight category, would actually allow another 20#’s or so before they would bump me out of the best rates as long as I didn’t have any other health issues that would preclude that.
Having said that, 5′10, 220#’s is going to catch the prize with any company. They aren’t going to care if that is the same weight that you played football at in high school. They aren’t going to care if you work out five times a week or run five miles a day. They aren’t going to care if your health is perfect in all other aspects. Obesity is obesity and along with it comes substantially increased risk of health issues that have the ability to shorten your life span and assessing your mortality risk is what life insurance underwriters do.
So, the folks whose weight (or lack of height) doesn’t get them what they want, in general, will blow off whoever is honest enough to tell them what insurance will really cost, and go on to another agent. Many are apparently so offended, in my experience, by honesty that they will never return a call again. It’s as if I called them fat or ugly or something, when all I really did was gave them an accurate quote. To them, possibly it feels as though I am just one more person in their lives who is treating them unfairly.
I don’t know what is going through their minds really, because they don’t call back to discuss it.
The truth is that the rates are fair based on build and that evenly the morbidly obese can put together a plan of life insurance that should fit into their budget. The challenge is to get over the fact that weight is an issue and it’s not going to change and work with your independent agent to find the company and the plan that will work best for you. There is not a cookie cutter interpretation of the weight issue from company to company and there are good rates to be found.
Bottom line. With obesity ranking high among the leading causes of type 2 diabetes, heart disease and cancer, underwriters can’t afford to ignore weight. Even if those health issues are currently present, you are at a greater risk than the average sized person of coming face to face with one, or more of them.
June 5th, 2008
There must be a couple of million people in the US licensed to sell life insurance. If you take in the giant internet mega agencies, all of the independent agents, and all of the captive agents (work for just one company), the possibilities for purchasing life insurance become staggering.
Put in context, there are probably as many, if not more doctors. Does that mean that no matter what is wrong with you, there are 2 million choices for a place to go for treatment? I’m thinking not. If you have a cold, a cardiologist is likely not going to see you, and if you’ve had a heart attack, it’s highly unlikely that your general practitioner won’t refer you to a specialist. There are those unfortunate times when GP’s think they know the answer to everything and attempt to treat serious illness in house, but those are rare.
Life insurance is one of those areas where the millions of choices doesn’t mean you have millions of appropriate choices. For the average very healthy person under 50 probably any independent agent or agency can do a good job of finding a low rate with a good company. As I’ve mentioned before, young healthy buyer beware though. Even though the mega agencies on the internet can find competitive rates, they have a bad habit of signing lucrative bonus contracts to push the bulk of their business toward a certain company. The good news is that the company is generally competitive. The bad news is that, as I’ve noted in so many previous posts, competitive doesn’t mean best. An independent agent doesn’t do the volume and therefore we are never offered these type of contracts. Speaking for myself, I place every case with the best possible price and product for my client. Seems like the right thing to do.
One other note on our perfect health client. Stay away from your auto and homeowner’s agents. You will be outrageously overcharged for life insurance because it isn’t what they do. Sure, they have a product and they are licensed, but having a license doesn’t mean you know what you’re doing and having a product doesn’t mean the price isn’t way too high.
But I want to make a very important distinction. Just like the doctor scenario, if you have some medical issue, a knowledgeable independent agent is where you want to go. We are the specialists in the life insurance business. Just a quick list of what I am talking about will help separate the GP’s from the specialists. If you have diabetes, Hepatitis C, heart disease, a history of cancer, a seizure disorder, mood disorders such as depression, anxiety or bipolar, and on and on. These are issues that it is hard for the average agent to provide good service on. These are issues that will get automatically declined with most property casualty companies (auto, homeowners).
How do you know you’ve called the right person or stepped in the right door? All insurance agents make money from the culmination of a sale, the placing of a policy in force. They all want your business and the truth is that most of them are struggling. There is a real tendency in the business for agents to take on business that they have no idea what to do with, just in hopes that it works out. It usually doesn’t. You know you’ve found the right agent if they show a knowledge of your particular issue by the questions they ask. If they don’t ask questions they don’t have the information it takes for them to come through for you. If they don’t seem to know, for instance, the difference between type 1 diabetes and type 2 diabetes, they don’t have any business working for you.
Bottom line. Before you commit to applying through an agent, be confident that they know what they’re doing. In my next post I will reveal the secret weapon for weeding out the BSer’s from the straight shooters. It works every time, guaranteed.
May 28th, 2008
Probably one of the most challenging parts of life insurance is explaining to clients why their, at least to them, seemingly innocuous health issue impacts their life insurance rates. Their belief is that if it isn’t bothering them too much and their doctor hasn’t told them to buy a house close to the emergency room, what’s the big deal?
Sleep apnea is one of those issues. In most cases of obstructive sleep apnea a person would probably claim that they had overcome their only real mortality issue, that being their demise at the hands of their spouse if they didn’t do something about the snoring.
The most common risk factor (cause) of sleep apnea is obesity. While it is not uncommon in other cases, it is a relatively frequent occurrence among those who have lost control of their weight. In most cases the issues that arise from sleep apnea, snoring and sleep deprivation, are those kinds of things that fall into the “so what” category when a person is trying to wrap their mind around their own perceived life insurance risk.
The issue that very often doctors don’t talk about with their patients is the connection between sleep apnea and CAD (coronary artery disease), stroke and congestive heart failure. It is my belief that most doctors aren’t real keen on attempting to help people get a grip on lifestyle issues, so they treat the symptom and don’t discuss the underlying causative issues.
There is a definitive link between these issues, although the still unclear factor is whether sleep apnea leads to an increased risk of heart disease and stroke, or whether it is obesity that is the real culprit. Studies are ongoing to determine that answer. The other issue of congestive heart failure seems to be very clear. While sleep apnea doesn’t cause CHF, it absolutely aggravates it.
From a life insurance standpoint, while none of these cause and affect scenarios are consistent from person to person, underwriting has to consider the issues. Sleep apnea, if well controlled, is ultimately insurable at very good rates as long as it is characterized after testing as mild to moderate. Severe sleep apnea is generally still insurable, but there can be increased rates.
Bottom line. It’s not your snoring that concerns life insurance underwriters. If you have sleep apnea and need life insurance, find an independent agent who understands sleep apnea. They will know what questions to ask and most importantly, what companies will help you and what companies to avoid.
May 24th, 2008
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