Posts filed under 'Type 1 diabetes'
It’s been at least a year since I last shared my dismay with both the readers of this blog and the ADA about the ADA choice to just ignore the subject of life insurance for those with diabetes on their website.
Whether you have type 1 diabetes or type 2 diabetes, there is a wealth of help and information on how to successfully find and get accepted for life insurance. You just can’t find any of it on the website that of the organization whose mission statement is “Our mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes”.
I’m thinking anyone with diabetes who has ever applied for life insurance would find their lives improved greatly by the sharing of up to date, real life information on how to find life insurance when so many companies stand ready to block that effort and so many agents don’t even know what the difference between type 1 and type 2 is, or what your hbA1c is and how it impacts underwriting.
Any advocacy group that has ever been in my sights knows that I have no love loss or tolerance for groups that claim to represent your best interests but spend more time fund raising and dispensing warm fuzzy information than they do researching and sharing real life, money saving, family saving information. Shoot me if I’m wrong but I think that information about things that might cause diabetes (why would you be on the ADA site to see what might cause diabetes anyway?) probably isn’t as useful or timely as knowing how to get affordable life insurance.
Bottom line. Since I am blocked from sharing information on the ADA forums, I want those who should be able to find the information there, to be able to find it somewhere.
November 4th, 2009
Back in mid July I started working on a life insurance case for a young man with type 1 diabetes. He had already discovered how easy it is to find a company to decline him, but the picture he painted was not one that led to a logical decline.
He had the same strikes against him that most with type 1, insulin dependent diabetics, have. He was diagnosed at an early age so, no matter how you shook it out, he was going to be dealing with type 1 for most of his life. He would have to work as hard at controlling his diabetes as most folks work at their full time jobs, always just a slip up away from complicating things with more risk factors.
But he was doing a bang up job. He took his diabetes seriously from the time he was diagnosed, not an easy thing for someone in their teens. He monitored himself regularly and administered treatment just as be had been instructed by the his doctor. He didn’t fall into any bad habits. There’s always a temptation when part of your life has been reconfigured to fudge a little bit here and make up for it a little bit over there.
Nuf said. He is a model type 1 diabetes patient. We had several offers, and while very highly rated, at his early 30’s age, affordable for what he wanted to accomplish for his family. After all was said and done, exam examined and records reviewed, the company found that he actually presented less of a mortality risk than originally thought and the policy was approved at a better rate.
Bottom line. Like virtually all health issues, underwriting is looking at what has been done to negate or at least decrease the mortality risk in higher risk cases. In lower risk cases they check to make sure that other risk factors aren’t creeping in that can complicate things. Ultimately, and I know this seems a stretch if your experience has been with the wrong company, they are truly looking for a way to give a fair and affordable approval. This is a classic case where they did exactly that.
September 21st, 2009
I wrote a few posts ago about the challenges of finding fair rates on life insurance for type 1 diabetes and mentioned that I was currently shopping a case that I would share the results on.
Because of it’s early onset and inherently higher mortality risk with type 1 versus type 2 diabetes, underwriting is a little more critical and cautious. While someone with type 1 and a history of good control and no collateral health issues can expect to get reasonable offers, they are generally rated policies and “reasonable” has to be measured against the standard for most companies which is to decline to make an offer at all.
The client I am shopping for is 42 and was diagnosed at age 15. He has never had any collateral health issues and his most recent A1c was 7.1, reasonable control. The best offer on $500,000 of 20 year term for him came in at $1670 annually, about $146 per month. This, while certainly high if you are a completely healthy 42 year old, stacked up quite favorably against the three declines he had already experienced through other companies.
That was the best result and should lead to an approval. The other offers went steadily down hill from there with several companies offering table rates that most agents and clients never hear about. Several companies, like the ones he had already tried, declined to offer.
Bottom line. There is life insurance available for a well controlled type 1 diabetic. Make sure you use an agent that has access to a large list of companies and keep your expectations realistic.
July 16th, 2009
It’s been a while since we’ve talked about life insurance underwriting of type 1 diabetes. Plenty of time has been spent painting the parameters around type 2 diabetes, so let’s update since they are different from an underwriting standpoint.
Let’s talk first about the similarities. Underwriting of diabetes, no matter the type, still focuses on control and compliance. Are the glucose levels remaining in a controlled range based on the hbA1c? Optimal underwriting is between 6 and 7. 7.5 is still considered good control. Above that things start to slide from an underwriting view. Does the client monitor their glucose levels regularly and keep regular, usually quarterly appointments with the doctor for full blood and urinalysis workups?
With type 2 diabetes early onset, prior to age 50 or 40 depending on the company, is a key factor. With type 1 there is an assumption that most cases were diagnosed prior to age 20. Because both types of diabetes are hard on the body in a best case. Type 1 in almost all cases has longer to work on the body. Because of this, collateral issues such as eyesight, kidney, or cardiovascular problems really need to be absent completely for best case results.
I am currently shopping a case for a 42 year old type 1 diabetic. He was diagnosed at age 15. His a1c is 7.1 and he has no collateral health issues. I will share this coming week what kind of offers we get back.
Bottom line. With good compliance and control type 1 diabetes can be underwritten at fair rates. Overall there is about a 7 year difference in mortality between those who have type 1 and normal mortality, but remember that those kind of statistics take into account all of those who don’t take care of themselves as well as those who have exceptionally difficult diabetes to control. In the healthiest type 1 diabetes population the mortality risk is the same as the general population.
July 9th, 2009
This is a verbatim copy of the life insurance information page that the American Diabetes Association provides its’ members with. It’s important to note that much of what was written was put in place when a company called US Financial was still in business. They truly did stand out in diabetes underwriting, but they’ve been gone for 3 years. Comments from me are in bold print.
Once a person is diagnosed with diabetes, life insurance policies sold within the United States can become unaffordable or unavailable. This is because life insurance policies are allowed by state and federal law to “rate” or charge a premium based upon an applicant’s health status. In addition, a plan can choose to not provide a policy based upon an applicant’s health status. I just find this a bizarre way to start a discussion on diabetes and life insurance. Policies could be come unaffordable or unavailable, but in all likelihood they won’t. Federal law has absolutely nothing to do with insurance rate classifications. Stating that a plan can choose to do something means absolutely nothing to someone who’s not in the business.
Even so, it is possible for many people with diabetes to find affordable life insurance policies within the United States. You just have to know where to look. Certain life insurance companies, or carriers, specialize in selling policies to people with chronic health conditions like diabetes. US Financial is really the only company that ever specialized in impaired risk. Others have been good at certain aspects but their underwriting has never been truly consistent. That is why using an independent agent is so important.
To find the best life insurance policy for you, please consider the following:
* A major factor in the cost of life insurance policies for people with type 1 or type 2 diabetes is how well they manage their diabetes. If you have a lower A1C, good blood glucose control, lead a healthy lifestyle, and do not have complications from diabetes, chances are your rate will be more reasonable too. Age of onset is huge also. Especially today with type 2 diabetes occurring earlier due to the epidemic of obesity. The reason that age is so critical is that diabetes, given enough time even with good control, does damage.
* Find an insurance agent that is experienced in obtaining policies for individuals with “impaired risk” — they will know what carriers may offer you a policy and which one(s) may not. You will know a knowledgeable and experienced agent by their questions. If they don’t sound like they understand diabetes, find another independent agent and start over.
* Apply for a policy with a life insurance carrier that uses “clinical underwriting” — a process that looks at your total health, not just what health conditions you may have. US Financial is the company that coined the phrase clinical underwriting and they are the only company that ever truly utilized it. Again, out of business for 3 years.
* Shop around — on the internet, by phone, or through referrals from family and friends. Becoming your own advocate will help you to find a life insurance policy that best fits your needs. You should shop for an independent agent that you trust knows what they’re doing and let them take over the shopping duties. A good agent can cut the weeks worth of your time in just a few days.
* Never take no for an answer! Just because one company rates or declines your application does not mean that another company will not look at you more favorably. Can’t argue with that. There are a couple of thousand companies that sell life insurance in one form or another. There about ten that are truly good at what they do. If you got a decline, there is a very high likelihood that it was because the wrong agent took you to the wrong company.
Bottom line. My personal opinion is that the best suggestion that the ADA had in this whole thing is to “be your own advocate” since they are quite obviously not interested in taking on that task.
April 14th, 2009
About three weeks ago I had written about an attempt to help the American Diabetes Association with their less than professional information concerning life insurance for those with diabetes. It remains my contention that if an advocacy group is not going to provide complete, accurate information on a subject that impacts their constituency, they should at least provide active links to other sources for that information.
I was roundly booed by Tom Cullinan who, without knowing what had transpired between myself and the ADA, decided that my email to the ADA was caustic. I received a response from Kendall Van Pool, Associate Director of Policy and Strategic Alliances. He wrote back, “I’m excited that you have written us and I’m hoping we have a chance to work through the issues of the web page. The page was written a while ago and I agree along with others on the site they are not up to date on the issues. We are currently doing a full web redesign and that puts myself and one other here in the position to review all of the insurance pages on the site. Because we do not have an insurance advocacy division at the ADA we put information on these pages that will help individuals become self advocates for coverage if they are having trouble. If you have suggestions please send them to me and we will most certainly entertain the changes.” Seems like a normal response to caustic comments?
So, admitting that the information on life insurance was out of date, he asked for input and asked me to direct that to a different department, which I did. I shared what the state of current diabetes underwriting is and how it remains anything but static (the ADA page had been the same for years). I suggested ways to make the information alive and current without promoting any particular company or agency.
After 3 weeks and no response I emailed Mr Van Pool this morning to find out what the status of our discussion was and received this response concerning the rebuilding of the ADA website, “Unfortunately the sites will be static information regardless. I’m exploring ways to ensure it gets updated more frequently, however the option of outsourcing the content is not possible”.
This leaves the person with diabetes still looking to more biased outside sources rather than their self professed advocate for information that is critical to their every day life. Well, I can’t say that I hadn’t been warned that the ADA seems to have its’ own agenda. And my mother did warn me that the world doesn’t revolve around me, so the next best thing is to blog and offer direction to websites that do offer helpful, up to date information on how those with type 1 diabetes and type 2 diabetes can get the best possible life insurance values. And continue to blog and update as the underwriting evolves.
Bottom line. I started to get a sense of what the ADA was worth to the diabetic community when they didn’t even answer my requests for information they might have on mortality statistics for juvenile diabetics. The point was further driven home when, in spite of the fact that they admitted it didn’t appear that I was trying to sell anything, they rather rudely black balled me from their forums where people were asking about how to get life insurance. I predict that in spite of the size of the ADA and their historical position as “the diabetes advocacy group” they will soon be left in their static, dusty place by new groups such as tuDiabetes and DLife.
April 14th, 2009
Amazing to me that when I ask someone with diabetes what their most recent A1c was, the response is very often, “What’s that?” or “I don’t know, but my blood sugar this morning was 128.” or “My doctor says I’m doing fine”.
So, let’s start out with why your A1c is important. From the standpoint of your personal health it is a measure of how well your glucose levels are controlled. The hbA1c test, rather than taking a one second snapshot like a glucose test, can actually provide you with an overview of a 2 to 3 month period and what your average glucose was around the clock during that time.
Most with type 2 diabetes, unlike type 1 diabetes, that monitor their glucose get into a habit of doing it the same time everyday and usually, because they know the numbers are better, that is done before meals. But let’s be honest. You know that just because your glucose is 128 before a meal almost every day doesn’t mean that it is 128 after you eat or when you mess up and do something you know you shouldn’t. The hbA1c uncovers all of those readings and averages them with all of the good readings and gives a true picture of control. From the article above this chart gives you an idea of what your A1c equates to in average glucose readings.
HbA1c and Blood Glucose Levels
6.0% 120 mg/dl
7.0% 150 mg/dl
8.0% 180 mg/dl
9.0% 210 mg/dl
10.0% 240 mg/dl
11.0% 270 mg/dl
The other reason, other than your health, that the A1c is important is to a life insurance underwriter. That underwriter knows this chart and he knows that even if you have a glucose level of 108 on your insurance exam, if you A1c is 7.5 then your average glucose is really 165. Putting that further into context, if when you are good your glucose is 108, and the average is 165, then there must be plenty of times that it is 200 or over. Dangerous territory.
If your A1c is over 7.5 and your doctor tells you that you are doing great, ask him or her why you are doing great if your glucose is really all over the map and occasionally at dangerous levels.
Bottom line. For many of us we think the best we can do when faced with something like diabetes is to find a good doctor and get treated. Too many of us don’t take the opportunity to educate ourselves about our health issue and know what’s really doing Ok and what’s not. Always get copies of the labs you have done. Always ask about anything that isn’t in the normal range and honestly now, don’t accept the answer that it’s OK when it clearly isn’t where it should be. Take charge of your future.
March 27th, 2009
The ADA continues to strike me as an incomplete advocate. Just try to find information on what it takes to get affordable life insurance if you have diabetes. Unbelievable! I called them this morning and then sent the following email in an attempt to break through to someone that cares.
“I have attempted in the past to share information about how diabetes impacts a person’s ability to get life insurance and what it takes and how a person can find affordable life insurance rates with a history of type 1 or type 2 diabetes.
I am struck by the lack of information provided by the ADA website on this challenge. Life insurance is mentioned more often in the context of planned giving to the ADA than it is as an everyday need for people and families dealing with diabetes.
The only page you have that goes into life insurance at all, is less than informative, and at least in the first few sentences, inaccurate and misleading. I suspect a lot of people, if they can even find that page, are turned off and don’t read the entire article. If they do read the entire article, they certainly don’t have a clue where to go from there.
I have been treated rudely and unprofessionally by your staff in my attempts to provide useful information in this arena in the past. I would like to believe that there is a way to get valuable information on to your website, information that positively impacts your member’s everyday lives.
Is it possible to speak to someone about how we might collaborate to provide real, insightful, valuable information to those that face the challenge of protecting their family and/or doing planned giving through life insurance when diabetes stands between them and doing those things affordably?”
Bottom line. I certainly haven’t hidden the fact that I have no love loss for “advocacy” groups that don’t deal with, or deal inappropriately with their member’s need for life insurance. What the ADA isn’t for those with diabetes is the same as what AARP isn’t to older people is the same as what AOPA isn’t to private pilots.
March 24th, 2009
It’s been a fascinating couple of years. I will sum it up by saying that we have helped a lot of people get life insurance who never thought they could. And what better way to celebrate the information we’ve shared and the victories we’ve had than with a shared meal, a key word salad.
Diabetes has been at the forefront of our life insurance efforts from the very start. We’ve made huge headway in finding aggressive underwriting for type 1 diabetes and type 2 diabetes. I think our strong point has been in education. There are a lot more people out there today that know what their A1c is than when we started.
I’ve been very clear about where some of the problems lie in our industry. The AARP/New York Life collaboration, on what can only be described as a sick crime against older folks, continue to offer the worst term insurance and whole life insurance in the business. They are simply not the advocate they claim to be.
I’ve stepped on some toes along the way. Selectquote and Zander Life insurance have taken exception to some of my observations. Being a Dave Ramsey fan and I think, ultimately, a reasonable person, I did apologize to Zander. In spite of Selectquote’s berating commentary, I still stand by my assertion that they are biased in what companies they offer (otherwise they wouldn’t be so easy to beat) and I still believe that Suze Orman should go back to waitressing. As to their assertion that I only use Selectquote and Suze Orman for search engine optimization, well, I don’t, even though they think I do. If I didn’t think there was better service elsewhere and more honest advertising, I would never have mentioned Selectquote.
We’ve touched on scuba diving and Prudential being a leader in great rates for recreational divers. Pru also stomps the competition on prostate cancer, sleep apnea and mild anxiety issues. While providing direction on those issues we have also been able to provide direction for those involved in skydiving and foreign travel to places where kidnap and ransom insurance is more than just a casual thought.
We’ve stayed abreast of the economic meltdown and recession that have whacked us all and tried to help people understand how best to handle their life insurance needs in these tight times.
We’ve held lengthy discussions about obesity and the impact it can have on other health issues such as hypertension or high blood pressure, cholesterol, heart disease, heart attack, stroke and cancer. We’ve discussed the risk and benefits of gastric bypass surgery as a means to avoid the life threatening side effects of being over weight.
Probably our biggest response has been from those suffering from depression and bipolar disorder. We reached a group of people that have truly been black balled in the insurance industry and we’ve been able to find some level headed underwriting and hit some major home runs for those who have the name tag but lead normal lives.
We have bared the facts behind the black eye of all black eyes in the insurance industry, the non guaranteed whole life, universal life and variable universal life policies and explained the alternatives in the permanent insurance market. There is nothing that provides greater value and peace of mind than a rock solid guarantee.
We’ve had frank discussions about business life insurance such as key man insurance and buy/sell life insurance. We did a whole series on women and life insurance. We’ve provided direction and information to private pilots that they aren’t getting anywhere else. We’ve talked about the guts of the policy when it comes to the two year suicide and incontestability clause and the accelerated death benefit and the beneficiary rights and the beneficiary issues for those who aren’t in a legal relationship such as a gay couple or an unmarried couple.
Bottom line. And the list goes on and on. We’ve tried to leave no stone unturned and no question unanswered in our quest to find life insurance for those whose mortality risk might be more challenging than average. As an independent agent it has been gratifying to have so many ways to help those who have been mishandled by the wrong agent or the wrong company. As we continue to reach out my prayer is that all who need help find it, and that more agents consider serving those who are harder to help.
March 18th, 2009
With the percentage of Hispanics in the US being almost double what it is for Anglo Americans, the challenge of finding affordable life insurance to ensure the family heritage and legacy needs to be more focused than ever.
In most cases diabetes is ultimately insurable. Latino statistics aside, it still comes down to the same underwriting criteria. Good rates are available but those rates come with control and compliance. Life insurance underwriters don’t have a cultural mortality study that impacts rates, but they do have mortality risk studies that tell them what can be expected if a person isn’t compliant with treatment and if that ultimately leads to poor control of glucose levels.
The reason for underwriter’s concern and careful underwriting of diabetes is the host of collateral health issues that can ultimately make the disease deadly. Those with type 2 diabetes, especially poorly controlled, are at a substantially increased risk for heart disease, high blood pressure and kidney problems. If you factor in the major risk factor for diabetes being obesity, you drag along increased risk of stroke and cancer.
The good news is in good control. To put it bluntly, the good news lies with those who care enough to change their lifestyle and deal with it. Losing weight is huge in the fight with type 2 diabetes. For those who can meet that challenge through diet and exercise, it’s a home run. They have changed a life style and snapped the link that has them tied to a downward spiral with diabetes. Studies have shown that even those who need to employ a more drastic approach such as gastric bypass surgery, with the weight loss comes almost immediate improvement in their diabetes control. In many cases the drastic weight loss completely cures the diabetes.
So, what are life insurance underwriters looking at when they consider diabetes as an underwriting issue?
1. Age of onset. Type 1 diabetes is generally diagnosed between early childhood and age 30. The later the onset, the better. Children with type 1 diabetes are almost always not insurable for reasons that, while lame, are the facts of the issue. With type 2 diabetes, optimal chances for good rates would be with diagnosis after age 50. A few companies are leaning toward age 40 as long as all other risk factors are good, but prior to 40 there will be a hit with virtually all companies.
2. Compliance! Underwriters want to see people who have taken the bull by the horns and are exercising, losing weight, actively monitoring their diabetes with regular glucose checks. They also want to know that you see your doctor regularly (every three months is pretty standard) so that your doctor can monitor all the risk factors and also run blood tests that will include an A1c or hbA1c. Compliance with medications is crucial. Taking medication only when your glucose spikes isn’t compliant.
3. Control. As measured by the A1c, underwriters would consider excellent control to be an A1c of 6.5 or under, good control 6.5 to 7.5, and questionable control 7.5 to 8 and poor control over 8.
4. Education. Life insurance underwriters would like to know that you understand your diabetes probably to a higher degree than your doctor is willing to provide education for. That means self education and group diabetes education is a good idea. Don’t depend on your doctor to make you smart about your disease and what you should be doing about it.
5. Monitoring risk factors. The best rates come with good control and no other risk factors, so checking blood pressure and cholesterol, and staying ahead of any impending issues with regular checkups is imperative.
Bottom line. Diabetes is a life insurance showstopper and a life longevity demon if you allow it. Take control and the picture changes dramatically.
March 16th, 2009
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