Underwriting the Diabetic...No Longer Taboo.
Updated: Aug 11
By Lori Meehan
How many of your clients have been deemed uninsurable because of diabetes?
Diabetes is no longer a Decline. It is important to know the facts when selling.
First: Education. What is diabetes and what is the difference in the classes of diabetes?
Type 1 diabetes is an autoimmune disease typically presenting acutely in genetically susceptible individuals with virtually total insulin deficiency. Insulin therapy is almost universally required from the outset. The disease presents in the young. Type I (Juvenile) diabetics are usually diagnosed during teenage years (the peak age for dx is 12 years old.) Once diagnosed it is too late to turn back the underwriting clock. Many carriers will not make an offer on a Type I diabetic until they reach adulthood. This is one reason why parents like to lock in insurability on their children with a child rider on their own policy or an individual policy on the child. After turning 18, controlled type I diabetics generally range from table 4 to decline. Wouldn’t rule out table 2 if they were diagnosed very young and they have had long history of being well controlled.
Type 2 diabetes, however, is typically a disease of insulin resistance (hence higher insulin levels are detectable); it also has a genetic link with a key risk factor being central obesity. The lifetime risk for a first-degree relative of a patient with type 2 diabetes is 5 to 10 times higher than that of age- and weight-matched subjects without a family history of diabetes.
The illness occurs typically after age 40 at presentation. Because age is one of the strongest risk factors for atherosclerosis, at the time of presentation many people with type 2 diabetes already have silent but established arterial disease.
Gestational diabetes (diabetes that is first identified during pregnancy), typically goes away after giving birth. One is usually more susceptible to getting Type II diabetes later in life though, especially if one is overweight or there’s a family history of Type II. Gestational diabetes can often be managed with diet and exercise, but some will have to take insulin. Carriers almost always postpone applicants until after they give birth.
Second: Know your client.
What type of diabetes? When was he diagnosed? What was his last A1C reading? Is he compliant with his doctor and medication? What other medical issues are present?
When applying for life insurance, the client with Type 2 Diabetes with excellent control of pre-existing conditions (i.e., hypertension, cholesterol, and kidney function), can potentially be upgraded from a low substandard rate to Standard. And if they participate in a healthy lifestyle, they may also qualify for a lifestyle credit – making even a preferred rate possible.
It is important to know and understand the lifestyle of your client as health behavior is critical in underwriting. Lack of compliance with medications, smoking, weight gain (over time), persistently high A1C, high lipids or BP would all be unfavorable markers and will result in a sub-standard classification.
Insurance carriers have improved their rates for healthy clients with type 2 diabetes. The healthy diabetic may even qualify for preferred rates! When you know the various types of diabetes and your client's health, UMS can work with you to find a good fit for your client's needs. Here's just one example:
• A case study
A 60-year-old diagnosed with type 2 diabetes 12 months prior, with excellent lipid, blood pressure and HbA1c management (American Diabetes Association recommends a range of 5.7% to 6.4%) as evidenced by achieving the best practice guidelines/goals. Preferred.
This client is a much better risk and may be considered for living insurance benefits in addition to life coverage. A recent diagnosis (implies less duration exposure to the complications due to diabetes) are favorable rating factors. It is critical to ensure that the traditional risk factors of BP and lipid control are ideal as they are strong influencers of heart attack and stroke in addition to the HbA1c level.
If you have a diabetic client, and you'd like some help finding a good fit, get a quote! Let's see what we can do together to help your client. Contact Lori or Neelam at: 800-524-1774.