News

Two years into the COVID-19 pandemic, mortality and death benefits paid remain higher for life insurers, even as the rush of working-age mortality abates and face values get lower.
 

This first article in SCOR’s Extreme Sports series will take readers on a deep dive into the world of scuba, examining the training and safety standards required to dive, the risk of injury while diving, risks associated with preexisting conditions, and other important considerations underwriters should have in mind when considering a diver’s application.

An implemented all-singing, all-dancing predictive model doesn’t automatically improve business operations or results. Sometimes it’s barely used. Why not? Based on many years of experience and academic study, Tom Fletcher shares his perspective on why this happens, and presents considerations for optimally deploying model development resources and gaining the full benefits of a new model.
 

For both insurer and insured, the case for wellness remains strong. RGA's Julianne Callaway and Matt Berkley study the value and potential of incorporating wellness into insurance offerings.
 

Interview with Samantha Chow on "the state of life insurance underwriting now, in the wake of all of the changes brought on by advances in underwriting data sources and technology."
 

While the media has reported how COVID-19 impacts the elderly the most, the data provided by the Centers for Disease Control and Prevention (CDC) may be telling us a more insightful story for middle-aged and younger individuals on the relative to expected mortality rate basis. As such, the experience over the past two years may be instructive for the life insurance industry going forward.
 

Concluding our 4-part 2022 interview series on cancer, Dr. Achim Regenauer answers questions for Life underwriters on cancer and genetics, questions relating both to cause and to advances in clinical medicine.
 

Antimicrobial resistance (AMR) has long-term environmental, health, and financial implications. It is a major threat to human health, but measures are being put in place to address the crisis. RGA's Hilary Henly, Global Medical Researcher, analyzes this major threat to human health, and explains how AMR is likely to affect the insurance industry.
 

Long COVID – One Year On, authored by Munich Re’s Dr. Tim Meagher, was originally published by the Journal of Insurance Medicine.
 

Insurance companies are assessing ways to integrate artificial intelligence (AI) and machine learning (ML) into their businesses to increase efficiency, and underwriters are a crucial part of that implementation.
 

In this article, RGA's Carolyn Pritchard highlights why it's important for underwriters to understand cryptocurrency and establish guidelines for adapting financial underwriting to this new asset class.
 

Two years of a worldwide coronavirus pandemic is leaving its imprint on life insurance.
 

Multiparametric magnetic resonance imaging (mpMRI) is an imaging tool with growing use in diagnosis, risk assessment, and management of individuals with prostate cancer. Explore current challenges with prostate cancer detection and diagnosis, and the role of mpMRI.
 

In this third interview of a 4-part series, Dr. Achim Regenauer answers questions relevant to Life & Health underwriters on advances in cancer therapy.
 

With a sweep of a smartphone camera, waves of infrared light penetrate the skin and beam back biometrics based on blood flow. It sounds like science fiction, but this electro-optic technique – photoplethysmography (PPG) – is real and the subject of rising insurer interest due to its affordability and array of potential digital applications.
 

Differentiated products and services are key to growth among life and annuity carriers.  Underwriters are poised to help drive this new growth, but they need the right tools and training.
 

SCOR's medical experts discuss the lasting impacts of infection
 

In 2012, Reinsurance Group of America (RGA) completed its initial assessment of TrueRisk Life in the United States. In a new study, RGA looks back and finds that credit data continues to be a strong predictor of mortality, even over the extended time period.

The trends and issues that will influence the development of the underwriting manual of the future

Designing effective applications means making it psychologically easy for applicants to answer questions honestly. In Insurance Thought Leadership (ITL), RGA's Peter Hovard makes the case for "positive friction," or prompts that encourage an applicant to offer a more considered, and accurate, response.
 

Accelerated underwriting has historically been a slow movement within the insurance industry, a panel acknowledged Monday at the 2022 Life Insurance Conference, sponsored by LIMRA, LOMA, Society of Actuaries and the American Council of Life Insurers.

The global pandemic’s toll on cancer diagnoses and what it may mean for the future of US life expectancy

The symptom of fatigue is one of the top five most frequently presented health complaints in primary care. Find out what underwriters should consider in the context of risk assessments for life insurance.

In this second interview of a 4-part series, Dr. Achim Regenauer answers questions relevant to Life & Health underwriters on advances in cancer diagnostics.

RGA's Dr. Maryam B. Shapland, Vice President and Medical Director, U.S. Mortality Markets, explores reactive thrombocytosis, a condition associated with higher mortality in acutely ill patients.
 

How a better understanding of behavioral economics (BE) can improve the quality of structured data and bring new insights to the underwriting process in China.

How diets can affect health over time, especially for people with known pre-existing conditions, and to what extent diet might be considered during underwriting.
 

In this whitepaper, multiple RGA experts address the status quo of testing for the purposes of early disease detection and look forward to the future of screening. 
 

Covid’s impact has been severe and far-reaching. With Omicron’s high transmission rate and current widespread vaccination, PartnerRe has surveyed worldwide Life & Health industry experts to find out what they think about Covid’s impact on the industry thus far and what the future holds.
 

With the arrival of SARS-CoV-2, insurance medical directors found themselves in a position of unparalleled influence within the life and health insurance industry.
 

COVID-19 has now been with us for two years. It has hit the global life insurance industry hard. Although we can’t predict the ultimate course of pandemic, we expect the virus to impact global mortality in the near future. 
 

Insurers facing outdated technology, legacy processes, and the industry-wide retirement of experienced underwriters are taking a thorough look at how underwriting works within their businesses. RGA's Dave Rengachary offers a new vision for how RGA can help insurers thrive in the new underwriting ecosystem.

Dr. Achim Regenauer discusses how far we are along the road to having multi-cancer early detection tests – essentially powerful liquid biopsies – in the clinical setting. It appears that this is much closer than previously assumed, and that these tests will complement, rather than replace, current detection options.
 

What does COVID-19 do to lungs? RGA's Hilary Henly explores the permanent and irreversible lung damage caused by the disease, and shares different factors insurers should consider.
 

Could the pandemic weight-gain observations simply be an extension of the trends already occurring?
 

The rapid development of liquid biopsy technology, along with its potential for multiple clinical applications, has garnered significant excitement. RGA explores the challenges and concerns, as well as the opportunities ahead.
 

For the United States as a whole, and life insurers in particular, 2021 was a year marked by higher mortality as the COVID-19 pandemic entered a third year. The Centers for Disease Control and Prevention reported deaths up across many categories, higher even than 2020.
 

Mortality and morbidity trends among hospitalized COVID-19 survivors can shed vital light into the insurance implications of the pandemic. 
 

In this first interview of a 4-part series, Dr. Achim Regenauer answers questions relevant to Life & Health underwriters on general cancer trends, including trends relating to incidence, detection at earlier stages and overdiagnosis.
 

Incorporating Electronic Health Records provides an opportunity for life insurers to modernize underwriting systems and improve underwriting product offerings, turnaround times, and the customer experience.
 

Greig Woodring, former RGA Chief Executive Officer, joined Paul Carroll, editor-in-chief of Insurance Thought Leadership, in a lively conversation about the ways genomics has the potential to transform life insurance. Contact us to explore what advances in genetics, genomics and medicine can mean for your organization.

There is a surge of services, innovative solutions, streamlined processes and automated underwriting for life insurance utilizing Electronic Health Records (EHR). 
 

No one would argue that the current pandemic caused by the SARS‑CoV‑2 virus has had a devastating impact on the world. 
 

There was an expectation by life insurers that COVID-19 deaths would decline as vaccination rates increased throughout 2021. That has not happened.
 

Life insurers are embracing the use of machine learning (ML) and artificial intelligence (AI) models and techniques in all areas of their business. 
 

Better understand the latest trends and developments in life and health insurance by exploring findings from RGA’s 2021 surveys. 
 

From voice assistants to personalized recommendations on streaming services, machine learning is a branch of artificial intelligence that many of us encounter daily and makes our lives easier.
 

RGA's Dr. Sheetal Salgaonkar, Vice President and Medical Director, Global Medical, RGA India, offers a fascinating case study on serum protein tests and how they should be considered in risk assessment.
 

The changes to daily life and the uncertainty brought on by the COVID-19 pandemic continue to have impacts on the mental and physical health of populations around the world. One health impact often attributed to the COVID-19 pandemic is weight gain due to decreased activity and indulgence in “comfort foods.”
 

RGA's Dr. Adela Osman, Chief Medical Research Officer, RGA South Africa, offers an eye-opening examination of sleep and medicine in ReFlections. She argues that sleep deprivation is an under-recognized public health crisis.

According to the Foundation for a Smokefree America, smoking is the single most preventable cause of death and disease causing more fatalities than cocaine, auto accidents, AIDS, alcohol, heroin, fire, suicide and homicide combined.
 

Life insurance-linked wellness programs were first developed more than 20 years ago, and insurer interest in these programs has continued to grow ever since. Nevertheless, all these years and seemingly countless program launches later, the industry has yet to fully realize the potential of wellness initiatives. 

Incorporating a health exam into the life insurance application process helps insurers identify unknown or undiagnosed conditions in applicants. And the best tool for measuring cholesterol is a blood test with a lipoprotein profile.
 

By the year 2060, almost 24% of the US population will be age 65 or older. Biomedical and public health advances have led to great increases in longevity and a shift in disease burden to multiple chronic diseases with aging. In On the Risk, RGA's experts discuss frailty as an underwriting challenge. Explore the definition and prevalence rates of frailty and one of the most widely used frailty scales in geriatric research.

In this edition of ReCent Medical News, Paul Edwards explains why health and fitness data captured through the use of wearables is potentially very meaningful for life insurance underwriting.

Individuals who have only low-severity medications in their prescription histories may not necessarily be those with the least mortality risk.
 

In our first article we looked at some of the basic terminology used around the umbrella term artificial intelligence (AI). In our second we take a deeper dive into an area which we think has huge potential in underwriting and claims.

A harrowing bout with a breakthrough case of COVID-19 causes RGA's Jennifer Johnson to have a breakthrough of a different kind. She shares her wrenching personal experience, offers some lessons learned, and embarks on a conversation with RGA's physicians about the particulars of her case. 

Munich Re Life US evaluated LexisNexis Risk Classifier with Medical Data, a predictive modeling tool developed and owned by LexisNexis® Risk Solutions in collaboration with ExamOne. It assesses mortality risk by combining an individual’s behavioral and credit attributes and medical data, including prescription history, clinical laboratory results, and medical claims.

Continuous glucose monitoring (CGM) allows for real-time measurement of blood glucose, and is a technology being used by an estimated 7 million individuals in the U.S. and growing. In On the Risk, RGA's Drs. Dave Rengachary and Lauren Garfield explore the ways a sensor placed under the skin can now provide an extremely detailed picture of glucose homeostasis. Underwriters will need to understand the interpretation, associated terminology, limitations, and long-term mortality implications of this monitoring.

In this, the last of our 4-part series of insurance-focused articles on cancer, Dr. Achim Regenauer, Chief Medical Officer, presents a high-level overview of how genomic sequencing of cancers is blasting a trail for improved, early diagnosis and precision medicine by providing a powerful and ever-expanding means to detect, identify, subdivide and monitor cancer – and how this remarkable development could impact Life & Health insurers.

This article is the last in a three-part series, highlighting areas of research funded by the Longer Life Foundation (LLF), a not-for-profit organization that supports the study of scientific and public health factors predicting mortality, morbidity, longevity, and wellness.
 

Gen Re is pleased to present summary results of our 2021 Individual Life Accelerated Underwriting Survey.
 

It is important here to draw a distinction between what has historically been referred to as “accelerated underwriting” and the pandemic-fueled programs characterized as “alternative underwriting.”
 

Underwriters could reasonably ask whether a person with such a developmental learning disorder is at risk of worsening symptoms over time, leading to occupational disability, but can learning disorders really affect someone’s health status and lead to mental health issues?
 

In a time where tragedies have become more and more common, life insurance companies have adjusted to these new changes. Policies have generally remained the same, but there are some key differences worth discussing.
 

Insurers have known for a long time that the mortality rate of an insured population is much better than in the general population. This difference is critical for insurers, but there hasn’t been enough insurance data to fully understand mortality improvements, so we must rely on population mortality to guide our analysis.
 

Dr. Achim Regenauer, Chief Medical Officer, presents a high-level overview of targeted cancer therapy – a catch-all term for a spectrum of innovative new cancer therapies that are improving the outlook for patients and moving us closer to precision medicine – and its impact on Life & Health insurers.
 

Customers increasingly demand a seamless, non-intrusive, insurance purchasing experience. Multivariate technologies can empower life and health carriers to deliver. 
 

An increasingly common occurrence in an emergency room or even in a routine doctor office visit is the diagnosis of chest pain in a woman. 
 

Research collaboration between RGA and King’s College London shows potential of genetic predisposition in predicting common diseases
 

Heidi Alpren talks with Keith Brown, a self-described “BE enthusiast,” to hear more about how he has taken this “putting BE into action” message to heart – and how insurers can do the same.
 

Noisy underwriting? It’s when you give two underwriters a less than straightforward case to assess and they arrive at different decisions – maybe very different. Or if you asked an underwriter to assess a risk that he or she processed a while back, and the decision second time round is different from the first.

Dr. Achim Regenauer, Chief Medical Officer, presents a high-level overview of liquid biopsy, one of the most exciting potential advances in cancer research. With promising results to-date for certain late-stage cancers, early and painless diagnosis from liquid biopsies could have huge positive consequences for wider cancer treatments and recoveries.
 

Facultative cases exist on a spectrum of difficulty, and increasingly, insurers recognize that many of these substandard submissions benefit from a blend of human judgment and automated processes – a hybrid approach. RGA's Scott Sibley explains.

Digital point of sales solutions for life insurance continue to become more innovative.
 

In this edition of ReCent Medical News, Dr. Cliff Titcomb explains the most important characteristics of COPD and how they are key to evidence-based underwriting.

This paper is the third iteration of a review first published by RGA in 2016 and revised in 2019. Since that time, the field has progressed so rapidly that a significant update was once again needed.
 

PartnerRe’s analytics experts evaluated the Life predictive model, LexisNexis® Risk Classifier with Medical Data. Here we present the results of our objective and detailed review of the model.
 

Although more people may be interested in buying life insurance, their chances of obtaining coverage could be hindered by the thing that inspired it: COVID-19.

As insurers shift to incorporate new and alternative data sources, underwriters are taking on more specialized skills. In On the Risk, RGA data strategist Jordan Durlester and underwriter Jacqueline Waas join forces to discuss the value of collaboration in more effectively applying new evidence sources to underwrite new business.
 

For the first time in many of our lifetimes, life expectancy in the United States has declined. Not only did it just not go up as much as we expected—it actually declined.
 

In this, the first of a 4-part series of insurance-focused articles on cancer, Dr. Achim Regenauer, Chief Medical Officer, focuses on how these advances translate into high-level trends, and why they are so important to Life & Health insurance – all in a concise bulleted format, so there’s no need to wade through complex medical descriptions or interpret sensationalized headlines.
 

RGA's Dr. Maryam B. Shapland, Vice President and Medical Director, U.S. Mortality Markets, explores reactive thrombocytosis, a condition associated with higher mortality in acutely ill patients.
 

A few years ago, it was typical to see $1 million as the high end for an accelerated program. Now some carriers are at $2 million and even $3 million.
 

Underwriting is a vital function that is ripe with opportunities for innovation. Every day, new sources of insurability data are being developed and vetted. In this post, we’ll examine a few examples, providing our perspectives on how these electronic sources of data can be leveraged in the underwriting process and where they are in the adoption lifecycle.  
 

In this edition of ReCent Medical News, Dr. Cliff Titcomb explains asthma characteristics and possible challenges for medical underwriters.
 

The long-term impacts of the COVID-19 pandemic on product innovation and development strategies are yet to be determined, but RGA's Dan Lyons suggests that a few major changes may remain and even become more common.
 

To innovate, insurers must marry a deeper understanding of how consumers make decisions with sophisticated product development based on the principles of behavioral science. RGA's customer research in Asia reveals surprising insights about the most successful insurance-linked wellness programs.
 

The last 17 months has certainly brought on a lot of change, some planned and some not planned. Below are some of the major topics that our U.S. life and health clients have been focused on recently – and question how best to move forward.
 

It seems in 2021 that every couple of months I learn about a software solution, new process, or new service that innovates, enhances, and accelerates life insurance underwriting. 
 

As part of an ongoing series in On the Risk, RGA's Taylor Pickett, an actuary, and Catie Muccigrosso, an underwriter, examine the relationship between their professions and underscore the crucial role underwriters play in the development and implementation of predictive tools and accurate pricing.
 

Simply stated, the law of large numbers in probability and statistics states that as a sample size grows, its mean gets closer to the average of the entire population.
 

Smokeless tobacco has been evolving over the past 55 years and now, with various forms of e-cigarettes and additives available, this once ‘safer’ recreational activity is showing implications on brain, lung, and cardiovascular function. 
 

Aducanumab (Aduhelm), a new drug designed to treat Alzheimer's disease was approved by the FDA on June 7, 2021. RGA's Dr. Dave Rengachary discusses what this means for insurance, as well as the controversies around it.
 

Driven by the need to slow or stop the spread of COVID-19, accelerated underwriting may save lives while increasing sales of life insurance.
 

How will the COVID-19 pandemic impact life and health insurance distribution and sales in the long term? Peter Rodes and Eva Goldstein of RGAX, the transformation engine of RGA, discuss the key drivers of insurance's accelerated convergence.
 

Monty Forman, ALHC, FALU, FLMI Director of Underwriting Research, hosts the underwriting webinar: The Thick and Thin of Melanoma. Dr. Anuj Gupta, Senior UW Research Consultant, shares his insight and the following points:

• Importance in Underwriting and the clinical picture
• Staging, Treatment, and Follow Up
• Long-term outcomes and case studies

Life insurers have taken a fresh look at their established traditional underwriting practices as they consider and implement streamlined accelerated underwriting (AU) options, removing the need for paramedical exams and/or fluid collection for qualified applicants.

When you have deployed an underwriting engine, that is not the end of the journey. Quite the opposite: it is just the beginning.
 

Dr. Achim Regenauer shares an overview of this important study’s findings and his perspective on the impact on cancer detection and Life & Health insurance.
 

As part of an ongoing series in On the Risk, RGA's Taylor Pickett, an actuary, and Catie Muccigrosso, an underwriter, examine the relationship between their professions and underscore the crucial role underwriters play in the development and implementation of predictive tools and accurate pricing.
 

Many applications have APS trails that read like a suspense novel. There is a medical condition, oftentimes a serious one, that has an intervention, and the trail ends. Perhaps it is a chronic condition, with unknown degree of control or stability that leaves no clue as to the present status. 
 

Hypertension, or high blood pressure, is a common medical problem. It can be caused by a number of other medical conditions such as chronic kidney disease, thyroid disorders and other hormonal upsets, and a rare adrenal gland tumor called pheochromocytoma.
 

Post-traumatic stress disorder (PTSD) was first introduced into the Diagnostic and Statistical Manual (DSM) of the American Psychological Association in 1980. Since then, the diagnostic guidelines have been reviewed multiple times, and the understanding of risk factors, neurobiological consequences and psychological symptoms has improved dramatically.
 

RGA’s consultant oncologist, Dr. Radi Counsell, discusses the ways liquid biopsies will change the face of cancer care, from screening and diagnosis to treatment monitoring and surveillance of survivors. Dr. Counsell also examines underwriting and claims adjudication implications of this emerging technology. 
 

The pandemic has forced the industry to hasten its embrace of automation. By the start of this year, over 40% of life insurers had either already incorporated some degree of accelerated and automated underwriting into their new business process, or had imminent plans to do so. This was a dramatic increase from 18% the year before – according to research from Celent.

One of the most difficult calls facing an underwriter is the discussion with a producer who insists that his client has been unfairly rated due to an improper fasting time prior to blood drawing

During the pandemic, we’ve had fewer in‑person interactions and done more things remotely. A positive is that we are becoming better at using technologies that fit this new normal. The question is whether or not technology can be adapted to allow for socially distanced, fast and effective medical risk assessment and if successful, can it help invigorate underwriting?
 

“Precision” has become a popular buzzword in financial services – yet when it comes to life and health insurance, underwriting processes have been challenged to keep pace with medical advances. Is it time for a new approach to calculating risk?

LIMRA, the Reinsurance Group of America (RGA), the Society of Actuaries (SOA) and TAI have collaborated on an ongoing effort to analyze the impact of COVID-19 on the individual life insurance industry’s mortality experience and share the emerging results with the insurance industry and the public.

As many Americans return to post-pandemic normalcy, life insurers are as well, with many companies curtailing or eliminating underwriting restrictions that have been in place since March 2020.
 

New ‘polygenic’ screening techniques open a Pandora’s Box of ethical issues.
 

In 2020, RGA produced a five-part series of articles exploring life insurance fraud in the time of COVID-19 as a lead-up to the RGA Fraud Conference. One year later, with the ninth annual RGA Fraud Conference set for August 16-20, we checked back in with the authors of those articles to learn how the climate for fraud may have changed as the pandemic has evolved and how the industry can prepare for what lies ahead.
 

Will the COVID-19 pandemic cause ‘diseases of despair’ to rise and will this affect long term trends in mortality and morbidity?
 

When it comes to risk selection, insurers typically assess whether an applicant has a clinically diagnosed mental illness like schizophrenia or bi-polar disorder. 

Several systems are available in the market. To help you research beyond a provider’s high-level content and demos to evaluate the right system for your business, we recommend asking them the following five questions.
 

Munich Re Life US conducted an accelerated underwriting survey to capture new and emerging trends in the U.S. individual life accelerated underwriting market.

Underwriting pulmonary and thyroid nodules has always been a distinct challenge. In a two-part article for ReFlections, RGA's Sandeepan Basu seeks to simplify the underwriting challenges associated with both types of nodules by identifying factors to better quantify risks and provide guidance.
 

Options range from the most severe—refusing to extend coverage—to treating the virus like cancer, respiratory illnesses and other conditions that must be disclosed when applying for life insurance.

Data analytics projects have become increasingly common across the insurance industry in the last few years and have really taken off in the Life sector. It’s a trend that requires the input of Medical Directors - and it gives the Directors a chance to shine.

Rapid advances in medical science’s understanding of the human genome have led to the recent development of novel gene-based therapeutic strategies. In ReFlections, RGA's Dr. Dan Zimmerman defines gene and cell therapies and provides insights into these rapidly developing and impactful technologies.

Hypothyroidism is estimated to be present in over one percent of the population and up to five percent over the age of 60. While hypothyroidism is easily diagnosable through laboratory testing, most lab panels do not include it as a routine test.
 

Cancer is an abstract idea in underwriting, until it happens to the underwriter. Get a candid and highly personal perspective, which was first offered at the AHOU 2021 Annual Conference.
 

The global burden of gestational diabetes mellitus (GDM) is on the rise alongside increases in obesity and changing lifestyles. In ReFlections, RGA's Dr. Reema Nathwani Jani explores the history, complications, management, and long-term outcomes of GDM on maternal morbidity and fetal mortality, as well as links with diabetes, CVD, and cancer risks. 

Behavioral Economics may help find a balance between simplification of the underwriting process and the mitigation of risk.

Underwriting engines have been around for over 20 years. Initially they were used in head offices, processing application form information keyed in by clerical staff, and avoiding the need for (expensive) underwriters spending time on the more straightforward cases.

Quest continues to monitor COVID-19 and contribute to the scientific community’s understanding of this novel disease.
 

Many insurers currently look at substance use through a binary 'yes/no' lens
 

Dr. Tom Fletcher, VP, Data Analytics, North America Life, discusses the benefits of multidisciplinary teams.

While clinicians have a better understanding of COVID‑19 disease, science is still struggling to make sense of its long-lasting symptoms, known as Long COVID, and what “long haulers” have in common.
 

The U.S. hit a sad record in 2020, with deaths reaching more than 3 million for the first time.
 

When assessing glycemic control in the majority of our applicants, hemoglobin A1c is the gold standard for assessing glucose control over an intermediate period of time. 
 

Insurers were already welcoming technology and embracing ideas such as accelerated underwriting. But things move slowly in the insurance world. Then the COVID-19 pandemic hit and insurers no longer controlled those timelines.

One of the hardest challenges Life insurers encounter when adopting accelerated underwriting (AU) is figuring out how to compensate for the loss of information previously derived from blood and urine tests.
 

The coronavirus vaccine will lead to Covid underwriting restrictions being reduced or removed, according to an insurer.
 

A series of clinical trials examining biomarkers to reduce cancer deaths by around 20% could revolutionize cancer care. What does this mean for insurers?
 

Underwriting guidelines today follow the principles of evidence-based underwriting. By adhering to those principles, insurance companies make sure that all risk decisions made by underwriters have a substantial statistical basis.
 

As the burden of disease from diabetes rises to epidemic proportions, RGA's Heather Lund asks in On the Risk whether the possibility of remission for Type 2 diabetes mellitus (T2DM) signals an opportunity to escape a major public health traffic jam.
 

Polygenic risk scores are proving to be a powerful tool in the era of genomic medicine. Their application has grown substantially – from predicting common diseases to enhancing risk modelling for various types of cancers. What does this mean for insurers?
 

Hailed as a major scientific advance when they were introduced in the mid-1970s, monoclonal antibodies (mAbs) were slow to be applied outside of the lab. COVID-19 has changed everything. 
 

Carotid artery stenosis is a narrowing or constriction of any part of the carotid arteries, generally caused by atherosclerosis.

Understanding the effects of physical activity on mortality and morbidity risk

A small but significant amount who have “recovered” from the acute phase of the illness still have a degree of disability which affects their day-to-day living. These are the “long haulers”—those in whom COVID has spared in the short term but in whom we have truly no idea of what the long term prognosis will be, either morbidity or mortality wise.

Because of the pandemic, more people than ever are seeking out life insurance — just as insurers seek ways to identify people who have had COVID-19, and in some cases deny them coverage.

Resting heart rate effectively segments mortality across age, gender and BMI, even when factoring in number of steps and hours slept.

Multiorgan symptoms after recovery from COVID-19 are increasingly being reported. RGA conducts a comprehensive evaluation of 'long COVID' and other trends among survivors of the virus and addresses important underwriting and claims considerations. 

Electronic Health Records (EHR) are the hottest trend in life insurance underwriting today. The growing accessibility and innovation by solution providers is transforming the life underwriting process.
 

Understanding how sleep affects health and mortality for new underwriting methods

This Heart Month, we examine three contributing factors insurers can consider when reviewing a life insurance applicant’s laboratory and medical history. We also highlight some early research that has been published on what complications COVID-19 may cause to the cardiovascular system.

One year after the outbreak of COVID‑19, it has become apparent that patients who have recovered from the acute illness may still struggle with long-term consequences.

Digital health – for insurers “the digital transformation”, the “oil of the 21st century” – has been a hot topic for almost a decade now. So have digital opportunities now been fully embraced and a tidal wave of health data leveraged to the benefit of individual/insureds, healthcare systems and Life & Health insurers? 

How much do different factors influence COVID-19 mortality risk versus all-cause mortality risk? RGA’s Global Data Insights team set out to answer this question through a thorough analysis and comparison of COVID-19 and all-cause mortality risk factors for the population of England.

With an estimated 90% of the world’s data collected in the last two years, digital strategies are evolving rapidly. But how do we make business decisions with all the data that is available? What does it mean for underwriting?

Is diabetes more deadly for women and the young? Recent research, jointly undertaken by RGA and MIB, examines mortality and morbidity indicators for diabetics based, for the first time, on both MIB’s impairment records and RGA’s prescription drug history information.

Research suggests that the cause of rising incidence rates of cancer in adolescents and young adults relate to the increasing prevalence of obesity, the consumption of a Westernized diet, and leading a sedentary lifestyle. A focus on lifestyle and dietary habits of young insurance applicants would provide useful insights into the top modifiable risk factors for cancer and help stem the inevitable rising rates of claims for cancer.

Over the last 5 years, the life insurance industry has experienced an exponential growth in accelerated underwriting (AUW) programs. As the life insurance underwriting process continues to provide less invasive accelerated pathways, insurers increasingly rely on self-disclosed information for key risk factors instead of observed measures under traditional underwriting, such as smoking status and build. 
 

Aortic aneurysms are usually silent killers in that most (almost all that involve the abdominal part of the aorta and half that involve the upper or thoracic part) are generally asymptomatic.
 

Dr. Radhika Counsell, Consulting Medical Officer, offers a deep dive into differentiated thyroid cancers and discusses this topic in the context of critical illness claims assessment in ReFlections.

Here is an inside look on how life insurance solution providers adapted and innovated to these new challenges in 2020.

ReFlections editor Dr. Daniel D. Zimmerman, Senior Vice President, Head of Global Medical, reviews therapeutic monoclonal antibodies, which are rapidly growing in importance for a multitude of disorders for both prevention and treatment.

With the COVID-19 pandemic, the need for accelerated underwriting (AUW) in a fluidless environment has become urgent. The webinar on “Risk Selection in a Fluidless Environment” explores how we can understand if and when fluid testing is useful or needed in the underwriting process.
 

How insurers use big data and artificial intelligence to support their claims and underwriting strategies is likely to accelerate as a result of the Covid-19 pandemic.
 

Munich Re Life US reviewed the LabPiQture™ product from the ExamOne HealthPiQture™ suite as part of a collaborative effort to better understand the value of various medical data sources and tools.
 

In clinical practice differentiating Alzheimer’s from other conditions whose treatment is far different is important.
 

The webinar “Medicine and Machine Learning” explores the impact of machine learning on medical practices and how that applies to risk assessment.
 

GA has released its 2020 Foreign Risk Study, a comprehensive assessment of the relative mortality risk of 205 countries drawing on data from 2019, prior to the outbreak of COVID-19, and based on weighted rankings across 25 indicators grouped into six broad categories.

Munich Re Life US recently evaluated mortality risk scores from the ExamOne HealthPiQture™ suite to assess their impact in segmenting mortality as part of the life insurance underwriting process.

RGA Hong Kong and the RGA Asia Pacific regional team explore recent innovations in genetic testing and provide guidance on how insurers can prepare for and adapt to changes on the horizon in the genetic moratorium era.

Many smokers of five-a-day or fewer cigarettes, or those who have cut down while trying to stop, believe the occasional cigarette causes them little or no harm

Prior to COVID-19, 46% of American adults did not own life insurance and of those who did, many were underinsured, according to research by the Life Insurance and Marketing Research Association.
 

Less than a year ago it would have been excessive, if not redundant, to issue a 90-day impaired risk underwriting update. Not so in 2020.
 

Part III in a series of articles on developing underwriting thought processes, this third installment focuses on ways to develop critical thinking skills.

The practice of preventive medicine requires estimating the risks of developing chronic diseases so as to enable risk-mitigating measures such as diet, lifestyle and medical interventions to be implemented. 

The industry has been talking about the “future of UW” for decades, but now COVID-19 has “accelerated the inevitable” and the future is now.
 

Dr. Achim Regenauer, Chief Medical Officer, discusses a newly published study that links air pollution to the occurrence of common neurodegenerative diseases, namely Alzheimer’s and Parkinson’s disease, the two fastest-growing neurological conditions in the world.
 

In my experience, two of the most challenging underwriting topics for advisors to understand are liver disease and kidney disease. 
 

Sickle cell anemia affects approximately 100,000 Americans and is most prevalent in African-American and Hispanic-American communities.
 

We’re used to seeing hypercholesterolemia as a known risk factor, but high triglycerides are also associated with an increased risk of cardiovascular disease.

Several underwriting tools have been adopted by carriers to issue coverage faster, in many cases without the need for insurance exams or requirements such as a traditional APS.  Some of these tools are new, while others have been in use previously, but have recently been enhanced to streamline the underwriting process.

Applying Modern Biotechnology to Life Insurance Underwriting

In ReFlections, RGA's Dr. Georgiana Willwerth-Pascutiu provides a scientific perspective on one of the most controversial and complex plants in the world, including its derivatives, its prevalence of use, and insurance industry implications.

Dr. Tom Fletcher, VP Data Analytics, North America Life, shares his perspective on the component strands necessary to build and maintain ethical standards in predictive modeling.

Advancements in hepatitis C (HCV) reach further than just curing 90% of those infected with the virus. For the first time in a quarter of a century, the organ transplant list has decreased thanks to utilizing organs from HCV infected donors.

Body dysmorphic disorder (BDD) was first described in 1891 as “dysmorphophobia” by Enrico Morselli, an Italian psychiatrist.It is an obsession with perceived flaws in one’s own appearance that will most likely appear insignificant or unobservable to others. This article will look at BDD in more detail and cover the potential implications for obtaining insurance.

Millions of overweight and obese individuals are at increased risk of non-communicable diseases and early mortality than the non-obese. RGA's Hilary Henly explores what insurers need to know about the consequences of rising obesity rates and dietary trends across the globe.

Most cases of bronchial asthma are not an underwriting worry. It is a common disease, affecting between five to 10 percent of the population. But asthma is also becoming more concerning than it was ten or twenty years ago. Prevalence, hospitalizations, and fatal asthma cases have all increased, and there were close to 4,000 asthma deaths in the United States last year. Knowing which cases are the most concerning is the key to successful underwriting and case placement.

A cloud of uncertainty? In ReFlections, RGA's Hilary Henly, investigates growing use of e-cigarettes and the practice of vaping among the young and exposes adverse health effects, unknown risk, and the increased potential for long-term dependence.

We must chart a course that continues producing robust mortality gains absolutely critical to our bottom lines … despite the challenges posed by the incipient 2020 Great Recession and the protean consequences of the COVID-19 pandemic. This article identifies and discusses core factors that I believe will determine how all of this sorts out over the next decade. It also suggests how we can greatly minimize mortality-related adversities via prudent changes in how we underwrite life insurance.

Mortality results are of paramount importance to your bottom line. Here, a seasoned industry expert explains what the current situation is, why we are where we are, and how we can survive.

Life and Health Insurance Underwriting is entering a “new normal”. The industry is moving beyond exploring new technologies, such as advanced data analytics and automation, to real-world applications. In this new environment, innovation is not seen as novel but as critical to the success of the insurance enterprise. Insurers are taking tangible steps to fundamentally change the ways that global life and health risks are underwritten.

As accelerated underwriting (AU) and artificial intelligence (AI) begin to turn life underwriting upside down, several NAIC working groups are seeking to bring order to the disruption.

Part II in a series of articles on developing underwriting thought processes, this second installment focuses on potential challenges and shortcomings related to decision-making skills. RGA’s underwriting experts outline strategies to help neutralize heuristics and biases in the underwriting process and become effective in critical thinking.
 

Life insurers were prepared to embrace the COVID-19 challenge. Most carriers had pre-planned models and analytics ready for such an eventuality. The companies immediately calibrated their responses to the pandemic and responded with their own versions of shutdowns through product withdrawals, price increases in some cases, age limitations, offer restrictions, and postpones for clients with pre-existing conditions.

Pandemic-driven pressures are magnifying existing challenges within the underwriting profession. RGA's Lars Haaland and Catie Muccigrosso look into potential solutions that might help insurance companies emerge as leaders post-COVID-19. The key is to implement processes and partnerships geared toward the future of underwriting.
 

Endometriosis is a condition where normal tissue that lines the uterine cavity is found outside the uterus, mainly in the area of the pelvis and the ovaries. It is a common source of pelvic pain in women, and is an increasingly diagnosed entity in workups for infertility.

This year continues to present challenges that force us all to think differently. The pandemic response promoted independent action, self-help and a heightened sense of social responsibility. This has accelerated the harnessing of technology as solutions for how we work, communicate, access healthcare, buy goods and receive services. 

The practice of underwriting has often been described as both a science and an art – and for good reason.
 

Body mass index is an important driver of risk class and stands as the second largest concern for misrepresentation in accelerated underwriting after smoking non-disclosure.

Underwriting advocacy to navigate the new world is as critical as the digital processes itself.

Consider the standard “AA” or age and amounts table. Lockdowns and stay-at-home measures are making collecting fluids and conducting parameds less feasible, yet underwriters still base the decision to order evidence on an age and policy face amounts table that has not changed substantially in decades. The result? Insurers often order evidence unnecessarily or waive needed requirement.

It is a long way from Bob Dylan’s realistic prophecy of what was happening and what was to come back in 1964 when he wrote the song. No one can disagree with the state of the world protests and the COVID pandemic that the times certainly are a-changin’. This is also the phenomenon happening in underwriting and risk selection, and we have to be prepared to meet the changes to insure a positive outcome no matter our underlying feeling about what those changes are.
 

Putting together the health effects of nicotine and the chemical components of regular commercial e-cigarette inhalants leads to a conclusion that the risk is small but not trivial.

There are a lot of changes happening in the life insurance industry because of COVID-19—market environment, types of insurance products, processes, and technology.
 

Could air pollution contribute to the risk of developing Alzheimer’s disease? Can mental stimulation and social connection protect against the cognitive decline? RGA's Hilary Henly explores lifestyle and environmental risk factors, explores genetic insights and testing advances and more.

Smartphone addiction: Is this a legitimate disorder or just a trendy catch phrase? Some are calling it the new addiction of the 21st Century.

Head and neck cancers were the eighth most common cancers worldwide in 2018 and accounted for 3% of all cancer diagnoses and about 1.5% of cancer deaths in the U.S. alone. Epidemiologist Dr. Lauren Garfield discusses well known and emerging risk factors, survival rates, and more in ReFlections. 

The author makes the case that the new underwriting strategies will continue after the COVID-19 pandemic is over.

Munich Re analyzed the effectiveness of daily sleep duration in stratifying the mortality risk profile of a U.S. insured population simulated from National Center for Health Statistics survey data.

Underwriters and claims assessors should aim to keep up to date with the evolving management of mental health conditions to ensure risk and claims assessments are dealt with accurately and fairly to prevent stigma perpetuation.

Post-human underwriting? In On the Risk, RGA's Dr. Dihui Lai discusses the current state of artificial intelligence and the potential for machine learning, optical character recognition and deep neural networks to augment, but not replace, traditional life underwriting tasks.

Mobile apps are now widely accepted as a self-management tool for managing epilepsy – with smartphone applications used in tandem with traditional treatment and anti-seizure medications. This neurological disorder is a common condition seen by insurers, and many applicants with controlled seizure history can be considered favorably for life insurance.

Over the past three decades, the global prevalence of diabetes has risen to record levels. There has been a corresponding increase in the use of the glycated hemoglobin A1c (HbA1c) test to assess or detect diabetes. An increasing number of underwriters are now also considering using HbA1c as a good blood biomarker for mortality. 

Quite simply, hematuria is defined as the presence of blood in the urine. It can be obvious to the clinician (frank hematuria) or not visible to the naked eye (microscopic hematuria). The large majority of instances in insurance underwriting are picked up incidentally from the submitted urine sample. The critical question then is which cases are significant, which have benign causes, and which need additional investigation before underwriting can continue.

The center questions the use of factors such as employment class and education level in marketing, underwriting and pricing.

Critically important containment measures have been shown to ‘flatten the curve’ of new SARS-CoV-2 infections, save lives and ease the pressure on healthcare systems and medical supplies. At the same time, there are indications that these and other COVID-19 related measures will, depending on their extent and duration, also impact on the future mortality and morbidity trends of other areas of disease and health.

Munich Re assessed the effectiveness of Milliman Irix® Risk Score 2.2 in stratifying the mortality for the U.S. insurance applicant population.

Predictive models are an incredibly powerful tool with the potential to drive the life insurance industry forward in ways that are good for both consumers (improving their purchasing experience by removing intrusive requirements and long delays) and carriers (increasing taken rates and persistency, and increasing the accuracy of mortality assessments).

The incidence of melanoma is rising in much of the world, and it is now the fifth most commonly diagnosed cancer in North America.

Why do some COVID-19 patients experience critically low blood-oxygen readings? Why has mechanical ventilation been of varying benefit? RGA's Heather Lund explores these and other pertinent questions surrounding COVID-19-associated coagulation abnormalities. Insights shared and learned can only help to better understand, manage, and predict possible disease outcomes of this novel pathogen.

Tele-interviews, when carried out by well trained individuals, ideally with a medical, nursing or underwriting background, can bring new and more detailed disclosures than may be the case when applicant is questioned by an agent or broker.

Nonalcoholic steatohepatitis (NASH) is a more aggressive form of liver disease. It is inflammatory in nature, is much quicker in disease progression than the standard type and may result in liver cirrhosis and failure. Both in clinical practice and in underwriting, NASH is under-recognized in its incidence. It actually affects up to five percent of the United States population and its prevalence is on the rise.

There remains much debate about Coronavirus and the many ways in which it has affected, is affecting and will affect societies: for example, the death tolls so far and in future, ways to suppress its activity, the value of testing, tracing and monitoring, the economic impact of ‘lockdowns’ and whether governments have responded appropriately in a timely manner.

How can medical advancements extend a healthy lifespan and combat the diseases of old age?
 

Life insurers need actionable responses to current underwriting challenges – including the need for fluidless Accelerated Underwriting alternatives, while striving to maintain the same level of mortality.
 

This two-part article aims to review some of the important concepts and considerations for insurers wishing to use data and technology to become a partner rather than just a payer for their policyholders. These include ethical considerations, understanding exactly what data is, the implications of data misuse and of ethical intelligent data use, and the importance of integrating data from various sources, ultimately enabling us to grasp the true potential of data.

This two-part article aims to review some of the important concepts and considerations for insurers wishing to use data and technology to become a partner rather than just a payer for their policyholders. These include ethical considerations, understanding exactly what data is, the implications of data misuse and of ethical intelligent data use, and the importance of integrating data from various sources, ultimately enabling us to grasp the true potential of data.

Medical records are not only a crucial piece of the underwriting process but also one of the costliest in terms of time spent – positioned for transformation through data science and machine learning.

LIMRA worked with the Society of Actuaries and Oliver Wyman to conduct a series of short surveys on the COVID-19 pandemic and its potential effects on the insurance industry.
 

The importance of AI to the insurance world has grown in tandem with insurers' reliance on data. Hear how AI is impacting the industry.
 

Undoubtedly, after hours and hours of CNN and network news coverage, we are all “experts” on coronavirus, something we likely knew nothing about entering this new year. How it spreads, what to do to avoid it, how to practice social distancing, sheltering in place—all part of our new vocabulary in this stressful time. Just as it affects our daily lives, it also affects life insurance applications and how we are handling different steps in the process.

COVID-19 has had the biggest short-term effect on life insurance in two ways

Over the last several years, we have seen rapid advances in the technologies that aim to treat people with diabetes.

When cardiac events occur, such as a heart attack or the need for a revascularization procedure, there is quantifiable risk that can be identified and priced for.
 

Life insurers are demonstrating flexibility in response to the pandemic, smoothing the sales process through digital channels, relaxed underwriting requirements and coverage extensions.
 

Here are 10 things people in the sales and distribution community are saying about the current, and future, effects of the pandemic, drawn from written commentaries emailed to us, emailed to clients, or distributed through press release services.

In a response to the uncertainties COVID-19 has brought to the world, Swiss Re is opening access to its proprietary Life Guide underwriting manual to all life and health insurers for 90 days (from 27 April to 31 July 2020). The offer is designed to help life and health insurers navigate today’s crisis, better understand all risks they underwrite and give them confidence in offering coverage at a time when more people are thinking about life insurance and re-evaluating their financial situations.

Will the mortality associated with COVID-19 affect your life insurance business? This article examines early mortality experience related to COVID-19 and includes a discussion about the difficulties in using this data. It also provides some ideas for changes to life insurance underwriting to help cope with COVID-19.

With sweeping stay-at-home orders across the country and social distancing guidelines in effect, nearly all industries have had to adapt by making significant changes to once routine business practices. For many life insurers, this means figuring out how to handle underwriting in the absence of in-person exams or the collection of fluids, like blood and urine.

Much is still unknown about the 2019 novel coronavirus (SARS-CoV-2). This document, created by Achim Regenauer, Chief Medical Officer PartnerRe, is intended only as a general overview. Opinions expressed are those of the author. Over the coming weeks and months, a much clearer picture of this virus and its impact is likely to emerge. We hope you find this information useful.

The true value and purpose of the cover offered by our industry, providing financial resilience and peace-of-mind to households, individuals and businesses, has never been more apparent than during this historic phenomenon. 

Some insurers have added the carcinoembryonic antigen (CEA) blood test to the laboratory screening profile for Life and Health insurance applications, and some of our U.S. clients have asked for advice on whether to adopt this test.

A quick LIMRA and LOMA survey of financial services companies found that 91% have a pandemic stress scenario in place. In addition, 71% have assessed and quantified the potential impact on their key business in the event of higher mortality.

Nothing attracts media attention quite like a potential cure for cancer. Researchers from Cardiff University, UK, recently published this paper detailing one possible method to beat cancer with far-reaching, all-purpose abilities. While it is currently just a laboratory experiment, the method they have outlined certainly has merit.
 

Identifying depression is critical to minimizing patient distress, but despite treatment advances, excess mortality persists, says RGA's Akhilesh Pandey. He discusses the disease process, treatment and prognosis, and underwriting implications in On the Risk, the Journal of the Academy of Life Underwriters.

As today’s medical and technological advances continue to be utilized and applied to Diabetes mellitus (DM), a newer and even more complex framework for the disease is emerging, which may help us further our understanding of it. RGA's Dr. Karneen Tam explores the most recent classification update and some of the newer thinking emerging about DM in Reinsurance News. 

What will the life insurance/annuity sector be like in 2030? Resource turned to some seasoned executives for answers.

Brooks Tingle, president and chief executive officer, John Hancock Insurance, said the organization wants to promote engagement with insureds by partnering with a growing range of tech and service providers. Tingle spoke with AM BestTV at InsureTech Connect 2019, held in Las Vegas.

Top industry analysts discuss AI and the life insurance industry
 

Marfan’s syndrome is a systemic connective tissue disease that is inherited. It is characterized by abnormalities of the skeletal, cardiovascular and ocular systems predominantly. 

Underwriting practices today are a world away from those commonplace 20 years ago, but the biggest evolution is yet to come.

Epigenetics can uncover how poor health habits can affect future wellness and is being viewed as a potentially powerful underwriting tool.

Costing hundreds of thousands, even millions of USD per individual, a handful of immuno- and gene therapies have been developed to-date. But in fact it’s no longer correct to talk of just “a handful” – usage expansion is already well underway and set to increase medium term.

The news of an outbreak in China of a new type of coronavirus (2019-nCoV), leading to respiratory illness, recalls previous potential pandemic infections.

There are few things that contribute more to building an appreciation for different roles than sitting in someone else’s shoes.

While there is yet no HIV vaccine, a small blue pill can prevent HIV transmission. RGA explores the power of PrEP (pre-exposure prophylaxis) as an effective prevention strategy, as well as potential risks, protocols, and barriers to greater use.

The improvement in cancer survival rates has led to a growing life insurance need for cancer survivors worldwide. To mark World Cancer Day, Manuel Plisson, SCOR Global Life Head of Inclusive Underwriting & Medical Expertise, discusses an inclusive rating approach that could help address this protection gap.

Aerosol biopsy is intended to simplify the process of diagnosing major lung diseases by capturing and testing expelled droplets from the lungs.

Prevalence, current therapies and prevention are the key themes for insurers that are reviewing their approach to applications with a history of viral hepatitis.

Psoriasis is a common inflammatory skin condition that is characterized by bright red plaques, generally looking like silver scales, and most often present on elbows, knees and scalp.

An increase in opioid misuse has contributed to a rise in overdose mortality, gaining the attention of the media, Hollywood, and legislators.
 

Two significant and parallel change factors – innovative new medicines and advances in digital technologies – are shifting diabetes management into a new and more positive era, significantly improving the prognosis and quality of life for diabetics, and paving the way for new Life underwriting and product opportunities.

SelectX has been reviewing mental illness risks as part of maintaining and updating its RiskApps on-line underwriting manual. Some headline findings after scrutiny of nearly 50 journal articles are...
 

Jennifer Thoreson, R.N., AALU, Executive Director, Underwriting Services, U.S. Mortality Markets, RGA, provides a comprehensive overview of the current state of EHRs, how EHRs now compare with attending physician statements, and the benefits and challenges both bring to risk assessment in ReFlections.
 

15 Executives discuss new regulations, technology, customer experience, talent acquisition, fraud, business disruptors and more.
 

As global population pyramids invert, governments will strain to meet growing protection needs and dependency burdens. RGA's Tim Rozar takes a look Inside the crystal ball in The Actuary, a publication of the Society of Actuaries and delivers seven predictions that are by turns sobering and hopeful.
 

RGA's Colin DeForge and Danielle Storts provide key tips for underwriters to recognize the red flags that signal fraud. As the first line of defense, underwriters serve a crucial role in the identification and prevention of fraud. This article offers important insights, as well as an industry-wide call to action to tear down silos and improve communication to prevent fraud.

Bronchiectasis is a disease that is characterized by chronic dilation and widening of the smaller bronchial tubes and bronchi and destruction of the bronchial walls. It can either be congenital (such as in cystic fibrosis, the cause of almost half the cases) or acquired via recurring inflammation or infection of the airways.
 

Dr. Karneen Tam, Medical Consultant, RGA Asia Pacific, provides an in-depth discussion on cardiovascular and kidney complications related to diabetes mellitus and the mitigating effects of newer classes of medication in ReFlections.

Evolution not revolution

So how can we underwrite these cases better? How can we reach fair decisions quickly and efficiently?

Cardiorespiratory fitness (CRF) is a measure of the body’s ability to supply oxygen to muscles, including the heart, during sustained levels of exercise. Whether or not you believe the hype that just sitting around poses a significant health risk, the truth is most people could do with exercising more.

The industry has yet to tap the true potential of accelerated underwriting because the automation component has been missing.

An analysis of cause-specific mortality can shed light on variations in mortality patterns across sub-populations of an individual life insurance portfolio. These insights inform future mortality projections such as mortality improvement assumptions. The complex nature of mortality risk, especially for insured lives that are subject to the rigorous process of life underwriting, poses a challenge in understanding the likelihood of one cause of death over another.

Is science fiction becoming science fact? Liquid biopsies are a new class of blood- (or other bodily fluid-based) tests that can reveal direct evidence of cancer and are far less invasive than traditional biopsies. RGA's Dr. Daniel Zimmerman explores linkages between advances in genetics and this new technology. He also investigates limitations, potential mortality and morbidity impacts, and insurance implications. 

The Centers for Disease Control and Prevention in the U.S. just announced an investigation of a multistate outbreak of e-cigarette, or vaping, product use associated lung injury (EVALI). By November there were over 1,800 confirmed and probable cases and 37 deaths.1 This opens the safety of Electronic nicotine delivery systems (ENDS) to scrutiny once more.

RGA's Dan Lyons discusses the rise of a fourth industrial revolution and identifies six strategies insurers are adopting to manage disruptive change. 

Celiac disease is a dietary disorder caused by an immunologic response to gluten, which is a storage protein found in many grains.

The race to develop accelerated products has driven life insurers to cautiously embrace the next generation of data.

One of the most frequently-used phrases at business events these days is “the future of work.” It’s increasingly clear that artificial intelligence and other new technologies will bring substantial changes in work tasks and business processes. But while these changes are predicted for the future, they’re already present in many organizations for many different jobs.

Among the areas addressed include the structure of accelerated underwriting programs, how programs are monitored, how accelerated underwritten business is performing relative to expectations and how companies are considering accelerated underwriting cohorts in the context of VM-20 assumption setting.

Could the advances in artificial intelligence that have been applied to the game of chess enhance actuarial science and underwriting? While data drives machine learning today, RGA's Dr. Jeff Heaton notes that Google's AlphaZero demonstrated how a computer can teach itself chess without data.
 

Kyobo Life Insurance announced on October 30 that its AI-based underwriting system, known as Best Analysis and Rapid Outcome (BARO), is now fully operational.
 

For some, there’s no spookier scenario than blood work and cumbersome forms to obtain insurance coverage. But as Neil Parkin of RGA South Africa explains, emerging risk segmentation techniques, combined with smarter use of data, could help ease these fears. 
 

Slides from this presentation (Actuaries' Club of the Southwest, November 7, 2019) have been posted at the ACSW website.
 

In early August 2019, the US Centers for Disease Control and Prevention (CDC) issued a Clinician Outreach and Communication Activity urging clinicians to report possible cases of unexplained vaping-associated pulmonary illness to their state/local health departments.

One of the conditions met with a lot of confusion by brokers and agents in trying to assess where it falls underwriting-wise is bipolar disorder. Those with the disorder often represent it as if it were a minor inconvenience, and oftentimes any period of remission is met with a request for a standard or preferred issue.

The potential health risks of vaping – the use of e-cigarettes to deliver nicotine or cannabinoids as a vapor instead of smoke – are now capturing headlines for an alarming spike in sickness. RGA’s Dr. Dave Rengachary, Senior Vice President and Chief Medical Director, U.S. Mortality Markets, briefly discusses what is known, and not known.
 

Get a first-person view of the unfolding opioid epidemic from a physician who lived it. Dr. Elyssa Del Valle recounts her experiences attempting to treat pain, while preventing addiction, and draws lessons for insurers.
 

Now, there’s a movement in the insurance industry to leverage new forms of surveillance to assess risk during the underwriting process of life insurance policies (the process of assessing a potential customer’s risk).

Some of the articles featured in the September 2019 edition of RGA's Global Medical Newsletter include:

• Part II: Proposed New Classification and Nomenclature for Chronic Pain
• The Changing Face of Alzheimer’s Disease
• Brief Report: The Elusive Influenza Vaccine – Are We Any Closer?

As a young psychiatrist, I went through a period of being excited about the brain. It seemed that emerging technologies in imaging and genetics would transform clinical psychiatry.
 

In recent years, a substance known as kratom has grown in popularity in the U.S. and the U.K. as it is easy to purchase online and advertised as a ‘legal high.’ RGA's Hilary Henly explores the consumption, regulation, and risk of this increasingly popular plant-based psychoactive substance.

Because underwriters play an essential role in this “noblest profession,” it is critical our service be consistently outstanding. A key to ensuring such consistency is for Underwriting departments to measure and manage performance and productivity without inappropriate bias.

Lab results often fit a pattern, since the body’s physiologic system is generally in sync with each of its organ systems. If heart, liver, kidneys or metabolic results are affected, there will generally be a pattern where tests rise in conjunction with each other. Then there are “outliers,” profiles where one test stands front and center out of the normal and without any lab value friends to put it in perspective.

Top life underwriting issues include regulatory concerns, accelerated underwriting, and the opioid epidemic.

There is no single tool capable of defeating insurance fraud. In a wide-ranging paper and guide, RGA shares insights into fraud detection and prevention trends, techniques, and technologies at the RGA Fraud Conference. Insurers must be proactive and prepared to adapt nimbly, to keep pace with fraudsters. Find simple steps all insurers can take here.  

Is the recent slowdown of mortality improvement observed amongst the U.S. population also happening in the individual life insurance population, and what are the implications for the future?

Life underwriting professionals are experiencing a paradigm shift in modus operandi, driven by the introduction of automation initiatives. Multiple consulting studies and analyses indicate that automation in underwriting is a valid business need. The coevolution of humans and technology must be supported by business strategies that focus on identifying necessary underwriting skill sets. The convergence of the art of underwriting and the science of technology presents many challenges. Insurers and reinsurers must plan accordingly.

Cognitive testing in life insurance is becoming more and more prevalent, particularly as the number of older age applicants grows. You can expect testing now as a routine at age 70 or older, and although the platform isn’t rigorous, it can derail an application almost irreversibly if performance is poor.

As more countries either partially or fully legalize cannabis for medical or recreational use, underwriters should be aware how changes in legislation may affect disclosures by applicants regarding their use of cannabis. RGA's Hilary Henly explores the considerations. 

Cystic fibrosis was rarely encountered by Life and Health underwriters until relatively recently. However, advances in our understanding of this inherited lung disease, and the emergence of more effective treatments, mean that children born with the disease are now surviving into adulthood and living much healthier lives.

Survival for infected individuals continues to improve as newer, less toxic drugs and simpler one-tablet daily regimens are increasingly available. RGA's Hilary Henly explores what underwriters need to know about HIV in part one of a two part series.

Life Insurance Industry Trends Insurtech Survey 2019

Significant and rapid progress in genetics research and data analytics is currently enabling an unprecedented expansion in science’s understanding of the genetic underpinnings of rare and common diseases. Large-scale cohort studies such as the UK Biobank are helping scientists build powerful prognostic models for a number of diseases, including breast cancer and coronary artery disease, and hastening the development of a new tool for quantifying the inheritability of common diseases: Polygenic risk scores.

Lest anyone think the previous exchange is fanciful or seems a bit paranoid, it is already happening. It is known as using accelerated underwriting using external data and over two dozen U.S. insurers are currently using it.

When one looks at a curve of the mortality rates by age in developed countries, we notice a very regular pattern. Especially the middle-age groups - age 30 to 70+, for example - seem to have close to an exponential curve in mortality rates. 

While it sounds like something Joe Friday of Dragnet or the FBI would do, medical surveillance involves the following of a condition before deciding whether or when to take a definitive action of treatment. The waiting period can precede a possible surgery, a medical intervention, or an institution of therapy that disrupts the status quo. That’s what surveillance truly is: Waiting and watching before deciding whether to take an action that will disrupt the status quo.
 

Genetic testing is becoming more accessible and commonplace, with new genetic links to diseases regularly being identified. However, the many constraints on the use of predictive genetic tests in insurance means that the easy availability of direct consumer testing is an issue that the industry must consider very carefully.

The pressure is on for carriers to provide the best customer experience, while implementing consistent, comprehensive and accurate underwriting policies.  Advanced e-underwriting systems can help insurers respond.

Earlier this year researchers at Heidelberg University Hospital announced the development of a blood test that can detect breast cancer cells in patients - with higher accuracy than mammography.

More and more often, algorithms mediate social processes, business transactions, governmental decisions, and how we perceive, understand, and interact among ourselves and with the environment. Gaps between the design and operation of algorithms and our understanding of their ethical implications can have severe consequences affecting individuals as well as groups and whole societies.

Epigenetics is poised to improve the underwriting process, moving beyond deep venous puncture blood collection and a lengthy approval process that takes months to complete.

Perspectives magazine checked in with several BGAs, carriers and technology vendors to see how we sit on the learning curve, as well as discovering what lies ahead in technology to help you make the grade.

The Life Predictive Analytics Survey Report from Willis Towers Watson

There was a time in the very early days of life-insurance underwriting, somewhere actually in the 1700s, when the only useful and predictive piece of data recognized was age. And using it affected a simple equation: as the certainty of death approached year by year, so was risk duly assessed. It would take another two hundred years or so before we began to understand that gender also directly impacts the science of mortality. We now utilize a wealth of information to analyze and quantify risk, and yet, it appears, we may have still only scratched the surface. Today, we could be standing at the precipice of a quantum leap in how we understand, interpret and eventually underwrite an ever-expanding inventory of exposures.

The incidence of prostate cancer - especially the early stages - has been increasing steadily for years. This is also due to early detection methods, such as PSA screening or urological prostate exams. If diagnosed in its early stages, prostate cancer can nowadays be treated successfully with innovative methods.

Are cannabis, hemp and marijuana the same thing? What are THC and CBD? Are the medicinal benefits of cannabis true? What are the health risks? And as of now, is there enough data to assess the mortality impact?

Historically, insurance premiums were differentiated only by age, with gender (now removed in some markets) and smoking incorporated later. The introduction of a numerical rating system 100 years ago meant underwriters could immediately better differentiate medical risk. This allowed them to broaden their offers of cover beyond “only healthy individuals”, thereby realising the significant economic potential and much greater inclusion by extending cover to so-called substandard risks.

RGA's Marc Sofer, Head of Data and Strategic Analytics, Asian Markets, discusses how the newest data sets, together with existing data and novel analytics, are impacting the industry’s growth and development.

The traditional method of applying for life insurance is quickly becoming the exception rather than the rule, as more and more companies strive to improve the customer experience and expand their applicant pool by offering a faster and less invasive approach to buying life insurance.

The rise of genetic testing in recent years is fueling a debate in insurance circles over the potential risks versus benefits posed by the readily available genetic information.

Liver fibrosis is the replacement of functioning hepatic tissue with fibrous tissue. Alcohol overuse, hepatitis of any kind, and nonalcoholic steatohepatitis (NASH) often leave behind damage with not only an active process but one where compromise may persist long after the cause has been controlled or eradicated. Knowing how to assess liver fibrosis in the aftermath of these conditions is an important part of underwriting liver disease.

This is a link to the recording of Hank's webinar on Fair vs Unfair Underwriting presented on June 18, 2019.

Accelerated underwriting programs continue to evolve at a rapid pace. Triage systems have become a key element in many of the newer programs in the market. Depending on the criteria used at the triage point, these programs can have residual effects on class prevalence and mortality, which in turn affect the profitability of these programs.

Behavioral economics is an area that is making a substantial splash in many industries and insurance is no exception.  Behavioral economist Matt Battersby examines how his discipline can play a role in reducing disclosure gaps.

Life insurers are using digital health data to streamline the underwriting process

RGA's Sandeepan Basu provides an overview of the Fourth Universal Definition of Myocardial Infarction. This well-researched article delves into key aspects of the updated definition, explores its complexity, and presents potential implications for the life insurance industry.

Slides from Jenna Fariss’ presentation at the Actuaries’ Club of the Southwest Meeting has been posted.

Facial analytics has the potential to streamline the underwriting process. Some insurers are investigating this new technology.

The term epilepsy denotes any disorder characterized by recurrent, unprovoked seizures. Seizures are disturbances of cerebral function that are electrical discharges in the brain. It may consist of violent shaking, convulsions, absence spells, automatisms (unusual recurrent behaviors), up to loss of consciousness. Epilepsy is quite common and occurs in up to one in every two hundred people.

considered by life insurance underwriters are highly influenced by routine clinical assessments, often undertaken in acute situations following an episode of self-directed violence.

When BE techniques are applied to insurance applications, small changes in the way that questions are designed and worded can lead to more thoughtful completion by the individual.

Insurers seem to be chasing appearances, investing eye-watering sums of money into projects to improve the application process, but these sleek, web-based systems can mask a distressing reality: Underwriting technology underpinning the decision process is not attracting the same attention. RGA's Bruce Bosco calls for a greater emphasis on automated underwriting to improve the customer experience and help bridge the protection gap. 

The wider implications of recent advances in genetics and genomics, including polygenic risk scores, need to be considered in the context of the protection industry. RGA's Heather Lund and Richard Russell explore the topic in depth in the Journal of the Association of Insurance Medicine of Japan.

Takotsubo Syndrome (TTS) was originally described by Japanese authors in the 1990s. The name was derived from the Japanese word for octopus pot, due to the shape of the left ventricle (LV) at the end of systole, which resembles an octopus trap used by Japanese fishermen. It has been described under a remarkable number of different names in the literature including Broken Heart Syndrome, Stress Induced Cardiomyopathy and Apical Ballooning Syndrome.

The frailty index (FI) holds a robust and consistent correlation with mortality and morbidity and is a stronger predictor of mortality than chronological age. Frailty status may be a promising risk factor to add into the underwriting mix, particularly for disability products. 

​For decades medical records, a.k.a. APSs, have been known as the gold standard for life insurance underwriting data, though the  acquisition of medical records remains largely an inefficient paper process. Since the introduction of electronic health records (EHR) in the health field, life insurance labeled them the Holy Grail and vendors of this data as potential disruptors.

Life insurers have long recognized the value of oral fluids for risk assessment through screening for HIV-1 and tobacco or drug use, but oral health itself is not routinely evaluated as part of the underwriting process.

Underwriting in the US life insurance industry has had more change in the last five years than it has in the prior 30…and many underwriters are struggling to keep up with the pace. Terms like accelerated underwriting, automated underwriting, simplified issue, predictive models and big data are bounced around at industry meetings like ping pong balls. If you are confused by all the new terminology, you are not alone.

Wearable technology could dramatically change the way life carriers do business and interact with their customers. See what some insurers are already doing with wearables.

Build is one of the essential points of information in underwriting that go into a rating. Generally, height and weight are calculated into a measure called BMI, which is body mass index. Most companies make build tables available to their agents and brokers to allow a general idea of whether or not there will be debits on a case. However, more things go into an assessment than just absolute measures, so companies may vary on how they perceive build information.

Slides from Hank's presentation at the WAHLU 2019 Spring Seminar have been posted at the WAHLU website.

Recent celebrity deaths have brought the topic of suicide out of the shadows and sparked conversation about the causes for suicide and possible preventive measures.

The cutting edge of the insurance industry involves adjusting premiums and policies based on new forms of surveillance.

So how do insurers unlock value from big data? Jeff Heaton, RGA’s Chief Data Scientist, published author and professor at Washington University in St. Louis, has a few ideas. To start, he suggests it’s time for insurers to better understand the basics of data science. To that end, he self-produced a video to explain the basics in just four minutes. RGA sat down with Heaton to discuss the video and his thoughts on what every employee at an insurance company should know about this form of statistics.

From a financial point of view, the cost of suicide to society is significant in terms of lost productivity and income, and the life insurance industry annually pays out millions for suicide claims.

The impact of genetic testing on the insurance industry will continue to be an important topic of actuarial research for some time as insurers address its effect on pricing and valuation. Insurance product development opportunities may also emerge to capitalize upon the genetics revolution. This paper explores the implications for the insurance industry.

Blood taken from insurance examinations are subject to many possible influences. Delays in handling, processing, and different atmospheric conditions may causes changes to lab results as opposed to those you would avoid when the labs are processed locally.

The risks associated with the practice of mixed martial arts (MMA) should always be assessed with a high level of attention. The practice of this sport, however, does not yet say everything about the risk potential.

Indirect use of discrimination factors that are outlawed is inexcusable and needs to be avoided by due diligence by insurer and indeed the firm supplying the data. Any decent carrier would not want to cross those red lines anyway – and that is even if the data company involved is not itself subject to regulatory oversight and/or consumer protection laws. Moral: act with integrity and choose your business partners carefully.

There’s not enough oversight for apps that track everything from people’s fitness routines to their menstrual cycles, bioethicists say.

Insurers are using customers’ social-media posts to determine premiums, inviting the potential for our digital lives to become disingenuous performances.

‘Insurtech’: our inboxes are full of news alerts, and hardly a day passes without a notable insurer or reinsurer somewhere commencing a digital initiative, applying artificial intelligence, partnering with a hi-tech high-flyer or investing in a digital/data/analytics start-up. Insurtech is big these days.

Slides for the presentation at ReFocus 2019, March 10-13, Las Vegas

In this age of amazing medical advances, it seems as though anything broken can be fixed.  In my native South Africa, the surgeon Dr. Christiaan Barnard proved that even defective hearts can be replaced when he performed the first heart transplant in 1967.

Rapid medical advances, as well as growing volumes of health and mortality data, are transforming cancer risk assessment. RGA's Neil Parkin explores our deepening understanding and insurance implications.