More than 29 million Americans have diabetes, 86 million more have prediabetes, and more than 1 million new cases will be diagnosed this year, according to the Centers for Disease Control.
What does this represent for you as an agent? Opportunity! Now is the time to learn about diabetes from an underwriting standpoint in order for you to serve your existing clients and to capture new market share.
What Is Diabetes?
Diabetes mellitus is a condition characterized by abnormally high levels of glucose in the blood (hyperglycemia) resulting from the body’s inability to use blood glucose for energy, according to the American Diabetes Association. In Type 1 diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In Type 2 diabetes, either the pancreas does not make enough insulin or the body is unable to use insulin correctly. With gestational diabetes, women experience high blood glucose levels during pregnancy.
In order to work effectively in the diabetes marketplace, you will need to learn about the handful of companies that specialize in helping diabetics. As you learn about this market, you will discover that some companies are interested in covering only Type 2 diabetics, while others may specialize in covering Type 1.
Field underwriting requires that you ask questions — lots of questions. Complete and accurate medical information about your client will yield better results when you quick-quote your clients to life insurance companies. A quick quote is a summary of your client’s medical history that is sent to insurance companies for preliminary underwriting feedback.
The availability and price of life insurance will depend on the answers to these questions.
At this point, you want to gather as much information as possible so that you can shop for your clients effectively. Reassure your clients that the more accurate the information they can provide to you, the better you will be able to help them.
While many underwriting outcomes for diabetics will incur a table rating expense, getting your clients to the right company from the onset may save them a substantial amount of money. Remember that every table rating you save your clients will save them about 25 percent in premium expense.
Now that you have an understanding of the potential of the diabetes market, these additional details will allow you to hone your skills and develop your practice.
Type of Diabetes and Duration of Disease
Did you know that there are some life insurance companies that publish specific guidelines for diabetes underwriting? The guidelines provide you with detailed information about health conditions. The information is readily available from some insurance companies.
These guidelines indicate potential underwriting outcomes based on the type of diabetes, age at policy issue, diabetes complications and the duration of time since the onset of diabetes.
Type 1 diabetics pay more for life insurance than do Type 2 diabetics, assuming similar control of the disease. Gestational diabetes is a non-factor in underwriting, assuming all symptoms have disappeared after pregnancy.
The duration of time that your client has had diabetes contributes to the underwriting rating they will receive. The younger they were at the time of onset, the higher the table rating will be. This becomes less of a factor for clients age 50 or older, assuming they have good control over their disease.
For your clients who were recently diagnosed with diabetes, many companies want to see a minimum of six months of follow-up treatment and care before they will consider coverage. However, there are instances in which companies will consider covering a client within a few months of being diagnosed.
The hemoglobin A1c (HbA1c) is the single most critical lab result that life insurance underwriters look at when underwriting your diabetic clients. The HbA1c test provides underwriters with an indication of diabetic control over the past 60-90 days.
Expressed as a percentage between 6.5 percent and 10 percent, HbA1c control is broken out as follows:
HbA1c of 7 or less is considered optimal control
HbA1c of 7.1 to 8.5 is considered average control
HbA1c of 8.6 to 10 is considered below-average control.
HbA1c of 10 or greater is considered to be uncontrolled diabetes.
The most ideal clients from an underwriting standpoint are those with HbA1c ranges between 6.5 and 7.5. Clients with HbA1c ranges between 8 and 10 will be rated by companies and may be uninsurable, depending on the client’s entire medical history.
If the HbA1c is 10 or greater, your client is uninsurable with traditionally underwritten life insurance policies. Guaranteed issue life insurance may be the best option if this is the case.
Diabetic Compliance, Medications and Other Health Issues
Nothing derails underwriting faster than having a diabetic client who does not follow their physician’s advice or take their medication as prescribed.
As part of your field underwriting, it is important for you to find out how often your client visits a physician and whether they follow their doctor’s advice. When asking about their medications, find out what they take, how much and how often. Ask them if they have had any changes prescribed to their medications over the past 12 months.
Other health issues may have a significant impact on underwriting outcomes. It’s important to ask whether there is any history of complications such as retinopathy, neuropathy, kidney problems or history of diabetic coma, and if there is any history of cardiovascular health issues.
Underwriting Credits for Health Improvements
The positive steps your client has taken to improve their health since their diabetes diagnosis often are overlooked by agents.
Your client’s weight loss and exercise regimens, as well as improvements your client has made to their diet, are helpful to share with underwriters. Let the underwriters know whether your client has improved their average HbA1c over time or has good cholesterol control. Favorable cardiac workups, such as a stress test or echocardiogram, will help with more favorable underwriting outcomes.
As an advocate for your clients, you are in a position to help them obtain coverage they may have thought was impossible to obtain. When you take some time to learn about diabetes, obtain the underwriting guidelines from the companies you represent, and ask your clients the right questions, you will be well on your way to becoming the next diabetic life insurance expert.