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The Added Value of Medical Testing in Underwriting Life Insurance.

Bronsema J, Brouwer S, de Boer MR, Groothoff JW - PLoS ONE (2015)

Bottom Line: The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing.The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population.The indication for additional medical testing at underwriting life-insurance can possibly be done on limited variables instead of the obligatory medical testing based on age and the amount of insured capital.

View Article: PubMed Central - PubMed

Affiliation: Legal & General, Hilversum, The Netherlands.

ABSTRACT

Background: In present-day life-insurance medical underwriting practice the risk assessment starts with a standard health declaration (SHD). Indication for additional medical screening depends predominantly on age and amount of insured capital. From a medical perspective it is questionable whether there is an association between the level of insured capital and medical risk in terms of mortality. The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing.

Methods: A history register-based cohort study was conducted including about 15.000 application files accepted between 2007 and 2010. Blood pressure, lipids, cotinine and glucose levels were used as dependent variables in logistic regression models. Resampling validation was applied using 250 bootstrap samples to calculate area under the curves (AUC's). The AUC was used to discriminate between persons with and without at least 25% extra mortality.

Results: BMI and the overall assessment of the health declaration by an insurance physician or medical underwriter showed the strongest discrimination in multivariable analysis. Including all variables at minimum cut-off levels resulted in an AUC of 0.710 while by using a model with BMI, the assessment of the health declaration and gender, the AUC was 0.708. Including all variables at maximum cut-off levels lead to an AUC of 0.743 while a model with BMI, the assessment of the health declaration and age resulted in an AUC of 0.741.

Conclusions: The outcome of this study shows that BMI and the overall assessment of the health declaration were the dominant variables to discriminate between applicants for life-insurance with and without at least 25 percent extra mortality. The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population. The indication for additional medical testing at underwriting life-insurance can possibly be done on limited variables instead of the obligatory medical testing based on age and the amount of insured capital.

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Related in: MedlinePlus

Cut-off values minimum loading +25% extra-mortality of four global reinsurer manuals (RI 1 to 4) for systolic blood pressure in mmHg: male/female.Data march 2012. RI 1 = cut-off values obtained from manual reinsurer 1. RI 2 = cut-off values obtained from manual reinsurer 2. RI 3 = cut-off values obtained from manual reinsurer 3. RI 4 = cut-off values obtained from manual reinsurer 4.
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pone.0145891.g001: Cut-off values minimum loading +25% extra-mortality of four global reinsurer manuals (RI 1 to 4) for systolic blood pressure in mmHg: male/female.Data march 2012. RI 1 = cut-off values obtained from manual reinsurer 1. RI 2 = cut-off values obtained from manual reinsurer 2. RI 3 = cut-off values obtained from manual reinsurer 3. RI 4 = cut-off values obtained from manual reinsurer 4.

Mentions: As a cut-off value for systolic and diastolic blood pressure, total-cholesterol, ratio of total-cholesterol and HDL-cholesterol and triglycerides, we used 25% extra-mortality, the minimum for an extra premium in life-insurance. The individual risk assessment of extra-mortality for every dependent variable from the medical testing, was based on the guidelines of four global reinsurance manuals. Examples of cut-off values for systolic blood pressure and triglyceride are shown in Figs 1 and 2. As the manuals show significant differences in the cut-off levels, the calculations were done on the overall minimum and maximum levels.


The Added Value of Medical Testing in Underwriting Life Insurance.

Bronsema J, Brouwer S, de Boer MR, Groothoff JW - PLoS ONE (2015)

Cut-off values minimum loading +25% extra-mortality of four global reinsurer manuals (RI 1 to 4) for systolic blood pressure in mmHg: male/female.Data march 2012. RI 1 = cut-off values obtained from manual reinsurer 1. RI 2 = cut-off values obtained from manual reinsurer 2. RI 3 = cut-off values obtained from manual reinsurer 3. RI 4 = cut-off values obtained from manual reinsurer 4.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4696800&req=5

pone.0145891.g001: Cut-off values minimum loading +25% extra-mortality of four global reinsurer manuals (RI 1 to 4) for systolic blood pressure in mmHg: male/female.Data march 2012. RI 1 = cut-off values obtained from manual reinsurer 1. RI 2 = cut-off values obtained from manual reinsurer 2. RI 3 = cut-off values obtained from manual reinsurer 3. RI 4 = cut-off values obtained from manual reinsurer 4.
Mentions: As a cut-off value for systolic and diastolic blood pressure, total-cholesterol, ratio of total-cholesterol and HDL-cholesterol and triglycerides, we used 25% extra-mortality, the minimum for an extra premium in life-insurance. The individual risk assessment of extra-mortality for every dependent variable from the medical testing, was based on the guidelines of four global reinsurance manuals. Examples of cut-off values for systolic blood pressure and triglyceride are shown in Figs 1 and 2. As the manuals show significant differences in the cut-off levels, the calculations were done on the overall minimum and maximum levels.

Bottom Line: The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing.The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population.The indication for additional medical testing at underwriting life-insurance can possibly be done on limited variables instead of the obligatory medical testing based on age and the amount of insured capital.

View Article: PubMed Central - PubMed

Affiliation: Legal & General, Hilversum, The Netherlands.

ABSTRACT

Background: In present-day life-insurance medical underwriting practice the risk assessment starts with a standard health declaration (SHD). Indication for additional medical screening depends predominantly on age and amount of insured capital. From a medical perspective it is questionable whether there is an association between the level of insured capital and medical risk in terms of mortality. The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing.

Methods: A history register-based cohort study was conducted including about 15.000 application files accepted between 2007 and 2010. Blood pressure, lipids, cotinine and glucose levels were used as dependent variables in logistic regression models. Resampling validation was applied using 250 bootstrap samples to calculate area under the curves (AUC's). The AUC was used to discriminate between persons with and without at least 25% extra mortality.

Results: BMI and the overall assessment of the health declaration by an insurance physician or medical underwriter showed the strongest discrimination in multivariable analysis. Including all variables at minimum cut-off levels resulted in an AUC of 0.710 while by using a model with BMI, the assessment of the health declaration and gender, the AUC was 0.708. Including all variables at maximum cut-off levels lead to an AUC of 0.743 while a model with BMI, the assessment of the health declaration and age resulted in an AUC of 0.741.

Conclusions: The outcome of this study shows that BMI and the overall assessment of the health declaration were the dominant variables to discriminate between applicants for life-insurance with and without at least 25 percent extra mortality. The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population. The indication for additional medical testing at underwriting life-insurance can possibly be done on limited variables instead of the obligatory medical testing based on age and the amount of insured capital.

Show MeSH
Related in: MedlinePlus