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Policy Matters

First Quarter 2021


You probably have clients who have some type of heart condition. After all:

  • 121.5 million Americans (about 48.5%) dealt with heart or blood vessel disease as of 2016.1
  • Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States.2
  • One person dies every 36 seconds in the United States from cardiovascular disease.2
  • About 655,000 Americans die from heart disease each year; that’s 1 in every 4 deaths.3
  • Every year, about 805,000 Americans have a heart attack.4

It’s pretty obvious that heart conditions can cause significant risk for insurance companies. For that reason, odds are that some of those clients think they won't qualify due to their heart condition. But a lot has changed in the life insurance industry. Do they know the latest underwriting standards? Do you?

We thought American Heart Month was a good opportunity to take a look at some of those changes, many of which have occurred in the last year, 365 days, 35 million heartbeats, during a COVID outbreak. So we asked Mark Maurer, CFP®, LLIS’s President and CEO to share his experience.

Claudia Molina (LLIS Marketing): Let’s start with, in general, what has happened in the last year in the life insurance industry?

Mark: A lot! Insurance companies have seen more applications than ever. Probably because people have more time with the lockdown or they’re considering their own mortality more than ever.

C: How has the industry responded?

M: They’ve really stepped up. They’ve put into place a number of new processes to make the application process easier for everyone involved:

  • One company even went exam-free. They still do phone interviews, data checks, and order medical records, but now paramedical examiners don’t have to come into people’s homes.
  • Some companies have moved to accelerated underwriting with the interview and data check, then making the determination of whether or not to order medical records and/or an exam.
  • Some companies have expanded their limits for accelerated underwriting, up to $5 million policies, which is huge.
  • Interviews have moved from phone to online. Not completely, but many companies now offer clients the option, which is much more convenient.
  • The medical records request also got an update. It used to be the longest part of the application process (due to the sheer number of parties involved); applicants can now choose to link their medical records to the insurance company underwriter.

C: What’s new specific to the heart?

M: This isn’t necessarily since COVID, but it’s worth noting. Heart conditions used to be either an automatic decline or a pricey rate. But there have been so many advancements in detection, treatment, and prevention of heart conditions that insurance company underwriters now look not just at the disease itself, but at each person’s situation.

The COVID-19 pandemic, though, has changed how certain medical conditions are viewed, and heart disease has not escaped those changes. For typical applicants, the pandemic has not affected approvals; Standard rating is common for most people with mild heart conditions and no other health complications. For those with more severe forms of heart disease, table ratings (maybe with flat extra charges) are to be expected from most insurance companies. It’s important to note, however, that in the current COVID environment, most insurance companies are postponing applications from clients whose heart disease would result in a low to moderate rating (like Table 4) due to the higher risk if they were to become infected with the virus (especially the older population). For example, American General will postpone any case not expected to be approved Standard or better for ages 60-69. And since the average in the U.S. for a first heart attack in men is 65 (72 for women), clients in this age range would often have a sub-Standard rating for several years. By limiting the issue classes to Standard or better, the company is limiting the applicants who may have recently had heart disease. That may make it more difficult for clients with heart issues to get new coverage until the COVID situation improves.

You can find a chart of the different rating types here.

C: What do life insurance company underwriters look for when it comes to heart disease?

M: There are a number of factors that go into both the coverage decision and the premium:

  • Date of diagnosis: The more recent the diagnosis, the higher likelihood they will not be approved or will get an unfavorable rating and premium.
  • Type of heart disease: The term heart disease is used to describe a large number of conditions, each of which is underwritten differently based upon the amount of risk it poses to the insurance company. Applicants with high blood pressure or elevated cholesterol may be eligible for Preferred rates as long as it is well-controlled (even if they are on medications for it). A heart murmur may result in a Standard offer. Heart arrhythmia or congestive heart failure would most likely be table rated or a decline.
  • Preventive measures: Controlling blood pressure, controlling cholesterol and triglyceride levels, maintaining a healthy weight, eating a healthy diet, regular exercise, limiting alcohol intake, not smoking, and managing stress.
  • Treatments (normally recommended when preventive measures haven’t been enough): Medication: Underwriters look at whether or not the medication is controlling the condition and also the potential side effects; and how many medications the client is taking (three medications to control blood pressure poses a higher risk to the insurance company than someone taking just one, and multiple medications can lead to negative drug interactions plus multiple side effects). Surgery: Surgeries provide underwriters with an idea of the severity of the condition since surgery is typically recommended in situations where other treatment plans were not successful. However, past surgery can also be positive because, if it corrected a condition (such as a bypass graft for a clogged artery), that would be a better risk than someone with that condition who did not have surgery.
  • Family history: Underwriters look for parents and siblings who may have been diagnosed with -- or died from -- a heart condition prior to age 60.
  • Comorbidity issues: Some medical or lifestyle conditions can make the heart disease a higher risk (obesity, sleep apnea, diabetes, stroke, smoking, alcoholism). Again, the underwriter will review the individual’s case and overall health, not just the heart disease.

C: What hasn’t changed about life insurance underwriting since COVID?

M: Insurance companies set their own underwriting guidelines, so they’re different for each insurer, making it critical for your clients to be up-front with us about their medical information (some are more lenient in their underwriting of heart and other medical conditions). We know each company’s sweet spots and will help your clients find the one that works best for them. They won't get that from an online search engine or a company rep, and they may end up paying for it (literally) in the end.

C: Can you give us some examples of clients you’ve worked with recently with who had heart conditions?

M: Sure.

Notice we didn’t provide examples including females. While heart disease is sometimes thought of as a man’s disease, the CDC says it’s the #1 cause of death among women in the U.S. (1 in 5) and that almost as many women as men die from it each year. That makes us wonder: Do your female clients know their risk? If they do, are they not pursuing life insurance because they think they’ll be automatically declined?

C: Has COVID also affected underwriting for disability (DI), critical illness (CI), and long term care insurance (LTCi)?

M: No. For heart conditions, they remain:

  • LTCi: Clients with heart conditions still may be approved at Standard after six to 12 months post event, stable, no tobacco use, and no comorbidities.
  • DI: Clients who have suffered a recent heart attack will most likely be declined. If the heart attack was more than three years ago, they may get a graded benefit plan (the benefit goes up each year they don’t go out on claim).
  • CI: Heart attack, bypass surgery, and angioplasty are covered conditions. Family history with first degree relatives is reviewed for heart issues, based on their age and gender. If the applicant had a heart issue, underwriting will depend on their age when diagnosed, their age at time of application, current medications, date of last symptoms, tests completed or prescribed, and a few other factors.

C: Do financial advisors need to know about their clients’ health conditions?

M: This varies from advisor to advisor. Some advisors find that the more they know, the better they’re able to help them plan. Others prefer to let their clients maintain more privacy. Some advisors like to do the quote request for their clients. Others direct them to our website to fill it out on their own. The good news is that we give advisors the choice of how to navigate their clients’ application process and we can do that deep digging for them.

C: Do you have a crystal ball picture of what you think the insurance industry will look like post-COVID?

M: I sure wish I did. It’s yet to be seen what will happen with underwriting for heart conditions and others as the vaccine rolls out. But I do think that the process modifications the insurance companies have made will stay, and hopefully continue to improve.

1 American Heart Association, AHA Journal Circulation.

2 Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention.

3 Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, et al. Heart disease and stroke statistics—2020 update: a report from the American Heart Association.

4 Fryar CD, Chen T-C, Li X. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010. NCHS data brief, no. 103. Hyattsville, MD: National Center for Health Statistics; 2012.


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