Articles - New Medical Markers in Life Insurance Underwriting


The sponsors would like to thank the following individuals who served on the Project Oversight Group:

Jean-Marc Fix, Chair
Tom Edwalds
Cynthia French-Poteet
Carl Holowaty
Val Munchez-van der Wagt
Jan Schuh, SOA Sr. Research Administrator
Ronora Stryker, SOA Research Actuary

 The Society of Actuaries' Committee on Life Insurance Research, Product Development Section and Reinsurance Section are pleased to make the following report available. Authored by Allen Klein and Karen Rudolph of Milliman, this paper presents the results of research that identifies laboratory tests that are not widely used in the life insurance industry but could have potential benefits for use in the life insurance underwriting process. In addition, the authors have provided an Excel workbook illustrating the calculation for determining mortality savings.
  
 Milliman was engaged by the Society of Actuaries (SOA) to conduct research identifying laboratory tests that are not widely used in the life insurance industry but could have potential use in the life insurance underwriting process. The medical markers of interest were those that met the criteria of i) currently available but not widely used and ii) applicable to life insurance underwriting (i.e., being a good indicator of all-cause mortality).
 Representatives from the three main U.S. laboratories, Clinical Reference Laboratory Inc., Heritage Labs, Inc. and Quest Diagnostics Inc./ExamOne, were interviewed to help determine the potential markers to review. The medical markers analyzed in this report include:
 
 -Apolipoprotein A-1 and B (Apo A-1 and B)
 -Complete blood count (CBC)/red cell distribution width (RDW)
 -Cystatin C
 -Hemoglobin
 -Hemoglobin A1c
 -Microalbumin
 -Amino-terminal pro B-type natriuretic peptide (NT-proBNP)
 -Oxidized low density lipoprotein (oxidized LDL)
 -Phospholipase A2 (Lp-PLA2)
 -Tumor necrosis factor-alpha (TNF-alpha)
 -Troponins I and T
 
 A methodology was developed to review the cost and benefit of each marker, which is described in this report so the reader can use it in independent research. The Internet was researched to find clinical studies that provided mortality data on the markers.
 The elements considered in determining the cost of these new tests were:
 
 -Laboratory charges to administer the test
 -Underwriter training costs
 -Underwriter time costs
 -Cost of an attending physician statement (APS)
 -Cost of additional not takens
  
 The benefit was determined as the mortality savings.
  
 For most ages where the test is relevant and where blood testing is routinely conducted, the addition of each of the markers appears to be cost-justified at a face amount level of $100,000, the most typical level in the industry where blood and urine testing begins. Table 53 shows more details on the results of this analysis for each marker.
 
 A spreadsheet was developed to facilitate the review of each marker and allow the readers to do their own sensitivity analysis.
 
 Milliman is not recommending or rejecting any of these markers for use. Instead, the goal was to provide independent research and to provide enough information for each company to make their own informed decision as to whether or not to implement these or any other new markers.
  
 To read the entire research paper please download below:
 
  
 © Society of Actuaries, Schaumburg, Illinois. Posted with permission.

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