The Impact of Diabetes on Underwriting Decisions

There are an estimated six million people living with diabetes in South Africa. Diabetics need to be fastidious in understanding and controlling their condition to ensure not only a longer and healthier life, but also their insurability and future financial stability.

Diabetes occurs when the body is unable to convert glucose into energy. It develops when the pancreas fails to produce sufficient quantities of insulin (Type I), or the insulin produced is defective and cannot move glucose into the cells (Type II). Insulin is the hormone that helps your body to convert sugars into energy. Diabetes may be hereditary, but your daily activities and diet also play a big role.

• Type I (or insulin-dependent) diabetes occurs frequently in children and young adults, although it can occur at any age and can run in families.

• Type II (or maturity onset / non-insulin dependent) diabetes is more common, accounting for up to 95% of all diabetes. It primarily affects adults and shows a strong correlation with physical inactivity and obesity.

Treatments for diabetes include insulin, oral medications, or a combination of both. In some cases, particularly when treating Type II diabetes, lifestyle changes such as a healthier diet and increased exercise are all that is required.

There are a variety of medical complications associated with diabetes. These include:

• Nerve and kidney damage;

• Vision disorders such as retinopathy, glaucoma, cataract or corneal disease;

• Heart disease;

• Stroke; and

• Peripheral vascular disease

The complications of diabetes are less severe in people who have well-controlled blood sugar levels. Wider health problems such as smoking, elevated cholesterol levels, obesity, high blood pressure and lack of exercise are known to accelerate the destructive effects of diabetes. .

Complications of diabetes are often preventable if blood sugar levels are kept as close to normal as possible. The goal is for an A1C level of between 6.5% and 7%. Blood sugar control is measured by means of an Hba1C test which measures the sugar coating on red blood cells. The lifespan of a red blood cell is three months, so this test should be done every three to six months.

Various medical tests will be requested when applying for insurance. One of the most important tests is the diabetic questionnaire which should cover the following:

• Date of diagnosis;

• Treatment;

• Associated diagnosed risk diseases;

• Medical check-up frequency; and

• Details of any hospitalisation and in particular, whether the client does any home checks for glucose control.

The feedback provided by the client provides a good barometer of their insight into their medical condition and attitude towards their health.

Beyond the standard medical tests, diabetics will be required to undergo the following:

• An Hba1c test to indicate average sugar levels over an extended period of time as well as how well-controlled the diabetes is. A result of 6.8 is considered within healthy levels.

• Urine micro-albumin to indicate signs of early kidney damage.

• Rest and effort ECG: To screen for signs of heart disease. (This test is only requested based on individual considerations).

Based on the individual underwriting assessment, diabetic applicants can expect some combination of the following:

• Where optimal control is demonstrated, where the client is monitored closely and where they demonstrate insight into their medical condition, loadings for life, disability and critical illness can be applied.

Where this is not possible, different underwriting considerations based on individual consideration and assessment could result in:

• Life Cover being loaded.

• Exclusions being placed on critical illness for those impairments related to diabetes, such as cardiac and renal diseases. The advantage of this is that the client still gets the benefit of cover for all other critical illnesses. Discounts are also applied to the premium in terms of the excluded critical illnesses.

• Impairment Cover with diabetes exclusions.

• Income benefits for accidental causes.

By considering each applicant’s unique conditions and circumstances, effective underwriting can keep insurance costs low, even for clients with existing health conditions.