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Underwriting uncovered

Diving into Diabetes

This month we’re diving into diabetes to support your knowledge of the condition as well as some of the key underwriting considerations we undertake to determine an outcome.

With 45 people per day developing diabetes in New Zealand and Type 2 diabetes diagnoses predicted to rise by 70-90% within the next 20 years (Te Whatu Ora 2023), diabetes will continue to be one of the most commonly disclosed pre-existing conditions.

What is diabetes?

Diabetes is a chronic condition that occurs when the pancreas is no longer able to make insulin, or when the body cannot make good use of the insulin it produces. Insulin is a hormone made by the pancreas that ensures the glucose we consume can pass from the blood stream into the cells in the body to produce energy.

Being unable to produce or use insulin effectively leads to raised glucose levels in the blood (known as hyperglycaemia). Long-term, high glucose levels can cause damage to the body and result in the failure of various organs and tissues. This is why a customer’s control of their diabetes is of particular interest to our underwriters when they’re assessing an application.

The different types of diabetes and how we assess them
Condition Explanation What to expect:
Type 1 diabetes

Type 1 diabetes is an autoimmune condition resulting from the body not creating enough insulin to keep blood glucose levels in the normal range. It’s typically diagnosed earlier in life, however it can occur at any age.

 

Approx. 10% of all diabetes diagnoses are attributed to Type 1, for which there’s currently no cure.

As Type 1 diabetes is usually diagnosed at a younger age, we often assess customers who have been living with diabetes for some time. In these cases, it’s most common to be able to offer life cover only, with a loading of at least 100%. 

In situations where:

  • a customer was diagnosed with Type 1 diabetes at age 40 or older, and
  • the diabetes is well controlled with no complications.

We may be able to consider other benefits, however this is the exception.
 

Type 2 diabetes

The most common form of diabetes where either:

  • the body doesn’t produce enough insulin, or 
  • the cells in the body don’t recognise the insulin that is present.

This results in high levels of glucose in the blood. For many (but not all) it can be prevented and/or managed by following a healthy lifestyle.  

Type 2 diabetes usually occurs in adulthood after the ages of 30–40 years. However, increasing numbers of teenagers and children are developing it.

Type 2 diabetes terms are heavily dependent on control, age of diagnosis and duration of diabetes.  

For customers recently diagnosed with diabetes we’ll often need to defer cover for 12 months to give us time to determine if they have adequate understanding, compliance and control of their blood sugar through lifestyle measures or medication.  

The younger a person is diagnosed with Type 2 diabetes, the higher the loading, whereas customers who are diagnosed at an older age (eg. 60) whose diabetes is well controlled with no complications may have a loading of 50-75%.
 

Gestational Diabetes

Gestational diabetes occurs during pregnancy, where the pregnant person has high levels of glucose in their blood. High blood glucose is caused because the body can’t produce enough insulin (a pregnant person’s insulin needs are 2-3 times higher than normal).

While gestational diabetes is only temporary and usually disappears after pregnancy, a person who has had gestational diabetes has an increased risk (50-60%) of developing Type 2 diabetes in the future.

If a customer discloses that they’re currently pregnant with gestational diabetes, we’ll need to obtain medical records to ensure they have good control of their blood sugar. If this is the case, then standard terms can be offered for life cover.

If a customer has a history of gestational diabetes, we’ll need to obtain medical records to make sure they’re fully recovered with no signs of abnormal blood sugar. In these circumstances we’ll be able to consider all benefits at standard terms.
 

Pre-diabetes and abnormal glucose tolerance

Also known as “Impaired Glucose Tolerance” - this occurs when the glucose in the blood is higher than normal, but not high enough to be diagnosed as diabetes.

People with pre-diabetes have a higher chance of developing Type 2 diabetes and heart disease.

Underwriting terms will be based on a customer’s “HbA1c” result both now and historically. 

If a diagnosis of diabetes has not been given, but their “HbA1c” is of a level where diabetes is possible, the underwriter will likely defer cover until a diagnosis of diabetes has been investigated.
 

How you can help us assess the risk:

Your underwriter will need to know the following information to assess the risk:

  • type of diabetes
  • age at diagnosis and duration of diabetes
  • control of condition (this is best evidenced by “HbA1c” blood test results)
  • treatment compliance
  • any complications (retinopathy, vascular disease, renal insufficiency or neuropathy)
  • presence of cardiovascular risk factors such as hypertension (high blood pressure) and dyslipidaemia (high cholesterol)
  • any abnormal urine or kidney functions (a sign that the diabetes has affected kidneys).

Some of this information can be obtained through the application form and telephone underwriting, however in most cases our underwriters will need to request medical records from the customer’s General Practitioner.  Medical information will assist our underwriters to obtain a full picture of your customer’s condition, both now and historically.

How diabetes can impact premium term and loadings

In general terms, the longer a customer has had diabetes, the higher the loading. This is because the effects of diabetes on the body’s organs generally worsen over time. Age of diagnosis also has an impact. 

Please also keep in mind your customers’ premium terms can be impacted by other considerations such as their BMI, smoking status, other metabolic risks (cholesterol, liver function and blood pressure) or any other conditions they may have.  

Got any questions?

As always, if you have a customer with any form of diabetes we recommend a pre-assessment conversation with one of our Chubb Life underwriters. Your underwriter will help you with the right questions to ask your customer and talk you through the availability of benefits and possible terms.

Your insurance is underwritten by Chubb Life Insurance New Zealand Limited (Chubb Life). Chubb Life has an A (Excellent) financial strength rating given by A.M. Best Company Inc. A summary of the rating scale is: A++, A+ Superior | A, A- Excellent | B++, B+ Good | B, B- Fair | C++, C+ Marginal | C, C- Weak | D Poor | E Under Regulatory Supervision | F In Liquidation | S Suspended. For the full rating scale and more rating information visit www.ambest.com/ratings/guide.pdf