disability, and long-term care insurance
companies continue to use PSA testing in
evaluating overall risk in male applicants.
Smoking continues to be one of the
greatest morbidity and mortality risks to
applicants and a major financial risk to insurance companies that issue life, disability,
and long-term care policies. Most of these
insurance companies have an applicant’s
urine tested for cotinine, a breakdown
product of nicotine, to accurately assess
the smoking status of their applicants.
The most-used infectious/immune system
biomarker in life, disability, and long-term
care insurance assessment continues to be
HIV (see Table 9).
HIV-infected individuals have a very
large increased risk for both morbidity and
mortality. However, since the introduc-
tion of highly active antiretroviral therapy
(HAART) in 1996, the overall survival of
HIV-infected individuals has markedly
improved (Couzigou, 2007).
Life, disability, and long-term care insurance
companies continue to evaluate health and
mortality risks of their applicants during
underwriting prior to any issue of a policy.
These companies are looking for laboratory and biometric testing that provides
insightful and cost-effective health risk
information to accurately project future
applicant costs in relation to the premium
they receive. The overall uniformity of the
laboratory and biometric tests ordered on
applicants by most insurance companies
shows the risk assessment value received
by this type of testing.
Some of the newer clinical laboratory
tests, like NTproBNP, can assess left ventricular dysfunction and cardiac risk in
populations with increased risk factors,
as well as older populations. Historically
used as a monitoring biomarker for patients
with congestive heart failure, NTproBNP
is now being utilized to screen general
populations for cardiac disease.
Even though most health insurers do
not currently individually underwrite individuals prior to issuing policies, they do
want to effectively manage their members
with increased morbidity and mortality
risks. In this regard, many of the risks
that are assessed by the life, disability, and
long-term care insurance companies may
be helpful for health insurers as well.
JAMES A. PALMIER, MD , is vice
president and medical director, Insurance
and Employer Services, at ExamOne.
Life Insurers Fact Book 2016; American
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