Do you know the top two leading causes of death among men in the United States? If you answered heart disease and cancer, you are correct!1 What you may not know is that prostate cancer is the most prevalent type of cancer among men. Currently, nearly 2.9 million American men are living with the disease, and the American Cancer Society estimates that in 2017, 161,360 men will be told they have prostate cancer.2 With these statistics, there is a high probability you will encounter the opportunity to protect a prostate cancer survivor, if you haven’t already.
As a result of increased preventative screening to include Prostate Specific Antigen (PSA) – normal values between zero and four – digital rectal exam (DRE), and advancement in treatments, early detection is naturally higher.
When Prostate Cancer is diagnosed, usually through a biopsy procedure, a specific stage will be assigned. The staging refers to the extent of the cancer (how much cancer is present and how far it has spread), stage I-IV. Staging is a big piece of the puzzle in underwriting, along with a Gleason Score, which is based on the tumor pattern the pathologist sees.
All of these factors have improved many life insurance carriers’ underwriting guidelines, leading to decreased postponement periods and more favorable ratings. The key to successfully insuring your prostate cancer survivor is understanding what information is important to find the very best solution.
Two important pieces of information will be whether or not they are in full remission/cancer free and for how long (month/year the remission was established). The longer your client has been cancer free, with regular follow-up and testing, the more favorable their offer may be.
For most life insurance carriers to give consideration of someone who has a history of prostate cancer, the client must fully complete treatment (surgery, radiation, chemo) and often the carrier will require a waiting period, referred to as a postponement period. The extent of the rating and duration of postponement varies depending heavily on the stage of the prostate cancer, type of treatment, and date of last treatment. Risk philosophy also varies from carrier to carrier based on the reinsurance manual used or the carrier’s own proprietary guidelines.
With increased early detection, we are seeing more and more cases with these considerations. Active surveillance or watchful waiting means the client’s physician is treating them by regularly monitoring the client’s lab markers (PSA, CEA, etc.) on an interval basis and closely monitoring PSA velocity.
This treatment option may be elected with a first-time diagnosis or biochemical recurrence. A biochemical recurrence happens when the PSA levels transition from undetectable to detectable, generally increasing, and may occur among men treated with radical prostatectomy or radiation for localized prostate cancer. These clients require careful consideration on an individual basis with the most favorable being age 65 or older, initial diagnosis Gleason Score of six or less, availability of favorable PSA trending documented over several years, and being three or more years out if previously treated.
Let Ash Brokerage assist you with your next Prostate Cancer case. To simplify fact-finding, use our Prostate Cancer Questionnaire. We leverage our experience, carrier relationships and resources to identify viable solutions based on your client’s individual circumstances and insurance needs. Reach out to your underwriting team for information or assistance.
1Centers for Disease Control: https://www.cdc.gov/healthequity/lcod/men/2014/index.htm
Ash Brokerage Underwriting Questionnaire:http://go.ashbrokerage.com/rs/535-YRX-827/images/Cancer-Prostate.pdf
Julie’s unwavering passion and dedication for risk advocacy promotes lasting partnerships while driving impactful results for all stakeholders, from our agents to our carriers. She leverages her 20 years of industry experience with her relational approach to ensure you experience the Ash difference.
What is it that we get spooked so easily by challenges? Something changes, or becomes a little difficult, and we prefer to complain, or just avoid the problem completely.
Well, I believe inside every challenge lies an opportunity. Recently, I talked with Mike McGlothlin (Ash’s EVP of retirement and one of the most respected guys in the annuity business) about why so many advisors are running away from a certain challenge rather than running toward it.
The challenge we discussed? Tax-deferred assets. I’m blow away by the number of advisors who have NO IDEA they can turn tax-deferred gains into tax-free benefits. Yes, you read that correctly. Tax-deferred into TAX-FREE. I’ll give you a couple examples of what I’m talking about.
You can take an existing, nonqualified annuity and do what’s called a 1035 exchange, moving those funds into a linked-benefit product for long-term care. Your clients’ asset is leveraged into a larger pool of benefits, which are tax-free. We call this “transferring the risk” because you’re shifting the risk of long-term care expenses to an insurance company, rather than leaving that risk on your clients’ retirement assets (and subsequently taking a hit with taxes on their pent-up gain).
Non-qualified annuities are great accumulation vehicles for many reasons – multiple investment options, tax deferral and guaranteed income for life. However, a highly appreciated annuity is one of the worst assets to have on your personal balance sheet at death. Controlling the tax – the amount and the timing – is a critical factor to a successful legacy strategy. You need to have the conversation with all your clients about controlling tax at distribution, regardless if that comes during their lifetime or at death.
By using these strategies, you’re accomplishing multiple things at once:
If you’re avoiding your clients’ tax-deferred assets because you’re afraid of the taxes on their pent-up gains, then you’re missing the boat. Better yet, you should just get your own boat because this might be the next “blue ocean.”
Mike and I dove deeper into this topic during a webinar Sept. 21. If you client has ANY tax-deferred asset, you need to watch this replay.
So your client is planning a trip outside of the United States. While their travel list may contain things like flip-flops, sunblock, beach towels, and toothbrushes, a life insurance underwriter’s travel list will often include things like political climate, crime rate, access to health care, participation in risky activities, and length of stay. These are just some of the many angles from which an underwriter is going to evaluate your client’s foreign travel risk.
When an underwriter talks about political climate, they are often referring to countries or regions where governments may be unstable or where governments have unfavorable opinions of the United States. Of the many lenses from which an underwriter evaluates a case, this is likely the most obvious, because oftentimes, these areas are the ones commonly seen on the news – the Middle East, Venezuela, the Philippines, and much of Africa.1 While travel to these countries/regions may not eliminate your client from potential coverage, the political climate in these areas raises some obvious red flags in consideration for your client’s safety.
So your client isn’t going to a politically unstable region, they should be good to go, right? Not so fast … The local violent crime rate is a major factor an underwriter takes into consideration when evaluating risk. A prime example of this is Acapulco, Mexico. When most people think Acapulco, they think beautiful beaches, a bustling nightlife, and wonderful golf courses, but when you look under the surface, another amazing characteristic jumps out … Acapulco, in 2016, had the second highest murder rate in the world, checking in at 113.24 murders per 100,000 residents, which is nearly twice as high as the most violent city in the United States.2 This, again, won’t automatically eliminate an individual from coverage, but does have potential to result in an adverse action depending on the client’s plans while there.
Another consideration while examining travel is access to health care. Should the client be injured or become ill during their trip, what is the quality of health care that they would receive? And, how far do they have to travel to receive care? There is a clear risk if health care is substandard or difficult to obtain.
While traveling, will your client be participating in any potentially hazardous activities, such as mountain climbing, SCUBA diving, sky diving, or any other avocations that could add to their potential risk? While many of these activities carry an innate risk in and of themselves, when compounded with possible language barriers and/or poor access to health care, an adverse underwriting action can occur.
Lastly, the length of your client’s stay abroad may affect their potential rating. If a client is planning a trip that is less than six months, then assuming they otherwise qualify based on the above criteria, there is generally no concern. But, if their expected stay crosses the threshold of six months, they become foreign residents and thus are evaluated differently. In some cases, a country can be OK for travel, but not OK for foreign residence, and an adverse action may be taken.
Overall, there are many considerations that go into foreign travel risk. If you have a client who has travel plans in which you suspect may result in an adverse underwriting action, consider that clarity is key and that a detailed cover letter can eliminate many concerns about your client’s upcoming trip. Check out our Foreign Nationals and Travel Questionnaire, a guide that can help you collect all the information you need for underwriting.
Should you have any questions about any of your potential clients, please don’t hesitate to reach out to an Ash Dedicated Underwriter, and we would be more than happy to answer any questions that you have.
Foreign Nationals and Travel Questionnaire: https://ashcmsstorage.blob.core.windows.net/media//Docs/uw/impairment/Foreign_Nationals_and_Travel.pdf
1U.S. Department of State, Travel Alerts and Warnings: https://travel.state.gov/content/passports/en/alertswarnings.html
2Business Insider, “The 50 most violent cities in the world,” April 8, 2017: http://www.businessinsider.com/most-violent-cities-in-the-world-2017-4/#50-durban-south-africa-had-3443-homicides-per-100000-residents-1
Joe Taulbee has been in the life insurance industry for nearly 11 years with more than five years as an underwriter, and he’s helped numerous families and individuals gain much needed financial security and peace of mind through the procuration of life insurance. He has an Associate designation (AALU) through the Academy of Life Underwriting and is currently pursuing an underwriting fellow designation with ongoing LOMA coursework.
© 2018 Ash Brokerage LLC.