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Ask an Underwriter: Why should clients be screened for diabetes?


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November is American Diabetes Month and, ironically, the month for pumpkin pie! But … diabetes is about far more than skipping or modifying dessert. It’s a common condition affecting millions of Americans with potential life-threatening complications.

In fact, according to the American Diabetes Association, 29.1 million Americans, or 9.3 percent of our population, had diabetes in 2012, and 1.4 million Americans are diagnosed with diabetes every year.

So, even if your clients haven’t been diagnosed as diabetic or pre-diabetic, it’s important to understand the disease and its risk factors. One simple screening could save a life or a lifetime of complications! Unfortunately (or fortunately), their lab results can come back with surprising results.

 

Types of Diabetes

Type 1 diabetes

usually develops in childhood or adolescence (prior to age 30) and accounts for 10-15 percent of all cases. In Type 1, the cells in the pancreas responsible for producing insulin have either been destroyed or produce no insulin. Since no natural insulin is available, treatment involves injection of laboratory-manufactured insulin for effective control of glucose metabolism. Risk factors for Type 1 include autoimmune disease and a family history of diabetes.

Type 2 diabetes

is commonly associated with obesity and onset after age 30. A family history of diabetes is common, and sufferers probably inherit a predisposition to glucose intolerance, which is exacerbated by obesity. 

Gestational diabetes

starts or is first recognized in pregnancy, in a previously non-diabetic woman. It usually becomes apparent during the 24th to 28th week of pregnancy. Risk factors include family history of diabetes, obesity, birth weight over 9 pounds in a previous infant, unexplained death in a previous infant, congenital malformation in a previous child and recurrent infections. Thirty to 50 percent of women with a history of gestational diabetes develop non-insulin dependent diabetes within 10 years. 

 

Potential Complications

  • Diabetes Mellitus

    is a group of metabolic disorders characterized by chronic hyperglycemia from insulin deficiency or resistance, or both. It is usually irreversible and, although a reasonable lifestyle can be enjoyed, the late complications result in reduced life expectancy. Macrovascular disease leads to an increased prevalence of coronary artery disease, peripheral vascular disease and stroke. 

  • Neuropathy

    is damage to the small blood vessels that supply all nerves, causing numbness and tingling in the extremities, abnormal sensations and muscle weakness.

  • Nephropathy

    is a progressive kidney disease caused by damage to the capillaries due to longstanding uncontrolled diabetes.

  • Retinopathy

    is damage to the retina in the eye from microvascular changes which can cause blurry vision and, in extreme cases, blindness.

  • Proteinuria

    is the presence of excess levels of protein in the urine due to damage to the kidneys.

 

Testing – Hemoglobin A1C

The industry gold standard for identifying applicants with, and those at risk for, diabetes is an A1C screen. This test measures a person’s average levels of blood glucose, or blood sugar, for the past two to three months. It is measured as a percentage, and the ideal range is less than 5.7.

A hemoglobin A1C screen is stable, is not affected by glycolysis and does not require fasting, making it more reliable and accurate that a glucose test. These screenings can empower applicants to take control of their health, especially those who are pre-diabetic and have the chance to make life-saving changes.

So let’s all become aware – about diabetes or any disease. Ask questions. Educate yourself. Be an advocate for yourself and your clients. More importantly, know your number!

 

Learn More

Statistics About Diabetes, American Diabetes Association: http://www.diabetes.org/diabetes-basics/statistics/

 

About the Author

Debra Misko is passionate about her work and gratified to help clients find security for their family’s future. She has worked in underwriting for 21 years and has been with Ash Brokerage for more than eight years. A graduate of Schoolcraft College, she has a business degree and has also completed two of the Academy of Life Insurance Underwriting exams. 

 

UW Underwriting Diabetes

Why You Can’t Afford to Avoid Long-Term Care Planning


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Personally, I’ve seen two family members require long-term care, and those care events were emotionally, physically and financially draining for everyone involved. Planning ahead could have made a world of difference.

Professionally, I’ve seen an advisor’s relationship with his clients negatively impacted when he avoided discussing LTC. Again, a little planning could have made a world of difference …

A Missed Opportunity

About two years ago, I received a call from an advisor whom I’d been trying to connect with for months. He apologized for not returning my calls and emails, and he said he needed my help, which made my day.

The advisor, who focused primarily on investments, explained that recently, one of his top clients came into the office and laid down two linked benefit policies – one for him and one for his wife. The client said he was at the bank when the bank’s advisor pitched the policies to cover their future potential LTC expenses, in return protecting the rest of their assets. This made sense to the client and his wife, so they moved forward, using excess cash they had sitting at the bank.

The client brought the policies back to the investment advisor to see how they would fit into the couple’s existing retirement plans. The client said, “We purchased these from the bank advisor because we know you don’t deal on the insurance side.”

Not only was the investment advisor upset because he lost business, but he also felt he let his clients down by not helping them prepare for potential LTC expenses. He also told me these same clients starting moving their money away … to the bank advisor. He said, “I need to be brought up to speed about LTC planning and available solutions before this happens again.”

Moral of the story: If you aren’t having LTC discussions with your clients, someone else will.

 

Your Chance at Redemption

The concept of a three-legged stool is used a lot in our industry. We usually position three needs and point out that any two will have a hard time standing without the third.

This is a simple way to position LTC planning with clients. You may have done a great job of planning their retirement income and wealth transfer plans … But what happens if their health becomes compromised? Their income and estate plans could be ruined. Tell your clients, “This is why I would like to discuss a plan that addresses potential long-term care expenses.”

By positioning an LTC plan as protection for your clients’ assets and income, you’re showing them you care about protect everything they have worked so hard to accumulate over their working years. You’re showing them how to support all three legs of their stool.
Your LTC team at Ash Brokerage is here to help you in any way we can. We understand you’re busy with many other aspects of the financial planning process, and LTC planning may not be your main focus. Let us help you streamline the process and grow your business along the way.

When you’re proactively discussing LTC planning with clients, you’re a step ahead of your competition. Want to get started? Check out last month’s post on opportunities within your existing book of business [LINK] or give us a call.


About the Author

Mickey Belt has been in the insurance industry for about four years and has been able to assist many advisors with incorporating LTC planning in their practices. He views LTC planning as a value-added service that advisors can provide to their clients to protect their assets. Mickey is currently working his way through the Financial Services Certified Professional® designation through The American College.

5 Opportunities Sitting in Your Book of Business


Protection

About a year ago, I gave a presentation on linked benefit solutions for a group of top advisors in Philadelphia, Pennsylvania. I started by asking, “How many of you have written a linked benefit case or think you have at least five clients who fit the profile for a linked benefit solution?” Only three advisors raised their hands …

But, as I walked through my presentation, many of them started writing on the handouts I provided. I explained that as our clients age, their needs and goals change as well. With a linked benefit solution, they can leverage a pool of benefits for long-term care if their health becomes compromised, or they can provide a death benefit for their beneficiaries if they don’t need care. Plus, many clients can use existing assets to fund these solutions! I gave the advisors several examples.

At the end of my presentation, I asked the same question … This time, every advisor in the room raised their hand!

I challenged the advisors to find at least one existing client who fits each scenario I discussed – I challenge you to do the same. If you have just one client to fit each of the profiles below, you can take your practice to a new level while helping your clients protect their retirement nest eggs.

You probably have a client who …

  1. Has an existing cash value life insurance policy
  2. Is taking required minimum distributions they don’t need for income
  3. Has an existing nonqualified annuity they don’t need for income
  4. Who says, “If I need care, I will spend down some of the money I have sitting idle at the bank (CDs, excess savings, etc.)”
  5. Has qualified funds they don’t need for income

If you have clients who fit any of the above scenarios, you have opportunities for linked benefit solutions within your existing book of business. Isn’t it much easier to talk with a client who already trusts you rather than going out and positioning a solution to a prospect that you haven’t yet built a relationship with?!

Help your clients “repurpose” an existing asset in order to protect the rest of their portfolio. Your LTC Marketing Team at Ash Brokerage is ready to help you implement linked benefit solutions within your practice. We’ll help you grow your book of business and protect everything your clients have worked so hard to accumulate over their working years.

About the Author

Mickey Belt has been in the insurance industry for about four years and has been able to assist many advisors with incorporating LTC planning in their practices. He views LTC planning as a value-added service that advisors can provide to their clients to protect their assets. Mickey is currently working his way through the Financial Services Certified Professional® designation through The American College.

Ask an Underwriter: Are Breast Cancer Survivors Able To Get Life Insurance?


Protection

With an estimated 2.8 million women with a history of breast cancer in the United States and 246,660 new cases of invasive breast cancer to be diagnosed in 2016 alone, there is a very high probability you will be faced with protecting a breast cancer survivor in the future if you haven’t already.  

 

As a result of increased preventative screening – including regularly performed breast self-exams, routine mammograms, discovery of genetic predisposition testing and advancement in treatments – early detection is naturally higher. For that reason, many life insurance carriers have improved underwriting guidelines, leading to decreased postponement periods and more favorable ratings for clients with a history of breast cancer.

 

Underwriting Breast Cancer 

The key to successfully insuring your breast cancer survivor is understanding what information is important to enable your underwriting team to find the very best solution. 

  • Stage of the breast cancer
  • Date the cancer was diagnosed
  • Type(s) of treatment
  • Date of last treatment  

 

Additional questions that may help in your assessment: 

  • What was specific type of breast cancer? (Ductal Carcinoma In Situ/DCIS or Lobular Carcinoma In Situ/LCIS)
  • Any lymph node involvement?
  • Any metastasis (spreading of the cancer to other areas in the body)?   
  • Any relapses?
  • Any medications currently being taken? 
  • Family history of breast cancer? If so, any genetic testing? 

 

Additionally, one of the most important pieces of information will be whether or not the client is in full remission/cancer-free and when (month/year). The longer they have been cancer free, with regular follow-up and testing, the more favorable their offer may be.   

 

Postponement Period

For life insurance carriers to give consideration of someone who has a history of breast cancer, they must fully complete treatment (surgery, radiation, chemo) and often undergo a specific waiting period referred to as a postponement period (which varies based on stage of breast cancer). If they are past the initial waiting period, and they are taking hormonal therapy, such as Tamoxifen, Arimidex, etc., as part of their treatment plan, there would not be an additional postponement/waiting period for consideration. Everything will still depend on the stage of the breast cancer, type of treatment, and date of last treatment.   

 

Let Ash Brokerage assist you with your next breast cancer case – to simplify your fact-finding process, use our Breast Cancer Client Questionnaire and reach out to us for help. We leverage our experience, carrier relationships and resources to identify viable solutions based on your client’s individual circumstances and insurance needs.  

 

Dedication

On March 11, 2016, Kristina Alderdice lost her 10-year battle with breast cancer and we lost a sister of our Ash Brokerage Family. Kristina’s legacy lives on in all of our cherished memories and through her mission at Hope in a Handbag . The organization supports mastectomy patients with a necessities bag, which gives supplies and information to aid in their recovery, and also provides a resource for surgeons and nurses to improve communication with patients about the challenges of major surgery. To date, Hope in a Handbag has distributed more than 2,000 bags to women in northeast Indiana.

 

Learn More

 

About the Author

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.

 

UW underwriting breast cancer cancer

Ask an Underwriter: Prostate Cancer’s Impact on Life Insurance


Protection

Let’s be honest: Cancer is scary. No one wants to hear this diagnosis, but understanding the type of cancer and treatment options, along with early detection, is key. This is especially important when determining insurability of a client.

Prostate cancer is one of the most common cancers we see in underwriting. What is it? It’s a cancer that starts in the prostate gland, which is part of the male reproductive system. According to the Centers for Disease Control, it’s the most common type of male cancer and the second leading cause of cancer death in men.

 

Risks Factors and Symptoms

There are many precursors of possible prostate cancer, and risk increases with age. CDC statistics show 5.84 percent of men currently age 60 will get prostate cancer within the next 10 years. That’s nearly six out of 100 men.

Symptoms of prostate cancer include:

  • Trouble with urination or decrease 
  • Discomfort of the pelvic region
  • Erectile dysfunction

 

Detection

Two tests that are common in early detection of prostate cancer are Digital Rectal Exam (DRE) and Prostate Specific Antigen (PSA). The DRE is essential in making sure the size of the prostate is normal, smooth and no abnormalities can be felt, while the PSA is a blood test that measures the levels of the prostate. 

Elevated PSA levels can be a pre-cursor for prostate cancer; however, they are not indicative of actual prostate cancer. When high levels of PSA are seen, there’s a higher risk for prostate-related disease. In these individuals, routine screening is essential and may warrant a prostate biopsy at their doctor’s discretion. A prostate biopsy is the only procedure that can detect the actual prognosis of prostate cancer.

 

Treatment

Treatment of prostate cancer varies, depending on the staging of the cancer. The most common treatments are radiation therapy, (external beam and/or brachytherapy) hormone therapy, or a radical prostatectomy, which removes the prostate. Once treatment has been successful, routine PSAs are done to evaluate levels and check for possible recurrence. 

With medical advancements, we are seeing an increase in the number of physicians taking conservative treatment measures through watchful waiting for those with early stage, localized prostate cancer.  This method of treatment closely monitors PSA levels on an interval basis, such as every six months.

 

Prostate Cancer and Underwriting

Depending on the client’s age, staging and treatment, along with currently undetectable PSA levels and no recurrence of disease after one year, we have seen life insurance carriers give possible consideration of coverage with a small flat extra or table rating.

Generally, the most favorable cases are individuals who are diagnosed over the age of 55 with localized, organ-confined prostate cancer, a Gleason score of six or less, a radical prostatectomy and PSA levels undetectable after three years. These clients may qualify for standard, non-smoker rates.    

Our prostate cancer underwriting questionnaire can help guide your conversations with clients by obtaining the details essential for an accurate assessment. No matter the situation, we encourage you to ask questions and get all the facts. If you have a specific scenario you would like to discuss, please reach out to me at Kiana.Chiarulli@ashbrokerage.com or contact your dedicated Ash Brokerage underwriter.

 

Learn More

 

About the Author

Kiana has been working in the brokerage industry for 20 years, with the last 15 years in underwriting. As an underwriter at Ash Brokerage, she truly loves serving as a client advocate because she values the responsibility of satisfying each client's planning needs.