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Ask an Underwriter: Why are Baby Boomers at Higher Risk for Hep C?


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Hepatitis C is a blood-borne virus. Today, most people become infected with the Hepatitis C Virus (HCV) by sharing needles or other equipment to inject drugs. But, according to the Centers for Disease Control, baby boomers seem to be at higher risk – your clients could be infected and not even know it!

 

The CDC explains people born from 1945-1965 are five times more likely to have HCV than other adults. The reason is not completely understood. “Baby boomers could have gotten infected from medical equipment or procedures before universal precautions and infection control procedures were adopted. Others could have gotten infected from contaminated blood and blood products before widespread screening virtually eliminated the virus from the blood supply by 1992,” the CDC says. 1 

 

Know The Facts

The Hepatitis C virus is a common, infectious virus that targets the liver; still this illness can appear in many other body systems and organs. Studies have found that between 70 and 74 percent of those with Hepatitis C experience extrahepatic (outside the liver) manifestations which could affect the brain, eyes, thyroid, joints and muscles, digestion, glucose control and the hands and feet.2  

 

For some people, hepatitis C is a short-term illness, but for 70-85 percent of people who have HCV, it becomes a long-term, chronic infection.3 Chronic HCV is a serious disease than can result in long-term health problems, even death. Unfortunately, the majority of infected persons may not even be aware that they are infected as they do not feel ill nor do they experience chronic symptoms.

 

There is no vaccine for Hepatitis C. The best way to prevent it is to avoid behaviors that can spread the disease, especially injecting drugs.

 

Who Should Get Tested

Per the CDC, the following people should be tested for HCV at least once in their lifetime:4 

  • Adults born from 1945 through 1965, even with the absence of prior risk factors, i.e., drug and blood transfusions
  • Those who are currently injecting drugs, or have ever injected drugs, including those who injected once or a few times many years ago
  • People with certain medical conditions, including those who received clotting factor concentrates produced before 1987, or who were ever on long-term hemodialysis, with persistently abnormal alanine aminotransferase levels (ALT), or those who have an HIV infection
  • Prior recipients of transfusions or organ transplants, including those who were notified they received blood from a donor who later tested positive for HCV infection, or received a transfusion of blood, blood components, or an organ transplant before July 1992
  • Health care, emergency medical, and public safety workers after needle sticks, sharps, or mucosal exposures to HCV-positive blood
  • Children born to HCV-positive women

 

Treatment – HCV Can be Cured!

Harvoni (ledipasvir/sofosbuvir) is currently one of the most advertised prescription treatments for HCV and has shown tremendous results. In clinical studies, most patients with HCV genotype 1 who had no prior treatment were cured with just 12 weeks of therapy. Most infected patients are experiencing little side effects and are able to tolerate the medication. 

 

Unfortunately, the cure rates are not as high for people with cirrhosis who were previously treated unsuccessfully with interferon-based hep C regimens, people with decompensated cirrhosis and those with genotype 3 of hep C. 

 

The typical treatment window is 8-12 weeks, with many patients clearing the virus (negative HCV RNA) as early as eight weeks. Once the HCV RNA has been negative for greater than six months after treatment, a person is considered to have sustained viral response (SVR) and is essentially cured. 

 

Underwriting considerations and offers

Underwriters will consider multiple factors and test results when assessing the risk for an applicant with a history of HCV.

 

Aside from factors such as date and age of onset, symptoms, and prior treatments, they will also review serology, imaging (US/MRI/CT), biopsy results and scans. Today, there are more sophisticated blood tests (FibroSURE) and scans (FibroScan), which will measure liver damage (fibrosis and cirrhosis); these advances have significantly reduced the need for invasive, costly and riskier needle biopsies. 

 

Applicants who have successfully cleared the virus (sustained neg HCV RNA more than six months) with no liver damage may be approved at preferred rate classes! (Depending on the carrier)

 

Applicants unable to clear the virus are considered chronic hepatitis C applicants and will be rated and possibly declined, depending on the individual’s overall factors and test results. 

 

Reach Out

At Ash Brokerage, you have a dedicated staff of seasoned underwriters available to answer your questions regarding your clients with Hepatitis C. We’d welcome the opportunity to talk with you about your client’s specific needs. Also, be sure to check out our helpful questionnaire to use with your clients. 

 

Learn More

Ash Brokerage Hepatitis Questionnaire: http://go.ashbrokerage.com/WC2017-07-UW-Hepatitis_LP-Content.html?utm_source=blog&utm_medium=landing_page&utm_campaign=uw_questionnaire

 

1Centers for Disease Control and Prevention, “Know More Hepatitis”: https://www.cdc.gov/knowmorehepatitis/media/pdfs/factsheet-boomers.pdf 

2HCV Advocate, “HCSP Fact Sheet, Extrahepatic Manifestation of HCV” July 2015: http://hcvadvocate.org/hepatitis/factsheets_pdf/extrahepatic.pdf

3CDC, Viral Hepatitis, Hepatitis C: https://www.cdc.gov/hepatitis/hcv/index.htm

4Centers for Disease Control and Prevention, “Testing Recommendations for Hepatitis C Virus Infection”: https://www.cdc.gov/hepatitis/hcv/guidelinesc.htm

 

About the Author

For more than 35 years, Charlie Kuhn has taken a personal interest in every case. To her, it’s more than a file – it’s a person trying to protect the people they care about, or a business trying to protect its future and the future of their employees. Charlie can think of no better vocation than to help provide financial and emotional security for others. Through her personal commitment to continuous professional growth, Charlie is one test away from becoming an Associate of the Life Management Institute. She is already an Associate of Customer Service with LOMA, has passed all three of the Academy of Life Underwriting exams, and is certified in EKG interpretation.

 

Underwriting Hepatitis C Life Insurance

It’s Just Math: Tax Efficient Planning with Life Insurance


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People in our industry like to make things complicated. But, what we do isn’t complicated. It’s mostly just math. Plain and simple. 

 

For our July webinar, I posed a simple question: 

 

Is there a better way to own a non-qualified investment?

 

The simple answer: Yes! In many cases, cash value life insurance is a more tax-efficient solution. If you missed the webinar, you can watch the replay to see the breakdown of the numbers. But, it was easy to see that tax treatment of cash value life insurance – thanks to IRC 7702 – makes it a more efficient savings tool than many non-qualified investments.

 

For our purposes, we used the S&P 500, but you can compare the efficiency of life insurance with ANY non-qualified instrument. With funds that have high turnover rates or high interest income, the comparison is even more compelling – cash value life insurance, when properly structured, is usually the more tax efficient savings tool. 

 

The proof is in the pudding. Still don’t believe me? Go ask your tax advisor. 

 

This is the reality for most of your high income clients who have maxed out their qualified investments. I’m not this insurance zealot that says everyone should own cash value life insurance. This savings strategy is for those with higher incomes who are looking to accumulate funds more tax efficiently. And, it’s efficient for your business, too – because your clients’ taxes will come out of your assets under management. 

 

Finally, wouldn’t you rather own an instrument that gives you something in return? Other instruments aren’t going to give you a death benefit – they’re going to give you a 1099. Think about that. 

 

You see, tax efficiency isn’t complicated. It’s just math. Want to know more? Watch the replay or reach out directly – I’d be happy talk about how we can help you tell this story with your clients. 

GO DEEPER: On-demand video

Hear the strategy. See the math. Watch and learn in just 30 minutes.

Tax-Efficient Planning for the Future

About the Author

Tim_Ash_atrium.jpg Tim Ash is known as a visionary in the financial services community. He is an industry leader who envisions a future where insurance is easy, affordable and an essential part of a sound financial plan.  As CEO of Ash Brokerage, Tim has fostered an environment of success with team-focused empowerment and client-centered service. He has built a culture where people not only believe in what they do, but more importantly, they understand the reason behind their efforts. 

Cash Value Life Insurance Webinars Tax Efficiency

How to Tell a Tax-Efficient Planning Story


Protection

Imagine you’re me. And you have to stand up in front of a room of financial advisors and talk about the tax efficiencies of a certain investment vehicle. At first, everyone is alert and attentive. No one likes taxes, so everyone is ready to learn. 

 

But then? I say the magic word: insurance. People slump in their chairs, check their phones … some even roll their eyes. Maybe just reading this, you’ve already lost some of your excitement. The objections are already flying through your mind: 

 

  • My clients have been burned in the past …
  • It’s too expensive … 
  • It’s too complicated … 

 

Put your prejudices aside. What if, instead of mentioning the word insurance, I asked a simple question: 

 

Is there a better way to own the S&P 500?

 

Would all those planners in the room want to listen? You bet. Do I have your attention again? Good. 

 

No matter your prior experience with insurance planning, I’m willing to bet you’ve never heard the cash value life insurance story the way I tell it. I want you – and your clients – to understand the largely-unused and underestimated impact of IRC 7702, which is the tax code that makes life insurance an incredibly efficient vehicle for saving. 

GO DEEPER: On-demand video

Hear the strategy. See the math. Watch and learn in just 30 minutes.

Tax-Efficient Planning for the Future

 

About the Author

Tim_Ash_atrium.jpg Tim Ash is known as a visionary in the financial services community. He is an industry leader who envisions a future where insurance is easy, affordable and an essential part of a sound financial plan.  As CEO of Ash Brokerage, Tim has fostered an environment of success with team-focused empowerment and client-centered service. He has built a culture where people not only believe in what they do, but more importantly, they understand the reason behind their efforts. 

Financial Planning Tax Efficiency Cash Value Life Insurance

My Love-Hate Relationship with Term Life Insurance


Protection

I recently received a difficult call from a family friend. His brother Matt, age 44, had unexpectedly passed away, leaving behind a wife and two teenage children. He asked if I could assist with a review of Matt’s life insurance policy.

 

I met with him immediately and, upon seeing the policy, a slight bit of nervousness came over me because it was clearly a term policy. I took a look at the duration, which was 10 years … thankfully, the policy had been issued nine years prior and was in good standing as all premiums had been paid. My nervousness eased. I was able to tell my friend that Matt’s family will soon receive a tax-free benefit of $500,000. 

 

Temporary Love?

This event really had me thinking about term insurance – its purpose and place in the market. If Matt had passed away just one year later, his policy may not have been there for his family. And, since Matt had purchased his policy from a college buddy who was no longer selling insurance, chances are he wouldn’t have thought of purchasing another policy, leaving a gap in his family’s financial future. 

As it was, a terrible event was eased, just a bit, by immediate financial security. That’s what insurance does. That’s my love relationship. 

 

I own term insurance. I have sold term insurance. Term insurance works, as is shown in the above situation. However, selling a term insurance policy and not following up with it comes with as much peril as selling a security and not paying attention to the market. By its very nature, term insurance is a temporary fix, a Band-Aid that will swoop in and save the day in the darkest moments of people’s lives. But it does have a shelf life that must be paid attention to. 

 

Converting to a New Philosophy

Many reps say they will sell term and then convert the policy to permanent (usually universal life) when the client gets older. While a good plan, this leaves all of the control up to the insurance company. When your client needs to convert the policy, possibly due to declining health, will they still be able to? 

 

Many insurance companies have limited the conversion period of their term products. If they can convert, what products are available to convert to? Many insurance companies keep just a single product available for conversions, many times this product is not something that your client would have considered purchasing if not forced to.  Is that in their best interest? That is my hate relationship.

 

Today’s financial advisors don’t leave much to chance. They manage, they balance, they review and they make sure that their clients’ retirement income is secure. Yet many of these same advisors still pull out the term spreadsheet and sell a term product by price. They don’t have an insurance value discussion with their clients. How are their clients saving for college? How are they offsetting down market years in retirement? How are they accounting for the cost of medical care? Permanent life insurance can help with all of these things, and in a very tax efficient manner. 

 

I can understand selling term insurance for a young family who doesn’t have two nickels to rub together, or for business partners who have a specific time frame they wish to cover. But for most other clients, AND for almost all clients who use a financial advisor, life insurance should be sold as a value proposition, incorporated into and complementing all financial plans.  

 

Make a Permanent Change

Remove the love and hate, the yin and yang, the ups and downs that term insurance brings. Have a value added permanent insurance discussion with all of your clients and make sure they are covered whenever they may need it. 

Life Insurance Term Insurance Permanent Insurance

Ask an Underwriter: Dealing with Mental Health Disorders ... Keep This in Mind


Protection

Each year, millions of people face the reality of living with a mental health disorder. In fact, each year one in five adults in the United States experiences a mental health issue.

 

Because May is Mental Health Month, we would like you to more clearly understand some of the conditions and what you can expect in underwriting. There are more than 200 classified forms of mental illness,but on life insurance applications, we most commonly see anxiety and depression. 

 

Anxiety – Anxiety is the body’s reaction to stressful, dangerous or unfamiliar situations. In people with anxiety disorders, this feeling does not go away and gets worse over time. Generalized anxiety disorder, panic disorder and social anxiety disorder fall into this category.

 

Depression – Depressive disorders can occur in combination with any of the anxiety disorders and include major depression, persistent depressive disorder and bipolar disorder. Major depression is often disabling and can include symptoms of hopelessness, fatigue, insomnia, restlessness and thoughts of suicide. With bipolar disorder, once called manic-depressive disorder, we see a large spectrum of moods from severe depression to mania, including hallucinations

 

PTSD – Years of war in Afghanistan and Iraq have increased the diagnosis of Post-Traumatic Stress Disorder (PTSD) in military personal. But PTSD is also found among survivors of natural disasters, victims of crime, and many others who have experienced traumatic events. Symptoms include flashbacks, angry outbursts, insomnia and guilt. Some people recover within six months, while with others, the condition becomes chronic.  

 

Underwriting

Losing a loved one, getting fired, going through a divorce, and other difficult circumstances can lead a person to feel sad, lonely or anxious. We see these episodes as “situational” and understand they are normal reactions to life’s stressors. The concern in underwriting is people who experience these feelings daily, for no apparent reason, making it difficult to carry on with normal activities.

 

In addition to the conditions above, we see many other mental health conditions, including attention deficit hyperactivity disorder (ADHD), eating disorders, obsessive-compulsive disorder (OCD), and postpartum depression, but the key to successful underwriting of ANY mental condition is control and compliance. Medication and psychotherapy are extremely effective in the management of symptoms, so underwriters look for stability and long-term prognosis. We will want make sure your client sees a physician on a regular basis and takes their medication as prescribed. 

 

Our Mood and Anxiety Disorder Questionnaire will help you get to the heart of the matter. It is straightforward, yet kind, asking questions in a way that should be comfortable for you and your client. Naturally, if you have a specific scenario you would like to discuss, please reach out to me at Laura.Dagle@ashbrokrage.com. 

 

 

Learn More

1National Alliance on Mental Illness: https://www.nami.org/Learn-More/Mental-Health-Conditions

2National Institute of Mental Health: https://www.nimh.nih.gov/index.shtml

Anxiety and Depression Association of America: https://www.adaa.org/understanding-anxiety

Ash Brokerage comprehensive questionnaire for Mood and Anxiety Disorders: http://192.168.97.44/docs/forms/impairment/Mood_Anxiety.pdf

 

About the Author

Laura Dagle has been in the insurance industry for more 35 years, during which time she has been both a producer and an underwriter. As someone who has seen the business from “both sides,” she is keenly aware of your desire to have the smoothest process, easiest underwriting and best possible outcome. She has worked closely with the behavioral and mental health care system and understands the nuances of each condition.  

Underwriting Mental Health Depression Anxiety