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.
Most of the advisors we work with manage family wealth. You’re seeing more and more people migrate to this assets under management (AUM) practice – and, why not?! It’s a great business model, and you’re helping people build and manage their personal wealth.
But I have a question. Are you walking by AUM that is right under your nose? I might be bold in saying this, but you likely are!
The reason is simple. Most practices are managing wealth for individuals and families – many of these folks are business owners. I’ll give you a hint: Are you managing their corporate assets as well? Or, are you letting those assets walk right out of your office?
Literally BILLIONS of dollars are sitting in the coffers of businesses, earning next to nothing. Law offices, construction firms, farms/ranches, plumbing and heating firms – it doesn’t matter the type of company. Let’s be real. Most businesses have a lot of cash sitting on the sidelines, whether it’s in reserves, being held for bonding requirements, or just sitting in a rainy day, feel-good fund.
Unfortunately, they are earning 0.0 percent on that cash if it’s in a bank … OK, maybe 10 basis points at the most.
Aside from holding your clients’ business cash for next to nothing, banks are doing something else that’s worth paying attention to … They’re holding assets in Bank-Owned Life Insurance (BOLI). BOLI is simply an institutionally priced life insurance policy for banks’ Tier 1 capital.
Why do they use it? I’ll give you two reasons:
Are banks smarter than other organizations of that size? Why don’t other businesses use these types of products? Because they do exist!
At Ash Brokerage, we have three different highly rated companies that offer BOLI-type products for businesses – from “mom and pop” companies up to large corporations. They can take $100,000 deposits, or we’ve participated in placements that have approached eight figures.
All you have to ask your business owner clients is one thing:
“Do you routinely have significant cash balances sitting in your company? If you do, I’d like to show ways to put that money to work and use the same instruments that more than 82 percent of the largest banks in the country use.” (Oh, and the yields can be 2.5-3 percent NET of all costs … That’s a lot better than 10 basis points!)
Trust me, you will get a lot of interest if you ask! And when you do, please contact me or one of my team members on the Ash Brokerage Advanced Markets team – we will customize a design for you and your business owner clients.
Take a closer look at this solution and see the numbers for yourself – join us for a webinar on this topic at 10 a.m. August 28.
*2017 Equias Alliance/Michael White BOLI Holdings Report: http://www.equiasalliance.com/2017-equias-alliance-michael-white-boli-holdings-report
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
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.
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.
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.
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.
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
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.
© 2018 Ash Brokerage LLC.