Ask an Underwriter: The Key To Hep C

Ask an Underwriter: The Key To Hep C

Hepatitis C is the most common bloodborne disease in the United States and is also the most frequent type of hepatitis we see in underwriting. What is it? An inflammation of the liver that may be acute and mild, or a more serious chronic type that attacks the liver. 

Hep C virus (or HCV) is spread primarily through contact with blood of an infected person. It’s often called the “silent epidemic” because no symptoms are present until the disease progresses. If not identified early, it may lead to cirrhosis of the liver or liver cancer, which may require a transplant.


Interesting Facts

  • Hep C spreads through contact with the blood of an infected individual, often by sharing needles or syringes; needle-stick injuries in health care settings are also common
  • Less common exposures include sharing personal items that may have come in contact with someone’s blood or having sexual contact with someone infected with the disease
  • Mothers with Hep C can pass to the disease to their unborn children
  • Many years ago, contaminated blood transfusions were another exposure risk; this was prior to the implementation of mandatory testing of donated blood
  • More than 3.5 million people in the United States are affected by Hep C


Staggering Statistics 

  • 75-85 out of 100 people with Hep C will develop chronic liver disease
  • 5-20 people will go on to develop cirrhosis over a period of 20-30 years
  • 1-5 people will die from cirrhosis or liver cancer
  • Baby boomers (those born between 1945-1965) are five times more likely to be infected than any other adults; many were infected before the dangers were known



A few years ago, the outlook for treating chronic Hep C was less favorable. Patients would have to undergo protocols of injections and multiple pills a day with major side effects for almost a year. There would then be a six-month follow-up period to evaluate if treatment was a success. The cure rate was only 50 percent.

But, we’ve come a long way! Due to research in the field, many patients can now be cured with direct-acting antiviral drugs, a less potent combination in one or a few pills for only a few months. Cure rates are about 95 percent for most patients. FDA approved anti-viral drugs include Harvoni, Olysio, Viekira Pak, Zepatier and Daklinza. There also continues to be research for patients who don’t respond well to this new treatment protocol. 


Hep C and Underwriting 

Depending on the type and specific details of a client’s hepatitis history, life insurance carriers will give possible consideration of coverage, some even qualifying without a rating. With the significantly improved cure rates associated with new treatments, we have seen several carriers update their risk philosophy specific to hepatitis with reduced/eliminated postpone periods after treatment and more clients qualifying for non-rated coverage. 

Generally, the most favorable clients include those who have completed treatment with documented stability through interval lab testing, which shows normal liver function results (AST, ALT and GGT). Carriers also like to see an undetectable viral load (HCV RNA or HCV PCR), which measures the amount of virus in the bloodstream.    

Important factors of consideration also include date of diagnosis, disease duration, liver biopsy results (if any), type of treatment (if any), date of last treatment, current/historic alcohol use and overall control/compliance of care.  

To make your next case a little easier, view our Hepatitis Questionnaire with your client, then contact your Ash Brokerage team. We’re ready to help!


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About the Author

Lisa Oleski has been brokerage underwriting for the past 20 years. She is passionate about treating each case she touches as an opportunity to exemplify the Ash difference, with the ultimate outcome of finding the most favorable solutions for advisors and their clients.