Because EKGs can easily be performed incorrectly in the field and/or the results transmitted illegibly, carriers are considering alternatives. Many carriers are electing to use a blood test called an NT-proBNP instead. In this ONE Idea, we will discuss what this test represents and show you how it can affect underwriting offers.
Over the last few years, we have seen remarkable changes in the approach to life insurance underwriting. Technology and access to data are making digital platforms and lab-free accelerated programs possible. This year we will continue to see changes in underwriting, particularly with age and amount requirements. Carriers are continually analyzing COST versus the PROTECTIVE VALUE of the medical data they use to make underwriting decisions.
What is it?
B-type natriuretic peptide (BNP) is a hormone produced by your heart. N-terminal (NT)-pro hormone BNP (NT-proBNP) is a non-active prohormone released from the same molecule that produces BNP. Our bodies continually produce these hormones in small quantities and the amount released relates to pressure variations within the heart. A blood test showing the release of a larger amount suggests the heart is working harder than normal due to conditions such as heart disease, arrhythmia, heart failure, etc. The results are also considered predictive of new cardiac events and heart disease that may not yet have been discovered by the doctor. While this blood test does not measure what the EKG does (which primarily measures the electrical conduction of the heart), the NT-proBNP is considered an age-based screening tool for all-cause mortality, simply put, any potential cause of death.
NT-proBNP levels are typically higher in women, older ages in both male and female, and individuals with kidney disease. For life insurance purposes, a male’s NT-proBNP should be less than 75pg/mL and a female’s less than 300pg/mL.
There is nothing your Clients can do to “prepare” for this NT-proBNP portion of the life insurance exam. However, carriers currently RATE slight elevations very differently, so it is important that you ask your Clients to RETRIEVE THEIR LAB RESULTS for AgencyONE’s review. This helps to ensure their cases get directed to the carrier best suited to evaluate them.
Ms. Sally Smith is an (age nearest) 79-year-old, non-smoker applying for a $1,000,000 VUL policy. Aside from medically managed high blood pressure and cholesterol, her medical history was fairly benign. Getting a jump start on the insurance application process, Ms. Smith was examined for Carrier B and proactively retrieved a copy of her lab results for AgencyONE’s underwriting review. Ms. Smith’s labs were within normal limits EXCEPT FOR an elevated NT-proBNP of 363. Armed with this information, AgencyONE’s underwriting team approached the carrier most suited to Ms. Smith’s case, Carrier A, along with two additional carriers at the request of Ms. Smith’s Advisor. As anticipated, Carrier A provided the most favorable offer at Standard Non-Tobacco. Both Carrier B and C were at the opposite end of the spectrum at Table 4.
It is also important to note that Ms. Smith’s mature age is outside the underwriting parameters for most (if not all) carrier shave/crediting programs. This drastic difference in the underwriting offers between Carrier A, B, & C is solely due to the NT-proBNP value. This difference is more astonishing when we look at the variation in annual premium amounts as seen in the table below:
AgencyONE successfully negotiated a Standard Non-Tobacco offer for Ms. Smith with Carrier A who offered a significantly lower annual premium than the next two carriers. The Client and the Advisor were very pleased with the handling of the case and its outcome.
Each Client’s case is unique, and each carrier is unique in the way they review and underwrite cases. AgencyONE’s carrier knowledge and case evaluation and placement are just three of the many reasons our Underwriting Department is considered THE BEST in the field.
Please contact AgencyONE’s Underwriting Department at 301.803.7500 for more information or to discuss a case.