Starting a family is an exciting time in life and often motivates one to think about additional financial protection AND the purchase of life insurance. Generally speaking, pregnancy for a healthy woman holds little mortality risk. However, there are some complications that can affect underwriting offers. In this week’s ONEIdea, we will cover the mortality implications of pregnancy.
There are many complications that can occur during a pregnancy. Those with the greatest risk to mortality include embolism (clot), hemorrhage, pregnancy-induced hypertension, and infection. Pre-existing conditions, such as cardiovascular disease, diabetes, kidney disease, etc. can be greatly exacerbated by the physiologic demands of pregnancy and need to be carefully monitored and managed. The risk of pregnancy-related death increases with age, with the greatest risk after age 40. Some of the most common questions regarding pregnancy that AgencyONE encounters from our advisors center around the mother’s build, gestational diabetes and pre-eclampsia.
For a woman with a normal Body Mass Index (BMI), healthy weight gain during pregnancy is about 25 to 35 pounds. Underwriters will request the pre-pregnancy weight to assess for a healthy weight increase. Assuming an allowable weight gain during pregnancy, the pre-pregnancy build will be considered for the underwriting offers.
Increasing body weight combined with hormonal changes can lead to the danger of insulin resistance, possibly resulting in the body’s inability to effectively lower blood glucose levels. Gestational Diabetes is typically diagnosed between 24 to 28 weeks of pregnancy when fasting blood glucose levels exceed 105mg/dl. Treatment typically combines dietary modification and insulin. Pregnant insurance applicants diagnosed with gestational diabetes will be postponed for coverage until after delivery, when blood sugars typically return to normal. However, up to 50% of women with Gestational Diabetes will go on to develop Type 2 Diabetes within 10 years of the pregnancy. As such, many carriers withhold Preferred offers until 10 years after delivery of the child. Prior to that time a Standard offer is generally the best that can be expected.
Pre-eclampsia is the presence of hypertension (high blood pressure) and proteinuria (protein in the urine) during pregnancy. Diagnosis is typically made after 20 weeks of gestation. Pre-eclampsia can lead to a condition known as eclampsia (onset of seizures in a pregnant woman with pre-eclampsia). The complications of this condition are very dangerous and include:
· cerebral edema;
· massive hemorrhage;
· HELLP Syndrome (hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelets); and
· fetal and/or maternal death.
Treatment for pre-eclampsia/eclampsia is delivery of the baby with the aim at saving the mother’s life. As such, if a pregnant applicant carries this diagnosis, she will be postponed for coverage until after delivery. Once the mother fully recovers, this medical history can be disregarded in the underwriting process.
As with all medical impairments, our carrier partners possess varying underwriting philosophies and niches for pregnant applicants. The following is a recent AgencyONE case study for a woman with a history gestational diabetes.
Dr. Gerber is a successful 40-year-old vascular surgeon who approached her advisor earlier this year seeking $4,000,000 of Variable Universal Life (VUL) coverage. The advisor and client’s goal for the case included securing Preferred Non-Tobacco rates with a Single Pay scenario and guaranteed coverage. Dr. Gerber’s medical history showed that, while pregnant with twins in 2015/2016, she was diagnosed with Gestational Diabetes. Dr. Gerber received the necessary pre-natal care and delivered her twins, without complication, in May 2016. Dr. Gerber subsequently lost the “baby weight” and has maintained a favorable build and hemoglobin A1c since that time. AgencyONE sent the case to a number of our carrier partners for evaluation. AgencyONE’s successful negotiations with Carrier C resulted in securing the PREFERRED rating desired by Dr. Gerber and her advisor!
AgencyONE has the underwriting knowledge and expertise, along with well-established relationships with carrier underwriters, to successfully place even your most challenging cases.
Please call AgencyONE’s Underwriting Department at 301.803.7500 for more information or to discuss a case.