As predictive genetic tests become more accurate and cost-effective, life insurance providers are looking at using them to classify mortality risk more accurately. More research needs to be conducted in order to ascertain if polygenic scores will enhance current underwriting methods or not.
While the Genetic Information Nondiscrimination Act of 2008 protects health insurers from discriminating against applicants based on genetic test results, this protection doesn’t extend to life insurance policies.
What is Genetic Testing?
Genetic testing can predict one’s risk of certain health conditions in the future; however, it cannot accurately forecast whether such illnesses will actually manifest themselves. Therefore, some people consider genetic testing more as a preventative test than a predictive one.
People denied life insurance due to genetic predisposition can file suit against their insurer for unfair discrimination; however, in most instances insurers cannot prove their decision was due to predictive genetic testing results; additionally, in many states there is a prohibition against using genetic results as grounds for rejection due to being already suffering from known diseases with genetic components.
Predictive genetic testing will remain a central focus of actuarial research for some time to come. There are multiple strategies insurance companies can leverage genomic advances to enhance morbidity and mortality outcomes and increase healthy life expectancies; such as including genetic testing in products, creating policies to promote preventive care, or offering wellness programs which promote lifestyle habits that reduce health risks.
However, many are still reluctant to undergo genetic testing because of its potential detrimental effect on life insurance prospects. According to one recent study, nearly half of all those willing to have predictive genetic tests were dissuaded from doing so due to concerns that results would impact their life insurance policy negatively.
Concerns surrounding genetic discrimination (GD) were expressed by several participants, who reported being deterred from applying for life insurance due to fears about genetic information (GI). Therefore, it is crucial that these concerns are addressed and consumers become informed of the FSC moratorium against discrimination based on genomic information in life insurance policies.
If the life insurance industry were to ban accessing predictive genetic information and correlating it with clinical information from medical records and family histories, more individuals might agree to take genetic tests and early medical intervention for those at a greater risk. This would lead to improved morbidity and mortality outcomes as well as lower in-force lapse rates.
How Will Genetic Testing Affect the Life Insurance Industry?
Insurance industries across the board are grappling with how best to approach genetic testing. Though genetic tests provide invaluable health insights for making informed health decisions, their use may also impact life insurance eligibility and thus jeopardise financial security for people who depend on life insurance for financial protection.
Current law does not protect life insurance customers against discrimination due to genetic testing, since life insurance is risk-rated product (unlike Australian health insurance which is community rated). Genetic tests could result in discriminatory underwriting for life insurance underwriting, leading to potential fear-induced GD outcomes; fearing this impact has shown to significantly diminish uptake of genetic testing both for clinical and research purposes.
Participants who reported experiencing genetic disorder feared life insurers would decline coverage upon learning of an applicant’s results (Subcategory 2.1). They highlighted the need for legislative limits on what life insurers could consider when underwriting policies, in addition to considering mitigation and management instead of simply genetic risk alone.
Many participants were dubious of the insurance industry’s capacity to self-regulate itself, noting its history of unprofessional behavior. Particularly, they expressed concerns that life insurers may fail to distinguish between predictive and diagnostic genetic testing results that is key for life insurance underwriting purposes.
Participants indicated a strong preference for insurance products that offer genetic underwriting without requiring access to predictive test results. Such an approach would enable life insurers to assess applicants’ genetic risk using factors like current health status, family medical history and other available sources of data.
Genetic information will still be readily available to life insurers and may have an enormous effect on underwriting, mortality and morbidity outcomes, in-force policy lapse rates, as well as premium pricing. To address the imbalance of information between life insurers and policy holders, further research must be conducted into its effect on mortality and morbidity outcomes as well as on product pricing – an issue which must be dealt with immediately in order to avoid potential market disruptions.
What Are the Benefits of Genetic Testing?
Genomics testing can offer many advantages to consumers and insurance providers alike; however, it is vital that both are mindful of any possible risks or limitations associated with genetic testing technology. While people may fear genetic testing will result in them being denied life insurance policies due to increased risks revealed, genetic tests only reveal someone’s risk of contracting a particular illness rather than actual probability for contracting it in future years.
Remember, too, that an individual’s medical records include information derived from genetic tests as well as from routine laboratory testing and other sources of health data. Therefore, one’s health history will likely play the most significant role in determining their eligibility for life insurance and it is unlikely that an insurer would refuse someone coverage simply due to having undergone genetic testing results or disclose those results directly to them.
There have been no reports of life insurance companies mandating genetic testing as part of their application process; however, life insurance applications usually include a medical questionnaire and access to clinical records of an applicant; therefore it’s possible that life insurers could discover prospective policyholders’ genetic test results through review of this documentation.
As genetic testing becomes faster, cheaper, and more accurate, its value to both doctors and patients increases exponentially. A genetic test can assist both parties involved with creating tailored treatment plans for specific individual needs; while for individuals it could indicate whether proactive health management with lifestyle changes and medication management might be more appropriate.
An individual genetic test can also serve as an invaluable resource to assist their family members in making informed decisions regarding the benefits and drawbacks of any health care strategy. Unfortunately, however, many are unwilling to undergo genetic tests due to life insurance implications; thus it is crucial that we monitor the effectiveness of the FSC moratorium on genetic discrimination (GD) while working toward legislation prohibiting life insurance discrimination based on predictive genetic information.
What Are the Drawbacks of Genetic Testing?
Genetic testing can be expensive, and its results can have a dramatic effect on an individual’s finances. Furthermore, the interpretation of results can be challenging; there is also a risk that this information will be misused; for instance, some companies have used genetic test results against employees or consumers and even become obsolete over time as new technologies emerge.
Genetic tests differ from other forms of medical testing by disclosing intimate family information that could lead to tension or discomfort among family members, leading some of them to refuse testing altogether. Therefore, it’s essential that before undertaking genetic testing you discuss its potential advantages and disadvantages with a healthcare professional.
Genetic testing can be emotionally upsetting. When individuals receive their test results, many become angry, anxious or depressed – sometimes all at the same time! Others fear the results could influence health insurance or job eligibility negatively; although GINA prohibits discrimination based on genetic test results in health insurance and employment contracts; most states also have laws in place which offer protection for genetic information of individuals.
Though genetic tests can improve health care, they have limitations. A positive test result does not imply that an individual will actually develop the disease; also, genetic tests cannot predict when symptoms will emerge, their severity or how rapidly a disease will progress over time. Furthermore, genetic testing may not always provide enough scientific evidence linking gene mutations with specific diseases; additionally they do not take other factors such as environment or lifestyle choices into consideration which could affect an individual’s disease risk.
