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"We havent received even one call from agents who have clients worrying about how hormone replacement therapy might affect their life insurance rates."
Thats the word from General Agent John Felton over at the Tennessee Brokerage Agency. The firm is a Knoxville, Tenn., brokerage shop specializing in placing life insurance for people with complicated medical histories or impairments.
To date, Felton says, HRT has not become a concern on the applications his firm submits to underwriters. No one asks about what to do if a female applicant has taken HRT for a long period of time, he says, "and no home office underwriters have been telling us to look for anything special in applications that show HRT among the prescriptions taken by the client."
HRT is a regimen of hormones that some women take to relieve symptoms related to menopause and also sometimes for preventive care. There are four types of HRT, the two most common being pills and patches, taken as estrogen alone or estrogen combined with progesterone, says Hank George, president of Hank George Inc., a Greendale, Wis., risk consulting firm. (See chart on this page.)
The therapy is making headlines this year because, in the summer, a unit of the federal National Institutes of Health put an early stop to a major clinical trial on the risks and benefits of one type of HRT regimen–the use of estrogen combined with progestin by healthy menopausal women who have an intact uterus, says Laura Vecchione, M.D., second vice president and medical director of General Cologne Re, Stamford, Conn.
Conducted through NIHs Womens Health Initiative, the study followed over 16,000 women, age 50 to 79. According to NIH, the study was stopped early, after an average follow-up of 5.2 years, due to "increased risk of invasive breast cancer" as well as increases in coronary heart disease, stroke and pulmonary embolism (see chart on page 5). There were also fewer cases of hip fractures and colon cancer in the tested group, NIH says, but, "on balance the harm was greater than the benefit."
The Journal of the American Medical Association announced the halt in its July 17 issue, and the popular media has been running stories about HRT risks ever since. Today, it is widely reported that doctors have been flooded with calls from worried women, to the point that some medical offices are now sending out letters to patients, summarizing the findings and suggesting that women come in to the office to review options.
Many women are reportedly electing alternatives to estrogen and progestin, and some are said to be going "HRT-free." Although national statistics on these shifts are not yet available, most experts characterize the public mood regarding HRT as worried and confused.
All this poses some key questions for the insurance community. What, for instance, should producers say to clients who express worry about whether their current or past HRT use will hurt their ratings, when applying for insurance? And, how are insurance underwriters assessing the new HRT findings–i.e., will the findings prompt them to make HRT a negative when assessing applicants?
For producers, the word seems to be: No changes for now. Therefore, if an applicant says she is concerned about her HRT usage, "suggest that the client discuss the matter with the physician," recommends Jill Mocarski, M.D., medical director at Northwestern Mutual Life Insurance Company, Milwaukee, Wis.
Starting or stopping HRT is a very individual decision, she explains, and it does have benefits as well as risks, but the producer is not the one to review that with the client.
Regarding the impact on insurance underwriting, underwriters at her own company do not credit or rate HRT in any way, Mocarski notes. They look at the persons impairments and the condition, but not HRT use, she says. For example, life underwriters will look at such things as build, blood pressure, family history, heart disease, and so on, but "weve never taken underwriting action on HRT."
In fact, Mocarski says, there only are few medications–such as the blood thinner Coumadinthat Northwestern Mutual underwriters do consider in underwriting.
Another suggestion for producers from Mocarski: Do not offer the client any anecdotal information, such as about how a relative or friend has responded to the HRT scare. The message to deliver, she says, is "this decision needs to be based on clear scientific evidence and be customized to each person."
Producers can be sympathetic, she adds, but they should avoid offering medical advice or information that might be interpreted as such.
If a client is persistent about finding out the underwriters probable response to her HRT usage and if the producer knows the policy of the company regarding this, the producer might relay that policy to the client, Mocarski says. But if the producer doesnt know the companys policy, the producer can say: "I am not aware of this, but I will write your question down and get back to you."
The approach being used at the Impaired Risk Marketing brokerage in Glenview, Ill., "is to underwrite the medical condition, not the individual," says Diane Bobinas, national marketing manager. She says the firm does this regardless of prescriptions or any other medical treatment.
"We always look at what the person does to help their condition," she says.
Where HRT is concerned, she suggests agents take history as they do on any medication: "Ask the client why is she on the med, for how long, and what are the results."
In cases of long-term use of medications, Bobinas says it is especially helpful to find out if the client has been doing what she was supposed to do with the medication–i.e., following the directions.
