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Genetics Knowledge Improving Health 'LONDON IDEAS'

Insurance and Genetics

right arrow Current situation

right arrow Insurance industry

right arrow If you have a family history or a pre-existing condition

right arrow London IDEAS activities

right arrow Papers and presentations

right arrow Links

 

Current situation (mid 2007)

There has been considerable concern about how the insurance industry might use the results of predictive genetic tests (i.e. tests that tell you whether you are at risk of developing a condition in the future). Concerns include whether insurance premiums will be unfairly high for someone who has had a genetic test that tells them they are at risk, and whether this worry in turn could stop people taking tests which would be useful for their healthcare.

The insurance industry has entered into a voluntary ban (a moratorium - click to download pdf 140kb) on using predictive genetic test results, until November 2011. The current situation (for life, critical illness and income protection insurance) is:

  • insurers can use the results of diagnostic genetic tests: these tests are treated in the same way as any other medical diagnosis because they give information about an existing condition
  • insurers cannot use adverse results of predictive genetic tests e.g. genetic tests taken without symptoms which have shown that you are at high risk e.g. of breast cancer (n.b. if you do have a strong family history, but you take a test and are shown not to have inherited the disease-causing gene in your family, you can choose to disclose this information when applying for insurance to "cancel out" your family history  - how insurers act in these situations might vary between companies)
  • the only exception to the "ban" on use of predictive test results is for high value policies i.e. for a payout of more than £500,000 for life insurance, £300,000 for critical illness or £30,000 per year for income protection predictive tests can be used in some circumstances (see below): more than 97% of policies bought in 2004 did not fall into this bracket
  • for high value policies, only predictive tests that have been specifically approved by the Genetics and Insurance Committee (GAIC) can be used
  • so far the only predictive test that has been approved is for Huntington's disease and only for life insurance (not other types of insurance).
  • predictive genetic tests cannot be used for travel, private medical or long term care policies of any value
  • if you take any kind of genetic test as part of a research project insurers are not allowed to use this information
  • as with all types of medical test, if you take a predictive test after buying an insurance policy, this will not affect the premium you are paying; an insurer's assessment of your application for insurance can only be made once, on the information available at the time

Insurance industry concerns

Insurance is a business that needs to be able to pay out when claims are made, and still make a profit. There is some concern among insurers that if they are not allowed access to the results of predictive genetic tests that their customers have taken, they will suffer from "adverse selection". This is when customers who know they are at high risk of ill health take out relatively high levels of insurance without telling the insurer about their high risk. This could lead to the insurer having to pay out on many more policies than they predict. This in turn would dent profits, raise premiums for everybody and ultimately could lead to collapse of insurance business.

The organisation representing the industry is the Association of British Insurers. This body is responsible for submitting applications to GAIC for the approval of use of predictive genetic tests in insurance.

If you have a family history or a pre-existing condition

Don't assume that you won't be able to get insurance, or that it will be too expensive. The vast majority of people manage to buy life insurance at standard rates. If you do have concerns it would be worth talking to an Independent Financial Advisor (IFA) about specialist insurance companies who are used to selling insurance to people at so-called "non-standard risk".

In addition there are specialist IFAs who deal in life insurance (Special Risks Bureau,   Risk Placement Services) and specialist advisors on travel insurance (Freedom) for people at non-standard risk.

Disclaimer: London IDEAS does not accept liability for services provided by Independent Financial Advisors, or insurance companies mentioned on this website. London IDEAS does not recommend individual insurance companies.

London IDEAS activities

London IDEAS surveyed industry policy regarding life insurance rating for applicants with a family history of familial hypercholesterolaemia (FH) and of breast cancer. The results, indicating wide variation within the industry but providing reassuance that standard terms could be found, have been disseminated to the medical profession and public audiences. Both data sets provide a benchmark for further research beyond the current genetic test moratorium.

London IDEAS also created a multi-disciplinary working group to streamline insurance applications for customers with inherited conditions. The supplementary application forms developed are being piloted for four conditions and the results will be disseminated across the industry and patient groups, and patient groups will be helped and encouraged to adapt the model for their own use.

With the Association of British Insurers, London IDEAS also worked on a circular to their member companies clarifying the position of FH research subjects taking DNA tests, so that the subjects can be reassured that research tests are not relevant to life insurance applications.

Papers and presentations

Surveys of the industry:

Neil HAW et al. 2004. Effect of statin treatment for familial hypercholesterolaemia on life assurance: results of consecutive surveys in 1990 and 2002. BMJ 328:500-1.

Hunter A, Humphries SE 2005. Effect of a family history of breast cancer on cost of life insurance: a test-case comparison of current UK industry practice. BMJ 331:1438-9.

This study was also presented as a BSHG poster in 2005.

Ethical, legal and social issues:

Newson AJ 2004. Predictive genetic testing and access to insurance: is there a need for regulation? Presentation to the Department of Genetics, Addenbrooke's Hospital, Cambridge. (Published prior to the extension of the moratorium to 2011).

Raithatha N, Smith RD 2004. Disclosure of genetic tests for health insurance: is it ethical not to? Lancet 2004; 363: 395-396.

Godard B et al. 2003. Genetic information and testing in insurance and employment: technical, social and ethical issues. Eur J Hum Genet 11, Suppl 2. S123-S142.

Daykin et al 2003. Genetics and insurance: some social policy issues. Presented to the Institute of Actuaries and the Faculty of Actuaries.

Radetzki et al 2003. Genes and Insurance: Ethical, Legal and Economic Issues. Cambridge: Cambridge University Press.

 

Low L et al. 1998 Genetic discrimination in life insurance: empirical evidence from a cross-sectional survey of genetic support groups in the United Kingdom. BMJ 317: 1632-1635.

Barlowe-Stewart K, Keays D 2001. Genetic discrimination in Australia. J Law & Med. 8:250-262.

Links

Association of British Insurers

Genetics and Insurance Committee

UK Forum for Genetics and Insurance

 

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