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Medical underwriting - why we ask about your health

25 October 2017
5 minute read

My 1Life Policy

When you apply for a life insurance policy, 1Life asks 12 medical questions. These questions are there to help insurers, such as 1Life, determine the risk of a policyholder claiming earlier than expected. When the risk of an early claim is considered high, there might be a higher premium assigned. Answering these questions accurately and honestly is extremely important, and goes a long way in getting claims paid out successfully.

The questions we ask

First, you are required to tell us your height and weight, which is used to determine your Body Mass Index (BMI). This shows if you are under or overweight, or a normal weight for your height. BMI is a good indicator of risk – a high BMI, for example, could mean that you are more likely to suffer a chronic illness, which may lead to an early claim on a policy. So a high BMI might mean a higher premium.

The medical questions
*Please note that these questions can change – depending on changes in underwriting practice
You will then be asked 12 medical questions to which you must answer yes or no to:

  1. In the past 12 months, have you used any product that contains tobacco or nicotine?
  2. How many units of alcohol do you drink per week? 1 unit is a can of beer or small glass of wine.
  3. Do you have or have you ever had any disorders of the heart, e.g. heart murmur, chest pain or heart attack?
  4. Do you have or have you ever had any respiratory or lung trouble, e.g. asthma, bronchitis or a persistent cough?
  5. Do you have or have you ever had any stomach, bowel, kidney, bladder, liver or pancreatic trouble?
  6. Do you have or have you ever had any disorders of the nervous system, e.g. epilepsy, stroke or multiple sclerosis?
  7. Do you have or have you had any disorders of the skin, muscles, bones and joints, e.g. arthritis, back problems or gout?
  8. Do you have or have you ever had any episodes of depression, anxiety or stress?
  9. Do you have or have you ever had any condition requiring treatment or medication, e.g. raised blood pressure, diabetes or raised cholesterol?
  10. Have you ever had any counselling, medical advice or investigation, e.g. blood test or treatment, other than for insurance purposes or company sponsored testing in connection with HIV/AIDS?
  11. Have you ever been diagnosed with or been treated for any cancer, leukaemia, growth or tumour?
  12. Have you ever had any illness or any medical or surgical device or treatment other than already stated, e.g. operations, accidents or hospitalisation?

If you answer yes to any of the questions you will be asked to provide details before moving onto the next question. If we need medical records we will ask for them at this stage.

You should know...

Smoking includes vaping
Smoking includes smoking any kind of tobacco, vaping, and taking any kind of nicotine or smoking replacement. So if you vape, life insurance companies in South Africa consider you to be a smoker (even if you vape a nicotine free substance – there are still cancer risks associated with vaping).

You’ll need an HIV test
In addition to the medical questions you will need to have an HIV test. We do a saliva or a blood test which can be done at a Lancet lab or Link pharmacy, or, depending on where you live, at your home or place of work, by a nurse. You will need your ID and your policy number, which your consultant will give you at the end of the call.

Tell us everything
Don’t be tempted to say “no” when the answer is “yes”! If you don’t tell us you have a medical condition, or you give us inaccurate information, there might be a problem when a claim is submitted. All your medical reports and medical history are requested when a claim is made, and if a medical condition was present when you took out the policy and you did not let us know, the claim may be reduced or rejected.

Top tip: Rather give too much information than not enough.

What happens if you answer ‘yes’?Answering yes to a question, or having a medical condition such as diabetes doesn’t mean you won’t get cover. When you apply for insurance, even if you answer yes to some of the questions, there are several possible outcomes:

  • The policy is issued for the cover requested at standard rates
    Most of 1Life’s policies fall into this category. Healthier people have normal risks, and pay standard rates. Many people with raised blood pressure or raised cholesterol are issued policies at standard rates.
  • The policy is issued for the cover requested but the premium is increased
    This is where you pay an extra amount on the standard rate – for example 75%, because you have a higher risk than a standard life. Let’s say you have diabetes, which means you are more likely to claim than a person without diabetes. In this case, the standard risk premium rate might be R200 a month, so a 75% increase would make it R350 a month.
  • The policy is issued for the cover requested – with an exclusion
    This is where the cost of insuring a specific risk is too high, but other risks can be covered at standard rates. For example, if you have had a recent heart attack, we might offer you cover except for a claim due to a heart problem.
  • The policy may be deferred
    This means that we cannot offer you cover today, but might be able to do so in the future. For example, we might need medical tests for a condition in three months or a year to see if it has improved.
  • The cover requested may be declined, but other benefits offered, such as accidental death cover
    This is rare, but it can happen if you are very ill and are likely to make a large claim within a short time of taking out insurance.

Reviewing the decisionIf your premium is increased or an exclusion applied for a particular condition, and a few years on your health has improved, you can apply to have a decision changed, with supporting medical reports. And if you give up smoking, you can apply for a better rate one year or more after quitting completely.

The bottom lineInsurance is a safety net – there to give financial protection for you and your family. When this happens, you want your claim to be paid. And it will be, if you’ve given us accurate medical information on your application.

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