My first reaction when asked to take a genetic test as part of an Investec Life product launch was one of trepidation. I was concerned the result could detract from my current or future risk insurance purchases. What if the test revealed a hereditary condition that made it impossible for an insurer to underwrite my critical illness, death or disability insurance policies? My concerns proved unfounded, because the test only assessed a small subset of genetic markers to make observations about diet, exercise, sleep and stress linked to my genetic make-up.
Awareness about genetic testing and its consequences is on the rise. Angelina Jolie, who received widespread media attention in 2013 after informing the public that she had tested positive for a gene associated with a higher risk of breast and ovarian cancers, is a case in point. She had a double mastectomy to mitigate her risk. Given there are countless tests that can reveal an individual’s genetic predisposition for hundreds of diseases and conditions one must ask what happens if a genetic test reveals potentially compromising information.
South Africa’s life insurers are guided by a 10-year-old “Standard on genetic testing” released by the Association for Savings and Investment SA (Asisa) in 2009. Their position, confirmed in recent discussions with large life insurers, is that genetic testing is not presently a component of the life insurance industry’s underwriting process.
“We will not request an applicant to undergo a genetic test to support an application for insurance, whether done to obtain a lower than standard premium rate or to indicate the presence or absence of a suspected genetic condition,” said Janet Brodie-Thompson, the chief underwriting officer for product development at Momentum.
This does not mean you can side-step questions about genetic testing in the policy application form.
A direct question that might appear in your application form is whether you have been tested for any genetic, hereditary or familial disorder. Insurers also acquire genetic information by exploring your family history and using that information as a proxy to determine the probability of you developing hereditary conditions.
Dr Maritha van der Walt, the chief medical officer at Discovery Life, advises that any genetic tests already performed must be disclosed. “Only tests performed prior to the date of commencement have to be disclosed; tests done thereafter need not be, whatever the outcome,” she said.
Her response aligns with the position taken by the Ombudsman for Long-term Insurance.
“Once cover is in force it is unlikely that there is an ongoing duty of disclosure in respect of test results, unless the policy imposes such a duty, which I have not seen in any policy,” said deputy ombudsman for long-term insurance Jennifer Preiss.
Her office has not yet received complaints specifically dealing with genetic testing.
All this could change as DNA testing becomes more accessible and affordable. Avi Lasarow, founder and chief executive of UK-based DNAfit, reveals a staggering growth in the number of genetic tests sold online. Popular genetics testing company 23andMe has sold more than 10 million DNA tests since it started out while Ancestry.com sold more than 1 million units over Black Friday last year.
A recent exclusive partnership between Investec Life and DNAfit illustrates how health and life insurance overlap without necessarily impacting the underwriting process. Results from a simple “saliva swab” DNA are used to determine how an individual’s genetic make-up affects his or her response to changes in fitness, nutrition, sleep and stress. And the insurer uses this information to offer a health-linked value-add for its policyholders.
“We are always on the lookout for ways to improve upon the traditional life insurance experience,” said Michael Goemans, the chief executive of Investec Life. “This partnership connects our clients with the latest innovations in health and wellness and enables them to fine-tune their approach to maintaining their health and optimising their well-being.”
The quid pro quo for the insurer is an improved claims experience.
The fact that life insurers increasingly face ethical, regulatory, social, constitutional and emotional questions around genetic testing has forced Asisa to review its standards - a process under way.
Until such time life insurers seem content to stick with the “tried and tested” underwriting methodologies perfected over decades.
“We do not foresee sending clients for genetic testing at this time, but there might be instances where clients voluntarily participate in specific genetic tests to prove that they are at lower risk than what we attribute to them based on their family history,” said Brodie-Thompson.
Discovery agreed that underwriting practices are unaffected by genetic testing. “Results of genetic tests must be disclosed at the underwriting stage,” said Van der Walt.
“A range of data, including personal medical history, family history, applicable tests and treatments are considered, so there is no change in underwriting philosophy in the age of genetic testing.”