DIABETICMedicine
DOI: 10.1111/dme.12832
Gestational diabetes mellitus and life assurance: the United Kingdom perspective Diabet. Med. 33, 406 (2016) Following the publication of the Hyperglycemic and Pregnancy Outcomes study results [1], new diagnostic criteria for diabetes in pregnancy have been recommended by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) [2] and endorsed by the World Health Organization (WHO) [3]. However, adoption of the new criteria has not been universal with objections both scientific and otherwise. One of the concerns regarding the new criteria is the risk that ‘. . . a medical label of high risk for the future that will influence the mother’s insurance premiums in most U.S. states’ [4]. Similar concerns have been expressed in Australia [5]. In order to place this question into perspective, we surveyed 12 major Australian insurance companies with a hypothetical proposal. The scenario presented was: a lady of 40 years of age, with no adverse alcohol habits, a lifetime non-smoker, no adverse family history, currently taking no medications, has a BMI of 25 kg/m2 and has had no past health problems apart from gestational diabetes mellitus (GDM) during her second pregnancy 10 years ago. An oral glucose tolerance test (OGTT) performed 7 weeks after this pregnancy was normal and subsequent blood sugar tests have also been normal. She is currently not pregnant. She would like to take out life cover and income protection cover.
The responses received covered ~ 94% of the retail life insurance new business in Australia. They were unanimous that they all take into account a previous diagnosis of gestational diabetes mellitus, but the diagnosis per se would not lead to an increase in premiums for life or disability insurance [6]. A similar survey has been conducted in the United Kingdom (UK), with the assistance of the Assurance Medical Underwriting Society (AMUS), and the Australasian Life Underwriting and Claims Association (ALUCA). Life and income protection covers in the UK are also known as life and disability assurance. We surveyed 17 companies, but excluded three because they did not provide assurance products in the UK with direct public access. Of the 14 companies remaining, 11 responded, representing an estimated 76% of the new business share of the UK market. One company declined to identify their market share. The UK responses were very similar to those from Australia. They were unanimous that no extra premium would be added to life assurance products. Surprisingly, only 7 of the 11 companies would take into account a previous
406
Letters
diagnosis of gestational diabetes mellitus. This means 4 of 11 companies would not include a previous diagnosis of gestational diabetes mellitus in their assessment of the applicant. Only one company would apply an extra premium (25%) for disability income protection. The assurance companies that took account of the gestational diabetes mellitus wanted to be informed about a previous history of gestational diabetes mellitus. However, because the applicant had a normal post-partum OGTT and random glucose levels, no additional premium was required. Overwhelmingly, the assurance companies in UK have indicated that a diagnosis of gestational diabetes mellitus would not impact on a woman’s life assurance premiums, a result essentially the same as in Australia. Based on these results, concerns regarding the mother’s potential life and disability insurance premiums should not impact on discussions about the diagnostic criteria for gestational diabetes mellitus. We acknowledge the limitations of posing a hypothetical case for consideration, and observations of the behaviour of assurance companies in the future will need to be considered.
Funding sources
None.
Competing interests
None declared. A. S. Y. Zheng1, T. O’Leary2 and R. Moses3 Endocrinology and Diabetes, Wollongong Hospital, Wollongong, 2Australian Life Underwriters and Claims Association, Sydney and 3Illawarra Diabetes Service and Clinical Trials and Research Unit, Wollongong, Australia 1
References 1 Metzger BE, Lowe LP, Dyer AR, Trimble ER, Udom C, Coustan DR et al., The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991–2002. 2 Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PM, Damm P et al., International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676–682. 3 World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva: WHO Press, 2013. 4 Ryan EA. Balancing weight and glucose in gestational diabetes mellitus. Diabetes Care 2013; 36: 6–7. 5 d’Emden MC. Reassessment of the new diagnostic threshold of gestational diabetes mellitus: an opportunity for improvement. Med J Aust 2014; 204: 211. 6 Zheng ASY, O’Leary T, Moses RG. Gestational diabetes mellitus and life insurance: what is the impact of gestational diabetes mellitus on life insurance premiums? Diabetes Care 2014; 37: e235.
ª 2016 The Authors. Diabetic Medicine ª 2016 Diabetes UK
DOI: 10.1111/dme.12832
Gestational diabetes mellitus and life assurance: the United Kingdom perspective Diabet. Med. 33, 406 (2016) Following the publication of the Hyperglycemic and Pregnancy Outcomes study results [1], new diagnostic criteria for diabetes in pregnancy have been recommended by the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) [2] and endorsed by the World Health Organization (WHO) [3]. However, adoption of the new criteria has not been universal with objections both scientific and otherwise. One of the concerns regarding the new criteria is the risk that ‘. . . a medical label of high risk for the future that will influence the mother’s insurance premiums in most U.S. states’ [4]. Similar concerns have been expressed in Australia [5]. In order to place this question into perspective, we surveyed 12 major Australian insurance companies with a hypothetical proposal. The scenario presented was: a lady of 40 years of age, with no adverse alcohol habits, a lifetime non-smoker, no adverse family history, currently taking no medications, has a BMI of 25 kg/m2 and has had no past health problems apart from gestational diabetes mellitus (GDM) during her second pregnancy 10 years ago. An oral glucose tolerance test (OGTT) performed 7 weeks after this pregnancy was normal and subsequent blood sugar tests have also been normal. She is currently not pregnant. She would like to take out life cover and income protection cover.
The responses received covered ~ 94% of the retail life insurance new business in Australia. They were unanimous that they all take into account a previous diagnosis of gestational diabetes mellitus, but the diagnosis per se would not lead to an increase in premiums for life or disability insurance [6]. A similar survey has been conducted in the United Kingdom (UK), with the assistance of the Assurance Medical Underwriting Society (AMUS), and the Australasian Life Underwriting and Claims Association (ALUCA). Life and income protection covers in the UK are also known as life and disability assurance. We surveyed 17 companies, but excluded three because they did not provide assurance products in the UK with direct public access. Of the 14 companies remaining, 11 responded, representing an estimated 76% of the new business share of the UK market. One company declined to identify their market share. The UK responses were very similar to those from Australia. They were unanimous that no extra premium would be added to life assurance products. Surprisingly, only 7 of the 11 companies would take into account a previous
406
Letters
diagnosis of gestational diabetes mellitus. This means 4 of 11 companies would not include a previous diagnosis of gestational diabetes mellitus in their assessment of the applicant. Only one company would apply an extra premium (25%) for disability income protection. The assurance companies that took account of the gestational diabetes mellitus wanted to be informed about a previous history of gestational diabetes mellitus. However, because the applicant had a normal post-partum OGTT and random glucose levels, no additional premium was required. Overwhelmingly, the assurance companies in UK have indicated that a diagnosis of gestational diabetes mellitus would not impact on a woman’s life assurance premiums, a result essentially the same as in Australia. Based on these results, concerns regarding the mother’s potential life and disability insurance premiums should not impact on discussions about the diagnostic criteria for gestational diabetes mellitus. We acknowledge the limitations of posing a hypothetical case for consideration, and observations of the behaviour of assurance companies in the future will need to be considered.
Funding sources
None.
Competing interests
None declared. A. S. Y. Zheng1, T. O’Leary2 and R. Moses3 Endocrinology and Diabetes, Wollongong Hospital, Wollongong, 2Australian Life Underwriters and Claims Association, Sydney and 3Illawarra Diabetes Service and Clinical Trials and Research Unit, Wollongong, Australia 1
References 1 Metzger BE, Lowe LP, Dyer AR, Trimble ER, Udom C, Coustan DR et al., The HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008; 358: 1991–2002. 2 Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PM, Damm P et al., International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676–682. 3 World Health Organization. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva: WHO Press, 2013. 4 Ryan EA. Balancing weight and glucose in gestational diabetes mellitus. Diabetes Care 2013; 36: 6–7. 5 d’Emden MC. Reassessment of the new diagnostic threshold of gestational diabetes mellitus: an opportunity for improvement. Med J Aust 2014; 204: 211. 6 Zheng ASY, O’Leary T, Moses RG. Gestational diabetes mellitus and life insurance: what is the impact of gestational diabetes mellitus on life insurance premiums? Diabetes Care 2014; 37: e235.
ª 2016 The Authors. Diabetic Medicine ª 2016 Diabetes UK
