cotinine

cigarette and marijuana smoking

Smoking raises red flags for insurers across the board – applicants are usually rated if they produce a positive cotinine test. Further, tobacco use can lead to the potential onset of additional health risks, such as cancer, heart disease, stroke, diabetes and/or lung diseases. Aside from these health concerns, studies show a correlation of tobacco use and marijuana use. Statistics also reveal an increased risk of positivity for other drugs of abuse.

The likelihood of a tobacco user testing positive for marijuana

Our data scientist, Brian Lanzrath, extracted a sample of ExamOne applicant data to identify what, if any, correlation exists between the use of tobacco and marijuana. From 2017-2018, nearly 6.6% of ExamOne life insurance applicants tested positive for cotinine. You can see the states with the highest cotinine positivity rates on this map with Ohio, Kentucky, Indiana, Arkansas and Mississippi being among the five highest. Within each of those states, the positivity of those who tested positive for both THC and cotinine is as follows:

cotinine positivity by state

 

 

 

 

 

 

Overall, tobacco users are nearly 5 times as likely to test positive for THC as non-tobacco users.

Study finds tobacco users 25x more likely to test positive for PCP

Brian also discovered tobacco users were 5x more likely than non-tobacco users to test positive for methadone, PCP and cocaine. Further, marijuana users were nearly 25x more likely than non-marijuana users to test positive for PCP. They were also 15x more likely to test positive for cocaine and 10x more likely to test positive for methamphetamines. As the opioid epidemic continues to spread, it’s important for insurers to be diligent in their testing requirements. Laboratory expert, Betsy Sears, says as a result of the compelling data, there is a growing interest among carriers in using cotinine as a reflex for drug/expanded opioid screens.

Underwriting with precision

It’s important to understand that a positive cotinine test could mean more for insurers. Not only could it mean the applicant is at high risk for multiple health conditions, there is an increased risk the applicant could be misusing other substances that increase mortality. Navigate through the smoke by ensuring you are receiving a complete profile of your applicants.

To review your parameters, discuss reflex testing or to complete an analysis on your applicants, please contact us.

A recently commissioned study by Hank George, Inc. surveyed 110 direct-writing U.S. and Canadian life insurance carriers on fully underwritten businesses. The survey covered a variety of tobacco, alcohol, and drug use topics*. ExamOne asked consultant and former risk management director at Allstate Financial, Eric Hjerpe, to outline and expand upon some of the findings and trends he extracted from the survey results.

Behind the smoke

The majority of respondents underwrite fully underwritten business based on tobacco/nicotine use. A compelling reason to continue with full underwriting is concern over anti-selection. In the absence of cotinine testing, will there be a spike in “smoker’s amnesia”? The survey discovered more insights into the industry’s view on cotinine testing.

  • The survey found nearly two-thirds of respondents estimate 5+% of their applicants do not disclose their tobacco use. Shockingly, more than one-third of respondents put tobacco misrepresentations at 9% or greater on fully underwritten business.
  • Nearly 25% of respondents now begin cotinine testing at age 16.

There has been much discussion among insurers in recent years about the appropriate cotinine-positive threshold. Does your company use the threshold recommended by the laboratory? Congratulations. So do four out of five of your competitors.

  • Slightly fewer than 20% of respondents feel heavy exposure to secondhand smoke can trigger a positive cotinine test. However, ExamOne research consistently shows that using the laboratory-recommended cotinine threshold of .30 all but eliminates the possibility of a false positive test result.
  • Ninety percent of insurers underwrite smokers who use electronic cigarettes in the same way they underwrite traditional cigarettes.

Will a predictive model used to identify potential tobacco users be sufficient to stem the tide of anti-selection? Will companies have sufficient processes in place to address potential false positive results? Will the increased mortality associated with false negative results erode profitability? These are questions that still need to be addressed.

Drinking and drugs

Turning to alcohol and drug use, the number of companies screening with the blood alcohol test is approaching one in five. This makes sense, given the questionable reliability of application drug and alcohol questionnaires used to identify drinking that may adversely affect mortality. Blood alcohol testing can help eliminate appeals. And the majority (just under 70%) of respondents report using CDT as a reflexive test.

Finally, the survey shows that fewer than 20% of companies routinely screen for marijuana with another 10% or so indicating this is something they are considering. ExamOne data shows there is a correlation between marijuana use and increased mortality. Clients may want to discuss these findings with ExamOne’s Laboratory Executive Vice President Betsy Sears or their Strategic Account Representative.

Industry concerns

There is much discussion in the industry today regarding simplified and accelerated underwriting programs. Can tobacco use anti-selection be fully mitigated by acquisition expense reduction and the use of data analytics? Does the recent inquiry by the state of New York Insurance Department regarding data analytics portend choppy waters for insurers? We don’t know. But this survey does show that anti-selection remains a significant concern for life insurers.

*Companies such as ExamOne which sponsored the survey, as well as companies completing the survey received the full survey report.

 

About the Author 

Eric Hjerpe Consulting offers practical solutions to enhance life insurance underwriting processing through cutting edge risk management tools. Eric has 25+ years of experience “reinventing” life underwriting and is also an experienced expert witness for matters related to underwriting and underwriting policy.

Eric was previously Director of Risk Management for Allstate Financial/Lincoln Benefit Life, responsible for setting underwriting policy, coordinating underwriting research and development, and managing vendor relations. Much of his effort the past 25 years has been devoted to re-engineering the underwriting process through enhanced utilization of laboratory testing and innovative underwriting processes.

Debunking the myths: the facts about cotinine

September 21, 2017 Carriers

According to the Foundation for a Smokefree America, smoking is the single most preventable cause of death and disease causing more fatalities than cocaine, auto accidents, AIDS, alcohol, heroin, fire, suicide and homicide combined. The relationship between nicotine and cotinine Cigarettes are made up of tar, carbon monoxide, acetaldehyde, nitrosamines, nicotine and 4,000 different carcinogenic […]

Read the full article →

Cotinine positivity: Has it increased or decreased in the past 12 years?

July 2, 2013 Carriers

It is important to know the cotinine positivity rates of a life insurance applicant during a typical life insurance underwriting process. An applicant’s cotinine positivity rate, when correctly captured, is useful in classifying smoking and non-smoking premium rates. In most cases, smokers pay rates as high as three times the premium of non-smokers and this […]

Read the full article →

Smoking Tips and Health Benefits

November 29, 2012 Producers

In our previous blog, we gave a breakdown of the costs a smoker will spend on cigarettes alone. On top of spending nearly $20,000 in ten years on cigarettes alone, a smoker is paying a lot in their health risks. When an applicant quits smoking they will have money added to their pocket and potentially […]

Read the full article →