laboratory testing

According to a 2015 U.S. Census Bureau report, baby boomers are now trailing the millennial generation as the second largest generation today with an estimated 75.4 million individuals. Although the millennials outnumber this aging segment, it is in the 60+ age group where life insurance application activity is rising. Each month, underwriting specialists at the MIB Group release a report showing life insurance activity year-over-year (Y/Y). The most recent report illustrates April 2019 application activity as down 0.7%, with ages 0-44 off -4.0%, ages 45-59 up 1.3% and ages 60+ up 10.8% Y/Y. According to MIB, application activity ages 60+ has seen double-digit growth in three of the past four months.

ExamOne collaborates with many customers who are evaluating the changing insurance market and trying to find the right combination of risk assessment requirements to meet today’s demographics. Although many clients are looking to ExamOne data sources to solve their underwriting needs, there continues to be a focus on the unique challenges of underwriting the older-age risk.

These trends will likely continue. In 2018, a Census Bureau press statement indicated “by 2030, all baby boomers will be older than age 65. This will expand the size of the older population so that one in every five residents will be retirement age.” Older-age underwriting presents multiple challenges as 25-year-old and 55-year-old applicants clearly pose different risks and impacts on mortality.

The changing body

Consider that many body organs experience tissue loss and decreased function as we age. Cardiac dysfunction, malignancies, cognitive impairment and frailty become greater underwriting concerns. But frequently, our routine older-age “age and amount” parameters and “for cause” Attending Physician Statements (APSs) are unable to identify sub-clinical diseases. It may take years before overt diseases become apparent to the attending physician.

ExamOne has offered specific laboratory testing panels for older-age underwriting for more than a decade. Over that time, many carriers have been evaluating laboratory studies and using targeted markers to build test parameters that protect against the risks associated with applicants ages 50 and older. Insurers tell us they want faster issue times and more customer-friendly experiences, yet the leading cause of delayed issue and customer/producer dissatisfaction is the APS. Because blood profiles are routinely required at these older ages, adding additional laboratory test components to replace some of the traditional, more cumbersome older-age requirements, especially APSs, is a viable solution. Here are the trends continuing to gain momentum.

Using NT-proBNP as an EKG alternative can save time and money

NT-proBNP detects cardiovascular risk and overall mortality risk early and reliably (S.P. Schoen, 2007). Over the past 7-10 years, many carriers have eliminated treadmills and error-prone resting EKGs in favor of NT-proBNP. Companies have been very satisfied with this blood test that can better identify cardiovascular risk and in a more applicant-friendly manner.

One ExamOne client reported that for an annual NT-proBNP cost of less than $100,000 per year, present value of future mortality savings exceeds well into seven figures.

Carriers who are using NT-proBNP versus EKGs see an overall reduction in applicant acquisition cost, as well as improved policy issue times. Testing applicants at age 50 and above should be the norm, especially for larger face amounts. Across the board testing at ages 60 and above is strongly recommended.

Assessing renal function, cognitive function and cardiovascular risk

Cystatin C is a serum protein that is filtered out of the blood by the kidneys. It serves as a measure of renal function and is a strong predictor of the risk of cardiovascular events. This test is more accurate in assessing risk in the older ages because levels of cystatin C are independent of muscle mass and more closely correlated with mortality. There is also recent clinical literature to support the potential for cystatin C to replace conventional cognitive screening (W. – W. Chen, 2015).

Detecting frailty and potential chronic diseases

Hemoglobin is the protein in red cells that transports oxygen from the lungs to the body tissues. A reduction in hemoglobin is called anemia and has been shown to be associated with increased frailty and, consequently, mortality in the elderly population (Röhrig, 2016). It is usually not the anemia that is of concern, but the underlying cause – typically a chronic disease.

Anemia should not be accepted as an inevitable consequence of aging. A cause is found in approximately 80 percent of elderly patients. The most common causes of anemia in the elderly are chronic disease and iron deficiency. Vitamin B12 deficiency, folate deficiency, gastrointestinal bleeding and myelodysplastic syndrome are among other causes of anemia in the elderly (Douglas L. Smith, 2000). Many clients have started testing applicants age 50 and over.

The table below shows the percent of abnormal hemoglobin levels for both males and females, according to laboratory results.

older-age underwriting NT-proBNP
Source: ExamOne applicant data

Updating your older-age underwriting requirements

The laboratory solution provides concise, accurate and detailed information about your older-age applicant. To learn more about some of these laboratory tests and how you can incorporate them into your testing requirements, visit our educational resource page on

sensitive laboratory results

Now that marijuana is legal in many states, as well as in Washington D.C., some underwriting departments have asked us to update their sensitive test results to allow for positive THC. Several clients indicated that waiting for sensitive test results can cause a delay in their underwriting process. By reducing your number of sensitive tests, some of these delays are eliminated and underwriters can make faster decisions. This is a simple change that is requested through our team and may include other tests as well.

To walk you through this process, one of our Regional Account Managers, Rebecca Shady, answers some frequently asked questions.

Q. What results can be changed from sensitive to non-sensitive?
A. There are now 17 laboratory tests that can be categorized as non-sensitive. They include:   

Cocaine, codeine, fentanyl, hydrocodone, hydromorphone, morphine, norfentanyl, methamphetamine, marijuana, amphetamine, barbiturates, benzodiazepines, methadone, oxymorphone, oxycodone, phencyclidine, 6-monoacetylmorphine Each test is individually-based and a carrier can customize which ones should be identified as sensitive versus non-sensitive. Please note, a sensitive test must be reported as sensitive on both the raw data feed and on the text report.

Q. Am I able to customize my sensitive results by state?
A. At this time, we only have the ability to classify a result as sensitive or non-sensitive. We are unable to discern categorizations by state.

Q. What happens when a result is changed from sensitive to non-sensitive?
A. Once our team makes the change, all positives for that test will be received through your normal results feed. For example, if you want to start receiving THC as a non-sensitive, then a positive THC screen would appear with all other laboratory test results.

Q. I’ve determined that we currently have some results marked as sensitive, but I would like to accept them as non-sensitive. How do I make this request?
A. If you would like to update your requirements on what you identify as sensitive, please work with your Regional Account Manager (RAM). If you do not know who your RAM is or you do not have one, you may email our team at and one of our team members will contact you regarding your request.

Q. Can HIV be reported as non-sensitive?
A. At this time, any and all positive HIV results must still be reported as a sensitive test result.

Q. Will the process change for those tests that I want to keep as sensitive?
A. No. For any test that is currently identified as sensitive, you will continue to receive those results the same way as you do today.

We hope this helps answer any questions you may have regarding sensitive test results. If you have additional questions, please contact your Strategic Account Executive or Regional Account Manager.

*Professional Services fees may apply for complex or custom product and system integrations

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