The Genetics of Breast and Ovarian Cancer III: A new model of family history with insurance applications

Insurers’ access to genetic test results is often restricted and the only genetic information that might be collected during underwriting in some countries is family history. Previous studies have included family history in a simple way but only for diseases which have no cause other than gene mutations, because then the event ‘affected parent’ contributes all possible information short of a genetic test result. We construct a model of breast cancer (BC) and ovarian cancer (OC) — common diseases with rare genetic variants — in which the development of a family history is represented explicitly as a transition between states, hence as part of the applicant's own life history. This allows the impact of a moratorium to be modelled. We then apply this family history model to life insurance in a semi-Markov framework and to critical illness (CI) insurance in a Markov framework to: (a) estimate premium ratings depending on genotype or family history; and (b) model the potential cost of adverse selection.     

A Model for Coronary Heart Disease and Stroke with Applications to Critical Illness Insurance Underwriting II: Applications

Abstract

In Part I we constructed a model for the development of coronary heart disease (CHD) or stroke that either incorporates, or includes pathways through, the major risk factors of interest when underwriting for critical illness (CI) insurance. In Part II we extend this model to include other critical illnesses, for example, cancers and kidney failure, and describe some applications of the model. In particular, we discuss CI premium ratings for applicants with combinations of some or all of high body mass index, smoking, high blood pressure, high cholesterol, and diabetes. We also consider the possible effect on CI premium ratings of genetic conditions that increase the likelihood of high blood pressure, high cholesterol, diabetes, CHD event, or stroke.