Diabetes is a condition that impacts over 11% of the U.S. population, and every year, over one million Americans are diagnosed with diabetes. This makes diabetes a common impairment for advisors to encounter. However, overcoming diabetes in the underwriting process can prove challenging for advisors who are not aligned with a distributor who understands carrier niches and can position these cases properly. 

Many advisors assume they’ll face limited options, settling for standard. However, understanding how carriers assess diabetic clients and the nuances of A1C control can help advisors improve the odds of securing better than standard offers. With the proper knowledge and strategy, advisors can present a compelling case for diabetic clients.

Understanding diabetes and its impact on underwriting

Diabetes is a chronic condition where the body either doesn't produce enough insulin–a hormone that regulates blood sugar–or can't effectively use the insulin it does produce. There are many types and subtypes of diabetes that can impact underwriting outcomes. 

Diabetes is usually monitored through A1C levels, which assess the percentage of glucose attached to hemoglobin, a protein that carries oxygen in red blood cells. A1C indicates how well blood sugar is being managed over time and is a crucial indicator that carriers look at for diabetes cases. 

While the Centers for Disease Control states that A1C levels below 5.7% are normal and levels above 6.5% are diabetic, carriers have their own guidelines. They may rate a client as diabetic even without a formal diagnosis. 

Keep in mind that each person’s diagnosis and health outlook are different and can vary depending on factors like age, gender, lifestyle, and medical regimen.

Types of diabetes

• Prediabetes: Clients with A1C levels between 5.7% and 5.9% may be considered prediabetic by carriers and can qualify for better than standard if A1C levels are stable, especially if they have no formal diabetes diagnosis. 
• Type I diabetes: This type is considered an autoimmune disorder, and patients are dependent on insulin injections or an insulin pump to regulate their blood sugar. Type I diabetes can lead to other health risks like cardiovascular, kidney, and nerve issues later in life if not well-managed. For this reason, these clients may receive a rating between Table 2 and Table 4. For clients diagnosed before age 12, their rating could go as high as Table 6, or they could be denied. 
• Type II diabetes (adult-onset): People with type II diabetes can produce insulin, but their bodies usually can’t use it properly. Type II typically develops in obese middle-aged adults, but it can also be hereditary. Generally, carriers consider A1C levels above 6.0% to be diabetic. Clients with A1C levels between 6.0% and 7.0% can still qualify for better than standard ratings with the right carrier and case positioning. Non-diabetic clients with a family history of Type II diabetes can still receive a debit because they are at higher risk of developing diabetes later in life. Depending on their diagnosis and medical outlook, these clients can still receive offers that are better than standard.
• Gestational diabetes: Occurring during pregnancy, gestational diabetes typically resolves after birth but suggests an elevated risk of Type II diabetes later. Clients with a history of gestational diabetes may still qualify for standard or standard plus ratings. Once the gestational diabetes has resolved, some carriers will consider preferred ratings under certain criteria.

How diabetes is tested in underwriting

Carriers include diabetes testing in the underwriting process with a basic blood panel to check glucose levels. If glucose is high or other signs of blood sugar issues are present, a reflex test is conducted. The carrier will contact the lab and request additional testing to examine A1C levels. For known diabetics, the carrier will typically request an A1C test from the start to evaluate long-term glucose control. Carriers will also review urine results to evaluate microalbumin–an early indicator of kidney disease. 

Common underwriting scenarios

Carriers consider many factors when underwriting clients with diabetes, like age of onset, A1C control, and related health conditions. Here are some common underwriting scenarios:

• Undiagnosed diabetes: For clients without a formal diabetes diagnosis with an A1C below 6.3%, preferred ratings could be considered when positioned with the right carrier.
• Newly diagnosed diabetes: Carriers generally prefer stability in glucose control, often postponing coverage for newly diagnosed clients with A1C levels above 9%. For Type II diabetes, clients with A1C levels between 6.3% and 7% can still receive a standard offer. Once the client shows a history of stability, preferred ratings can be possible, depending on factors like age, compliance, and control. 
• Well-controlled diabetes: Clients with steady A1C levels usually see more favorable outcomes. Type II diabetes is generally considered well-controlled at A1C levels below 7.0% and below 7.5% to 8% for Type I, depending on the carrier. Clients using insulin pumps may qualify for improved ratings due to consistent blood sugar management.
• Poorly controlled diabetes: Clients with A1C levels over 8% face higher risks. In such cases, carriers will likely assign higher ratings or postpone applications until glucose control improves. Clients with fluctuating A1C levels may need to demonstrate stable control before reapplying.

Positioning diabetes cases effectively

To secure the best outcomes for diabetic clients, advisors can employ several strategies that could enhance underwriting outcomes:

1. Set the right expectations: Have open and honest conversations with clients about what they can expect during the underwriting process and possible outcomes based on their diagnosis. For example, even if a client recently lost significant weight to help control their Type II diabetes, the carrier will only count 50% of that weight loss. However, they may no longer be rated for diabetes. 
2. Proactive health management: Clients with a diabetes diagnosis should adhere to medications, diet, and overall diabetes management to improve their underwriting outcomes. 
3. Proper exam preparation: Advise clients to avoid exercise and properly hydrate 48 hours before the exam. While it may be awkward to discuss, clients should not partake in any sexual activity 48 hours before the exam. Sexual activity (including masturbation) can temporarily increase blood or protein in the urine sample, which could raise unnecessary red flags for underwriters.
4. Consider table shave programs: For clients who qualify for permanent policies, table shave programs can lower premiums over time if they meet certain criteria, like weight loss or lifestyle changes, making broader coverage options accessible. This approach is particularly helpful when the A1C and control are above 7.5%.
5. Select carriers strategically: Choosing carriers based on their leniency and stance on diabetes cases is essential. Partnering with a knowledgeable brokerage can help match clients with carriers that offer the best potential ratings for their unique profiles.

How Modern Life supports advisors 

Modern Life leverages its extensive underwriting experience to assist advisors in positioning diabetes cases effectively, working closely with carriers to secure the best possible ratings.

For example, Modern Life recently supported an advisor in a challenging case involving a 50-year-old male client applying for $6 million in term coverage. While the advisor knew of his previous mental health history, routine insurance testing revealed an A1C level that indicated a potential, yet undiagnosed, diabetes condition. 

The new health finding, in combination with this previous mental health diagnosis, resulted in a standard rate with crediting. By leveraging our established carrier relationships and applying a targeted underwriting approach, we negotiated a standard plus rating, ensuring the client secured the desired coverage at a more favorable rate and preserving the sale for the advisor.

Even if an ideal rating isn’t available initially, Modern Life’s forward-looking approach ensures advisors can guide clients in enhancing their health profiles and reapplying if their circumstances improve. With immediate and long-term solutions, Modern Life prioritizes clients' financial security with complex health conditions like diabetes.

Next steps

If your clients have diabetes or other challenging impairments, Modern Life’s underwriting expertise can help you navigate complexities and find the best coverage. Connect with us to discuss how we can support your next case and position it for success.