Recent developments in health insurance, life insurance, and disability insurance case law.
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Life insurance is a necessary part of life. There are many types of insurance, with varying costs, so each individual situation calls for a carefully tailored policy, modified periodically according to one's changing needs. To do this requires some basic knowledge on the part of the purchaser, plus the coordinated help of a competent insurance advisor, lawyer, and accountant. The medical prescription a physician writes first requires an adequate examination and workup of the patient, following which it is written for a specific purpose. In the same way, the life insurance plan selected by an individual should be decided upon only after a complete history and examination of that person and his or her needs.
The health condition of man has changed considerably since life insurance companies have been established. The initial problem of the companies was the fact that many young persons died from tuberculosis. For many decades persons from families with tuberculosis cases or with underweight were not accepted for insurance on their lives. Nevertheless companies observed many deaths causes by this disease. Medical directors and actuaries studied these cases in detail (dates and numbers), even of the deceased. The resulting statistics formed the premium calculation basis for persons with an increased risk. Comparative studies allowed acceptance for more people. Within the last decades when sulfonamides, antibiotics and insulin were discovered and produced the mortality ratio decreased. Nowadays, even persons who suffered from tuberculosis do not present an increased risk anymore. The life expectancy has doubled during the last century. This is why degenerative diseases increased, especially the coronary heart diseases. While thirty years ago the mortality ratio stood at about 500%, improved medical and surgical therapy made prognosis easier and when risk factors can be eliminated the mortality ratio tends to be less than 200%. Since insulin is available, patients with type I-diabetes do not die anymore in coma, the remaining risk is the sclerosis of the vessels. Diabetes with adults increases with overweight, high blood pressure and hyperlipemia. The mortality ratio depends on these risk factors. Morbus Crohn, first described in 1932, seems to increase. Life insurance needs more long-term statistical data. For only some years we are confronted with the immunodeficiency "Aids".(ABSTRACT TRUNCATED AT 250 WORDS)
In the Netherlands, people with familial hypercholesterolaemia (FH) have been actively screened since 1994 by means of DNA analysis. Recently, the Stichting Opsporing Erfelijke Hypercholesterolemie (Foundation for the Detection of Familial Hypercholesterolaemia) initiated a large scale-screening programme aimed at finding all 40,000 people. The Dutch ministry of Health, Welfare and Sport is providing the financial support. Genetic screening has social implications and raises questions on insurability. The Dutch Medical Examination Act prohibits insurers from posing questions about untreatable, serious inheritable conditions for insured sums under a certain value: for life-insurance policies < [symbol: see text] 150,000 and for disability-cover policies < [symbol: see text] 30,000 in the 1st year and < [symbol: see text] 20,000 in the 2nd year and following years. The Health Council of the Netherlands has defined FH as a serious disease, but one which responds well to treatment. Therefore insurers can request information for the purpose of an accurate risk classification. Insurance contracts can be accepted at normal rates if the target value of LDL-cholesterol < 4 mmol/l and additional risk factors such as smoking and an abnormal BMI are absent; the risk is determined by the phenotype and clinical factors and not by the genotype.
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