Brca2 Gene: Life Insurance Impact And Implications

The Genetic Information Nondiscrimination Act (GINA) was passed in 2008 to prevent health insurance companies from denying coverage or charging different rates based on gene mutations. However, GINA does not apply to life insurance companies, which can use genetic testing results to impact applicants' rates or deny them coverage altogether. This is because life insurance revolves around planning for death, and insurance companies will not cover high-risk applicants without creating a buffer for themselves. However, insurance providers are not allowed to penalise applications for Life Insurance, Critical Illness Cover, or Income Protection if the applicant has a mutation in the BRCA1/BRCA2 genes but no personal history of cancer. This is because having the gene does not mean the applicant will definitely develop cancer.

Life insurance companies can use BRCA2 gene mutation results to a customer's disadvantage

The BRCA gene mutation is associated with an increased risk of breast and ovarian cancer. As a result, individuals with this mutation may face higher life insurance rates or even be denied coverage due to the potential future costs of treating these cancers. This is despite the fact that not everyone with the BRCA gene mutation will develop cancer, and being aware of the mutation means that applicants can take the necessary precautionary measures to decrease their risk.

The use of genetic testing results in life insurance underwriting has sparked ethical concerns and debates about social fairness. Some argue that life insurance companies should not be allowed to access and use genetic test results, as this may deter people from undergoing genetic testing and taking advantage of early medical intervention. Additionally, genetic test results may not significantly impact a person's risk classification, as non-genetic information such as age, current health status, and family history are already considered in the underwriting process.

In some countries, such as Canada and the UK, there are voluntary agreements or laws in place that restrict life insurers from using genetic test results. However, in the United States, there is currently no legislation prohibiting life insurers from accessing and using genetic test results to make coverage and pricing decisions. As a result, individuals considering genetic testing may want to secure life insurance beforehand to avoid potential negative consequences.

BRCA2 gene mutation results can be used to deny life insurance coverage

While the Genetic Information Nondiscrimination Act (GINA) passed in 2008 prohibits health insurers from denying coverage based on gene mutations, it does not apply to life insurance, disability insurance, or long-term care insurance. This means that life insurance companies can use the results of genetic testing to impact applicants' rates or even flat-out deny them coverage. This is because life insurance companies are still businesses, and protecting their customers is not free. They do not hand out free money and they do not assume high levels of risk without creating a buffer for themselves.

In the case of BRCA2 gene mutations, which are associated with a heightened risk of breast and ovarian cancer, life insurance companies may choose to deny coverage altogether. This is because, despite an individual taking the necessary precautionary measures such as MRIs, mammograms, or mastectomies to decrease their risk, the presence of a risk-conferring allele still indicates a high lifetime risk of cancer. For example, a woman with a BRCA2 mutation and no affected first-degree relative still has a 63.1% lifetime risk of breast cancer.

However, it is important to note that not all life insurance companies will deny coverage based on BRCA2 gene mutations. Some companies may choose to provide coverage at higher rates to account for the increased risk, while others may not consider genetic testing results at all when determining eligibility and rates. Additionally, in some countries like Canada, life insurance companies are prohibited from using genetic test results when applying for new coverage worth a certain amount.

The use of genetic testing results in life insurance underwriting is a highly controversial topic, with some arguing that it should be prohibited to encourage individuals to undergo genetic testing without fear of economic consequences. Others argue that life insurance companies should be able to access this information to accurately assess and underwrite genetic risks. Ultimately, the decision to use or deny coverage based on BRCA2 gene mutation results is currently left to the discretion of individual life insurance companies and varies depending on location and company policies.

Life insurance companies are not allowed to penalise applications if the customer has a BRCA2 gene mutation

It is important to note that laws and regulations surrounding the use of genetic testing results in life insurance underwriting vary across different countries and regions. In the United States, the Genetic Information Nondiscrimination Act (GINA) was passed in 2008. GINA prohibits health insurers from denying coverage or charging different rates based on gene mutations. However, it is important to highlight that GINA does not apply to life insurance, disability insurance, or long-term care insurance. This means that life insurance companies in the US can use genetic testing results when determining rates and approvals for their policies.

Despite this legal framework, there are strong arguments and ongoing debates about why life insurance companies should not be allowed to penalise applications if the customer has a BRCA2 gene mutation. Here are four key reasons:

• Promoting Early Medical Intervention: If life insurance companies refrained from using genetic test results or were legally prohibited from accessing them, individuals with a BRCA2 gene mutation would be more inclined to undergo genetic testing. This increased testing would lead to early medical intervention, potentially improving health and increasing life expectancy.
• Inadequate Predictive Value of Genetic Testing: The presence of a BRCA2 gene mutation does not automatically mean that an individual will develop cancer. The mere presence of this mutation does not warrant denying life insurance coverage. Additionally, genetic test results are less valuable in calculating mortality risk than often assumed. Traditional health information, such as age, current health status, occupation, behavioural risk factors, and family health history, are more significant in assessing risk.
• Actuarial Fairness vs. Moral Fairness: Actuarial fairness focuses on ensuring that insurance practices reflect accurate determinations of risk. While this is important, it is not sufficient to ensure moral fairness. Moral fairness considers the broader societal impact of insurance policies, such as promoting justice, beneficence, autonomy, and population health. By discouraging voluntary genetic testing, life insurance companies may hinder early detection and proactive management of health conditions.
• Saving Lives: Removing the disincentive for at-risk individuals to undergo genetic testing can save lives. Many individuals are reluctant to undergo genetic testing due to the potential economic consequences, such as higher life insurance rates or denial of coverage. By eliminating the use of genetic test results in life insurance underwriting, individuals will be more likely to get tested, leading to early detection, improved treatment options, and potentially longer lifespans.

In summary, while US life insurance companies are currently permitted to consider genetic testing results when assessing applications, there are compelling ethical, social, and medical reasons why this practice should be re-evaluated. Restricting the use of genetic information in life insurance underwriting could encourage more people to undergo testing, leading to better health outcomes and potentially saving lives.

The Genetic Information Nondiscrimination Act does not apply to life insurance

The Genetic Information Nondiscrimination Act (GINA) was passed in 2008 after advocacy groups fought for it for over a decade. GINA prohibits health insurance companies and employers from discriminating based on genetic information. The Affordable Care Act explicitly protects against discrimination of pre-existing conditions, including those found as a result of genetic testing. However, GINA does not apply to insurance products outside of health insurance, such as life insurance, long-term care insurance, and disability insurance. This means that life insurance companies can use the results of genetic testing to impact applicants' rates or even deny coverage. This creates a Catch-22 situation, where individuals who undergo genetic testing to proactively manage their health may find themselves unable to secure life insurance to protect their families.

The exclusion of life insurance from GINA has significant implications. With the increasing availability and affordability of genetic testing, more individuals are likely to have knowledge of their genetic data. However, life insurance companies must also consider genomic health risks in their calculations to remain profitable. This tension between an individual's right not to be penalised for their genetic makeup and insurance companies' need to manage risk and profitability is challenging to resolve. While some states have passed laws prohibiting genetic discrimination in life insurance, there is a lack of clarity and consistency across the country.

One possible step towards resolving this issue is to strive for information equity and transparency. Insurance companies have access to all patient health information, while consumers do not have equivalent access to insurance actuarial tables and algorithms. Achieving greater transparency and providing consumers with access to this information could help level the playing field. Additionally, as precision medicine and direct-to-consumer genetic testing advance, there may be a growing case for regarding the insurance industry as having a role in public health, with ethical and policy implications to be addressed.

A personal or family history of cancer could affect life insurance rates and eligibility

A personal or family history of cancer can impact your life insurance rates and eligibility. While it is not illegal for life insurance companies to request and use your genetic testing results when determining your rates and eligibility, it is important to note that this practice is not standard across all insurance companies. Some companies may only consider your parents' health history, while others may be more lenient with a history of cancer.

If you have a personal history of cancer, it is unlikely that you will be approved for a traditional life insurance policy. However, you may be eligible for alternative options such as simplified or guaranteed issue life insurance, which do not require medical exams but come with higher premiums and a lower death benefit. If you are in remission, you may be able to switch to a traditional policy after a few years. The length of the waiting period depends on the insurance company and the type of cancer, with some companies requiring up to 10 years of remission.

If you have a family history of cancer, it is likely that the insurance company will increase your premiums due to the increased risk of you developing cancer in the future. The number of affected family members and their age at diagnosis will also be taken into consideration. For example, having a sister diagnosed with breast cancer at 40 is seen as a higher risk than having a mother diagnosed at 80. Additionally, if the affected family member was diagnosed late in life (after 60 or 65), most insurance companies will disregard this information and it will not impact your premiums.

It is important to be honest when applying for life insurance and disclose any relevant medical history, as providing false information may result in your application being denied or your policy being cancelled. However, if you have undergone genetic testing, you are not required to disclose this information to the insurance company unless you have symptoms or a family history of cancer.

Frequently asked questions