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Women’s Health and Disability Insurance

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By Stephanie Pearson, MD, FACOG, A 2022 Platinum WCI Medical School Scholarship Sponsor

There have been several recent posts covering varying aspects of disability insurance. As many White Coat Investor followers know, women pay more for disability insurance than men; however, the reasoning behind this truth is not as sexist as it initially appears. The cost differential is based on carrier data and claims histories (proprietary information) that show that, across all fields, women leave the workforce more often than men due to injury and/or illness. Women get a little break on the life insurance side, as men tend to die younger and more often by suicide, making coverage for men more pricey.



As an OBGYN-turned-insurance-broker following a career-changing injury, I will be focusing on women’s health issues as they pertain to medical underwriting and securing quality disability insurance coverage. As you can expect, it is impossible to cover every medical situation in this piece, so I’ve done my best to focus on some of the most common health issues that come up in daily conversations.

When I started in this industry, learning how the carriers viewed many women’s health issues was both eye-opening and a bit disturbing. Often, I would get told that insurance medicine is not the same as community medicine. I now find myself repeating that phrase on a regular basis. The carriers are looking for pre-existing diagnoses that will allow them to exclude, or not cover, a part of your body or disease process. You want your broker/agent to be familiar with the topics, to help manage realistic expectations about potential outcomes, to advocate for you, and to make recommendations appropriately.

Breasts

Fibrocystic Disease/Benign Cysts/Fibroadenomas

Many women are diagnosed in early adulthood with one or more of the above findings. Many of the carriers will exclude future breast complications based on this history alone. If the cysts or fibroadenomas are limited to one side, only that side should be excluded—not both breasts. If the mass has been removed and you have had no residual issues, you may be able to get the coverage back on your policy. Ultimately, it will depend on your medical records—how and when were you diagnosed, what were your symptoms, and how were you treated.

Abnormal Mammograms

If you have started obtaining mammograms, the carriers will want to know that you are following guidelines appropriately; I know, there are differences in opinion among different associations. If you are due for testing but have not done so yet, the insurance carrier may put a health hold on your application until they get the results. If you have a result other than BIRADS 1, most of the carriers will exclude your breasts and add a reconsideration to the policy. This reconsideration and removal of the exclusion typically mandate that you have two negative mammograms. A BIRADS 3 or 4 typically results in a declination of coverage until you have had at least one BIRADS 2 or better.

Strong Family History of Cancer or Positive Genetic Screening

If you are undergoing increased surveillance with mammograms and MRIs, expect an exclusion on your breasts. If your genetic screening is negative but you are undergoing increased surveillance, some carriers will make their decision based on the extent of the family history—how many affected members and at what ages. Additionally, depending on the history and genetic markers, your ovaries may also be excluded. Please get your coverage in place before it is documented in your records to undergo testing.

Breast Cancer

Breast cancer and how it affects potential coverage is based on many factors: age of onset, type of cancer, staging, treatments, and timing since the last treatments. Depending on these factors, you may be unable to secure traditional coverage for some time, there may be an exclusion on your breasts, there may be a limitation placed on the benefit period of your policy (the length of time a carrier pays you for any disability), and there may be an increase in the cost. You want to have all of this information ready when you speak to a potential broker/agent.

Uterus



Fibroids

The carriers will be looking at your medical records for how the fibroids were diagnosed, the severity of symptoms, and medical and/or surgical treatments to base their decisions. If the fibroids were found incidentally on exam or your symptoms are mild to moderate, you may not experience an exclusion. Severe symptoms will most likely lead to an exclusion for fibroids or your whole uterus. If you have had surgery and are back to work full-time with no residual issues, you should not have an exclusion. If you are planning surgery at the time of applying, most carriers will want to wait to make you an offer until after the procedure. If there are any medical records tying fibroids to the inability to get pregnant or stay pregnant, there may be exclusions for infertility and pregnancy.

Abnormal Bleeding/Clotting Histories

Again, the carriers will be looking at medical records for the cause, severity, and treatments to make their decisions. Just a few years ago, women diagnosed with any of the coagulopathies (Factor V Leiden, protein S/C deficiency, etc.) would automatically result in adverse medical underwriting—exclusions, limited benefit periods, and/or other limitations. After numerous discussions with underwriters at various carriers, many of them will now take a closer look at individual histories. Have you had an event (PE or DVT) or not? How long ago was the event? Are there any residual complications or current treatments?

Offers range from no exclusions, exclusions for thromboembolic events, limited benefit periods, increased cost, or declinations. It is important that your broker/agent is aware of these factors. If you were anemic, how low was your hemoglobin? Has a cause been identified? What treatments were utilized? How long have your labs been normalized? Depending on the above, there may be an exclusion for bleeding, an increase in cost, or a declination.

Fallopian Tubes

Ectopic Pregnancy

While ectopic pregnancies can occur anywhere, the most common occurrence is in the fallopian tubes. Coverage and potential exclusions will be dependent on how many ectopics have been experienced, how long ago, medical vs. surgical treatment, and any need for infertility treatments. Most often, an ectopic pregnancy will result in an exclusion for future pregnancies. If an infertility workup has started or you are undergoing Assisted Reproductive Technology (ART), there will be an exclusion on infertility treatments and pregnancy.

Ovaries

Benign Cysts

Benign ovarian cysts include but are not limited to ovulatory, pregnancy-related, hormone-related, infectious, and benign neoplasms. Underwriting will depend, again, on presentation, diagnoses, the severity of symptoms, medical vs. surgical treatment, and timing of the application process. Exclusions can be unilateral or bilateral. Depending on the cause, an option for reconsideration of the exclusion may be placed on the policy. Occasionally, if enough time has passed, you may not experience an exclusion.

Polycystic Ovarian Syndrome (PCOS)

There is still no universally agreed-upon definition for PCOS, making it a problematic diagnosis for underwriters. It is often diagnosed in adolescence due to irregular menstruation or later as part of an infertility workup. Many adolescents are placed on hormonal contraceptives and don’t think twice about the diagnosis until they are ready to conceive. Because it is known that women with PCOS carry a two- to five-fold increased risk of developing Type 2 diabetes, many carriers may request a HgA1c as part of your underwriting. At this point in the article, it should not come as a surprise that decisions will ultimately be based on your medical records. There may be no exclusion, an exclusion on your ovaries, or an exclusion for infertility and pregnancy.


disability insurance women

Egg Preservation

As women have been delaying childbearing for education and training, there has been an increase in proactive egg preservation. Historically, this act resulted in an exclusion for infertility and pregnancy. Recently, there has been some movement in changing the underwriting to only state an exclusion for infertility treatments. Some women go on to spontaneously conceive and not use their frozen eggs, and they deserve to have those pregnancies covered.

Cervix

Abnormal Pap Smears

Most carriers want two negative Pap smears before they will reconsider a cervical exclusion placed on a policy. Some carriers will exclude both the cervix and the uterus for an abnormal result. If a follow-up study or procedure has been recommended and not performed yet, the carriers will delay an offer until they have results. If you have had treatment with normal follow-up prior to applying, it is usually a non-issue.

Pregnancy

I have often been overheard saying that all women need to obtain disability (and life) insurance before the first time they try to get pregnant. If I could shout it from the rooftops, I would! Most women spend their whole lives trying not to get pregnant, and when they want to be pregnant, they wish they were pregnant yesterday.

Missed Abortions

Unfortunately, if you have suffered a miscarriage in the 12 months preceding your application, you will most likely have a pregnancy exclusion on your policy. It may state, “to be reconsidered at the one-year anniversary of the policy.” I hate telling a woman that if she wants her next pregnancy covered, she has to wait a year. If you have suffered several miscarriages, the exclusion may be permanent.



Currently Pregnant

If you are currently pregnant during the underwriting process, the carriers view that as a pre-existing disorder, and they will place an exclusion for pregnancy on your policy. If you have a happy, healthy, uncomplicated pregnancy, delivery, and postpartum course, you should be able to get the exclusion reconsidered and have future pregnancies covered. If you underwent any infertility workup or utilized any ART to get pregnant, there will be an exclusion for infertility and future pregnancy.

Recently, I argued about spontaneous pregnancy following ART, and now there's a carrier willing to only exclude infertility treatments. I hope that other carriers follow suit.

Gestational Diabetes (GDM)

GDM is one of the most common complications of pregnancy. Women with GDM are at increased risk of developing other pregnancy complications, such as pre-eclampsia and the need for cesarean section. GDM sufferers are also at increased risk of developing Type 2 diabetes later in life. Because of those and other reasons, most carriers will not cover future pregnancies once you have had gestational diabetes. Also, suppose your blood glucose levels remain elevated three months postpartum before applying for coverage. In that case, most carriers will treat you like a person with Type 2 diabetes and place other limitations on your policy.

Gestational Hypertension/Preeclampsia/Eclampsia

Any decision will depend on your medical records, the severity of your symptoms, and your treatments. If you had mildly elevated blood pressure requiring no medication or early delivery, it should be a non-issue. Anything more serious will typically result in a pregnancy exclusion that may or may not be permanent.

Cesarean Sections

When I started in this industry, all of the carriers viewed C-sections as an abnormal outcome of pregnancy and put an exclusion on future pregnancies. I was appalled. This felt extra personal; I myself had breech pregnancies. Having a cesarean section was standard of care, not an abnormal outcome. I started reaching out to the carriers with ACOG bulletins and other literature.

Remember when I said that community medicine and insurance medicine are not the same? Many hospitals will not allow (except in emergencies) vaginal breech deliveries or multiple birth vaginal deliveries. The insurance companies said that their decisions were based on claims data. I continued to defend the standard of care position, and I am happy to report that most of the carriers will now look at why someone has had a C-section and may word the exclusion as “complications of future cesarean sections” and not the entire pregnancy.



Conclusion

As you can see, there are many potential pitfalls relating to women’s health and the ability to obtain strong disability coverage. I cannot stress enough how important it is that your broker/agent is aware of these and other medical issues and how the individual carriers differ in their approaches to coverage. Who you speak with matters, and you ideally want someone who is armed with the knowledge to advocate for you.

I also cannot emphasize enough the importance of getting coverage before trying to conceive. With all of the varying complications pregnancy can bring, you want to ensure that if an exclusion is placed on your policy, your broker/agent advocates to get the exclusion reconsidered or removed appropriately.

The world of disability insurance is oftentimes confusing, but it doesn’t have to be so long as you’re prepared with the education necessary to make empowered decisions regarding coverage. I hope this article helps in that regard.

[Editor's Note: Many thanks to Dr. Stephanie Pearson of Pearson Ravitz, one of our Platinum Level (contributing $8,000+) Sponsors, and her long-time relationship with WCI in helping physicians find the proper coverage that they and their families deserve. Stephanie is a long-time advertiser and is on our list of Recommended Insurance Agents, and PearsonRavitz’s mission is to educate and empower physicians and other healthcare professionals to make informed decisions regarding disability and life insurance coverage. This is the fifth of our five scholarship-sponsored posts for 2022. Thank you for supporting those who support this site and especially the scholarship. All proceeds go to the scholarship winners.]

The post Women’s Health and Disability Insurance appeared first on The White Coat Investor - Investing & Personal Finance for Doctors.

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By: Josh Katzowitz
Title: Women’s Health and Disability Insurance
Sourced From: www.whitecoatinvestor.com/womens-health-and-disability-insurance/
Published Date: Fri, 14 Oct 2022 06:30:49 +0000

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