Genetics and Insurance

Index• Introduction• Body– Concerns on Genetics and Insurance– Genetic Testing– Underwriting– Actions by UK Bodies – Genetic Testing and Insurance in Other Countries

• Summary

Introduction• Genetic information enable prediction an individual

risk to genetic disorders.• The use of genetic information has generated

numerous debates and concerns. – Psychological Impact – Potential discrimination in access to insurance and

long term care

Concerns on Genetic and Insurance

What kind of discrimination?• A slight change in allules/DNA sequencing => higher

risk => higher premium/reject application

So, there need to be an equilibrium between client and insurer bearing the risk.

SHOULD Insurers be allowed to ask for genetic information?

Family history of inherited disease No family history of inherited disease All0%

10%

20%

30%

40%

50%

60%

Yes No

Don't Know

Source: Swiss Re

CAN insurers ask applicants to take genetic test?• NO!• This is set by the Code of Practice on Genetic Testing

by the Association of British Insurers (ABI)

Genetic Testing

Two Types of Genetic Test

Predictive Genetic Test

• You show no signs of symptoms

• A predictive genetic test predicts your future risk of developing the condition

Diagnostic Genetic Test

• You show signs of genetic condition

• A diagnostic genetic test confirms or rules out whether you have the condition

Cheapest Test Method• Swap Test– Biochemical analysis– Direct analysis

Underwriting

Genetic Testing and Implication for Insurance

• Genetic testing as part of underwriting• Family medical history is also used in underwriting => increase premium depending on

oNumber of affected family memberso Severity

What Information to disclose for family medical history?• Current and previous illness amongst family

members• Genetic conditions run in the family• Death due to genetic condition

Who counts as ‘family’?• Immediate family members• Complete family medical history include;

grandparents, aunt and uncles, cousin.

What is allowed/not allowed to ask?

What Insurance company ARE allowed to ask…

• If a genetic condition runs in your family

• Your family medical history

What insurance company are NOT allowed to ask…

• Your predictive genetic test results*

• Family members’ predictive genetic test result

*Unless you are seeking to obtain life insurance cover of more than £500,000 and have taken the predictive genetic test.

When should applicants disclose genetic test results?

Test Predictive genetic test Diagnostic genetic testLife insurance of less than £500,000

Life insurance of more than £500,000

Life insurance of more than £500,000 for Huntington’s disease

Critical illness insurance

Income protection insurance

What is Huntington’s disease?

• The disease damage brain nerve cell causing deterioration and gradual loss of function.

Why only Huntington’s disease need to show predictive genetic test?

• In October 2000, Genetics and Insurance Committee (GAIC) approved it.

• Disease under consideration:– Early onset Alzheimer disease associated with mutation in the amyloid precursor protein and the presenilin 1 gene.

– Hereditary breast and ovarian cancer associated with the BRCA 1 and the BRCA2 genes.

What about in LTC and CI?

Use of genetics are allowed for:• Hereditary Breast Cancer• Hereditary Ovarian Cancer

Actions from UK Bodies

Actions from UK Bodies1995

Dec 1996

Dec 1997

Nov 1998

• House of Commons Science and Technology Select Committee ensure commercial interests do not conflict with medical interests

• Set up Human Genetics Advisory Commission (HGAC)

• Set up Code of Practice on Genetic Testing

• Set up UK Forum for Genetics and Insurance (UKFGI)

Actions from UK BodiesApril 1999

Dec 2000

Oct 2001

• Set up Genetics and Insurance Committee (GAIC)

• Storage, protection, and use of genetic information

• Set up Concordat and Moratorium

Concordat and Moratorium

Concordat

Preserve the principle that unless otherwise agreed, insurance companies should have access to all relevant information to enable them to price risk fairly in the interest of all their customers.

Moratorium

Allows patients who have taken a predictive genetic test to obtain significant levels of insurance cover without disclosing the results of the predictive genetic test. This is the exception of the predictive genetic test for Huntington’s disease for life insurance over £500,000.

Genetic Testing and Insurance in Other Countries

Countries where Use of Genetic Information for Businesses is NOT Allowed

• Austria• Belgium• Denmark • France• Norway• Netherlands

Countries that Issued Moratoria on Use of Genetic Information

• Finland• Germany• Sweden• Switzerland

Summary• The use of genetic information in the insurance

industry is still debatable. • A good law/guidance and data storage is important.• The law on usage of genetic information is set up by

GAIC and insurers are not allowed to make their own decision.

My experience• Name of mutated gene: TAS2R38, ‘brussels

sprouts’ gene• Defect: Cannot taste PTC

(phenylthiocarbamide)• Asked to declare in insurance application form

Q & A