Insurers base the premium and conditions of a life or disability insurance on, among other things, the health profile of the insured. In the event of an increased risk, the insurer can calculate a premium surcharge, adjust the conditions or decide not to offer insurance. The Association considers it important that the assessment of risks is based on good, up-to-date information and that as many people as possible have access to appropriate insurance.
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Why medical acceptance?
If someone applies for disability insurance, the insurer wants to know how big the risk is that the customer will become and remain incapacitated for work. With a term life insurance policy, an estimate is made of the risk that the customer dies prematurely. This risk assessment is based on the (health) risk profile of the customer. Based on this risk assessment, the insurer assesses the application. This process is called medical acceptance.
Medical acceptance is necessary because the insurer takes over a risk from the customer: if the customer becomes incapacitated for work or dies, the insurer pays out an amount. Of course, there is a price tag attached to this. In order to determine the amount of the premium, the insurer must make an estimate of the risk. In the event of an increased risk, he may decide to calculate a premium surcharge, to adjust the conditions or not to offer insurance.
Both consumers and insurers have freedom of contract. Consumers are not obliged to take out life or disability insurance. This means that insurers must be able to decide for themselves to whom they offer insurance and under what conditions. How an insurer shapes medical acceptance is its own responsibility.
Expert assessment of risks
It is important that the assessment of risks is done in an expert and objective manner. Insurers must comply with legislation and codes of conduct, such as the Medical Examinations Act (WMK), the Insurance Inspections Protocol and the Equal Treatment on grounds of Disability or Chronic Illness Act (Wgbh/cz). For example, the assessment of the health situation is always done by or under the responsibility of a medical advisor. This uses information in the health declaration, a list of questions that the insured fills in when he applies for the insurance. If necessary, this is supplemented with information from treating doctors or from medical research. Based on this information, the medical advisor gives advice to the insurer. The medical advisor must always substantiate an acceptance advice.
Promotion of risk assessment and insurability
The Association is committed in various ways to promote the assessment of health risks in a professional manner and on the basis of verifiable and up-to-date information:
- New health declaration. Since 1 January 2017, insurers can use a renewed model Health Declaration. The Association has developed this in consultation with patient organisations and the Koninklijke Nederlandsche Maatschappij ter bevordering der Geneeskunst (KNMG). The modernised declaration provides more clarity about what a consumer should and should not fill in.
- New prediction model for breast cancer. In consultation with the Dutch Federation of Cancer Patients organisations, life insurers have asked the Integral Cancer Centre of the Netherlands to develop a new prediction model for breast cancer. This allows them to estimate the risk of death of someone who has ever had breast cancer. This model was launched in 2018. (Ex-)cancer patient? Read more about medical acceptance in term life insurance (site in Dutch)
- Guideline for accepting people with mental illness. The Association finances research by the Dutch Association of Medical Advisers insurance (GAV) into a guideline for accepting people with a mental illness.
Wide accessibility
Insurers believe that as many people as possible should be able to take out appropriate insurance. That is why they have taken the following initiatives:
- Safety net opportunities for self-employed entrepreneurs. For self-employed people who cannot take out a normal AOV for medical reasons, there is the private safety net insurance. The conditions and premium are the same with all insurers. Self-employed persons must apply for this insurance within fifteen months after the start as an entrepreneur. Entrepreneurs who come from paid employment can also go to the UWV for voluntary insurance, but they must apply for it within thirteen weeks.
De Hoop. Life insurers can offer risks that they cannot or do not want to accept themselves at reinsurer De Hoop. As a result, people with a higher risk of premature death can often still take out life insurance. - HIV. Twenty years ago, it was impossible for people with HIV to take out life insurance. But the treatments for this have now been greatly improved. That is why Dutch life insurers – as virtually the only ones in the world – have agreed that they consider HIV as a chronic condition that can simply be insured.
Hereditary predisposition
There are many misunderstandings about insurance and hereditary disorders. Some people in whom a hereditary disease runs in the family postpone a genetic examination or preventive treatments. They are afraid that they have to report this to the insurer and then cannot take out insurance.
Is this fear justified? In other words: can the medical advisor ask about a hereditary predisposition to a certain disease or condition? That depends on the amount for which you want to take out insurance.
Above the question limit
If you take out insurance above the question limit, a medical examination may be required. Above the question limit, you may also receive questions about the chance of a serious, untreatable hereditary disease of yourself or your family or about the results of previously performed genetic research (a chromosomal or DNA test). If it is known that you have a hereditary predisposition to a disease, you must report this, even if you do not (yet) have this disease.
Below the question limit
If it concerns an amount below the question limit, the medical advisor may not ask about a hereditary predisposition. However, if a doctor has seen during a heredity test that you have a hereditary predisposition and you already have complaints or symptoms, you must report this. If it is known that you do have a hereditary predisposition to a disease, but if you do not (yet) have this disease, you do not have to tell. Have you undergone surgery or other preventive treatment as a precaution but no signs or symptoms of this disease? Then you do not have to report this operation or treatment.
Health declaration
Anyone who wants to take out life insurance or disability insurance usually has to fill in a health declaration. This contains a series of questions about health. After the statement has been completed, a medical advisor assesses the health situation. This results in advice to the insurer as to whether it can accept the participant and, if so, under what conditions. This page contains all the information about how that process works exactly.
