Medical Acceptance

Background

Why Medical Acceptance?

When 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 term life insurance , an estimate is made of the risk that the customer will die 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, this comes at a price. In order to determine the amount of the premium, the insurer must make an assessment of the risk. In the event of an increased risk, he may decide to calculate a premium surcharge, adjust the conditions or not offer insurance.

Both consumers and insurers have freedom of contract. Consumers are not required to purchase term 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 risk assessment

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 the 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 adviser. This uses information in the health declaration, which is a list of questions that the insured fills out when applying for the insurance. If necessary, this will be supplemented with information from treating physicians or from medical examinations. Based on this information, the medical adviser gives advice to the insurer. The medical adviser must always substantiate an acceptance recommendation.

Promoting the assessment of risks and insurability

The Association is committed in various ways to promoting the assessment of health risks in a professional manner and on the basis of verifiable and up-to-date information:

• Clean slate scheme for ex-cancer.

  As of 1 January 2021, there is a scheme for ex-cancer patients who want to take out term life insurance or funeral insurance. In a number of cases, when applying for such insurance, they no longer have to report that they have had cancer. More about this scheme can be found here.

• Health declaration. Since 2017, insurers have been able to use a new model Health Declaration. The Association has developed this in consultation with patient organisations and the Royal Dutch Society for the Promotion of Medicine (KNMG). The modernised statement provides more clarity on what a consumer should and should not fill in. In 2021, the model Health Declaration was adapted to the clean slate scheme for ex-cancer patients who want to take out term life insurance or funeral insurance.
  
  
• New prediction model for breast cancer. In consultation with the Dutch Federation of Cancer Patient Organisations, life insurers have asked the Netherlands Comprehensive Cancer Centre 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.

Are you a (former) cancer patient? Read more about the new options for insuring as of 2021 and about medical acceptance for term life insurance.

• Guideline for acceptance of people with mental illness. The Association finances research by the Dutch Association of Medical Advisors Insurance (GAV) into a guideline for accepting people with a mental illness.

Broad 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 options for self-employed entrepreneurs. For self-employed persons who are unable to 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 of starting as an entrepreneur. Entrepreneurs who come from paid employment can also apply to the UWV for voluntary insurance, but they must apply for it within thirteen weeks.
  
  
• The Hope. Life insurers can offer risks that they cannot or do not want to accept themselves with reinsurer De Hoop. As a result, people with a higher risk of premature death can often still take out term life insurance.
  
  
• HIV. Twenty years ago, it was impossible for people living with HIV to get life insurance. But the treatments for this have now improved considerably. That is why Dutch life insurers – as almost the only ones in the world – have agreed that they consider HIV to be a chronic condition that can simply be insured.

Hereditary predisposition

There are many misunderstandings about insurance and hereditary disorders. Some people who have a hereditary disease in the family postpone genetic testing or preventive treatments. They are afraid that they will have to report this to the insurer and then not be able to take out insurance.

Is this fear justified? In other words: can the medical adviser 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 necessary. Above the question limit, you may also be asked questions about the risk of a serious, untreatable hereditary disease of yourself or your family or about the results of previously performed genetic testing (a chromosomal or DNA test). If it is known that you have a hereditary predisposition to a disease, you must report it, even if you do not (yet) have this disease.

Below the question limit

If it concerns an amount below the question limit, the medical adviser may not ask about a hereditary predisposition. However, if a doctor has seen during a genetic test that you have a hereditary predisposition and you already have complaints or symptoms, you must report this. If it is known that you have a hereditary predisposition to a disease, but you do not (yet) have this disease, you do not have to tell us. 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.

Learn more about heredity.