The word “hepatitis” is a general term referring to inflammation of the liver. Toxins, certain drugs, some diseases, heavy alcohol use, and bacterial and viral infections can all cause hepatitis. There are three different types: Hepatitis A, Hepatitis B, and Hepatitis C. Each of the three diseases can have similar symptoms which include: loss of appetite, nausea, fatigue, fever, vague abdominal discomfort, jaundice (yellowing of the skin), muscle aches, and dark urine. Although each can cause similar symptoms, they have different modes of transmission and affect the liver differently. They are not underwritten the same either.
What is Hepatitis A?
Hepatitis A is a disease of the liver caused by the Hepatitis A virus that is usually spread by eating or drinking food or water contaminated with infected feces. The disease is highly contagious and outbreaks have been known to occur, particularly in restaurants and day care centers. While children often do not have symptoms when infected, they are still able to infect others.
Most cases of hepatitis A are self-limited and resolve spontaneously. Hepatitis A does not progress to chronic liver disease. After a single infection, a person is immune for the rest of his or her life. When underwriting an applicant with a history of being diagnosed with hepatitis A, as long as the condition is completely resolved, applicant will be non-rated (in other words, the underwriters don’t care about the fact that the applicant once had hepatitis A.)
What is Hepatitis B?
Hepatitis B is a liver infection caused by the Hepatitis B virus (HBV). According to the CDC, hepatitis B is transmitted when blood, semen, or another body fluid from a person infected with the hepatitis B virus enters the body of someone who is not infected. This can happen through:
- Sex with an infected partner
- Injection drug use that involves sharing needles, syringes, or drug-preparation equipment
- Birth to an infected mother
- Contact with blood or open sores of an infected person
- Needle sticks or sharp instrument exposures
- Sharing items such as razors or toothbrushes with an infected person
Hepatitis B virus is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, hand holding, coughing, or sneezing.
Hepatitis B can cause both acute (short duration) and chronic (long-term) infections. It’s a common condition with more than half of the world population chronically infected. In the United States, however, only 2 percent have chronic infection. The incidence of new infections is decreasing mainly due to widespread administration of the long-lasting vaccine that has been available since the early 1980s.
The risk for chronic infection varies according to the age at infection and is greatest among young children. Approximately 90 percent of infants and 25-50 percent of children aged 1-5 years will remain chronically infected with HBV. By contrast, approximately 95 percent of adults recover completely from HBV infection and do not become chronically infected.
Infection persisting more than six months is chronic hepatitis. Persons with chronic hepatitis B may develop cirrhosis (end stage liver disease) after 25 years of infection and liver cancer after 30 years of infection. Approximately 25 percent of those who become chronically infected during childhood and 15 percent of those who become chronically infected after childhood die prematurely from cirrhosis or liver cancer, and the majority remain asymptomatic until onset of cirrhosis or end-stage liver disease. In the U.S., chronic HBV infection results in an estimated 1,800 deaths per year.
The routine medical exam required for most life insurance policies includes blood and liver tests. If these results show elevated transaminases, the underwriters are going to do a little more digging into the applicant’s medical history since these elevated levels are often the first laboratory sign of hepatitis B infection.
Applicants with a history of hepatitis B, if completely resolved and no evidence of being a chronic carrier of hepatitis B, will be non-rated. If the hepatitis B surface antigen remains positive but all liver enzymes are normal, the applicant could be approved, but likely table rated. Cases of cirrhosis or chronic hepatitis B will usually be declined for individual life insurance coverage.
What is Hepatitis C?
Hepatitis C is inflammation of the liver due to the Hepatitis C virus (HCV). It is contracted through exposure to infected blood. This can happen through:
- Injection drug use (currently the most common means of HCV transmission in the United States)
- Receiving of donated blood, blood products, and organs (once a common means of transmission but now rare in the U.S. since blood screening became available in 1992)
- Needlestick injuries in health care settings
- Birth to an HCV-infected mother
Hepatitis C is a common infection with up to 6 percent of the United States population affected. Up to 15 percent of those infected have spontaneous recovery, and have no virus in their blood. The remaining 85 percent have chronic hepatitis C. Acute hepatitis C often does not cause symptoms and chronic hepatitis C may also be asymptomatic.
Decades usually elapse between the acquisition of hepatitis C infection and the diagnosis of advanced liver disease. Inflammation of the liver can lead to fibrosis, and fibrosis can progress to cirrhosis (scarring of the liver). Although it is difficult to predict which people with hepatitis C will develop advanced liver disease, some factors that have been associated with faster disease progression include:
- Alcohol use
- Male gender
- Age over 40 at time of infection
- Longer time period since infection
- Coinfection with Hepatitis B
- Presence of fatty liver on biopsy
Treating Hepatitis C
No vaccine is currently available to help prevent hepatitis C, unlike hepatitis A and B, but it can be treated. For many years the standard of care had been pegylated interferon, which is injected under the skin, in combination with an oral medication called ribavirin. The use of the pegylated interferon/ribavirin combination has potentially serious side effects and suboptimal success rates. It is now possible, however, to successfully treat hepatitis C with oral medications and without the use of pegylated interferon.
The new medications hold the promise of higher success rates (perhaps over 90 percent), fewer side effects, and shorter treatment periods than pegylated interferon and ribavirin, although they tend to be more expensive and, being rather new medications, there is no long term track record. Treatment for hepatitis C is considered successful if it results in a sustained virologic response (SVR), which is usually defined as the absence of detectable virus in the blood 24 weeks after completion of therapy.
Underwriting Hepatitis C
If an applicant has history of hepatitis C, underwriters are going to evaluate the application carefully. In addition to liver disease, hepatitis C is also associated with an increased risk of diabetes, kidney disease, hematologic disease, dermatologic conditions, neurologic complications, and autoimmune manifestations. However, studies have shown that successful treatment does decrease the mortality, reduce the effects of the liver damage, and decreases the incidence of cirrhosis and hepatocellular carcinoma and the need for liver transplantation.
Not all life insurance companies underwrite the same, but there are a number of factors generally used for evaluation when underwriting hepatitis C including:
- age at infection
- extent of liver damage
- alcohol use
- laboratory results
- results of any treatment administered
When it comes to life insurance underwriting, the “normal” risk classes are as follows (starting with the best offer possible): Preferred Plus, Preferred, Standard Plus, and Standard. If an applicant does not fit into one of these categories based on their risk assessment they may be table rated or declined.
When an insurance company classifies an applicant with a table rating, this typically means the applicant will have to pay the standard rates plus a certain percentage. Depending on the insurance carrier, an alphabetical or numerical table is used.
|Table Rating |
|1||Standard + 25%|
|2||Standard + 50%|
Standard + 75%
Standard + 100%
|5||Standard + 125%|
Standard + 150%
|7||Standard + 175%|
Standard + 200%
Standard + 225%
Standard + 250%
Let’s take a look at a couple examples of individuals with history of hepatitis C applying for life insurance to get a better grasp on underwriting and pricing.
Joanne Smith is a 60-year-old with a history of chronic hepatitis C who successfully completed treatment one year ago. Her liver biopsy performed before treatment revealed minimal fibrosis.
The risk class offered Joanne is Standard Plus. Her estimated premium cost for a 20-year $250,000 term policy is about $120 per month.
Donald Johnson is a 50-year old with a history of untreated hepatitis C contracted at age 25. His recent liver biopsy showed mild fibrosis. Donald does not use alcohol and his liver enzymes are elevated less than two times normal.
The risk class offered Donald is Standard Table 3. His estimated premium cost for a 20-year $250,000 term policy is about $140 per month. This is calculated by taking what a standard policy would cost him (roughly $80 per month) and adding 75% on top (80 + 75% = 140).
Ana Jensen is a 45-year old who has a history of untreated chronic hepatitis C with cirrhosis and drinks alcohol daily.
Ana would be declined for life insurance.
A benefit to working with Quotacy is that we work with multiple A-rated life insurance companies. We have the ability to shop cases around to different companies to try our best to get an applicant approved.
Our in-house underwriter has worked in many carrier home offices, knows how to navigate each individual’s health history, and knows which life insurance company would be the best option for your individual case. If you are ready to buy life insurance coverage, get a term life insurance quote now and let’s start the process.
If you have any questions regarding underwriting hepatitis, feel free to contact us or jot us a message in the Comment section below. If you are looking to get an idea on the cost of life insurance if you have a history of hepatitis, we will need the following information to provide you with an accurate quote.
- What was the date of your diagnosis?
- Which type of hepatitis was diagnosed?
- Hepatitis A
- Hepatitis B, resolved
- Hepatitis B, carrier or chronic infection
- Hepatitis C (non-A/non-B)
- If other, please describe.
- Please give date and results of the most recent liver enzyme tests:
- Are you on any medications? If yes, please give details.
- Do you drink alcohol? If yes, please note amount and frequency.
- Have any of the following studies been completed? If yes, note whether normal or abnormal.
- Liver ultrasound or CT scan
- Liver biopsy
- Have you been diagnosed with chronic hepatitis and/or cirrhosis?
- Have you been treated with interferon or anti-viral drugs? If yes, please give details.
- Do you have any other major health problems? (ex. Cancer, heart disease, etc.)
Give us 2-3 business days to respond with some individualized and thorough information. Quotacy is here to help make the life insurance buying process easier for you.