Breast cancer is the 2nd most common type of cancer for women in the U.S.; only skin cancer is more prevalent.  Approximately 1 in 8 women will develop breast cancer – 12% of the female population.  Men can also develop breast cancer, but for them this is a rare form of malignancy.  Given the prevalence in women, it’s important for insurance professionals to be familiar with underwriting strategies, so they can guide their client toward our industry’s best solution.

Underwriting Outcomes

Some non-invasive “in-situ” cancers caught and removed very early can result in offers of standard soon after treatment recovery.

Invasive forms of cancer are usually postponed for at least 1 – 2 years counting from the date of last treatment.  After that time, a low table rating with a flat extra ranging from $5 – $10 per $1,000 of benefit for the first 3 – 6 years following the date of last treatment are common.

Stage 3 and 4 tumors with multiple lymph node involvements are usually postponed for 15 years.  Since these more advanced forms of breast cancer tends to recur decades after an initial diagnosis, medical directors will consider underwriting options by reviewing available records and medical follow-up after the 15 year postponement.

Insurer Selection is Key

Many preferred risk insurers minimize their morbidity and mortality charges by heavily rating or declining women (and men) with breast cancer.  Given the frequency of the cancer, several other highly rated brand name insurers have developed proprietary underwriting manuals that enable them to make aggressive offers.  Unfortunately, there is no one insurer that is best for all breast cancer underwriting challenges.  It is best to develop key facts in advance of a formal application to ascertain preliminary underwriting outcomes.  This approach leads to an application to the right insurer from the start, based on approximate premium assumptions.

Pre-formal Underwriting Questions

Answers to the following questions will enable us negotiate underwriting with insurers that specialize in underwriting breast cancers.  If a surgical pathology report is available, please feel free to submit that to provide additional detail.

• What is your name?
• What is your gender?
• What is your date of birth?
• Exact name of the cancer (DCIS, LCIS, inflammatory breast cancer etc.):
• Date of first diagnosis:
• What was the stage of the cancer (“in situ”, Tis, 1A, 1B N1mic, N0, N1, N2, etc.):
• What was the tumor size?
• How many lymph nodes were involved?
• Which lymph nodes were involved?
• Cancer grade (typically low, moderate, or high; or I, II, II, IV):
• Was the tumor estrogen positive or negative?
• Was the tumor progesterone positive or negative?
• Was the tumor HER2 positive or negative?
• Type of treatment(s) (lumpectomy, mastectomy, radiation, chemo, other) with dates:
• Date of last treatment:
• Results from genome sequencing or other genetic assays:
• What type of medical follow-up has been done to detect possible recurrence?
• Any evidence of recurrence:
• Date of last cancer screen?
• Dates of use of Tamoxifen or Arimidex:
• If there is family history of breast cancer, who, and what is the outcome?
• List all other prescription medications and the condition each is treating:
• What forms of tobacco do you use and how often do you use them?
• Is there anything else you can think of that might impact insurance underwriting?

Please provide answers to your CPS Advantage representative or send them to requests@cpsadvantage.com along with an outline of desired coverage.  We’ll discuss details with appropriate insurers and will circle back to you with our industry’s top solutions within 3 – 5 business days.