Smoking, as most of us know, carries quite measurable health risks. The Surgeon General warning on every pack of cigarettes is virtually self-explanatory. The increased mortality risk of heart attack, stroke, worsening of diabetes, lung cancer, chronic pulmonary disease, and vascular disease is well studied, and even smokers without complications pay an increased premium for their policies.
Needless to say, there is a lot at stake for both the insurer and applicant in smoker and non-smoker classification.
Home office specimens are routinely tested for cotinine/nicotine. While laboratories used to exactly quantitate the amounts, they are reported now as greater or less than 0.5 in most testing labs. When positive, the testing is quite specific, and there is truly no amount of underwriting investigation that can determine with certainty that there was not ingestion or inhalation of nicotine. Retesting is also not an option, since an offer to retest or a request for an explanation can be too easily manipulated.
Most companies will wait for at least 12 months before reclassifying a smoker as a nonsmoker, because the recidivism rate on resuming smoking is quite high. Preferred classes are even more stringently controlled, with no cigarettes used in the last five years often a requirement. Preferred smoker rates, while seemingly an oxymoron, can be given, but the smoker rating outweighs anything gained, premium-wise, on the preferred classification.
There are other unique circumstances in which tobacco can be used and a nonsmoker classification can be given.
• Cigar or pipe smokers may receive such a policy when it is the only form of tobacco used.
• Preferred premiums can be considered when no cigarettes have been used for five years, cigar or pipe smoking is admitted on the application, and there is no nicotine in the testing sample.
• Those on nicotine gum, patch, or lozenges can qualify for a nonsmoker classification, but generally not preferred consideration, since even if smoking was discontinued more than 12 months prior, the ongoing use of these products likely indicates that the insured is still dependent upon nicotine and the risk of resumption of smoking is quite high.
• The use of newer medications such as varenicline (Chantix) for smoking cessation is considered similarly.
E-cigarettes are becoming more popular as an alternative to smoked tobacco products. These devices are usually battery powered and provide inhaled doses of nicotine by means of a vaporized solution. It is an alternative to smoked tobacco products, and the vapor often has a flavor and sensation similar to inhaled tobacco smoke. The FDA classifies these as drug delivery devices; and since nicotine is still being delivered into the system, e-cigarette users are classified as smokers by most insurers.
Smoking definitely increases mortality and worsens insurance company experience, and as such is severely priced. False statements regarding smoking, even with a “clean” specimen, can be grounds for rescission of the policy. Insurers are very specific about disclosure of tobacco use on their application, at the time of the medical exam, and on the laboratory ticket, which the insured must sign. If there are any disclosures about pipe smoking or chewing tobacco, etc., they must be made up front and at the time of application, as most companies will not readily believe a change in the story after adverse results are reported.
Robert Goldstone, MD, FACE, FLMI
Goldstone, board certified internist and endocrinologist, is vice president and chief medical officer for Pacific Life and Pacific Life and Annuity. He has extensive brokerage and life insurance experience, having been medical director at both MetLife Brokerage and Transamerica Occidental Life. Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World since 1990. Goldstone can be reached by telephone at 949-420-8390. Email: firstname.lastname@example.org.