Life Insurance with Rheumatoid Arthritis: What You Need to Know
More than 400,000 adults in the UK have Rheumatoid arthritis (RA) with many more currently undiagnosed.
RA is a disease that causes your immune system to wrongly attack the healthy tissues that line the joints, causing pain and swelling in multiple joints. Over time, this causes damage to joints and cartilage.
You may have arrived on this page because you want to find out more about how RA affects life insurance premiums. We often find that people that call us about insurance policies find themselves in one of the following three situations:
- Recent Diagnosis – you have received an RA diagnosis and want to secure a life insurance policy.
- Applied and been refused – you have applied for insurance with RA and have been refused.
- Premium Increase – you have managed to secure life insurance with RA, but your insurance provider has increased the premium and you are shopping around for a better deal.
It doesn’t matter which, if any, of the above that you fit into. This article explains how insurance providers decide on insurance premiums so that you can make a more informed decision. If you want an RA life insurance quote already then follow the link.
How Life Insurance Companies View Rheumatoid Arthritis?
Rheumatoid Arthritis is generally not considered to be a big risk for insurers. It is not a fatal disease, however, there are side effects from the drug treatments and extra-articular complications that can represent a risk to insurers. Some of the medications prescribed to treat RA may cause chronic and severe adverse effects to the heart, lungs or kidneys.
Insurers will need to investigate your condition thoroughly before providing you with a quote. They will look at the type of arthritis that you have, the degree of pain or limitation that you experience, how long you have had RA, as well as any medications that you take for it.
RA is a chronic auto-immune condition and is progressive in nature. As the condition progresses, protective cartilage can thin which leaves bones open to erosion. Bone erosion can then lead to the destruction of the joint, resulting in disability and an inability to carry out every day tasks.
In some cases, rheumatoid arthritis symptoms move beyond your joints. The Mayo Clinic reports that about 40% of people with RA have problems with their skin, eyes, heart, lungs, kidneys and other tissues or organs. These complications will see most insurers increase your premiums, and even refuse cover altogether.
Classifications of Rheumatoid Arthritis
Insurers will look at your symptoms, the treatment and any disability in order to assess the severity of your condition and how well you are managing it. They will look to classify your condition as mild, medium or severe. They may also refer to a Disease Activity Score (DAS) to build up a profile of your risk.
Disease Activity Score (DAS)
A DAS is calculated by considering a combination of factors, including assessing 28 joints to see if they are swollen/tender and looking at the levels of inflammation showing up in your blood. (click here for more information on DAS).
In mild cases, you will have slight pain and stiffness in some peripheral joints, usually the hands and feet, with minimal swelling and no deformities or evidence of erosion. The symptoms are controlled with over the counter medication and Non-steroidal Anti-inflammatory Drugs (NSAIDs). You will be able to complete all daily activities without assistance.
The underwriting outcome for mild cases of RA can vary from insurer to insurer, though in most cases you should expect to see a small loading. In the best case, it may be possible to secure ordinary rates.
In moderate cases you will be on continuous medication, taking steroids, DMARDS (disease-modifying antirheumatic drugs) or anti-TNF drugs to control the symptoms. You will experience pain and some major joints will be involved. The affected joints will effect your movement and you may have some cartilage damage, resulting in mild disability. You are still able to perform all facets of daily life with slight difficulty. Once again, the outcome for moderate cases will vary depending on where you look, though as a rule of thumb your premium is likely to increase by 100%, effectively doubling.
In severe cases, you will have significant joint damage, obvious deformities and a level of disability that means you are unable to carry out daily activities without assistance. You may use sticks and/or a wheelchair to get around. You will be in near constant pain and on steroids, DMARDs and other drugs to manage your condition. Many insurers will end up refusing cover to applicants with severe symptoms, especially if there is any organ involvement. Cover may still be available however through more specialist providers, but you should be prepared to see your premium increase by around 200%.
How medication affects your life insurance policy
The type of drugs you are on to manage your RA will serve as an indicator to the insurance company as to the severity of your condition as per the above. Some insurers will automatically change how they classify you if you are taking a certain type of medication. This factors in that some drugs carry greater risks and are more likely to carry side effects.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
If you use over the counter medication and NSAIDs to manage your RA, you are likely to be classed as mild. You may even be able to get a life insurance policy with no additional loading. Chances of complications to the heart or kidneys are unlikely to occur with these drugs. Stronger NSAIDs are available by prescription.
DMARDS (disease-modifying antirheumatic drugs)
When you are diagnosed with RA, you’ll normally be offered a combination of DMARD tablets as part of your initial treatment. Methotrexate is often the first medicine prescribed, often alongside another DMARD like sulfasalazine, hydroxychloroquine and leflunomide. For pain relief, you are also likely to be prescribed a short-course of corticosteroids (a group of medications, including prednisone, that help control severe pain.)
DMARDS relieve the symptoms and slow the disease down, helping to protect joints from further damage. They work by blocking the effects of the chemicals released when the immune system attacks the joints, which could otherwise cause further damage to nearby bones, tendons, ligaments and cartilage. DMARDs are often a long-term treatment.
There are side effects associated with DMARDs including liver damage and lung infections.
New biologic forms of DMARDS are being used to treat RA by targeting and modifying parts of the body’s immune system to stop chemicals attacking your joints. These biologics are usually taken with methotrexate and can work more quickly than traditional DMARDS.
Anti-tumour necrosis factor (anti-TNF)
Anti-TNF drugs are expensive and only prescribed if conventional treatments aren’t working. These drugs work by blocking tumour necrosis factor alpha (TNFα), which is present in the blood and joints of people with RA. Research has shown that excessive production of TNFα can lead to inflammation and damage to joints.
Arthritis Research explains how TNFα drives “not only the recruitment and activation of inflammatory cells, but also control(s) their destructive activities.” By blocking TNFα you can reduce this inflammation and joint damage.
In some cases anti-TNF drugs leave patients open to serious infections, especially in the early stages of treatment. With newer drugs in this class, the long-term side effects are not known. Insurers will therefore treat them with caution and apply an automatic loading.
Currently, there are five licenced treatments that can block the effect of TNFα (Brand name in brackets):
- etanercept (Enbrel)
- infliximab (Remicade)
- adalimumab (Humira)
- certolizumab pegol (Cimzia)
- golimumab (Simponi)
New Research around TNFα
There is research being carried out currently that rather than ‘block’ TNF in the body, looks at using the nerves to stop the excess TNF from being produced in the first place. Scientists in California have developed a ‘bioelectronic’ medical device that is implanted alongside the vagus nerve and stimulates certain fibres to regulate TNF production.
Other Factors impacting your Insurance Premium
Number of Years Since Diagnosis
For most insurers, the number of years since an RA will not be a factor. They are interested in your symptoms, the number and types of joints affected and the level of disability. The time since diagnosis is not a key factor.
Number and types of joints affected
The type and number of joints affected is key for underwriters. Insurers will look at RA affecting hands and feet as mild. If more major joints, such as shoulders, elbows, and hips are affected you will see the rating move towards severe. The more joints that are affected, the more your classification will increase in severity.
Deformity to joints
Some people with RA experience joint deformity. Insurers will consider any deformities and the joints where they occur in order to get an idea of the severity of your condition. Deformities to fingers, wrists and feet may still be classified as moderate. Deformities in the hips or knees that mean you need walking sticks or a wheelchair will see a severe classification and your policy increase significantly.
Rheumatoid nodules are hard lumps that can appear under the skin of people with RA. They usually occur over the finger joints and elbows. According to the National Rheumatoid Arthritis Society, individuals who develop nodules “are more likely to be smokers, tend to have more severe disease, are almost invariably rheumatoid factor and CCP positive. They are more prone to other extra articular features of rheumatoid, including vasculitis (inflammation of blood vessels) and lung disease.” It is for these reasons that insurers will load a premium when rheumatoid nodules are present.
Walking aids / Wheelchair
One of the factors that has the most impact on your insurance premium is a disability and how it impacts on your ability to do everyday tasks. If you require walking sticks or a wheelchair to move around then your condition is likely to be classed as severe and your premium increased.
There are two main types of antibody that are associated with rheumatoid arthritis:
Rheumatoid Factor (RF) – RF is an autoantibody which means it attacks a person’s own tissues. It is present in around 80% of people with RA.
Anti-CCP – Not everybody that has RA has this autoantibody, but most individuals with RA do have it. It is therefore used as a diagnostic test.
Blood tests are used to confirm the presence of these antibodies. The presence of both of these in high levels will impact your classification and increase your premium.
Joint replacement Surgery
If your condition progresses and your bones start to erode, the joint will eventually need to be replaced. Joint replacement surgery may be to reconstruct the joints or correct deformities. Common surgeries include synovectomy, which replaces the damaged joint lining, arthroscopy that removes inflamed joint tissue, tendon release or repair, joint fusion and total joint replacement. Hip, knee and shoulder joint replacements are all major operations that involve several days in hospital followed by months of rehabilitation.
If you have had surgery and had no repercussions, it should not impact your premium. If you are awaiting surgery, in particular more major surgery then insurance will be postponed until the surgery is complete.
In some cases of RA, the inflammation moves beyond the joints to the heart, skin, eyes and lungs. If you develop inflammation or scarring in the lungs then this can lead to breathing issues. Any evidence of extra-articular complications will see insurers increase your premiums, maybe even refuse you cover.
What you can do to reduce your RA Insurance Premium
If you develop other health conditions then your premium will increase dramatically so taking measures to prevent this is very important. The following will have a huge impact on your premiums:
- Smoking – smoking increases premiums dramatically
- Drinking alcohol to excess – excessive alcohol consumption will increase your premium
Although the following will not directly impact your life insurance premium with RA, they are important considerations:
- Diet – it’s important to ensure your overall diet is healthy and balanced. There’s no strong evidence to suggest that specific dietary changes can help improve rheumatoid arthritis. For more on diet and RA visit National Rheumatoid Arthritis Society (NRAS)
- Exercise and Physical Therapy – Although it can be painful, gentle exercise is beneficial to people with RA. Physical therapists can help devise exercises that you are comfortable with and physiotherapists will aim to improve fitness and muscle strength, and make your joints more flexible through their programmes.
Finding the best Life Insurance Companies
This is where Your Life Protected come in. As a broker that specialises in rheumatoid arthritis life insurance, we know which insurance companies are more sympathetic and can provide the best cover. Cover is not standard across the industry and because we specialise in this market, we can give you the best chance of securing a policy.
We are in constant discussions with insurance companies and their underwriters, so that we know the insurers that will offer the best cover for RA sufferers. We aim to save you time and unnecessary worry. Contact us today on 01275 404268 or get a quote for rheumatoid arthritis life insurance.
Further Reading and Information
- British Society for Rheumatology Biologics Register (BSRBR) – tracks the progress of patients with severe rheumatoid arthritis who are taking biologic therapy. The register aims to monitor the long-term safety profile of these agents, detecting any long-term and rare side-effects of TNFα inhibitors. Currently over 19,000 patients registered and they complete questionnaires on a 6 monthly basis and participate in clinical assessments. The data is analysed regularly.
- Arthritis Research UK
- NHS Arthritis Information
- National Rheumatoid Arthritis Society on Treatment
- Arthritis Care on RA Drugs
- Arthritis Research UK on Anti-TNF drugs
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