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How Your Insurance Premiums Are Calculated

By Sandy John, Contributing Reporter

Insurance is all about managing risks. And insurance companies don't take any risks when they are setting the rates you will pay for a policy. They want to take precautions to ensure that you won't die prematurely, causing them to pay out a lot more than you paid in.

What sort of risks are they interested in? Pretty much the same health risks doctors, medical researchers and health-conscious people are concerned about -- the same subjects you hear about over and over again if you listen to medical reports on TV or radio: tobacco use, cholesterol, being overweight, diabetes, and other conditions linked to poor health and early death.

To account for these risks, insurers will designate your status (using a title such as preferred or standard) based on age, gender and health, and that will determine how much you pay for a given amount of insurance.

To determine your health status, the insurance company will ask about your medical history and most likely require you to undergo some sort of physical exam. When filling out the health questionnaire "it is important that you are truthful," said Jack Dolan, spokesman for the American Council of Life Insurance, a trade organization that represents many of the nation's largest insurers. If you lie and the company finds out, it can cancel the policy. And if you were to die, and then the company found out you lied -- if, for instance, you said you were a non-smoker but ended up dying of lung cancer from a two-pack-a-day habit -- it could deny the death benefits, he said.

There are some risk factors you can't control, such as gender or age. "Women live longer than men, so women have lower rates on insurance, Dolan noted. And because men tend to have shorter life spans, they pay a lower rate on an annuity. Your age also affects the premium. Younger people, who have that much longer to pay premiums before they are likely to die, pay a lower rate than an older person would be quoted. Your family medical history, your lifestyle (do you have dangerous hobbies or travel frequently to locations where you could be exposed to disease or danger?) and your physical condition also come into play.

For most people buying most policies, the insurer will ask you to undergo a physical exam. A visiting medical practitioner, paid for by the insurance company, will check your weight, blood pressure and other vital signs, and perhaps take a blood and/or urine sample. In some cases, more extensive tests, such as an X-ray or EKG, might be required. Your blood and urine samples will be tested for any sign of disease, including the presence of the HIV virus, cholesterol level, and any indications of disorders such as diabetes, kidney problems, hepatitis and other problems. The samples will also be screened for the presence of nicotine and certain medications as well as for illegal drugs.

Each insurance company sets its own rates and determines what constitutes a preferred-plus buyer, a substandard buyer or any category in between. What if you know you have a risk factor? In the first place, alert your agent of the problem when you first talk about life insurance policies. It's likely the agent knows that some insurers charge higher rates for that risk factor than others, and he can look for a company that doesn't hike its premiums a lot for that particular condition. If it's a controllable risk factor, you can also do what your doctor or spouse might be urging you to do. Eliminate the risk factor: Quit smoking. Lose some weight. Take your blood pressure medication regularly. Get healthy.

If you substantially improve your health, you can alert the insurance company and see if it will lower your rates. There's no danger in doing this, Dolan said, because "an insurance company will never increase the premium, but it will decrease the premium when people give evidence of improved health."

Some insurance companies will also improve an individual's rating, and trim the premium, for risk factors that decrease over time. Dolan gave the example of someone who purchased life insurance shortly after a bout with cancer. That person is probably paying high-risk rates because of that health history. But, because the risk of the cancer returning decreases over the years, that individual could contact the insurer after being cancer-free for five years and might get a lower rate, he said.

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