Anaemia
The method of rating will depend on the type or cause (as discussed, it may occur as a secondary effect of various acute and chronic diseases), and on the severity of the red cell deficiency. If it is clearly identified as anaemia associated with a chronic disease – such as Crohn's – then the rating is usually that of the underlying disorder.
Mild to moderate degrees of anaemia can be regarded with less suspicion in pre-menopausal females than in males, as menstrual blood loss is a common and usually benign cause.
However, with unexplained anaemia should be postponed pending investigation, as the underlying cause may be serious.
Leukaemia
Leukaemia is sub-divided into acute and chronic types. Acute leukaemias are rapidly fatal if untreated or if there is no response to treatment.
Although, major advances have been made, and a considerable proportion of patients have prolonged survival rates, terms for acute leukaemia are generally unavailable for four years since cessation of treatment for life and disability cover. Following this period, a substantial extra is generally warranted. For critical illness (CI) cover, terms may be available in specially selected cases for patients with a 10-year, disease-free period for acute leukaemias.
For chronic leukaemia, terms are available for life only for specially selected cases with possible limitations to the terms of the policy.
Haemophilia
Terms will depend on the degree and severity of the haemophilia. Following cases in the 1980s involving contaminated blood, terms would be subject to a negative HIV test and hepatitis screen in most cases.
For those with mild haemophilia, which is characterised by prolonged bleeding only following surgery or trauma, and the sufferer is able to pursue all activities and no disability, then standard rates with the possibility of a small rating would be applicable for all benefits.
For those with more severe symptoms, terms are generally available for life. But for income protection (IP) or CI cover a moderate to severe rating would apply and, in the very worst cases, may warrant declinature.
Hypercholester-olaemia
Use of comparative studies has enabled groups such as the National Institute of Health in the US and the European Atherosclerosis Society to define optimum levels of cholesterol as 5.2mmol/l or below. Moderate risk is thought to be present when the cholesterol is over 6.3 mmol/l (SURE). However, raised levels of cholesterol becomes less significant the older the life. Also the risk posed by a raised total cholesterol level is reduced if the high-density lipoprotein (HDL ) which is a 'good' cholesterol is also raised (at least above 1.0).
When underwriting, it is also important to take the abnormal levels of cholesterol in conjunction with any other vascular risk factors, including smoking (which accelerates the production of atheroma), family history, diabetes mellitus and raised blood pressure. Any one of these risk factors or combinations significantly increases the risk.
Therefore, a total cholesterol level of 6.5 would be regarded as an important vascular risk factor in a hypertensive 40-year-old male smoker, but could probably be disregarded in a middle-aged woman with no other risk factors.
For an individual aged 45, if raised cholesterol is the only significant vascular factor for levels of cholesterol under 7.0, all benefits could be taken at standard rates. For levels between 7.0mmol/l and 9.00mmol/l, life cover and IP would be rated at about +50% and terms for CI cover would be about +150%. For levels over 9.00mmol/l terms would only be available for specially selected cases.
