What Does It Mean to Be Nonbinary When It Comes to Life Insurance?

You are not ineligible for life insurance because you are nonbinary, genderqueer, agender, or bigender. For the time being, though, you will have to apply as either a man or a woman. Despite a growing knowledge that many people do not identify themselves in binary gender boundaries, the underwriting process has remained unchanged.

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TAKEAWAYS IMPORTANT

• Being nonbinary does not prohibit a person from obtaining life insurance, nor does it imply that they will pay higher premiums.
• Higher premiums may be charged for certain health issues that are more common among nonbinary people.
• Regardless of an applicant's gender identity, each insurer evaluates their risk in a unique way. Despite the fact that both insurers use the same information, one may provide a standard rate while the other may offer a preferred rate.

Why Do Life Insurance Companies Inquire About Gender?

Because of the link between gender and mortality, life insurers inquire about gender. The gender we are allocated at birth has an impact on how long we live. "Male life expectancy is shorter than female life expectancy in all nations," according to a big, multinational study published in the journal Clinical Chemistry in 2019.  Men's greater vulnerability to cardiovascular disease and differential uptake of smoking began to show up after 1880; by the middle of the twentieth century, mortality of those over 45 was twice as high for men as it was for women, owing to "men's greater vulnerability to cardiovascular disease and differential uptake of smoking." The disparity has narrowed as women smoke more, but it still exists. There are major variances in rates between countries and times, however females live longer in almost all cases in modern times.

This simply means that when actuaries examine data from millions of people over decades, they find that women outlast males. According to Jake Tamarkin, cofounder and CEO of Everyday Life Insurance, “life insurance underwriting frameworks are backwards looking by design—based on actuarial examinations of enormous amounts of historical data—and are subject to being outmoded in how they categorize people for risk-analysis purposes.” “They are also heavily regulated and cannot be modified easily or quickly.” Tamarkin claims that his organization inquires about candidates' gender at birth.

In every state except Montana, life insurance can charge men and women separate premiums. Women, on average, live longer than men. A longer life indicates a reduced chance of the policy's death benefit being paid. According to the Social Security Administration's actuarial life tables, a man turning 40 in 2017 has a life expectancy of 78.56 years, while a woman turning 40 in 2017 has a life expectancy of 82.47 years.

Do persons who identify as nonbinary have a shorter life expectancy than people who identify as cisgender? That's a great question, but because the nonbinary community is small and has only just become more visible, actuaries may not have the data they need to provide these people different, potentially more accurate rates.

We don't know if someone born female but identifying as nonbinary has a life expectancy that differs significantly from cisgender people. There isn't enough medical research—particularly well-designed studies—to provide such knowledge, yet the minimal data we do have frequently shows that transgender people have poorer health.

On your life insurance application, you must select a gender.

We may see more than two selections on life insurance applications at some point (or we may not even have to answer the male or female question). We don't have any right now. When you don't identify with either and your choice could effect how much you pay for insurance, which box should you check?

“ACLI cannot speak with authority on the internal operations of individual life insurance companies,” says Jack Dolan, vice president of public relations at the American Council of Life Insurers (ACLI), a public policy advocacy organization. We do not gather statistics or information on the underwriting methods of specific companies." “Carriers' underwriting processes, including the reflection of [a] person's sex, vary,” he noted. He also mentioned that each life insurance company's underwriting criteria are confidential.

Insurance brokers' perspectives

We turned to insurance brokers, who connect clients with policies from a variety of providers, to learn more about how these processes differ. Long-Term Care Associates, a long-term care (LTC) insurance broker, and Quotacy, an online life insurance broker, provided some of the best public material we uncovered. Much of the information accessible is on trans people, which is a bigger umbrella under which nonbinary identity fits, rather than nonbinary individuals specifically.

Stephen D. Forman, CLTC, wrote in a blog article about insuring transgender applicants that life insurers were more inclined to underwrite a policy based on the gender an individual identifies as, whereas long-term care insurers were more likely to look at an individual's gender given at birth.

According to Quotacy, insurers' answers to trans people's underwriting are all over the place, ranging from just underwriting based on the person's given gender at birth to underwriting based on the person's gender identification. These responses, however, do not take into account the particular circumstances of nonbinary candidates.

“As for addressing LGBTQ applicants, I believe there is a vast diversity of approaches now being adopted by insurers,” Dr. Steven Weisbart, chief economist at the Insurance Information Institute, told us. Some use unisex (mixed male/female) rates, some use birth-gender rates, some use gender-preferred rates, and I think most or all are underwriting based on drug/hormone treatment, surgeries, and other health conditions, among other factors.”

Tim Bain, the founder and life insurance agent at QuickQuote.com, writes on his blog that his company has gotten only a handful applications from transgender people. “Life insurance company criteria for transgender individuals differ greatly from company to business,” he said, making it more difficult to locate the appropriate life insurance company for this applicant.

He needed to know how life insurance determine which gender applies, and he noticed that the answers varied from company to company. Another finding: Gender-affirming surgery may influence the gender an applicant is treated as by some companies but not by others, as well as eligibility and rates, depending on how long it has been since the procedure.

Transgender applicants, according to Bain, must spend more time than cisgender applicants looking for an insurer that will provide them the best rate for their situation and allow them to utilize their gender identification.

The difference between selecting'male' or 'female' may not be significant.

When you identify as neither male nor female, choosing male or female is unlikely to be a nonbinary person's desire.

Your box-checking, though, may not be as important as you believe. This is because life insurers consider a variety of criteria when determining an applicant's premiums, and the sum of these elements determines whether you're insurable, which firms will cover you, and how much you'll pay. This holds true regardless of who you are or how you identify.

Insurers will also learn how doctors have identified your gender in the past by analyzing your medical data. The only way around this is to acquire a policy that doesn't require medical underwriting, which usually means less coverage and higher premiums, but it might be the best option for certain people.

How Do Life Insurance Companies Determine Premiums?

Aside from gender, life insurance premiums are determined by a number of factors:

1. Age\sOccupation
2. Blood pressure is a measurement of how high or low
3. Construct (height and weight)
4. Cholesterol
5. History of physical health
6. History of mental illness
7. Surgical background
8. Medical history of the family
9. History of prescriptions
10. Health problems that last a long time
11. Tobacco consumption
12. Use of illegal drugs
13. Driving history
14. a criminal history
15. Bankruptcy
16. Travel to risky nations
17. Recreational activities involving a high level of risk
18. Life insurance can be of various types (term, whole, etc.)

All of these factors, with the exception of the last, have an impact on the age at which someone is expected to die. The lower the rates, the longer the insurer expects to collect payments and the less likely they are to settle a claim. Certain factors, however, are more likely to afflict nonbinary people, which may necessitate paying a higher insurance premium.

Construct (Height and Weight)

Build, or body mass index, is one area of underwriting where the box you tick might have a direct impact on your premiums (BMI). Despite its well-documented shortcomings, many insurers still use it to decide if an applicant's physical characteristics put them at a higher risk of dying prematurely. And the tables that underwriters utilize for men and women are different.

Applicants who are on the high or low end of what is considered an acceptable weight for their height may be charged differently depending on whose gender they are underwritten as. The BMI of a candidate who is 5'5" and weighs 174 pounds, for example, is 29. An insurance might say that for a guy, the highest limit for BMI is 30, whereas for a girl, the upper limit is 28.

All other things being equal, an applicant with this build who is underwritten as female would pay more than an applicant with this build who is underwritten as male.

Some insurers, on the other hand, do not use distinct BMI standards for men and women.

History of Mental Illness

Gender dysphoria is a prevalent problem for nonbinary people, and the American Psychiatric Association recognizes it as a diagnosis. It can entail, among other things, a strong desire to be treated as a gender other than the one assigned at birth and to have the primary or secondary sex traits of the opposite sex for at least six months, as well as substantial distress or issues functioning.

Gender dysphoria does not affect all nonbinary people, and its inclusion in the profession's diagnostic guideline does not imply that it is a mental disease. However, it may be able to assist certain patients in obtaining medications and therapies that will enhance their quality of life.

Suicide and depression are two common causes of death.

However, receiving a mental health diagnosis may result in increased insurance costs. Because suicide is the tenth greatest cause of death in the United States, life insurers take certain diagnoses, such as severe depressive illness, very seriously.

Transgender people are more prone to try suicide, according to several studies, and gender-affirming care lessens suicide attempts. Transgender people are frequently verbally abused, physically assaulted, sexually assaulted, and fired from jobs, resulting in mental and physical health issues that might affect life insurance prices and eligibility.

The severity of an illness and how it's been treated can have an impact on how an insurer weighs a mental health diagnosis when considering whether or not to grant someone coverage and at what price. Some insurers, for example, place a higher value on a diagnosis of depression than others. Despite their mental health history, one firm may offer the best rates to customers with that illness, while another may offer subpar rates.

Depending on the insurer, someone with mild to moderate depression or anxiety who is taking a maximum of two drugs, none of which is an antipsychotic, may still be eligible for the best rates.

A suicide attempt within the last two years, as well as a mental illness requiring hospitalization within the last year, can render someone uninsurable for the time being. Following that, an attending physician statement may be required for approval.

Previous Medical Conditions

Because of medical skepticism, a lack of gender-affirming care, or blatant prejudice by healthcare practitioners, some nonbinary people are in poor physical condition. According to studies, transgender people delay seeking medical help out of fear of being mistreated, and when they do, they are frequently abused.

Even if someone overcomes these difficulties and seeks preventative or acute treatment, if they do not trust their clinician, they may not follow medical recommendations. Health discrimination, such as a provider's refusal to treat, an insurer's unwillingness to offer coverage for treatment, or an individual's avoidance of the healthcare system, can result in higher life insurance premiums based on physical health difficulties.

When it comes to certain of the specifics of an applicant's health history, like as blood pressure and cholesterol, whether one is underwritten as male or female can make a difference. An insurer's desired diastolic pressure—the lowest figure in the blood-pressure ratio—for women may be lower than for men. And a male applicant with a cholesterol-to-HDL ratio of 4.8 may be rated higher than a female applicant with the same ratio.

Transgender people are also more likely to be HIV positive, which can result in life insurance being denied.

Surgical Background

Nonbinary people, like cisgender people, get surgery to make them feel better about themselves and their bodies. Breast reduction surgery may be performed on someone who is assigned female at birth but identifies as nonbinary, and breast augmentation surgery may be performed on someone who is assigned male at birth but identifies as nonbinary.

Any gender-affirming surgery could effect life insurance premiums because life insurers analyze surgical history when evaluating any applicant. Nonbinary people are less likely than transgender people who identify as male or female to have surgery, or to have less substantial surgery.

Insurers don't reveal how they calculate rates publicly, but here's what we discovered about the effects of gender-affirming operations and how that information could affect your rates.

What role does surgical history play in rates?

According to Munich Re, insurers should not accept a life insurance application until a year has elapsed after breast augmentation surgery, because roughly 15% of these patients require another procedure within a year. The insurer also points out that while little is known about the long-term hazards of many cosmetic treatments, breast augmentation does not appear to increase mortality.

Transgender interest groups have challenged Europe's life insurance sector to reveal how it assesses the medical risks of insuring transgender people, according to Karsten Filzmaier, a life insurance industry veteran and cardiologist in Munich. He coauthored a study that indicated that four out of every five transgender people who had gender reassignment and were tracked medically afterward experienced "a distinct improvement in their psychiatric symptoms and a gain in their quality of life."

According to Filzmaier, available research demonstrate that hormone use has a smaller impact on heart disease and cancer rates than previously thought, and that the medical risk associated with gender reassignment and long-term hormone therapy is minor to insignificant. He advises underwriters to concentrate on the risk profile of each individual applicant, and claims that the most significant difficulties impacting transgender underwriting are likely suicide and reckless behavior. These findings aren't exclusive to nonbinary people, but they could still be useful.

Munich Re has also chimed in on gender dysphoria underwriting, stating that transgender people have "mild to moderate" increased mortality, albeit male-to-female people have a larger mortality risk than female-to-male people, owing to suicide and, to a lesser extent, cardiovascular problems.

History of Prescriptions

Nonbinary people suffering from gender dysphoria may be prescribed androgen blockers, estrogen, or testosterone to help them feel better. If you've used gray market or black market hormones, they won't show up on your prescription history, but they could show up in normal blood and urine tests that life insurance often require.

Hormone therapy may have resulted in adverse effects that have an impact on life insurance prices. Feminizing hormones can raise cholesterol, raise potassium levels in the blood, and affect heart function. They can also cause blood clots or anemia, increase body fat, and change mood. Masculinizing hormones can alter cholesterol levels and boost red blood cell production, thereby causing or exacerbating cardiovascular disease. Gender confirmation operations might cause difficulties, making an applicant more difficult to insure.

People who have taken prescriptions to help their mental health will have these drugs on their prescription history, and depending on the medication and the insurance, they may be able to cut their rates by demonstrating that they are receiving therapy to help them improve their mental health. Alternatively, due of the dangers involved with the prescriptions themselves, these medications may raise premiums (side effects).

Nonbinary Life Insurance Applicants Should Know

Consider using technology to reduce the number of potentially unpleasant interactions with people during the application and underwriting processes.

Employers can provide group life insurance. Because you'll acquire insurance at inexpensive group rates without medical underwriting, this can be a terrific method to avoid an unpleasant underwriting procedure and/or higher premiums. The disadvantage is that your company may not provide adequate coverage, and you may lose coverage if you are laid off or change jobs. Another difficulty is that trans persons have fewer stable jobs, which makes relying on work-based life insurance even more difficult.

Turn to the Human Rights Campaign Foundation's Corporate Equality Index of organizations that are top-rated places to work for LGBTQ people to identify life insurers who are more likely to treat you with respect. “Equal health coverage for transgender individuals without exclusion for medically essential care” is one of the criteria for inclusion on this list. In its 2020 report, Appendix A, Employers with 100% Ratings, lists the following life insurance companies:

• AIG
• Allianz
• American Family Insurance
• Assurant
• Asurion
• AXA
• Cigna
• Chubb
• Farmers
• Guardian
• The Hartford
• Liberty Mutual
• Lincoln National
• MassMutual
• New York Life
• Northwestern Mutual
• Prudential
• The Standard
• State Farm
• Sun Life
• TIAA
• Transamerica
• Unum
• USAA
• Voya

Some of these companies don't provide life insurance to individuals directly, but they do offer it through their employers.

Ty Stewart, CEO and president of Simple Life Insure, a small, independent life insurance company, has one more suggestion. “Nonbinary people seeking comprehensive life insurance should check into the protections provided by their native state's laws,” he said. “Most jurisdictions have laws prohibiting policy discrimination based on a person's gender identity.”

California, Delaware, and New Jersey are three states where discrimination based on gender identification is explicitly prohibited. If you believe you have been discriminated against during the insurance application or underwriting process, you can submit a complaint with your state's insurance department.

Final Thoughts

In the United States, the dominant culture treats gender as binary: you're either male or female. This is something that life insurers do as well. For someone with a nonbinary gender identification, however, being forced to select between two alternatives that don't apply can make them feel invisible. Customers with nonbinary gender identities can feel included and appreciated by simple changes in business operations. Leaving the question open-ended, such as “What is your gender identity?” could assist in resolving this issue.

Nonbinary people make up a small percentage of the population in the United States, thus there may not be much motivation for life insurance to change their policies to accommodate such a small demographic. Even when an incentive exists, changing long-standing corporate practices, particularly in a highly regulated industry, can be a lengthy process.

According to the experts we spoke with, there is no push in the life insurance business to establish premiums based on an applicant's biological sex or gender identity.

“Unless you live in Montana, if you want life insurance, you'll have to navigate around this antiquated structure for years,” Tamarkin said.

There's no reason to believe that the life insurance market can't or won't adapt and offer unisex pricing. In Montana and Europe, this is already taking place. And, thanks to civil rights campaigns across the country, life insurers no longer consider race when calculating premiums or approving coverage amounts. They also have group policies that give unisex pricing. The same movement in public opinion that led to the Supreme Court's recent recognition of LGBTQ rights in the workplace could soon lead to improved insurance underwriting for nonbinary people.