International Risk UnderwritingForeign Travel and Residence Risks, Facts and Trends

Melissa Gallegos, FALU, FLMI, ACS, ARASenior Underwriting Consultant

September 12, 2018

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“The world is a book and those who do not travel read only one page.”

St. Augustine

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Historical Growth of World Travel

Source: UNWTO

1950: 25 million 2005: 808 million 2016: 1.2 billionAnnual growth: 4% Forecast for 2030: 1.8 billion

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Foreign risks are sensationalized in the news & entertainment media

Most short-term foreign travel is low risk

Foreign residence is far more significant than short-term foreign travel

Major mortality and morbidity differences exist among countries

Look beyond popular opinion and preconceptions

Foreign Residence and Travel Observations

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How dangerous or safe is foreign travel?

What are the most significant mortality risks?

What are the major differences among nations?

Why does it matter what country you live in?

6Source: CIA World Fact book 2016 est.42 – USA: 79.80 years

Life Expectancy at BirthHigh Years Low Years

Monaco 89.50 Chad 50.20Singapore 85.00 Guinea-Bissau 50.60Japan 85.00 Afghanistan 51.30Macau 84.50 Swaziland 51.60San Marino 83.30 Gabon 52.10Iceland 83.00 Central African R. 52.30Hong Kong 82.90 Somalia 52.40Andorra 82.80 Zambia 52.50Switzerland 82.60 Lesotho 53.00Guernsey 82.50 Mozambique 53.30Israel 82.40 Nigeria 53.40South Korea 82.40 Botswana 54.50Luxembourg 82.30 Uganda 55.40Italy 82.20 Niger 55.50Australia 82.20 Burkina Faso 55.50

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From Wikipedia, the free encyclopediaLife_Expectancy_2013_Estimates_CIA_World_Factbook

Geography of Life Expectancy

Life Expectancy at Birth (Years)

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HIV/AIDS Adult Prevalence Rate

Source: CIA World Fact book 2014 est.

Country Percent Country Percent

Swaziland 28.80 Brazil 0.55

Botswana 25.16 Spain 0.42

Lesotho 23.39 United Kingdom 0.33

South Africa 18.92 Mexico 0.23

Zimbabwe 16.74 Australia 0.17

Namibia 15.97 Germany 0.15

Zambia 12.37 Poland 0.07

Mozambique 10.58 Philippines 0.06

Malawi 10.04 Syria 0.01

United States – 0.60 %

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Tuberculosis (TB) Prevalence

Source: The World Bank 2015

(Selected Countries - cases per 100,000 population)

Countries TB Prevalence Countries TB Prevalence

South Africa 834 Russia 80

Lesotho 788 China 67

Mongolia 428 Mexico 21

Indonesia 395 Japan 17

Philippines 322 United Kingdom 10

Pakistan 270 Australia 6.0

India 217 Italy 5.8

Thailand 172 Canada 5.1

Vietnam 137 United States 3.2

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Hepatitis B Prevalence (percent of population)

Source: 2003 WHO & National Centers for Disease Control & Prevention 1999

Country Hepatitis B Prevalence Country Hepatitis B

Prevalence

Papua New Guinea 20 Saudi Arabia 8

Cameroon 15 South Africa 8

Peru 14 Malaysia 5

China 12 India 3

Hong Kong 12 Japan 2

Nigeria 12 Mexico 1

Singapore 12 Australia 0.5

South Korea 12 Canada 0.5

Taiwan 12 USA 0.5

Jordan 10 United Kingdom 0.3

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Hepatitis B Prevalence

Source: http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-3-infectious-diseases-related-to-travel/hepatitis-b.htm

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Hepatitis C Prevalence (selected countries percent of population)

Source: 1999 WHO

Country Hepatitis C Prevalence Country Hepatitis C

Prevalence

Egypt 18.1 India 1.8

Rwanda 17 United States 1.8

Bolivia 11.2 South Korea 1.7

Mongolia 10.7 Mexico 0.7

Vietnam 6.1 Australia 0.3

Thailand 5.6 Canada 0.1

China 3.0 United Kingdom 0.02

Japan 2.3 Sweden 0.003

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Maternal Mortality Rate (number of maternal deaths per 100,000 live births)

Source: CIA World Fact book 2016

Infant Mortality Rate (deaths before age one per 1,000 live births)

USA 5.80 (57th)

Country Deaths Country Deaths

Finland 3.0 Sierra Leone 1360

Greece 3.0 Central African R. 882Iceland 3.0 Chad 856Poland 3.0 Nigeria 814Austria 4.0 South Sudan 789Belarus 4.0 Somalia 732Czechia 4.0 Liberia 725

Australia 6.0 Canada 7.0 USA 14.0

Country Deaths Country Deaths

Monaco 1.80 Afghanistan 112.80Japan 2.00 Mali 100.00

Iceland 2.10 Somalia 96.60

Singapore 2.40 Central African R. 72.7

Source: CIA World Fact book 2015 est.

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Infectious and Parasitic Disease MortalityCountry Death rate per 100,000

populationTotal Fatalities in 2008

Australia 10.0 2,100

United Kingdom 13.4 8,200

Germany 15.9 13,100

United States 22.8 71,200

Canada 37.0 12,300

India 181.9 2,149,100

Haiti 299.7 29,600

Nigeria 568.7 860,000

Dem Rep Congo 687.4 441,700

Malawi 744.4 106,800

Source: WHO 2008

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Global Smoking Prevalence

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Global Obesity Prevalence

In the U.S., obesity levels continue to rise, with 42% of Americans predicted to be obese by 2030Source: CDC

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WHO World Health Systems’ Ranking

Rank Country Rank Country1 France 17 Netherlands2 Italy 18 United Kingdom6 Singapore 19 Ireland7 Spain 20 Switzerland9 Austria 25 Germany

10 Japan 27 United Arab Emirates

11 Norway 30 Canada12 Portugal 32 Australia14 Greece 36 Costa Rica17 Netherlands 37 USA

High correlation between this rank and life expectancy rank.

USA: Physician density/1,000 pop. = (2.4), rank 49 Hospital beds/10,000 pop. = (30), rank 64

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The availability of physician care is an indicator of the quality of a country’s healthcare system. The number of physicians per 1,000 population was provided by the World Economic Forum (WEF) as part of the Travel and Tourism competitive index. The most recent year of data available is as of 2017.

Physician Density

Physicians/1,000 population: Top 5 countries

Physicians/1,000 population: Bottom 5 countries

1 Qatar 7.7 131 Tanzania 0.03

2 Spain 4.90 132 Burundi 0.03

3 Greece 4.40 133 Ethiopia 0.03

4 Russia 4.30 134 Sierra Leone 0.02

5 Norway 4.30 135 Malawi 0.01

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Physician Density

The United States has a physician density of 2.45 per 1,000 population and ranks 49 of the 135 countries provided by the WEF data in our study.

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Annual Global DeathsCauses of Death Per Year

HIV/AIDS 1,100,000

Tuberculosis 1,800,000

Malaria 429,000

Motor vehicle accidents 1,250,000

Job related accident/illness 2,300,000

Armed conflicts 180,000

Terrorism* 28,238

Sources: WHO 2013-15, ILO 2014, IISS Armed Conflict Survey of 2015

*Includes perpetrators

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Deaths of U.S. Citizens Abroad by Non-natural Causes Reported to U.S. State Department abroad Jan. 1, 2014, to Dec. 31,2014

810 total deaths reported (approx. 67,000,000 U.S. citizens traveled/resided abroad in 2014)

Main Non-natural Causes Number of Deaths Abroad Percent of Total

Motor vehicle accidents 225 27.8Homicides 174 21.5Suicide 140 17.3Drowning 106 13.1Other accidents 94 11.6Drug related 27 3.3Air accidents 19 2.3Terrorism 19 2.3Maritime accidents 6 0.8

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Causes of Non-natural Deaths Abroad of U.S. Citizens in 2014

Motor vehicle accidents28%

Homicides22%

Suicide17%

Drowning13%

Other accidents12%

Drug related3%

Air accidents2%

Terrorism2%

Maritime accidents1%

Total 810 deaths

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Deaths of U.S. Citizens Abroad by Non-natural Causes

Source: US Department of Commerce, National Travel and Tourism Office, July 2015

Most Common Causes of Death(October 2002-June 2015)

Cause of DeathReported # of American

Deaths AbroadTraffic Accidents 3,104Homicide 2,000Suicide 1,461Drowning 1,320Other Accidents 1,294

Countries with the Most American Deaths 2014-2015

Country

American Deaths July 2014-June

2015American

Visitors in 2014Mexico 228 25,900,000Thailand 35 339,000Costa Rica 31 862,000Philippines 29 708,000Dominican Republic

28 2,700,000

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U.S. Citizen Non-natural Deaths Abroad

Non-natural Causes of Death Deaths in Mexico Deaths in Canada

July 2007 – June 2011 Jan. – Dec. 2016 July 2007 – June 2011 Jan. – Dec. 2016

Vehicle Accidents 352 78 18 3Homicides 313 73 1 1Drownings 117 38 11 3Other Accidents 80 31 5 1Suicides 75 35 11 1Other 30 3 3 0Drug-related 10 5 2 1

Total 977 263 51 10

Mexico vs. Canada

Source: U.S. State Department

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U.S. Citizen Non-natural Deaths AbroadCountry # of Homicides

July 2007-June 2011

Jan.-Dec. 2016

Mexico 313 73

Honduras 40 6

Philippines 39 8

Dominican Rep

27 4

Guatemala 24 3

Haiti 20 6

Colombia 19 2

Costa Rica 16 3

El Salvador 16 2

Iraq 15 0

Jamaica 12 8

Source: U.S. State Department

Vehicle Accidents July 2007-June 2011

Jan.-Dec. 2016

Mexico 352 78

India 32 5

Dominican Rep 32 6

Thailand 31 11

Suicides July 2007-June 2011

Jan.-Dec. 2016

Mexico 75 35

Thailand 34 11

Germany 34 7

South Korea 30 6

Drownings July 2007-June 2011

Jan.-Dec. 2016

Mexico 117 38

Costa Rica 34 13

Bahamas 27 9

Dominican Rep 18 5

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Natural Causes62%

Accidents25%

Murder7.8%

Suicide5.2%

Major Causes of Traveler Deaths Abroad

Source: MacPherson, J. Travel Med, 2000

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Major Causes of Traveler Deaths Abroad

1 Hargarten SW, Baker TD, Guptill K. June 1991. Medical College of Wisconsin, Milwaukee 2 MacPherson, J. Travel Med, 2000

U.S. Citizens1

Cardiovascular and cerebrovascular (mainly myocardial infarction and stroke/CVA) 49%

Injuries/trauma (mainly traffic accidents) 25%

Canadian Citizens2

Natural deaths 62%

Accidental 24.99%

Murder 7.80%

Suicide 5.20%

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International Homicide Rates (per 100,000 population)

Country Murder Rates Country Murder Rates

Honduras 74.6 Andorra 0.0El Salvador 64.2 Greece 0.1Venezuela 62.0 Cyprus 0.1Jamaica 36.1 Luxembourg 0.2Belize 34.4 Japan 0.3South Africa 33.0 Singapore 0.3Guatemala 31.2 Switzerland 0.5Colombia 27.9 Austria 0.5Trinidad & Tobago 25.9 Indonesia 0.5Brazil 24.6 Norway 0.6Puerto Rico 18.5 Slovenia 0.7Dominican Rep. 17.4 Poland 0.7Mexico 15.7 Spain 0.7

Source: The World Bank 2014

31USA: 3.9

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Homicide Rates (per 100,000 population)Two neighboring cities in 2016

Ciudad Juarez, Mexico: 43.63 El Paso, Texas: 2.77

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Country Guns per 100 people

Total firearm-related deaths per 100,000 population

Japan 0.6 0.06

Australia 15.0 1.04Canada 30.8 2.44Netherlands 3.9 0.46Belgium 17.2 2.43Sweden 31.6 1.47Finland 45.3 3.64Italy 11.9 1.28Switzerland 45.7 3.84United Kingdom 6.2 0.25United States 88.8 10.20

Sources: The American Journal of Medicine, “Gun Ownership and Firearm-related Deaths,” October 2013.

U.S. National Vital Statistics: 33,594 total firearm deaths in USA in 2014.

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Occupational Accident Fatality Rate (per 100,000 workers)

Country Rate Country RateUnited Kingdom 0.8 Vietnam 27.0

Netherlands 1.5 Bangladesh 26.4

France 3.0 Egypt 24.0

Australia 3.2 Philippines 20.0

Japan 3.2 South Africa 19.2

Germany 3.6 Malaysia 18.3

United States 5.2 Mexico 15.9

Canada 6.4 U.A.E. 15.9

Italy 6.9 India 11.5

Poland 10.0 China 10.5

Source: Global Estimates of Accidents. Tampere University of Technology (Finland) 2005

2015: USA 3.4 4,836 total fatalities: 93% male, 7% female Hours worked: male 57%, female 43% Source: U.S. Bureau of Labor Statistics 2015

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Worldwide, there are 2.3 million annual job-related deaths.

Work accidents are more prevalent in developing countries with dangerous construction, farming, mining, factory jobs and low safety standards

Developing countries’ occupational ill health risks are 10-20 times greaterthan those of developed countries

There were an estimated 58,200 workplace fatalities in China in 2013

Occupational Mortality

Source: International Labour Organization, 2014and The Rand Corporation, 2016

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GDP per capita on a purchasing power parity basis was found in the CIA’s World Factbook and is an indicator of a country’s wealth, as well as the standard of living of its citizens.

Economic Factors – GDP per Capita

GDP – Top 5 countries GDP – Bottom 5 countries Qatar $129,700 Somalia $400

Monaco $115,700 Central African Rep $700

Luxembourg $102,000 Burundi $800

Macau $96,100 Congo, D.R. $800

Singapore $87,100 Liberia $900

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Economic Factors – GDP per Capita

The per capita GDP in the U.S.A. is $57,300, which is a rank of 20 of the 203 countries.

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The data for the Gini index as of 2013 is included in the CIA’s World Factbook. “The Gini index measures the degree of inequality in the distribution of family income in a country.” The index ranges from 0 to 100, with 0 indicating perfect income equality among households in a country and 100 is perfect inequality. Therefore, the higher the Gini index, the more income disparity there is within a country.

Gini Index – Income Distribution Inequality

Gini Index – top 5 countries Gini Index– bottom 5 countries

1 Slovenia 23.7 141 C. African Rep. 61.3

2 Ukraine 24.6 142 South Africa 62.93 Denmark 24.8 143 Sierra Leone 63.04 Sweden 24.9 144 Botswana 62.55 Czech Republic 24.9 145 Lesotho 63.2

The Gini index is 45 for U.S.A which ranks 102 out of the 145 countries with data, meaning there is a greater difference in income distribution in the U.S. than in the majority of countries in this study

US CEO compensation ratio (S&P 500 companies) compared to rank & file worker: 1950s 20:1 1980 42:1 2013 204:1

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In US from 1979-2007 Top fifth in household income increased share of income by 10% (most going to top 1%), while 80% of households saw their share of income decline 2-3%. US income inequality has been steadily growing. Sources: Congressional Budget Office & Bloomberg

Generally, the Gini index is lowest in the Scandinavian countries in Europe and highest in South America and Africa.

Gini Index – Income Distribution Inequality

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Age of Death (Poor vs. Wealthy Countries)

Source: WHO, 2014

High-Income Countries(Deaths among people age)

70% >70 yrs

29% 15-69

1% 0-14

Low-Income Countries(Deaths among people

age)

20% >70 yrs

40% 15-69

40% 0-14

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Other Foreign Risk Factors

Mongolia has fewer than 2 people per square kilometer.

Population density of Lagos, Nigeria, is 10,000-50,000 per square kilometer.

Population density

Access to medical care

Environment, climate, drought, famine

Legal issues

Natural disaster frequency and severity

Military conflict

Political situation – instability (Bolivia: 193 coups since 1825); foreign relations

Corruption (CPI: least – New Zealand and Denmark; most – Afghanistan and Somalia)

Document and claims fraud

Transparency International Corruption Perception Index 2016

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Access to medications (prescription, nonprescription and non-FDA approved)

Availability of reliable medical records

Quality of medical care, access to new treatments, safety of blood supply

Socioeconomic conditions, hygiene, sanitation

Anti-selection potential

Other Foreign Risk Factors (cont’d.)

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Compounding Foreign Travel Risk

Serious pre-existing medical conditions

Older age

Hazardous avocations and lifestyle concerns

Long-distance travel (“economy class syndrome”): approx. 3x increased risk of venous thrombosis on flights >4 hrs.

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Tourist Injuries in European Union (EU) Approximately 300,000,000 tourists visit EU countries annually

Approximately 3,800 tourists die of injuries annually while visiting the EU

30% of all tourist fatalities are due to injuries

Tourist vs. resident overall injury mortality is 1.70/1,000 vs. 0.37/1,000, representing a 4.6 times greater injury mortality rate for tourists

Injury fatalities peaked in 25- to 44-year-olds and were predominantly among males

Main causes: traffic accidents (2,900), drowning (340) and mountain activities (280)

Source: Bauer R, Kormer C, Sector M; Int J of Injury Control and Safety Promotion, March 2005.

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Thirty years ago, Beijing had few cars. By 2007 it had 3 million cars. 2011, 5 million. Recently has begun banning on high pollution days.

Rapidly growing economies in the Middle East and Southeast Asia have a growing middle class with resulting increase in airborne particulates due to increased public transportation and personal vehicle use, with many thousands of deaths attributed to air pollution.

In 2009 China passed the USA to become the world’s largest new car market and remains #1 as of 2016.

Estimated: >700 fatalities and 45,000 injuries on China’s roads daily, >260,000 fatalities/yr.

Foreign Travel and Residence Risk: Changing World Traffic

Beijing, 1979 Beijing today

Source: WHO

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Road Traffic Mortality (annual number of deaths per 100,000 population)

CountryRoad Traffic

Mortality CountryRoad Traffic

MortalityThailand 36.2 India 16.6Iran 32.1 Mexico 12.3Rwanda 32.1 United States 10.6Dominican Rep 29.3 Canada 6.8Kenya 29.1 Belgium 6.7Saudi Arabia 27.4 Italy 6.1South Africa 25.1 Australia 5.4Belize 24.4 Japan 4.7Brazil 23.4 Germany 4.3Morocco 20.8 Netherlands 3.4Russia 18.9 United Kingdom 2.9China 18.8 Sweden 2.8

Source: WHO, Global Status on Road Safety 2015

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Alcohol related road traffic crashes,Per 100,000 of population

Source: WHO 2012

US 74.0 as of 2008

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Road Traffic Mortality Trends (Developing Countries)

Rush hour can be chaotic in Delhi, India.

Currently there are 1,250,000 fatalities/yr., 50,000,000 injuries/yr.; 90% of the world’s road fatalities occur in low/middle income countries though they only have about half the world’s vehicles

Half of those dying on the world’s roads are “vulnerable users”pedestrians, cyclists and motorcycles

WHO: “Without action, road traffic crashes are predicted to rise to become the 7th leading cause of death by 2030”

49Source: WHO 2004

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Traffic Mortality Statistics and Trends in DevelopedCountries

Country 1979 Fatalities 2002 Fatalities Percent Change

United States 51,093 42,815 -16.20%

Great Britain 6,352 3,431 -46.00%

Canada 5,863 2,936 -49.90%

Australia 3,508 1,715 -51.10%

U.S. ranking has fallen from 1st to 18th over the last 30 years

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With similar percentage improvement as Canada and the U.K., the U.S. could save 7,000 to 10,000 lives per year.

Some reasons U.S. is lagging• Less seat belt use (84% in U.S. vs. 95% in Canada) and less motorcycle helmet

use

• Not all U.S. states have primary seat belt laws

• Crumbling infrastructure, poorly maintained roads and bridges: 26% of U.S. roads and bridges are structurally deficient or obsolete

• Inconsistent enactment and enforcement of laws regarding driving under the influence of alcohol/drugs or distracted driving

Road Traffic Mortality Trends (Developed Countries)

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• More SUVs, pick-up trucks, minivans (rollover danger, and these large vehicles pose considerably more risk to occupants of cars than other cars do)

• Less public transportation available• Ill-considered new laws repealing mandatory helmet use by motorcyclists are guaranteeing

many more deaths and injurieso Only 19 U.S. states and the District of Columbia still require universal motorcycle helmets

for all riderso 47 states required helmets in 1975 when Federal Highway Finance was tied to helmet laws

• In the U.S. a total of 4,693 motorcyclists died in crashes in 2015. Motorcyclist deaths had been declining since the early 1980s but began to increase in 1998 and continued to increase through 2008. Motorcycle deaths accounted for 13 percent of all motor vehicle crash deaths in 2015 and were more than double the number of motorcyclist deaths in 1997.

Road Traffic Mortality Trends (Developed Countries)

53Source: The Association of Americans Resident Overseas, 2011

8.7 million Americans (excluding military) live in 160-plus countries as of 2016 per US State department.

2011 Government Estimate of Overseas Americans by region around the world

The estimated figures, by region, were:

Africa: 171,000East Asia and Pacific: 864,000Europe: 1,612,000Near East: 870,000South Central Asia: 212,000Western Hemisphere: 2,591,000

For a total of 6,320,000

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World’s Top Travel Destinations 2015

Total US Resident trips abroad by year:• 1990 – 44.6M• 2000 – 61.3M• 2009 – 61.4M• 2015 – 74.0M

Country Million Country MillionFrance* 83.7 Turkey 39.8United States 74.8 Germany 33.0Spain 65.0 United Kingdom 32.6China 55.6 Russia 29.8Italy 48.6 Mexico 29.1

* France 2012 results. Source: UNWTO

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U.S. Resident Travel Abroad (Outbound): 2006-2015

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United States Resident Travel Abroad: 2015

International Trade Association – Office of Travel and Tourism Industries

Historical Visitation (Outbound) 2014 vs 2015 – One or More NightsRegion/Country 2014 (000) 2015 (000) % Change

(2015/2014)

TOTAL OUTBOUND 68,185 73,997 9%Mexico 25,882 28,733 11% Canada 11,523 12,475 8% Overseas* 30,780 32,789 7% Europe 10,804 11,378 5%

Caribbean 7,387 7,837 6% Asia 5,694 6,066 7% Central America 2,370 2,590 9% South America 2,278 2,361 4% Middle East 1,724 1,902 10% Africa 893 951 7% Oceania 585 656 12%

*Overseas includes all countries except Canada and Mexico

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Top Destinations of U.S. Residents Traveling Abroad (Outbound) 2014 vs 2015

International Trade Association – Office of Travel and Tourism Industries

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International Processing and Administering Concerns

Where will exams and lab tests be completed?

Foreign language problems

APS time delays, bureaucracy, unavailable, non-existent

The one-paragraph “perfect health” APS

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Passport is proof of citizenship

Place of birth information (U.S. or another country)

Green card, immigrant visa

Non-immigrant visa

No visa or wrong visa

Citizenship and VisasWhy knowing applicant’s citizenship and visa status helps in foreign risk evaluation

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U.S. Resident Documents

1997 – 2010

1977 - 1997Employment Authorization Card

2010 – Current

Historical Green Card

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U.S. Visa and I-94 Form

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U.S. Non-Immigrant Visas

Complete list at U.S. Citizenship and Immigration Services website: USCIS and Non-immigrant Visas

Visa Description

B-1 & B-2 Temporary visitor for business or pleasure

E-1 & E-2 Treaty trader or investor

F-1 Academic Student

H-1B Specialty Occupations

L-1 Intra-company Transferee

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• Travel legislation in California, Colorado, Connecticut, Florida, Illinois, Maryland, Massachusetts, Missouri, New Jersey, New York, Oklahoma, Tennessee and Washington

• Directives issued in Georgia

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Application: place of birth, type of visa, address/residence, foreign travel questions

Foreign Travel Questionnaire: citizenship; visa type; anticipated foreign travel; list of specific countries to be visited; and duration, dates and purpose of travel

Inspection reports, telephone interviews, separate letter describing travel

Official Documents: copy of passport, green card, US visa, EAD, other US government issued documents on residential status

APS medical records (inoculations for travel, illnesses acquired abroad, mention of frequent travel or foreign residence)

Underwriting Foreign RiskKey information sources

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Locations, dates & duration of foreign travel or residence

Medical risk: medical history, applicant’s age, current health

Occupation & work duties abroad, office or field work

Planned activities abroad: any hazardous activities such as mountain/rock climbing, scuba diving, aviation, etc.

Red Flags: financial, lack of candor, conflicting information, substance abuse, unfavorable MVR, other risks

Underwriting Foreign RiskRisk Assessment

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Short duration of foreign travel/residence

Travel is not immediate and not already under way

Only major urban areas visited

Purpose of travel is business, vacation, family visit

Traveler is 18-70 years of age

Life insurance application is for permanent or level term plan

Proposed insured is in good health

Lodging is at a hotel or relative’s home

Country of destination is considered relatively safe

Favorable Underwriting Factors

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Long duration of foreign travel/residence

Anticipated travel is less than 60 days away or already under way

Travel is to rural and remote locations

Purpose of foreign travel/residence is to work as a missionary, journalist (132 deaths in 2009), relief worker, government official, public figure, etc.

Traveler is under 18 or over 70 years old

Application is for annual renewable term or short-term plan

Unfavorable Underwriting Factors

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Amount of coverage requested appears excessive

Engaged in hazardous activities abroad

Quality and type of lodgings are uncertain

Destination is one or more high-risk countries

Traveler has serious pre-existing medical condition

Minimum (one month) premium payment made or selected

Recent immigrant with no available medical records and little or no comprehension of English

Unfavorable Underwriting Factors (cont’d.)

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People residing in the US for less than 12 months prior to applying for life insurance

People residing in the US without an established physician

Older age recent immigrant to US (especially 60 years+)

Extra caution if applicant speaks little or no English

Financial justification is lacking

Grandparents who watch grandchildren and apply for $1M+

People crossing US/Mexican border multiple times/week

Red Flags of International Risk

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There are 25 indicator variables that are included in this analysis as contributors to a country’s overall risk and are used to rank the 205 countries studied.

In the example here, the U.S. would have a rank of 39

RGA 2018 Foreign Risk Study Research Bulletin Country summary

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Country Study Rank Country Study RankMonaco 1 Denmark 20Sweden 2 Belgium 21

Switzerland 3 Hong Kong 22San Marino 4 Canada 23

Austria 5 Korea, South 24Norway 6 Greece 25Iceland 7 United Kingdom 26

Netherlands 8 Malta 27France 9 Ireland 28Japan 10 New Zealand 29

Australia 11 Guadeloupe 30Italy 12 Portugal 31

Luxembourg 13 Czechia 32Spain 14 Cyprus 33

Germany 15 Poland 34Andorra 16 Bermuda 35Finland 17 Slovakia 36

Liechtenstein 18 Slovenia 37Singapore 19 Taiwan 38

RGA Foreign Risk Study Worldwide Country Rankings

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Message to readers of article:

“Before you plan on visiting any of these places, get a life insurance policy.”

Photo of soldier with fire & smoke in background with caption:

• “Travelers are under the ongoing threat of kidnapping and assassination in Afghanistan.”

US Business Magazine Headline:

“Most Dangerous Destinations 2006”

Source: Forbes, Sophia Banay, February 22, 2006

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Countries differ in many significant ways

Long-term foreign residence does matter

Most short-term foreign travel is low risk

A person’s health, age and planned activities abroad are important to consider in regard to foreign travel & residence risk

Foreign risk assessment should be based on relevant data & informed judgment. Avoid sensationalism & overgeneralization

More reliable record keeping and study of foreign risk are needed

Some valuable reference sources for international information follow

Conclusions

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International Information SourcesU.S. State Department Travel Warnings at http://travel.state.gov/travel_warnings.html

U.S. State Department statistics non-natural deaths of US citizens abroad at http://travel.state.gov/family/family_issues/death/death_600.html

British Foreign & Commonwealth Office (Travel Advice) at www.fco.gov.uk

BBC News, Country Profiles, News Services

CNN.com International

Foreign Affairs Canada at www.voyage.gc.ca/consular_home-en.asp

CDC Health Information for international travel at www.cdc.gov/travel

Australian Department of Foreign Affairs & Trade at smartraveller.gov.au or www.dfat.gov.au

USCIS (U.S. visa information)

WHO (World Health Organization)

United Nations Human Development Reports

CIA World Factbook

www.rgare.com/underwritingconnection

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Case 1 U.S. citizen, 35-year-old female who travels to Guatemala to volunteer as a nurse. Her stay is 1-3 weeks annually. She does not expect to visit non-urban areas.

Case 2 A 79-year-old male U.S. citizen applying for $750,000. Next month he is going on his honeymoon to Paris, France, for one week and then going on a safari trip in Kenya and Tanzania for two weeks.

Case 3 A 54-year-old male U.S. citizen seeking $1 million. He is an engineer with a multinational petroleum company. He is working and residing in Angola and travels back to the U.S. at least three times a year for visits.

Case 4 Male, age 56, Venezuelan citizen, seeking $2 million. He currently resides in Guyana, where the business he owns is located.

Case 5 Missionary living in Honduras, 41-year-old male. He makes two to three trips back to the States each year. He is a U.S. citizen and a resident of Honduras.

Case Studies

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Case 6 $2 million of permanent coverage requested a 48 year old physician, born in Mexico. who is a U.S. permanent resident living in El Paso, Texas. She travels daily to Ciudad Juarez, Mexico where her office is located.

Case 7 A 29 year old male citizen of Brazil who came to USA on a student visa when he was 16 and over-stayed his visa. Working as a building contractor in the USA and has no plans to ever return to Brazil.

Case 8 Citizen/resident of Peru seeking $2 million coverage. Male, age 44, non-smoker, has congenital non-obstructive hypertrophic cardiomyopathy. He has regular check-ups with his cardiologist in Peru.

Case 9 $400,000 application on a U.S.-born 3-month-old baby girl who will be going to China to live with her grandparents for one year. Mother has $600,000 of coverage, father has $500,000 of coverage.

Case Studies

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Case 10 A 66-year-old U.S. citizen seeking $2 million of coverage. Travels to Haiti with his church group every year to build water wells. He stays five to six days per trip.

Case 11 A 44-year-old female U.S. citizen seeks $250,000 term coverage. Retired and receiving disability due to a back injury. Income is from pension, Social Security disability and adoption stipend. Taking no medications. Plans two-week vacation to Liberia (Africa) in December.

Case 12 Female, age 51, U.S. citizen, has signed up for one of the first flights by Virgin Atlantic to go into outer space. The timing of this event is unknown and will occur in the future. Seeking $10 million of coverage.

Case Studies

78Thank you for your attention. Any questions?

“We shall not cease from exploration and the end of all our exploring will be to arrive where we started…and know the place for the first time.” T.S. Eliot

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