The Right to Be Forgotten (RTBF) grants cancer survivors the right to not disclose their prior cancer history when applying for life insurance. Introduced by the European Commission in 2021, following the publication of “Europe’s Beating Cancer Plan,” this legislation has already been adopted by several European countries and is now gaining momentum. As more and more countries adopt RTBF, the implications for life insurers are far reaching.
In this Quick Read, Cillian Tierney, Head of Medical Underwriting Propositions and Products at PartnerRe, shares insights and takeaways from his recent discussion on RTBF at the annual industry conference of the Association of Home Office Underwriters (AHOU).
Over the past 30 years, the number of cancer survivors has significantly increased, now making up around 5% of the population in several countries. This rise is driven by an increase in new diagnoses (due to ageing populations and lifestyle factors) and improved survival rates through better screening, earlier diagnosis and advanced treatment protocols.
In 2020, there were approximately 20 million cancer survivors in Europe.1 About one-third of these individuals are of working age, making them potential candidates for life and health insurance.
The RTBF aims to ensure that former cancer patients who have successfully overcome their illness do not face difficulties in obtaining insurance. This includes prohibiting insurers from considering medical information on cancers that occurred more than a defined period ago (usually 5 or 10 years) in premium calculations. Countries have applied RTBF differently as it relates to certain types of life insurance with restrictions on maximum sums assured and age ranges. Portugal, for example, applies it to death benefits and income replacement coverage.
As shown in Figure 1, different countries have implemented the RTBF with varying periods.
Status of RTBF Implementation in Europe
| Country | Year | Products(s) | Duration Since | Condition(s) | Max Sum | |
| France | 2019 | Mortgage Protection & Business Loans |
5 years (Down from 10 in 2022) |
Cancer & Hepatitis C (2022) |
≤€420k | |
| Belgium | 2020 | Mortgage Protection & Since 2022: Income Insurance |
8 years (Down from 10 in 2022) |
Cancer | N/A | |
| Luxemburg | 2020 | Mortgage Protection | 10 years | Cancer (10 types) & Hepatitis C |
≤€1m | |
| The Netherlands | 2021 | Life & Funeral |
10 years | Cancer & Hepatitis C (2022) |
N/A | |
| Portugal | 2021 | Mortgage & Consumer credit |
10 years | Cancer | N/A | |
| Ireland | 2022 | Mortgage Protection | 7 years | Cancer | ≤€1m |
Figure 1: Source: Europe’s Beating Cancer Plan, European Commission
In the realms of risk assessment and data utilization, RTBF involves potential to significantly disrupt the traditional underwriting model, posing challenges for insurers who rely on comprehensive data analysis to accurately determine premiums. Without the ability to consider past cancer diagnoses, insurers may struggle to evaluate the true risk of applicants, leading to potential underestimation or overestimation of premiums. As a result, insurers may need to adjust their data mining processes, application forms and underwriting rules to comply with RTBF, which could lead to increased operational complexities and costs.
In response to these challenges, the insurance industry may need to develop new strategies for underwriting and pricing.
One potential adaptation is the exclusion of family history of hereditary cancers from risk assessments, aligning with RTBF’s requirements but potentially reducing the accuracy of risk evaluations.
A further consideration might arise in terms of adjustment of premium structures, especially for substandard policies, to reflect the limited data available under RTBF. This could result in higher premiums for all policyholders or the need for retrospective policy reviews, where policyholders request adjustments based on RTBF provisions.
Ultimately, insurers will need to carefully manage their portfolios to secure optimum understanding of the long-term risks associated with cancer survivors, t in circumstances where traditional risk-based underwriting may no longer apply.
Survival rates after a cancer diagnosis vary based on factors like age, cancer type, stage and treatment protocol. Some cancers, such as testicular and thyroid, have a short time-to-cure and are suitable for early RTBF consideration. Others, like lung and certain breast cancers, have longer time-to-cure periods, often over 10 years, posing ongoing risks for insurers.
While treatments are improving, survivors may still experience long-term health issues, complicating risk assessments under RTBF. Consistent RTBF application requires clear definitions of “cancer” and “end of treatment,” and an informed approach to excluding ongoing preventive medications.
RTBF legislation decouples insurance pricing from actual risk. Its effectiveness remains unclear due to limited data, complicating long-term market impact assessments. Cross-subsidization may be needed to balance increased risks.
RTBF could impact the availability and pricing of insurance products, especially if extended to Critical Illness and Income Replacement insurance. Potential premium increases might lead to affordability issues, limiting consumer access to necessary insurance products.
Insurers in other markets should closely monitor the legislation, as it can present significant challenges. In the US, state and federal privacy law can impact these types of initiatives, and although RTBF has not been adopted in the US, there are some states that have certain privacy laws in place which may be of relevance. Legislation from your region should be reviewed if such an initiative is being discussed or implemented.
Legislative and regulatory changes, driven by interest groups aiming to prevent discrimination, can inadvertently limit consumer access to coverage. To address these challenges, insurers must engage proactively with regulators and interest groups, ensuring they have a voice in discussions. Most life insurance companies in the United States are part of the American Council of Life Insurers (ACLI), which represents them in state, federal and international forums for public policy. Life insurance companies are aware of RTBF’s potential impacts and are discussing how to implement it to support cancer survivors while maintaining financial sustainability and balancing consumer accessibility with accurate risk assessment.
The RTBF landscape is continually evolving, requiring insurers to navigate new challenges and opportunities. Active engagement with regulatory bodies remains essential to influence policy decisions and ensure that legislative changes strike a balance between consumer protection and industry stability.
As an international reinsurer, we continuously monitor local market legislation across geographies and share our insights on its impacts with insurers, while our pricing experts assess the effects across our clients’ product portfolios.
Find out more about Medical Underwriting solutions at PartnerRe.
Contributor
Cillian Tierney, Head of Medical Underwriting Propositions and Products, Life & Health
References
[1] https://pubmed.ncbi.nlm.nih.gov/38307102/