How Reinsurers Evaluate Digital Health Underwriting Programs

Reinsurers have spent the past three years figuring out what to do about digital health underwriting. The carriers they back are rapidly adopting accelerated underwriting programs that swap paramedical exams for electronic health records, prescription histories, and medical claims data. That creates a problem for reinsurers: the mortality assumptions underlying existing treaties were built on decades of traditional full underwriting evidence. When a carrier says "we're dropping the lab panel for applicants under 50," the reinsurer needs to know what that actually means for expected claims.

"All three digital underwriting evidence sources demonstrated significant value, both individually and in combination. EHR exhibited the largest single evidence mortality impact." — RGA, "Assessing Mortality Impact of Digital Underwriting Evidence" (2025)

How reinsurers measure mortality slippage in digital programs

Mortality slippage is the central question. When an insurer replaces traditional underwriting with an accelerated program using digital data, some applicants who would have been rated or declined under the old process will slip through at standard rates. Reinsurers need to estimate how much slippage occurs and whether the digital evidence sources compensate for the missing lab work.

RGA published a study in 2025 that laid out three methodologies for measuring this. The first is a true mortality experience study — a longitudinal analysis comparing actual death rates across underwriting classes. This gives the most reliable answer but takes years of exposure across tens of thousands of policies, making it expensive and slow. Most carriers don't have enough accelerated underwriting volume yet to run one with statistical credibility.

The second and third methods use underwriting decisions as mortality surrogates. RGA's approach assigns relative risk values to each underwriting class (standard, preferred, substandard, decline), then sums those values across a block of cases. The mortality impact of digital evidence is estimated by comparing the summed relative risk of cases underwritten with digital data against those underwritten without it. RGA's study found that combining electronic health records, LabPiQture, and medical claims produced a larger reduction in mortality slippage than any single source alone.

The practical implication for reinsurers: they're not just asking "did you add EHR?" They're asking which combination of sources you're using, how they interact with your existing triage rules, and what your decision rate looks like before and after.

What reinsurers actually look at during program reviews

The evaluation process goes well beyond reading a program summary. Reinsurers run their own analyses, request raw data, and sometimes embed their underwriters in the carrier's workflow for parallel reviews.

Evaluation area	What the reinsurer wants to see	Red flags
Data source coverage	Hit rates for EHR, Rx, claims across the applicant pool	Low EHR hit rates without compensating sources
Decision rate	Percentage of cases decisioned without human review	Decision rate dropping significantly with new data sources
Mortality slippage estimate	Holdout study or parallel FUW comparison results	No slippage monitoring program in place
Automation rules	Triage logic, auto-accept/decline thresholds	Black-box models with no explainability
Post-issue auditing	Random holdout programs, post-issue APS or EHR pulls	No post-issue controls
Eligibility limits	Max face amount and age bands for the accelerated path	Face amounts over $2M without banded age restrictions
Throughput rates	What percentage of applicants actually go through AUW vs. FUW	Very high acceleration rates with limited data sources

Gen Re's 2024 U.S. Individual Life Accelerated Underwriting Survey, which included 38 carriers, found that 63% use random holdouts as a control measure and 56% estimate mortality slippage through those holdouts. Reinsurers pay close attention to whether a carrier has any slippage monitoring at all. A program without post-issue auditing is a program the reinsurer can't price with confidence.

The three digital evidence sources reinsurers care about most

Electronic health records

EHR data pulls structured clinical information directly from provider systems: diagnosed conditions, lab results, vital signs, medications, and visit histories. In RGA's 2025 study, EHR showed the largest single-source mortality impact among the three digital evidence types tested. It also increased decision rates, meaning more cases could be resolved without ordering additional evidence.

The catch is availability. EHR hit rates vary significantly by region, age group, and the vendor's network reach. LexisNexis Health Intelligence, which acquired Human API's health data platform in early 2025, now provides formatted EHR summaries specifically designed for underwriting. But a reinsurer will still want to see the carrier's actual hit rate data, not just the vendor's marketing numbers.

Prescription drug histories

Rx data has been part of accelerated underwriting since the beginning. It's structured, widely available through pharmacy benefit manager databases, and correlates strongly with specific conditions. An applicant on metformin likely has diabetes. Statins suggest cardiovascular risk factors. The data is consistent and relatively easy to automate around.

Munich Re's 2024 survey confirmed that prescription data, motor vehicle reports, and MIB checks remain the "staple AUW tools" used by virtually every program. Rx data is table stakes at this point — a reinsurer won't take seriously any accelerated program that doesn't include it.

Medical claims data

Claims data captures billing records from healthcare encounters: procedure codes, diagnosis codes, provider types. It offers a broader view of healthcare utilization than EHR alone, though it lacks the clinical depth of actual medical records. Its value is in filling gaps — catching conditions that might not appear in the EHR if the applicant uses out-of-network providers or hasn't had a recent doctor visit.

How treaty pricing adjusts for digital underwriting

Reinsurers don't just evaluate a program once and walk away. Treaty terms evolve as mortality experience develops. Here's what typically happens.

In the early stages, the reinsurer may require a mortality load — an explicit pricing adjustment to account for uncertainty around the new underwriting approach. This load might range from a few percent to 10% or more, depending on the program's maturity and the reinsurer's comfort level.

As experience accumulates, the reinsurer will want to see periodic reviews. These usually happen annually or at treaty renewal. The carrier presents updated slippage estimates, post-issue audit results, and any changes to eligibility limits or data sources. If the experience is tracking well, the mortality load comes down. If not, it goes up or the reinsurer may push for program changes.

Munich Re's survey data showed that average maximum face amounts for accelerated programs have climbed to $2.5 million as of 2024, up significantly from earlier surveys. This expansion hasn't been arbitrary. Carriers often test higher face amounts by using banded age-and-amount structures, limiting the highest face amounts to younger issue ages. One-third of programs in Munich Re's survey use this approach. Reinsurers generally view banding as a reasonable risk management technique, especially when paired with additional digital evidence requirements at higher face amounts.

Contactless biometric screening and what reinsurers think about it

Remote photoplethysmography — camera-based vital sign measurement using a smartphone — is newer to the underwriting evidence landscape. It captures heart rate, respiratory rate, and blood pressure indicators without any physical equipment.

Reinsurers are watching this space with interest but haven't fully incorporated it into their evaluation frameworks yet. The appeal is obvious: it generates real-time physiological data during the application process, filling a gap that EHR, Rx, and claims data can't address. Those sources tell you about past healthcare interactions. A camera-based scan tells you something about the applicant's current state.

The evaluation criteria reinsurers are likely to apply follow the same pattern as other digital evidence sources. They'll want to see hit rates (what percentage of applicants successfully complete a scan), concordance studies (how the readings compare to clinical measurements), and eventually mortality experience data. Companies like Circadify, which has developed contactless vital sign measurement via rPPG, are working to bring this capability into the underwriting workflow. Whether reinsurers give it mortality credit in treaty pricing will depend on the same kind of evidence they demanded for EHR and claims data — just with a shorter track record to work from.

Current research and evidence

The body of published research on digital underwriting evidence and mortality outcomes is growing, though still limited compared to the decades of data behind traditional underwriting.

RGA's 2025 study on digital underwriting evidence remains the most comprehensive published analysis. The study used data from two different carrier blocks and tested seven combinations of digital evidence sources against full underwriting decisions. The methodology — using a modified version of the full underwriting surrogate approach while presenting results as a range — has become something of a reference framework for the industry.

Gen Re has conducted its accelerated underwriting survey annually, with the 2024 edition covering 38 participating carriers. The survey tracks throughput rates, evidence sources, mortality experience, and auditing practices. While detailed results are only shared with participants, the published summaries provide useful benchmarks for the industry.

Munich Re's biennial survey, now in its fourth edition as of fall 2024 with 27 participating companies, focuses on eligibility trends, tool adoption, and program evolution. Their finding that the AUW landscape has "begun to stabilize" — with expansion mainly in eligibility limits and digital health data usage — suggests the industry is past the experimental phase and into refinement.

The Society of Actuaries has also been active in this space, sponsoring research into predictive models that use digital health data for mortality estimation. Several working groups are developing best practices for incorporating non-traditional data sources into actuarial assumptions.

The future of reinsurer evaluation

The evaluation framework is going to get more quantitative. Right now, a lot of the assessment happens through manual program reviews and expert judgment. As more carriers accumulate actual mortality experience on their accelerated blocks, reinsurers will shift toward data-driven assessments.

Two trends will accelerate this. First, the major reinsurers are building their own digital underwriting platforms. Munich Re's REALYTIX ZERO and Hannover Re's hr|ReFlex both offer automated underwriting tools to their ceding companies. When the reinsurer provides the underwriting engine, they have direct visibility into how cases are being triaged and decisioned. That changes the evaluation dynamic — instead of reviewing a carrier's program after the fact, the reinsurer is involved in the rules from the start.

Second, the data sources themselves are getting richer. As EHR networks expand, as prescription databases add more granular information, and as newer sources like contactless biometric screening mature, the evidence available at point of sale will increasingly resemble what a paramedical exam used to provide. Reinsurers who can accurately price that shift will have a competitive advantage in the treaty market.

For carriers building or expanding their digital underwriting programs, the takeaway is straightforward: think about the reinsurer evaluation from day one. Build in holdout studies. Track your slippage metrics. Document your data source hit rates and decision logic. The carriers that make the reinsurer's job easier tend to get better treaty terms.

Frequently asked questions

What is mortality slippage and why do reinsurers care about it?

Mortality slippage is the difference in expected mortality between applicants underwritten through an accelerated program versus traditional full underwriting. If the accelerated program accepts some applicants at standard rates who would have been rated or declined under the traditional process, that's slippage. Reinsurers care because their pricing depends on accurate mortality assumptions — slippage that isn't accounted for erodes profitability.

Which digital evidence source has the biggest impact on mortality?

According to RGA's 2025 study, electronic health records showed the largest single-source impact on mortality slippage reduction. However, the study also found that combining multiple sources (EHR plus medical claims plus LabPiQture) produced better results than any individual source. Most reinsurers prefer to see carriers using multiple digital evidence sources rather than relying on just one.

How often do reinsurers review a carrier's accelerated underwriting program?

Reviews typically happen at treaty renewal, which is usually annual. However, significant program changes — like expanding eligibility limits, adding new data sources, or changing triage rules — may trigger an interim review. Reinsurers also expect ongoing reporting of post-issue audit results and slippage monitoring data between formal reviews.

Do reinsurers charge more for accelerated underwriting programs?

Generally, yes — at least initially. Most reinsurers apply some form of mortality load to account for the additional uncertainty in a newer underwriting approach. The size of the load depends on the program's maturity, the evidence sources used, the monitoring controls in place, and the reinsurer's own analysis. As favorable experience accumulates, these loads typically decrease over subsequent treaty renewals.