ReFlections is RGA’s medical underwriting newsletter, written by RGA experts. It presents underwriters and medical directors with timely, in-depth information to assist with underwriting issues. With ReFlections, RGA hopes to identify trends in mortality and morbidity that could impact your interpretation of medical information.

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2013 Editions

Summer 2013 (PDF) 

 Spring 2013 (PDF)

ReFlections Archive


  • Functional Impairments in South Africa
  • The risk of resurgence of infectious diseases such as tuberculosis
  • An actuarial viewpoint on predictive modeling
  • Electronic Health Records – the Direct Project

Fall 2012 (PDF)

  • Impact of increasingly complex predictive models
  • Mortality impact from the use of opioids
  • Functional MRIs and how they can be used to evaluate various medical conditions
  • Developments in Electronic Medical Records

  • Bariatric surgery and the issues related to post-surgical mortality
  • Introductory articles on Electronic Medical Records (EMR) and Predictive Modeling

Fall 2011 (PDF)

  • Advances in cancer
  • Insights on heart failure

 Spring 2011 (PDF)

  • Edema: What is it, and why is it important?
  • Age and amount requirements - prevalence and mortality
Fall 2010 (PDF)
  • Melanoma of the skin and changes in the staging protocol for skin cancer
  • Benefits and challenges of the PSA screening test for prostate cancer
  • Weighing-in on obesity (Part 2)
  • Prostate cancer statistics, risk factors and the histological grading of prostate cancer differentiation
  • Viral Hepatitis B and C — natural history, immune reactions and common progression to end-stage liver disease
  • MRSA and its impact on underwriting and mortality 
  • Sleep and sleep apnea
  • Pharmacy check utilization  
Fall 2008 (PDF)
  • Underwriting coronary artery
  •  Revascularization procedures 
  • Old-age underwriting 
  • The value of screening for cognitive function in the elderly 


Available Translations

Summer 2012: Japanese (PDF)

Fall 2011: Japanese (PDF)

Fall 2011: Spanish (PDF)

Spring 2011: French (PDF)

Spring 2011: Spanish (PDF)

Fall 2010: French (PDF)

Fall 2010: Spanish (PDF)

Spring 2009: Spanish (PDF)

Spring 2009: Korean (PDF)

Winter 2009: French (PDF)


J. Carl Holowaty M.D., D.B.I.M. 
Senior Vice President,
Chief Medical Director
T 636.736.7395