New research by RGA and the University of Leicester, published in the Journal of Insurance Medicine, explores how resting heart rate (RHR), a simple and non-invasive measure, can replace or strengthen lipid criteria in preferred underwriting. The insights give insurers the flexibility to shape preferred criteria around their own strategy, products, and available evidence, without compromising mortality experience.
Three ways RHR could be used in preferred underwriting:
Bottom line: All three approaches matched or beat the mortality experience of conventional lipid-based criteria, making the choice of lever a business decision, not a mortality trade-off.
Every preferred underwriting program faces the same trade-off: More evidence can mean sharper mortality selection but also more cost, more time, and more friction for applicants.
Lipid testing sits right at that pressure point: While clinically valuable, it usually requires a blood sample and lab work. Resting heart rate (RHR), meanwhile, is also clinically valuable, but without the blood draw. It is non-invasive, inexpensive, and increasingly captured through medical exams, electronic health records, and wearables.
As we outlined in Resting Heart Rate: The heart of underwriting decisions, RHR is a powerful, independent predictor of mortality, and RGA is already building it into tools such as ASAP Infinity. For insurers, a key question is whether RHR can improve preferred underwriting decisions. Our new research with the University of Leicester answers that question directly. The study was recently published in the Journal of Insurance Medicine, the official journal of the American Academy of Insurance Medicine (AAIM) and the premier peer-reviewed, MEDLINE-indexed journal in insurance medicine, read by insurance medical directors and underwriters worldwide.
The research team used data from more than 430,000 UK Biobank participants to explore how RHR could be used in preferred underwriting, evaluating results as insurers would: actual-to-expected mortality against insured lives tables. The results pointed to three potential applications:
The message for insurers is clear: RHR is not just a mortality marker but a practical underwriting lever.
Our earlier work published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes showed that simple physical measures, including RHR, can supplement, and even replace, traditional risk factors in mortality prediction. This study takes the next step: from prediction to preferred underwriting practice.
While lipids remain clinically important, insurers now have peer-reviewed, insurer-focused evidence to rethink how preferred classes are built.
Read the full paper in the Journal of Insurance Medicine and contact RGA to explore what RHR could mean for your preferred underwriting program.
Important note: UK Biobank data was provided only to the academic research team at the University of Leicester. RGA does not have access to UK Biobank data.
