April 28, 2015

Foreign Travel & Residence Risk Glen Preston FALU, FLMIDirector Underwriting RGA Reinsurance Company

2

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

St. Augustine

Historical Growth of World Travel

Source: UNWTO

1950: 25 million 2005: 808 million 2012: 1.035 billion

Annual growth: 6.5% Forecast for 2020: 1.6 billion 3

Foreign risk is sensationalized in 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

4

5

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?

Source: CIA World Fact book 2013 est.50 – USA: 78.62 years

Life Expectancy at Birth

6

High Years Low Years

Monaco 89.63 Chad 49.07

Japan 84.43 South Africa 49.48

Singapore 84.07 Guinea-Bissau 49.50

Switzerland 82.28 Swaziland 50.01

Hong Kong 82.20 Afghanistan 50.11

Australia 81.98 Central African R. 50.90

Italy 81.95 Somalia 51.19

Canada 81.57 Zambia 51.51

France 81.56 Namibia 52.03

Spain 81.37 Gabon 52.15

Sweden 81.28 Mozambique 52.29

Netherlands 81.01 Nigeria 52.46

New Zealand 80.82 Malawi 52.78

Germany 80.32 Zimbabwe 53.86

United Kingdom 80.29 Uganda 53.98

From Wikipedia, the free encyclopediaLife_Expectancy_2009_Estimates_CIA_World_Factbook

Geography of Life Expectancy

7

HIV/AIDS Adult Prevalence Rate

Source: CIA World Fact book 20098

Country Percent Country Percent

Swaziland 25.90 United States 0.60

Botswana 24.80 Canada 0.30

Lesotho 23.60 Mexico 0.30

South Africa 17.80 United Kingdom 0.20

Zimbabwe 14.30 Australia 0.10

Zambia 13.50 Germany 0.10

Namibia 13.10 Japan 0.10

Mozambique 11.50 Korea, South 0.10

Malawi 11.00 Poland 0.10

9

WHO World Health Systems’ Ranking

Sources: WHO World Health Report June 2000; World Economic Forum 2013

10

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

Physicians/1,000 population –top 5 countries

Physicians/1,000 population –bottom 5 countries

1 Greece  6.17 135 Rwanda  0.022 Austria  4.85 136 Ethiopia  0.023 Georgia  4.76 137 Malawi  0.024 Russia 4.31 138 Sierra L. 0.025 Norway  4.16 139 Tanzania  0.01

Physician Density 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 dataavailable is as of 2010.

The United States physician density is 2.42 per 1,000 population and ranks 48 of the 139 countries in WEF study. (Greece has 617 physicians per 100,000 people while Tanzania has only 1 physician per 100,000 people)

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

Source: CIA World Fact book 2013 est.

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

USA 5.90 (50th) 12

Country Deaths Country Deaths

Estonia 2.0 Chad 1100

Greece 3.0 Somalia 1000

Singapore 3.0 Sierra Leone 890

Austria 4.0 Liberia 770

Italy 4.0 Sudan 730

Sweden 4.0 Nigeria 630

Poland 5.0 Afghanistan 460

Australia 7.0 Canada 12.0 USA 21.0 Source: CIA 2010

Country Deaths Country Deaths

Monaco 1.81 Afghanistan 119.4Japan 2.17 Mali 106.5

Sweden 2.73 Somalia 101.9

Canada 4.78 Nigeria 73.0

International Homicide Rates (per 100,000 population)

Country Murder Rates Country Murder Rates

Honduras 82.1 India 3.4El Salvador 66.0 Turkey 3.3Ivory Coast 56.9 Canada 1.8Jamaica 52.1 France 1.4Venezuela 49.0 Australia 1.2

Guatemala 41.4 United Kingdom 1.2

South Africa 33.8 Italy 1.0Colombia 33.4 Sweden 1.0Dominican Rep. 24.9 Spain 0.9Brazil 22.7 Germany 0.8Mexico 18.1 Austria 0.5Russia 11.2 Japan 0.5USA 4.7 Iceland 0.3

Source: United Nations –Global Study on Homicide 2011

13

14

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: 31,672 total firearm deaths in USA in 2010.

15

Homicide Rates (per 100,000 population)

Two neighboring cities in 2010

Ciudad Juarez, Mexico: 272 El Paso, Texas: 0.8

Tuberculosis (TB) Prevalence(Selected Countries - cases per 100,000 population)

Source: 2011 WHO 16

Countries TB Prevalence Countries TB Prevalence

Sierra Leone 1,372 South Korea 149

Marshall Islands 924 Malaysia 101

Cambodia 817 Mexico 28

South Africa 768 Japan 26

Mauritania 686 United Kingdom 19

Laos 540 Australia 7.6

Philippines 484 Canada 5.6

Haiti 307 United States 4.7

India 249 Italy 3.5

17

Hepatitis B Prevalence (percent of population)

Source: 2003 WHO & National Centers for Disease Control & Prevention 199918

Country Hepatitis B Prevalence Country Hepatitis B

PrevalencePapua 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

Hepatitis B Prevalence

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

Pre-core mutant virus:50% - 60% of Asian HBV carriers27% of North American HBV carriers

19

Source: 1999 WHO

Hepatitis C Prevalence (selected countries percent of population)

20

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

Global Smoking Prevalence

*Source: OECD Health Data, 2011**Source: CDC 21

U.S.: 46% in 1964*

18% of U.S. adults were smokers in 2012**

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

2011: USA 3.5 4,693 total fatalities: 91.8% male, 8.2% female Hours worked: male 57%, female 43% Source: U.S. Bureau of Labor Statistics 2011 22

Worldwide, 1.1 to 2.2 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 greater than developed countries

136,340 workplace fatalities in China in 2003

Occupational Mortality

23Source: International Labour Organization

Infectious and Parasitic Disease Mortality

Country Death rate per 100,000 population

Total 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 24

Annual Global Deaths

25

Causes of Death Per Year

HIV/AIDS 2,900,000

Tuberculosis 1,693,000

Armed conflicts 1,341,000

Motor vehicle accidents 1,200,000

Job related accident/illness 1,100,000

Malaria 1,000,000

Terrorism * 491

Sources: WHO/UN and International Terrorism, “A Longitudinal Statistical Analysis”, Aug 2004, University of Gent-Belgium (1974-2003 yearly average)* 1,284 yearly average 1970-2009 Rand MIPT

GDP – top 5 countries GDP – bottom 5 countries 1 Qatar $102,800 199 Liberia $700

2 Liechtenstein $89,400 200 Burundi $600

3 Bermuda $86,000 201 Somalia $600

4 Luxembourg $80,700 202 Zimbabwe $500

5 Monaco $70,700 203 Congo, D.R. $400

Economic Factors - GDP per Capita 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. This data is generally as of 2012 and is available for 203 countries in the Foreign Risk Study.

The per capita GDP in the U.S.A. is $49,800, which is a rank of 11 of the 203 countries.

Gini Index – top 5 countries Gini Index– bottom 5 countries1 Sweden 23.0 131 C. African Rep. 61.32 Slovenia 23.8 132 Sierra Leone 62.93 Montenegro 24.3 133 Botswana 63.04 Hungary 24.7 134 South Africa 63.15 Denmark 24.8 135 Lesotho 63.2

Gini Index – Income Distribution InequalityThe data for the Gini index as of 2011 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.

The Gini index 45 in US ranks of 95 of the 135 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. Generally, the Gini index is lowest in Scandinavia & other countries in Europe and highest in South America and Africa. Gini index has high correlation with a nation’s public health, life expectancy, crime rates, social cohesion vs unrest.

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

Fact sheet N° 310 / February 2007

WHO Fact sheet 2008

High-Income Countries(Deaths among people age)

71% >70 yrs

28% 15-69

1% 0-14

Low-Income Countries(Deaths among people age)

17% >70 yrs

43% 15-69

40% 0-14

Age of Death (Poor vs. Wealthy Countries)

29

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

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

Other Foreign Risk Factors (cont’d.)

Anti-selection potential31

Thirty years ago, Beijing had few cars. By 2007 it had 3 million cars. China has 16 out of 20 of the world’s most polluted cities, with many

thousands of deaths attributed to air pollution. In 2009 China passed the USA to become the world’s largest new car

market. Estimated: 600 fatalities and 45,000 injuries on China’s roads daily, >220,000

fatalities/yr.

Foreign Travel and Residence Risk: Changing World Traffic

Beijing, 1979 Beijing today

Source: WHO

32

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

33

Country Road Traffic Mortality

Country Road Traffic Mortality

Dominican Rep 41.7 United States 11.4

Thailand 38.1 New Zealand 9.1

Venezuela 37.2 Italy 7.2

Nigeria 33.7 Canada 6.8

South Africa 31.9 France 6.4

Saudi Arabia 24.8 Australia 6.1

Brazil 22.5 Spain 5.4

China 20.5 Japan 5.2

India 18.9 Germany 4.7

Russia 18.6 Netherlands 3.9

Mexico 14.7 United Kingdom 3.7

South Korea 14.1 Sweden 3.0

Source: WHO, Global Status on Road Safety 2013

Currently there are 1,200,000 fatalities/yr., 50,000,000 injuries/yr.; estimated to increase 80% in developing countries and decrease 30% in developed countries by 2020

In 2008 India had118,000 traffic fatalities – up 40% in five years

WHO: “The tragedy behind these figures [world traffic fatalities] attracts less mass media attention than less frequent types of tragedy.”

Road Traffic Mortality Trends (Developing Countries)

Rush hour can be chaotic in Delhi, India.

34

Source: WHO 2004

Traffic Mortality Statistics and Trends in Developed Countries

U.S. ranking has fallen from 1st to 10th over the last 30 years

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%

36

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)

37

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 injuries Only 20 U.S. states still require motorcycle helmets for all riders 47 states required helmets in 1975 when Federal Highway Finance

was tied to helmet laws U.S. motorcycle deaths increased 111% in 12 years, from 2,116 in 1997

to 4,462 in 2009 (jumped from 5% to 13.2% of total traffic fatalities) Possible improvements: universal seat belt use, less cell phone

use/texting while driving, strict enforcement of drunk driving laws, better designed/maintained roads and bridges, safer cars, less fatigued drivers, mandatory motorcycle helmet use, stronger SUV roofs, more public transportation, better driver education and training

Road Traffic Mortality Trends (Developed Countries)

38

Source: The Association of Americans Resident Overseas, 2006 39

1990- 44.6M 1995- 50.8M 2000- 61.3M 2009- 61.4

Country Million Country MillionFrance * 83.0 Turkey 37.8United States 69.8 Germany 31.5Spain 60.7 United Kingdom 31.2China 55.7 Russia 28.4Italy 47.7 Thailand 26.5

World’s Top Travel Destinations 2013

* France 2012 results. Source: UNWTO

US residents traveling abroad 1990- 44.6M 2000- 61.3M 2009- 61.4M

International Trade Association – Office of Travel and Tourism Industries

2012 Rank

Country 2011 (000) 2012 (000) % Change (2012/2011)

1 Mexico 20,590 20,308 -1% 2 Canada 11,595 11,887 3% 3 U.K. 2,405 2,537 5% 4 Dominican Republic 1,675 2,252 34% 5 France 1,756 2,024 15% 6 Italy 1,702 1,938 14% 7 Germany 1,594 1,710 7% 8 Jamaica 1,486 1,511 2% 9 China 1,108 1,140 3% 9 Spain 1,081 1,140 5% 11 India 946 941 -1% 12 Japan 595 855 44%

Costa Rica 757 ** ** 13 Ireland 540 684 27% 14 Netherlands 649 656 1% 15 Hong Kong 676 627 -7% 15 Israel 649 627 -3% 17 Philippines 513 599 17% 18 Switzerland 567 570 0% 19 Republic of Korea 459 542 18% 20 Columbia 432 513 19% 21 Austria 378 456 21% 21 Taiwan 513 456 -11% 23 Brazil 378 399 5% 23 Turkey 378 399 5%

United States Resident Travel Abroad: 2012Top Destinations of U.S. Residents Traveling Abroad (Outbound) 2011 vs 2012

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

42

43

Motor vehicle accidents28%

Homicides22%

Suicide17%

Drowning13%

Other accidents12%

Drug related3%

Air accidents2%

Terrorism2%

Maritime accidents1%

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

Total 810 deaths

U.S. Citizen Non-natural Deaths AbroadJuly 2007 - June 2011 (Mexico vs. Canada)

Non-natural Causes of Death

Deaths in Mexico

Deaths in Canada

Vehicle accidents 352 18

Homicides 313 1

Drownings 117 11

Other accidents 80 5

Suicides 75 11

Other 30 3

Drug-related 10 2

Total 977 51

Source: U.S. State Department 44

U.S. Citizen Non-natural Deaths AbroadJuly 2007 - June 2011

Country Number of Homicides

Mexico 313

Honduras 40

Philippines 39

Dominican Rep. 27

Guatemala 24Haiti 20Colombia 19Costa Rica 16El Salvador 16Iraq 15Jamaica 12

Vehicle AccidentsMexico 352

India 32

Dominican Rep 32

Thailand 31

DrowningsMexico 117

Costa Rica 34

Bahamas 27

Dominican Rep. 18

SuicidesMexico 75

Thailand 34

Germany 34

South Korea 30

Source: U.S. State Department 45

Natural Causes62%

Accidents25%

Murder7.8%

Suicide5.2%

Major Causes of Traveler Deaths Abroad

Source: MacPherson, J. Travel Med, 2000 46

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%

47

Tourist Injuries in European Union (EU)

Approximately 300,000,000 tourists visit EU countries annually

Approx. 3,800 tourists visiting EU annually die of injuries

30% of all tourist fatalities are due to injuries

Tourist vs. resident injury mortality is 4.6 times greater injury mortality rate for tourists

Injury fatalities peaked in 25-44 yr. olds & predominantly 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.

48

Global Obesity Prevalence

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

49

Compounding Foreign Travel Risk

Serious pre-existing medical conditions

Older age

Hazardous avocations and lifestyle concerns

50

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

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

51

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 Visas

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

52

U.S. Resident Documents

1997 – present Green Card

1977 - 1997 Employment Authorization Card

53

U.S. Visa and I-94 Form

54

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

55

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 Risk

Key information sources

56

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 Risk

57

Risk Assessment

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

58

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

59

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.)

60

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 38 based on the Predefined weights and a rank of 42 based on the User Defined weights.

RGA 2013 Foreign Risk Study Research Bulletin Country summary United States of America 196

Predefined Rank out of 205 Countries 38User Defined Rank out of 205 Countries 42

Predictive Modeling Cluster 1RGA Class A

WeightsPredefined User Defined Category Ranking by Indicator 1=Best, 10=Worst

28% 17% Life Expectancy Life Expectancy 26% 3% Health Maternal Mortality 35% 3% Health Infant Mortality 26% 3% Health Underweight Children 14% 3% Health Adult Obesity 101% 3% Health HIV Prevalence 56% 3% Health Communicable Disease Death Rate 32% 3% Health Physician Density 42% 3% Health Sanitation 12% 3% Health Drinking Water 32% 3% Health Hospital Beds 56% 3% Safety/Security Traffic 26% 3% Safety/Security Homicide 52% 3% Safety/Security Military Conflicts 52% 3% Safety/Security Foreign Deaths6% 3% Safety/Security Occupational Accidents 21% 3% Environment Carbon Dioxide 101% 3% Environment Particulate Matter Concentration 31% 3% Infrastructure Internet Users 21% 3% Infrastructure Mobile Phone 61% 3% Infrastructure Road Density 33% 3% Economic GDP Per Capita (PPP) 11% 3% Economic Corruption 22% 3% Economic Education‐Expected Yrs of School 13% 3% Economic Gini Index 8

100% 100%

Country Study Rank Country Study RankMonaco 1 New Zealand 20Germany 2 Belgium 21Sweden 3 Canada 22Iceland 4 Liechtenstein 23

Switzerland 5 Malta 24Norway 6 United Kingdom 25Japan 7 Andorra 26

Netherlands 8 Luxembourg 27San Marino 9 Greece 28

France 10 Bermuda 29Italy 11 Czech Republic 30

Australia 12 Cyprus 31Spain 13 Portugal 32

Austria 14 Slovenia 33Ireland 15 Korea, South 34

Singapore 16 Qatar 35Denmark 17 Poland 36

Hong Kong 18 Brunei 37Finland 19 U.S.A. 38

RGA Foreign Risk StudyWorldwide Country Rankings

Source: Forbes, Sophia Banay 2-22-06

64

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

• Directives issued in Georgia.

Countries differ in many significant ways. Long-term foreign residence does matter. Most short-term foreign travel is low risk. Consider foreign risk based on relevant data and

informed judgment. Avoid sensationalism and overgeneralization. More reliable record keeping and studies of foreign risk

are needed. Some valuable reference sources follow.

Conclusions

65

International Information Sources

U.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 66

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

67

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

68

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

69

Thank 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

70