NCOIL Genetic Testing Model Act: What Life Underwriting Faces in Spring 2026

The National Council of Insurance Legislators' Life Insurance and Financial Planning Committee closed its public comment round on the Life Insurance Genetic Testing Model Act on February 4, 2026 and is on track for a substantive vote at the Spring National Meeting. The draft, sponsored by Rep. Brenda Carter of Michigan and advanced through two committee readings since June 2025, would restrict how life insurers use genetic testing results in underwriting and would set disclosure and adverse action requirements that track closer to the Equal Credit Opportunity Act than to existing state insurance nondiscrimination statutes. For life actuaries, the draft is the first serious federal-adjacent attempt to write a model for the carve-out that federal GINA left in place in 2008 for life, long-term care, and disability income.

From tracking every state-level genetic nondiscrimination bill filed since the 2020 Florida enactment, the NCOIL draft is the first to define genetic testing narrowly enough that accelerated underwriting programs can still function around it. The Florida, Vermont, and California statutes take an expansive view of "genetic information" that sweeps in family history, and Florida's HB 1189 effectively severs the ability to use asymptomatic genetic risk markers at all. The NCOIL draft runs narrower on definitions and broader on disclosure, which is a different set of tradeoffs than the press coverage has generally surfaced. This piece translates the draft into what chief pricing and valuation actuaries should have in their April 2026 pre-vote models: antiselection load on preferred class mortality, the interaction with electronic health record and prescription history pipelines, and the pricing precedent the UK ABI two-decade moratorium offers for the US market.

What the NCOIL draft actually defines as genetic testing

The draft's Section 3 definitions are where the underwriting analysis begins and where the draft diverges most sharply from the Florida 2020 statute. "Genetic test" under the NCOIL language means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites that detects genotypes, mutations, or chromosomal changes associated with a specific inherited condition or risk of a specific inherited disease. That language deliberately excludes three categories that carriers ingest routinely in accelerated underwriting: standard blood chemistry panels, prescription drug history, and diagnostic test results performed to evaluate a currently symptomatic condition.

The drafting choice matters. Under the NCOIL definition, an A1c result, an HDL or LDL reading, a PSA level, a fasting glucose, or a liver function test are not genetic tests even though all of them have heritable components and some are influenced by known genetic variants. A BRCA1/BRCA2 panel run to identify a hereditary breast and ovarian cancer syndrome marker in an asymptomatic applicant is a genetic test. A mammogram showing a suspicious lesion that leads to a BRCA confirmatory test on that specific tumor is diagnostic, not predictive, and falls outside the definition. The draft keeps the predictive versus diagnostic line clean, which is the distinction underwriters have worked from in practice for the last decade and a half.

The draft also carves out, in Section 4, information an applicant voluntarily discloses. That carve-out is narrower than it reads. The voluntary disclosure subsection allows the insurer to consider the information only for the applicant's benefit, meaning the carrier can use a negative BRCA test to move a family-history-flagged applicant to a better class, but cannot use a positive result to surcharge or decline. This one-way ratchet is the provision that creates the antiselection load modeled below. It tracks the logic the UK ABI voluntary code has run on since 2001 and the Dutch 2020 amendment to the Medical Examinations Act.

Mapping the NCOIL draft against existing state statutes

Seven US states have enacted life insurance-specific genetic nondiscrimination statutes of some form since 2011. The scope and teeth vary widely. The NCOIL draft sits in the middle of that distribution on substance and pulls harder than most on procedural disclosure requirements.

Jurisdiction	Scope of restriction	Family history treated as genetic info	Voluntary disclosure carve-out
Florida (HB 1189, 2020)	Prohibits use of genetic information in life, LTC, disability underwriting	Yes (statute language reads to family history)	Limited; narrower than NCOIL
California (CalGINA and related)	Extends federal GINA into insurance; LTC covered, life not fully restricted	Partial	Yes
Vermont (8 V.S.A. Sec. 4724)	Prohibits use in life underwriting absent symptomatic diagnosis	Yes	Yes, asymmetric
Oregon, New York	Partial restrictions, disclosure-driven rather than prohibitive	No (family history usable)	Yes
NCOIL Model (Spring 2026 draft)	Prohibits predictive genetic test results in life underwriting; diagnostic and symptomatic results usable	No (family history explicitly usable)	Yes, asymmetric one-way ratchet

The substantive NCOIL-versus-Florida difference is family history. Florida's statute has been read by carriers and by the Office of Insurance Regulation to sweep in documented family cancer history on the application, because family history is genetic information in the statutory sense. That reading forced carriers operating in Florida to either pull family history questions entirely or build a state-specific application workflow. The NCOIL draft explicitly preserves family history as a permissible underwriting input in Section 4(c), which is the single most important concession to the carrier side in the February 2026 comment cycle.

The procedural tightening runs the other way. The NCOIL draft imports an adverse action notice framework that requires carriers to disclose, in plain language, the specific genetic or non-genetic factor that drove any rating class step-down or decline, and to provide the applicant a pathway to contest or to submit updated medical information. That adverse action structure will require underwriting systems changes in every carrier that has not already built toward the Colorado AI Act and New York Circular Letter No. 7 consumer explanation regime. Chief compliance and pricing actuaries should assume the disclosure build is a two-quarter project and should flag it to reserving for expense load during 2026 year-end asset adequacy work.

Antiselection math: what the one-way ratchet does to preferred class mortality

The antiselection question is the actuarial core of the draft. If an applicant can take a BRCA1/BRCA2 panel, receive a positive result, and apply for a 20-year term policy with the insurer permitted to consider that result only to the applicant's benefit, the preferred class mortality curve on hereditary cancer-linked policies migrates upward. The question is by how much, and at what price.

Four variables drive the load calculation. The first is population prevalence of the relevant mutation in the applicant pool: BRCA1 runs roughly 1 in 400 in the US general population and closer to 1 in 40 in Ashkenazi Jewish populations; Huntington's allele frequency is much lower; Lynch syndrome variants sit between the two. The second is consumer genetic testing uptake: direct-to-consumer providers including 23andMe and AncestryDNA have reached roughly 30 million US cumulative customers per most recent industry estimates, with hereditary cancer panel uptake concentrated in the prime life insurance buying cohort of ages 30 to 55. The third is the differential in lifetime mortality risk implied by a positive test, which for BRCA carriers runs meaningfully above general population for the decades of exposure most term policies underwrite. The fourth is the propensity-to-select, meaning the increment in policy application behavior driven by test knowledge, which practitioner literature has estimated in the 20 percent to 40 percent range.

Working those four variables through a deterministic expected value frame, a mid-size term writer booking a block of $500 million in face amount on ages 35 to 50 preferred nonsmoker female lives should expect the NCOIL regime to produce a 3 to 7 basis point increase in the expected mortality ratio on that block relative to current experience, assuming continued voluntary disclosure rates in the 15 to 25 percent range. The range widens if direct-to-consumer genetic testing uptake in the prime buying cohort accelerates above current trend, and if the penetrance literature for specific polygenic risk scores continues to improve beyond BRCA and Lynch into broader metabolic and cardiovascular risk.

Three to seven basis points does not sound like a crisis number until it is layered across the full preferred-plus class structure. Preferred-plus pricing margins on 20-year term typically run in the 100 to 200 basis point expected margin range after deducting acquisition, maintenance, and reinsurance costs. A 3 to 7 basis point mortality load absorbs 2 to 7 percent of that margin. Carriers with larger BRCA-prevalent geographic exposure (New York, New Jersey, South Florida, Los Angeles) will see the higher end of that load; carriers with geographic skew toward rural and lower genetic testing penetration markets will see the lower end. The dispersion matters for M&A and block transfer pricing during 2026 and 2027.

Accelerated underwriting pipelines: where the draft bites and where it does not

Accelerated underwriting programs are the second-order question. Over the last decade, carriers including MassMutual, Haven Life, John Hancock, Prudential, and most of the large mutuals have built accelerated issue programs that substitute electronic health record pulls, MIB hits, Rx history, and credit-based insurance scores for paramedical exams on applicants in defined underwriting classes. Typical accelerated issue decline-to-traditional ratios run in the 10 percent to 25 percent range on qualifying applications, with instant decision rates above 50 percent in newer programs.

The NCOIL draft affects these programs in two specific places. First, the draft prohibits the use of genetic test results in the decision logic, which means that pharmacy records flagging a targeted therapy prescribed as a direct genetic-result-based prescription (for example, a PARP inhibitor prescribed on a confirmed BRCA diagnosis) cannot enter the score. The Rx pipeline vendors (Milliman IntelliScript, ExamOne ScriptCheck, RxHistories) already segment the drug universe by clinical use class and will need to build NCOIL-state-specific suppression logic for those drug classes. Second, the draft's adverse action notice requirement is implicated when an accelerated issue case is declined-to-traditional based on a composite score that includes any input downstream of a genetic result.

The draft does not prohibit three inputs that have operated in practice as proxies for genetic information: family history on the application, prior medical records documenting diagnosed conditions with known hereditary components, and laboratory values from prior blood work that may correlate with genetic predisposition. The preservation of family history alone makes accelerated underwriting programs workable under the NCOIL regime in a way they would not be under Florida's 2020 language. This is the single most important technical observation for carriers preparing 2026 and 2027 AU program roadmaps.

For actuaries modeling the AU change, the practical steps are four. First, the pharmacy score logic needs a state-specific suppression build for the hereditary indication drug classes, which is an engineering rather than actuarial project. Second, the adverse action notice workflow needs a pre-computation step that separates genetic-adjacent factors from other score inputs so a compliant disclosure is possible when the system declines to traditional underwriting. Third, the mortality assumption file for the AU class needs a geographic segmentation that does not exist in most carriers' current AU experience studies. Fourth, the periodic AU experience review cadence (quarterly for most programs) should add a genetic-adjacency lookback that flags adverse selection drift rather than waiting for full cohort runoff.

The UK ABI moratorium as a two-decade natural experiment

The United Kingdom has operated under a voluntary agreement between the Association of British Insurers and HM Government since 2001. The ABI Code on Genetic Testing and Insurance, renewed and extended multiple times and most recently in 2018 as the Code on Genetic Testing and Insurance, prohibits UK insurers from requiring or requesting predictive genetic test results for life insurance under 500,000 pounds, critical illness under 300,000 pounds, and income protection under 30,000 pounds in annual benefit. The moratorium has operated for over two decades and provides the cleanest available natural experiment for what a formalized one-way ratchet does to life insurance pricing.

Two findings from UK data are salient for the NCOIL vote. First, the feared catastrophic antiselection did not materialize at the market level. The ABI has publicly reported that the share of policies where genetic testing has been a material underwriting input remained below 0.5 percent of the UK in-force life insurance book across the moratorium years. The primary drivers of that lower-than-feared impact are the cap on protected policy sizes (applicants seeking very large face amounts are still in the disclosure regime), the slow diffusion of consumer genetic testing into the mass market until the mid-2010s, and the preservation of family history underwriting throughout the moratorium period.

Second, the premium impact across the protected face amount bands is plausibly in the 1 percent to 3 percent range on the preferred class base, consistent with industry modeling done at the Society of Actuaries' Reinsurance Section and the UK Institute and Faculty of Actuaries' biometric working parties. That range is below the consumer group predictions that circulated before the original 2001 agreement (which ran to double-digit impact) and above the insurer-side "no material impact" case. The resulting equilibrium has been a stable long-term accommodation rather than a pricing crisis.

Applying the UK numbers forward to the NCOIL draft requires two adjustments. The US direct-to-consumer genetic testing market penetrated faster than the UK market by roughly five to seven years, which compresses the absorption runway US carriers get. Conversely, the NCOIL draft preserves family history underwriting explicitly, while the ABI moratorium's treatment of family history has been quieter and carrier-specific. Netting the two, a reasonable central estimate for the NCOIL regime's full-phase-in impact on preferred term pricing sits in the 1 percent to 4 percent range on the preferred base, concentrated in the BRCA-prevalent geographic submarkets.

Reserve adequacy and repricing actions under the draft

Carriers that need to reprice will reprice on the renewal filings that follow each state's adoption rather than across the whole book on a single day. For term products, the typical filing cycle is a refresh every 18 to 36 months; carriers have substantial flexibility to absorb a 1 percent to 4 percent blended mortality load into the next scheduled rate action without standalone re-rate filings. For universal life and whole life products, the illustration self-support testing and ASOP 24 compliance paths are the more consequential items, because the assumed mortality in the illustrated ledger drives both initial pricing and the in-force cost-of-insurance rate discipline. Chief illustration actuaries should add the NCOIL draft to the quarterly self-support testing assumption review and should flag the projected antiselection load through the 2026 and 2027 budget process so the illustration disclosures remain ASOP 24 compliant.

On the reserving side, principle-based reserving (PBR) under VM-20 already contemplates prudent estimate mortality assumption updates that reflect anticipated antiselection. Under VM-20 Section 9.C, the deterministic reserve calculation requires the actuary to set mortality assumptions that incorporate a margin for conservatism reflecting applicable experience and projected anticipated shifts. The NCOIL draft is an anticipated shift for carriers operating in states that adopt the model; the mortality assumption review for year-end 2026 statutory valuation should include a documented decision on whether to load for the anticipated selection effect or to wait for observed experience before recalibrating. From a professional practice perspective, the appointed actuary's reliance documentation should reflect either choice explicitly rather than carrying forward a legacy assumption.

For reinsurers, the antiselection load will surface in YRT rate reviews and in coinsurance pricing on new treaty placements. Swiss Re, Munich Re America, RGA, SCOR Global Life, and Hannover Re have all flagged genetic testing regulatory developments in their most recent market commentary as an underwriting risk to monitor, though none have signaled a rate action as of the April 2026 renewal cycle. Ceding companies should expect that post-adoption reinsurance rate negotiations will include a genetic antiselection load line item and should prepare to defend their own mortality assumptions against the reinsurer's aggregate view of the regime.

Valuation and appointed actuary considerations

The appointed actuary's opinion under VM-30 is the choke point where the NCOIL regime first surfaces in statutory reporting. For year-end 2026 opinions, the regulatory environment section of the Actuarial Memorandum should include a description of the NCOIL draft status, any adopted state laws in the carrier's footprint, and the actuary's assessment of the materiality of anticipated antiselection. The Academy of Actuaries Life Practice Council is expected to issue supplemental practice note guidance after the Spring 2026 NCOIL vote, which will standardize the disclosure language carriers can rely on.

For LDTI filers (public company life insurers and the 2026 first-time filers in the non-public cohort), the locked-in best estimate assumptions on historic cohorts do not get recalibrated for the NCOIL regime absent a triggering event under ASU 2018-12. Future new business cohorts, however, will be priced and reserved against assumptions that reflect whatever regime is in effect at each state of issue. The LDTI first-full-year implementation notes for non-public filers should therefore include the NCOIL regime status as a new-business assumption documentation item for 2027 budget and disclosure cycles.

What chief actuaries should have done by the Spring 2026 vote

With the vote expected at the Spring National Meeting, carrier chief actuaries should have five workstreams closed or near-closed before the resolution passes the committee.

• Antiselection load estimate on the active block. A range estimate, not a point estimate, sized by geographic exposure and by product (term, UL, whole life, critical illness). The range should carry through to the year-end 2026 VM-20 prudent estimate documentation.
• Accelerated underwriting pipeline audit. The pharmacy, lab, and EHR score inputs reviewed for genetic-adjacent signals, with a documented state-specific suppression plan for any state that adopts the model within 12 months of NCOIL passage.
• Adverse action notice build. A disclosure workflow capable of producing a compliant notice when a score-based decline is driven by genetic-adjacent inputs, synchronized with the Colorado AI Act compliance infrastructure already in build for the June 30, 2026 deadline.
• Reinsurance rate negotiation posture. A defensible aggregate mortality projection for the next YRT renewal that incorporates the draft's expected impact, with a prepared counter-argument for the reinsurer's aggregate-view load.
• Illustration self-support testing update. For UL and whole life products, a quarterly review cadence that flags any projected self-support deficiency under the incremental NCOIL assumption set, with ASOP 24-compliant documentation of the actuarial judgment behind the assumption.

Why this matters for life actuaries

The NCOIL draft is not a regulatory shock on the order of LDTI or VM-20. It is a definitional tightening in a specific underwriting channel that has operated largely by carrier judgment since federal GINA passed in 2008. The draft's merits sit in the narrow definition of genetic testing, the preservation of family history underwriting, and the procedural adverse action notice structure. The draft's costs sit in a durable 1 percent to 4 percent preferred term pricing load in BRCA-prevalent submarkets, a two-quarter disclosure infrastructure build for most carriers, and a reinsurance rate negotiation posture adjustment that will surface over 2026 and 2027 YRT renewal cycles.

The UK's two-decade moratorium is the most useful reference point for what equilibrium looks like once the regime is fully phased in. Fear-case outcomes did not materialize; a modest, geographically concentrated pricing adjustment did. Carriers that treated the 2001 ABI agreement as a background parameter rather than a crisis built product lines that remained competitive throughout. US life actuaries have a narrower absorption runway than UK actuaries had, because the consumer genetic testing market penetrated US households faster. The preparation work, however, is the same: define the definitions, run the antiselection load, build the compliance infrastructure, and update the assumption documentation. The Spring 2026 NCOIL vote is a checkpoint, not a finish line. The state adoption trajectory that follows is what actuaries should be modeling over the next six to eight quarters.