The influence of medical progress on critical illness Critical Illness definitions are at risk of being affected by advances and developments in medicine. The CoC Medical Underwriting and Claims Consulting is continuously monitor-ing these changes. Expected devel-opments and their possible impact are summarized in the following Q and A article:

Why is the influence of medical progress on genetics so important to the protection industry?

Predictive medicine is a new philoso-phy in healthcare, with various research activities currently taking place to use genotyping to predict the prognosis of a disease and to apply targeted therapy for the indi-vidual. This is great news for poten-tial patients who will get a more individual approach to treatment for disease such as cancer. However it raises a number of challenges for insurers and is particularly important for critical illness products. The industry should carefully consider the impact on existing critical illness definitions which may become inad-equate or inappropriate in the future. Insurers should also bear in mind the risk of anti-selection with consumers having an increasing amount of infor-mation available on their own health which underwriters will not be aware of or have the legal right to enquire about.

What happens if the market will not allow us to use genetic information at underwriting?

Using cancer as an example, one possible outcome is that cancer defi-nitions will not be fit for purpose in the future. This is because cancers may be classified in terms of genetic make-up and response to treatment rather than categorised using the classic staging classifications seen today. If the use of such genetic infor-mation becomes part of normal clini-cal practice in the future, early dia-logue with regulators should be sought. Future discussions could consider if the genetic information on a cancer is really affected by the genetic debate, as the genetics of a cancer are (at least partly) different from that of the individual. Critical illness definitions could be adjusted accordingly and the use of genetic information potentially reconsidered. Clearly we must comply with legal and ethical obligations for genetics in our markets.

Which new surgical techniques should we look out for when considering critical illness product specifications?

One condition to be aware of is Transcatheter Aortic Valve Implanta-tion (TAVI). This is the insertion of an aortic valve replacement device via a catheter in the femoral artery. The technique began as a method of treating patients who had too many risk factors for open heart surgery or were inoperable, mainly found to be

Life

Critical illnessQuestions and answers

NOT IF, BUT HOW

Munich ReCritical illnessQuestions and answers

Page 2/2

© 2015Münchener Rückversicherungs-GesellschaftKöniginstrasse 107, 80802 München, Germany

Münchener Rückversicherungs-Gesellschaft (Munich Reinsurance Company) is a reinsurance company organised under the laws of Germany. In some countries, including in the United States, Munich Reinsurance Company holds the status of an unauthorised reinsurer. Policies are underwritten by Munich Reinsurance Company or its affiliated insurance and reinsurance subsidiaries. Certain coverages are not available in all juris dictions. Any description in this document is for general information purposes only and does not consti-tute an offer to sell or a solicitation of an offer to buy any product.

What impacts will new screening techniques have on the critical illness market?

New screening techniques being introduced can have a big impact on an insurance market. An example of this has already happened in Korea. Their protection market saw large losses following the introduction of a new screening service for thyroid cancer. Incidence rates materially increased for those with early stage disease, resulting in unexpected claims. However, there was no corre-sponding reduction in incidence numbers for those with more regional or metastatic disease. Unfortunately the insurers had used pre-screening numbers to price this.

In the UK, the SOBP for 2014 does not specifically exclude early stage thy-roid cancer. This could cause prob-lems in the future with the incidence of thyroid cancer increasing by approx-imately 65% in both men and women over the last ten years in the UK.

There are various ultrasound scan-ning companies who would be happy to perform private thyroid ultra-sounds. This could become the reality in the future.

Will we see companies asking people to have medicals to see if they can claim on their critical illness cover?

It is highly likely, especially as scan-ning becomes more readily available for consumers and ever cheaper. The growth in providers selling services to claim payment protection insur-ance (PPI) and pursue personal injury claims in other insurance sectors is an indicator that this could happen in our market.

the older lives. Newer TAVI devices have reduced mortality and result in fewer complications compared with open surgery, even in patients with lower risk scores.

TAVI may become the standard procedure in younger and healthier patients and numbers of TAVI will increase significantly. However, in younger patients TAVI will purely replace open surgery without an increase in numbers requiring aortic valve replacement itself, meaning no change in incidence rates.

In the future, consideration should be given to include TAVI as a claims trigger and paying TAVI claims.

Is there any risk if a procedure is excluded from cover?

Endovascular Aneurysm Repair (EVAR) is a catheter based procedure for aortic disease. It is still excluded from the ABI Statement of Best Prac-tice (SOBP) definition, despite the fact that 50% of all aortic aneurysm surgeries are now catheter based. Rejecting an EVAR claim could be a reputational risk, because:

− EVAR is mentioned in the NICE guidelines of the NHS − Mortality and morbidity are compa-rable between EVAR and open surgery − There is no significant cost benefit of EVAR compared to open surgery

As EVAR is, in most cases, replacing open heart surgery without the num-ber of individuals who require aortic aneurysm repair increasing per se, the impact on pricing should be negligible.

Contact

Julie ScottChartered Insurer ACII, DMU (AMS)Operational Underwriting ManagerUK & Ireland LifeTel.: +44 20 36 50 76 35 jscott@munichre.com

Dr. Andreas Armuss Senior Medical ConsultantCoC Medical Underwriting & Claims ConsultingTel.: +49 89 38 91-53 26Fax: +49 89 38 91-7 53 26aarmuss@munichre.com