Critical Illness definitions are at risk of being affected by advances and developments in medicine. The CoC Medical Underwriting and Claims Consulting is continuously monitoring these changes. Expected developments and their possible impact are summarized in this Q&A article.

1. 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 illness
Questions and answers

2. NOT IF, BUT HOW
Munich Re
Critical illness
Questions and answers
Page 2/2
© 2015
Münchener Rückversicherungs-Gesellschaft
Königinstrasse 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 juris­dictions.
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 Scott
Chartered Insurer ACII, DMU (AMS)
Operational Underwriting Manager
UK & Ireland Life
Tel.: +44 20 36 50 76 35
jscott@munichre.com
Dr. Andreas Armuss
Senior Medical Consultant
CoC Medical Underwriting &
Claims Consulting
Tel.: +49 89 38 91-53 26
Fax: +49 89 38 91-7 53 26
aarmuss@munichre.com