Sunday, August 24, 2014

The coming changes in Critical Illness Insurance definitions


So how will the definitions differ?

We take a look at the five critical illnesses which research findings from Gen Re’s “2012 Dread Disease Survey” shows that over 90 per cent of all severe stage claims received by life insurers are for. The markets covered by Gen Re’s survey included Hong Kong, Malaysia, Australia, United Kingdom and Singapore, and these five important or core CIs are found within the standard 37 CIs. 

The five are: 
  • Major Cancers 
  • Heart Attack of Specified Severity 
  • Coronary Artery By-pass Surgery 
  • Stroke 
  • Kidney Failure 

 


Major Cancers

Old Definition (2003):
Major Cancers

A malignant tumour characterised by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissue. This diagnosis must be supported by histological evidence of malignancy and confirmed by an oncologist or pathologist.
The following are excluded:
  • Tumours showing the malignant changes of carcinoma-in-situ and tumours which are histologically described as pre-malignant or non-invasive, including, but not limited to: Carcinoma-in-Situ of the Breasts, Cervical Dysplasia CIN-1, CIN-2 and CIN-3;
  • Hyperkeratoses, basal cell and squamous skin cancers, and melanomas of less than 1.5mm Breslow thickness, or less than Clark Level 3, unless there is evidence of metastases;
  • Prostate cancers histologically described as TNM Classification T1a or T1b or Prostate cancers of another equivalent or lesser classification, T1N0M0 Papillary micro-carcinoma of the Thyroid less than 1 cm in diameter, Papillary micro-carcinoma of the Bladder, and Chronic Lymphocytic Leukaemia less than RAI Stage 3; and
  • All tumours in the presence of HIV infection.


New Definition (2014):
Major Cancers

A malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells with invasion and destruction of normal tissue.

The term malignant tumour includes leukemia, lymphoma and sarcoma.

For the above definition, the following are excluded:
  • All tumours which are histologically classified as any of the following:
    • Pre-malignant;
    • Non-invasive;
    • Carcinoma-in-situ;
    • Having borderline malignancy;
    • Having any degree of malignant potential;
    • Having suspicious malignancy;
    • Neoplasm of uncertain or unknown behavior; or
    • Cervical Dysplasia CIN-1, CIN-2 and CIN-3;
  • Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
  • Malignant melanoma that has not caused invasion beyond the epidermis;
  • All Prostate cancers histologically described as T1N0M0 (TNM Classification) or below; or Prostate cancers of another equivalent or lesser classification;
  • All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
  • All tumours of the Urinary Bladder histologically classified as T1N0M0 (TNM Classification) or below;
  • All Gastro-Intestinal Stromal tumours histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs; 
  • Chronic Lymphocytic Leukaemia less than RAI Stage 3; and
  • All tumours in the presence of HIV infection.

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Heart Attack

Old Definition:
Heart Attack

Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. This diagnosis must be supported by three or more of the following five criteria which are consistent with a new heart attack:
  • History of typical chest pain;
  • New electrocardiogram (ECG) changes proving infarction;
  • Diagnostic elevation of cardiac enzyme CK-MB;
  • Diagnostic elevation of Troponin (T or I);
  • Left ventricular ejection fraction less than 50% measured 3 months or more after the event.


New Definition:
Heart Attack of Specified Severity

Death of heart muscle due to obstruction of blood flow, that is evident by at least three of the following criteria proving the occurrence of a new heart attack:
  • History of typical chest pain;
  • New characteristic electrocardiographic changes; with the development of any of the following: ST elevation or depression, T wave inversion, pathological Q waves or left bundle branch block;
  • Elevation of the cardiac biomarkers, inclusive of CKMB above the generally accepted normal laboratory levels or Cardiac Troponin T or I at 0.5ng/ml and above;
  • Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality. The imaging must be done by Cardiologist specified by the Company.

For the above definition, the following are excluded:
  • Angina;
  • Heart attack of indeterminate age; and
  • A rise in cardiac biomarkers or Troponin T or I following an intra-arterial cardiac procedure including, but not limited to, coronary angiography and coronary angioplasty.

Explanatory note: 0.5ng/ml = 0.5ug/L = 500pg/ml


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Coronary Artery By-pass Surgery

Old definition:
Coronary Artery By-pass Surgery

The actual undergoing of open-chest surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist.

Angioplasty and all other intra arterial, catheter based techniques, ‘keyhole’ or laser procedures are excluded.

New Definition:
Coronary Artery By-pass Surgery

The actual undergoing of open-chest surgery or Minimally Invasive Direct Coronary Artery Bypass surgery to correct the narrowing or blockage of one or more coronary arteries with bypass grafts. This diagnosis must be supported by angiographic evidence of significant coronary artery obstruction and the procedure must be considered medically necessary by a consultant cardiologist.

Angioplasty and all other intra arterial, catheter based techniques, ‘keyhole’ or laser procedures are excluded.

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Stroke

Old definition:
Stroke

A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis. This diagnosis must be supported by all of the following conditions:
  • Evidence of permanent neurological damage confirmed by a neurologist at least 6 weeks after the event; and
  • Findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke.

The following are excluded:
  • Transient Ischaemic Attacks;
  • Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease;
  • Vascular disease affecting the eye or optic nerve; and
  • Ischaemic disorders of the vestibular system.


New Definition:
Stroke

A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, intracerebral embolism and cerebral thrombosis resulting in permanent neurological deficit with persisting clinical symptoms. This diagnosis must be supported by all of the following conditions:
  • Evidence of permanent clinical neurological deficit confirmed by a neurologist at least 6 weeks after the event; and
  • Findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques consistent with the diagnosis of a new stroke. 

The following are excluded:
  • Transient Ischaemic Attacks;
  • Brain damage due to an accident or injury, infection, vasculitis, and inflammatory disease;
  • Vascular disease affecting the eye or optic nerve; and
  • Ischaemic disorders of the vestibular system.

Permanent means expected to last throughout the lifetime of the Life Assured.

Permanent neurological deficit with persisting clinical symptoms means symptoms of dysfunction in the nervous system that are present on clinical examination and expected to last throughout the lifetime of the Life Assured. Symptoms that are covered include numbness, paralysis, localized weakness, dysarthria (difficulty with speech), aphasia (inability to speak), dysphagia (difficulty swallowing), visual impairment, difficulty in walking, lack of coordination, tremor, seizures, dementia, delirium and coma.

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Kidney Failure

Old definition:
Kidney Failure

Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation.

New definition:
Kidney Failure

Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation


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