Transcript Masterclass - PruProtect
Masterclass - Coronary Heart Disease
Competitor analysis correct at time of publishing
For advisers only
July 2014
Agenda
1.
The role of the heart 2.
Anatomy of a heart attack 3.
How critical illness defines a heart attack 4.
How PruProtect defines a heart attack 5.
Underwriting considerations 6.
PruProtect - unrivalled cover for conditions affecting the cardiovascular system 2
The role of the heart
The heart
• A normal heart beats
100,000
times a day or
3 billion
times in an average lifetime • Each day it pumps
5,000 gallons
of life sustaining blood through a
60,000
mile network of vessels • Blood takes approximately
20 seconds
to circulate throughout the entire vascular system
Source:
https://www.bhf.org.uk/heart-health/how-your-heart-works.aspx 2014 4
Anatomy of a heart attack
Anatomy of a Heart Attack?
1.
2.
A coronary artery becomes narrowed It cannot deliver enough oxygen-containing blood to the heart muscle 3.
4.
This makes the artery even narrower and can quickly block off the artery 5.
The inside lining of the narrowed artery cracks, a blood clot may form over the cracks If the artery is blocked for more than a few minutes, the muscle cells in the heart may become permanently damaged Often, the amount of muscle damage is small and, once the heart attack is over, there is enough good muscle left for the heart to carry on its work satisfactorily 6
Impact of cardiovascular disease
Death by cause in men under 75, UK 2010 • Accounting for over a third of deaths, cardiovascular disease (CVD) is by far the
biggest killer
• Just under
50% of deaths
due to CVD are from coronary heart disease • CVD is one of the main causes of premature death, accounting for
30% of premature deaths
in men and 22% of premature deaths in women
Source:
http://www.bhf.org.uk/plugins/PublicationsSearchResults/DownloadFile.aspx?docid=508b8b91 1301-4ad7-bc7e-7f413877548b&version=-1&title=Coronary+Heart+Disease+Statistics+2012+&resource=G608- 2012 7 7
Medical and demographic trends
How heart disease has changed
Over 17,000% increase in life saving prescriptions since CIC was launched Heart disease death rates halved since 1961 Source:
http://www.bhf.org.uk/plugins/PublicationsSearchResults/DownloadFile.aspx?docid=508b8b91 1301-4ad7-bc7e-7f413877548b&version=-1&title=Coronary+Heart+Disease+Statistics+2012+&resource=G608 - 2012 8
Preventing and treating a heart attack
Angioplasty Angioplasty can help to relieve angina symptoms and is also used as an emergency treatment for people who've had a heart attack 9
Angioplasty key facts
The importance of our unique definition
c 5 x the number of Angioplasty to CABG Most angioplasty’s are performed on a single vessel Most people who undergo angioplasty haven’t suffered a heart attack Angioplasty (Coronary) or PTCA (Percutaneous Transluminal Coronary Angioplasty) – Severity F
PTCA or other percutaneous coronary artery procedures performed by a Consultant Cardiologist to dilate and treat a coronary artery stenosis. The procedure may or may not involve the use of a stent Dr Rod Stables, The Cardiothoracic Centre, accessed 2014 10
How critical illness defines a heart attack
ABI definition
Pre 2006
Heart attack
• The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: typical chest pain; • • new characteristic electrocardiographic changes; the characteristic rise of cardiac enzymes, troponins or other biochemical markers; where all of the above shows a definite acute myocardial infarction Other acute coronary syndromes, including but not limited to angina, are not covered under this definition 12
Industry definition
Heart Attack of specified severity • • • • • •
Death of heart muscle
, due to inadequate blood supply, that has resulted in the following evidence of acute myocardial infarction:
Typical clinical symptoms (for example, characteristic chest pain) New characteristic electrocardiographic changes The characteristic rise in cardiac enzymes or troponins recorded at the following levels or higher;
-
Troponin T>1.0ng/ml Accu Tnl > 0.5ng/ml or equivalent threshold with other Troponin I methods
The evidence must show a definite acute myocardial infarction For the above definition, the following are not covered: Other acute coronary syndromes including but not limited to angina 13
Typical clinical symptoms
Not every person suffering a heart attack will have obvious symptoms • • • • • The symptoms of a heart attack vary from one person to another They may feel tightness or pain in the chest For some people, the pain or tightness is severe Others may feel nothing more than a mild discomfort They may feel – light-headed or dizzy – – – short of breath nauseous vomiting 14
New characteristic ECG changes
“not all heart attacks can be detected by ECG” Source: http://www.patient.co.uk/health/electrocardiogram-ecg | http://www.thrombosisadviser.com/en/acs/a-leading-cause-of-mortality/ - 2014 15
Characteristic rise on cardiac enzymes/troponins
• The current ABI levels were set in 2006 • Since then troponin assays have become significantly more sensitive , with some now measuring as little as a few picograms (a picogram being 1/1000th of a nanogram [ng]) .
• Current clinical practice suggests a troponin T level of 0.1ng/ml or less as the criteria for diagnosis of a probable MI, well below the current ABI level of 1ng/ml 16
How PruProtect defines a heart attack
Our definition
Heart Attack of specified severity Death of heart muscle, due to inadequate blood supply, that has resulted in the following evidence of acute myocardial infarction: • • New characteristic electrocardiographic changes, and The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher; Troponin T > 0.5 ng/ml AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods The evidence must show a definite acute myocardial infarction • For the above definition, the following are not covered: Other acute coronary syndromes including but not limited to angina
Payable at severity C – 50% to a maximum of £1,500,000 We will now pay more heart attack claims
18
Our unique definition
Heart Attack Death of heart muscle, due to inadequate blood supply that has resulted in the following: Definite Diagnosis of an acute Myocardial Infarction by a consultant cardiologist, which is supported by current medical reports, tests and investigations, as defined by the recognised international standard* prevailing at the time of claim • • For the above definition, the following are not covered: Other acute coronary syndromes including but not limited to unstable angina. Myocardial Infarctions that meet the international standard that occurred before cover commenced *(International standard defined by the European Society of Cardiology or the universal standard definition of Myocardial Infarction)
Payable at severity D – 25% to a maximum of £750,000 We will now pay ALL heart attack claims
19
Competitor overview
Highlighting PruProtect’s unique cover for heart attack
Provider
PruProtect PruProtect Aegon Aviva Ageas Bright Grey Friends Life L&G LV= Scottish Provident Skandia Zurich
Definition name Payout %
Heart Attack Heart Attack of Specified Severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity Heart Attack of specified severity 25% 50% (100% booster) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
Typical clinical symptoms
× × × × × × × × × × ×
Troponin rise required New ECG changes
n/a 0.5ng/ml 1.0ng/ml yes yes 1.0ng/ml yes 1.0ng/ml yes yes 1.0ng/ml 1.0ng/ml × Source: PruProtect Analysis 20
Why PruProtect for Heart Attack
• We will pay 25% on diagnosis of ALL art attacks – We do not require characteristic ECG changes 21
Heart attack
What this all means
The Need
Traditional cover requires a heart attack to be a specified severity
What are we doing?
Covering diagnosis of All heart attacks It’s the UK’s biggest killer
Most
consumers expect a heart attack to be covered no matter how severe
45%
More likely to payout compared to industry standard definitions
We now cover ALL heart attacks
22
Underwriting considerations
Underwriting considerations
Risk factors of CHD • • • • • • • • • • Smoking High blood pressure High blood cholesterol Diabetes Decline Being physically inactive Being overweight or obese Family history of heart disease Ethnic background Gender - men are more likely to develop CHD at an earlier age than women.
Age - the older you are, the more likely you are to develop CHD.
• It is more acceptable for an older person to have a heart attack than a younger person and our ratings reflect this: A 46 year old with heart attack +- 200% A 66 year old with heart attack +- 125% 24
Underwriting considerations
What does the underwriter need before making a decision?
• • • • TGPR to include sight of all investigations and surgical procedures Date of onset and date of most recent symptoms Has there been more than one heart attack (increase rating if 2, but decline if more) Other risk factors present (as previously mentioned) •
Better risk
Older age, N/S, BP and Lipids all normal, single event, normal BMI, healthy lifestyle •
Poorer risk
Younger age, smoking, obese, more than one event, questionable lifestyle •
Definite declines
Combination of CHD and diabetes, client < age 40, >30 cigs pd, > 2 heart attacks 25
Underwriting considerations
Some case studies 1.
44 year old male-angina first diagnosed 8 months ago, now stable. No surgery pending
Postpone for 4 months then will require TGPR
2. 65 year old female. Heart attack in 2010 with single vessel bypass at the time. Has been well since but still smoking 10 cigarattes per day
A loading in the region of 50-100% will be applied
3. 55 year old male. Had a heart attack in 2009 and then another in 2011 followed by a 2 vessel stent and has been well since
A loading of 200-250% will be applied
4. 32 year old with a poor FH of CAD and who has had been suffering from angina since age 31. Maybe going in for an angiogram in next few months
Decline
26
PruProtect - unrivalled cover for conditions affecting the cardiovascular system
Unique cover
Heart and artery
Congestive heart failure Severe peripheral vascular disease Severe vascular disease affecting multiple systems Heart Attack - resulting in reduced ejection fraction Heart Attack of specified severity Heart Attack Any other cardiac condition resulting in a reduced ejection fraction Aorta graft surgery Cardiomyopathy resulting in a reduced ejection fraction Coronary artery by-pass grafts Endovascular repair of an aortic aneurysm Heart valve replacement or repair Surgical repair of a structural lesion of the heart Balloon valvuloplasty Femoral artery aneurysm repair Iliac artery aneurysm repair Pericardectomy Surgery to correct carotid artery stenosis Angioplasty Angioplasty to correct carotid artery stenosis Cardioversion for cardiac arrhythmia Emergency intravenous anti-arrhythmic therapy for ventricular tachycardia or fibrillation Infective endocarditis (restricted to one payment only). Keyhole coronary artery bypass surgery Permanent defibrillator insertion Permanent pacemaker insertion Surgery for cardiac arrhythmia Surgical repair of an atrial or ventricular septal defect
Severity
A A A A-B C D F F F F F F F A-B B B B-C D D D E E E E E F F F
Unique to PruProtect
28
Tools for you
Article Email Cover magazine
29