The life of a modern person is filled with events and plans. In the hustle and bustle of things, there is often no time left to get diagnosed by a doctor and find out the causes of the unpleasant symptoms that appear. When the discomfort becomes severe, it turns out that precious time is lost, and now attempts to combat the disease mean a huge waste of time and money. To avoid being on the verge of financial bankruptcy, the patient can take advantage of a special insurance product - critical illness insurance, i.e. potentially fatal illnesses. All costs associated with therapy will be borne by the insurer.
Main provisions of the agreement
Critical illness insurance is much like life or disability insurance. However, there is an important difference: for the two specified types of policies, payments are made if the insured person dies or receives a disability group incompatible with work. All expenses associated with receiving medical services and purchasing medications fall on the shoulders of the patient and his family.
VHI for deadly diseases, on the contrary, is valid when the patient is alive. Payments from the insurance company are used to purchase services and medications necessary for recovery. Having financial support increases the chances that a citizen will be able to cope with a dangerous disease. The cost of the policy is determined for each client individually. When calculating it, the insurer proceeds from the following factors:
- Patient's age;
- His gender;
- Indicators of the state of his body;
- Insurance period;
- Coverage amount.
Insurers reserve the right to revise the premium depending on the incidence statistics of certain ailments in the country as a whole. VHI for critical illness can be purchased as a stand-alone insurance product or as an addition to a policy with “standard” or limited coverage. The main conditions of critical illness insurance include the following:
- The citizen chooses the insurance period independently: there are policy offers on the market for 1, 2 years, 5, 7 years;
- A citizen undergoes a mandatory full diagnosis (Check up) at a medical institution that has an agreement with the insurer. For example, the seven-year “Borders of Health” program from Ingosstrakh involves examinations every two years;
- The policyholder is paid the amount of money specified in the policy upon making a specific diagnosis. To receive funds, a citizen must live at least 30 days from that moment;
- The patient has the right to spend the amount received for any needs;
- Basic insurance covers oncology, heart attack and stroke. Additionally, the client can include about 40 diseases in the policy.
The amount received from the insurer can be used for any purpose, including the purchase of medicines and payment for medical services and assistance, the use of alternative (non-traditional) methods of treatment, paying off debts, modifying a home and personal car, learning a new profession, etc. But if a citizen dies of a critical illness, the paid premiums are returned to his legal successors.
What is considered an insured event?
An insured event is a patient's visit to a doctor for diagnosis or treatment of a disease specified in the insurance policy during the period of VHI. Today, insurance companies offer protection that covers more than 40 potentially dangerous illnesses, but insurance does not cover suicide attempts, illnesses resulting from emergencies, military actions, due to the intentional actions of the patient, unsuccessful attempts at self-medication, professional sports and etc. Insured events include the following:
- Malignant tumors;
- Heart attack;
- Stroke;
- Heart bypass;
- Severe burns;
- Loss of vision or hearing;
- Paralysis or amputation of limbs;
- Multiple sclerosis;
- Kidney failure;
- Organ transplantation and so on.
The above list is not final; it may include additional items depending on the wishes and financial capabilities of the insurer. Oncology, heart attacks and strokes are diseases included in the basic coverage of the policy. Additionally, the patient and the insurer can agree to indicate other ailments. The larger the list, the larger the premium amount will be. Critical illnesses have one thing in common: in the absence of timely treatment, they will lead to the death of the patient, but with early diagnosis, in 90% of cases they can be treated.
Who is not entitled to insurance?
The goal of insurance companies is to minimize their own risks, so they have developed a system of requirements for potential clients. To assess such risks, insurers survey their clients and can also send them for a medical examination to make sure that the citizen came for insurance while sick. In general, the criteria for selecting potential policyholders can be reduced to the following points:
- Age. Insurers work with persons from 18 to 65 (75) years of age;
- Lifestyle;
- Patient's medical background;
- Current health status.
Registration of the policy is not available to citizens who are in prison, who abuse alcohol and drugs, or who are registered with a psychiatrist. Insurers do not work with those who have previously suffered serious illnesses (kidney failure, hepatitis, ulcerative colitis, etc.) or organ transplantation. VHI will not be issued to citizens with diabetes, people with disabilities, those diagnosed with heart disease, malignant tumors, etc. The insurance company will refuse to pay the money if it turns out that, for example, the patient developed cancer before purchasing the VHI policy.
Validity period of the insurance policy
A special feature of critical illness insurance is the “temporary deductible”. It means that a person cannot purchase a policy and begin treatment for cancer or kidney failure the next day. There is a deferment period that minimizes the risks of the insurer. The duration of the franchise depends on the validity period of the policy and is set by each company independently. For example, the Panacea society offers the following conditions:
- Waiting for an insurance policy - 5 days after purchase;
- The deductible applies when the main insurance coverage is not valid - 6 months after purchase;
- The period of full insurance coverage is the last 12 months.
If the client falls ill during the period of the “temporary deductible”, he will not be able to receive insurance payments. If an examination carried out after 7 months reveals that a person has cancer, he will be paid the amount due. To receive payments, the client contacts the insurer by phone or email. If the diagnosis is confirmed, the amount due is transferred to him, they help him choose specialists to contact, a medical institution, and settle all the formalities that arise.
Conclusion
Insurance against critical (fatal) illnesses is quite risky for insurance companies, so they have a number of client selection criteria in place to minimize such risks. Many companies prefer not to insure against cancer, since treatment costs are hundreds of times higher than premiums, and such diseases are often recurrent. The validity of an insurance policy also has its own characteristics, which, in particular, cannot be used immediately after the conclusion of the contract.
Critical illness insurance gives people a chance of recovery
Photo: Fotolia/ribalka yuli
The market for insurance against critical illnesses, including cancer, is growing rapidly following the increase in morbidity and due to the increased attention of people to their health. Moreover, the rapid growth of this market has become a driver for the entire life insurance segment.
Conscious choice
Every year on February 4, humanity celebrates World Cancer Day. One of the ways to do this is through critical illness insurance.
Only about a dozen insurance companies, whose specialization is either VHI or life insurance, are actively operating in the Russian critical illness insurance (CIC) and cancer insurance market. Moreover, most of them entered this segment in the last year or two. Before this, traditionally, the diagnosis of a malignant tumor was considered an exception to insurance cases for VHI, life insurance and accidents. Since 2014, however, a separate specific market segment has begun to emerge - insurance against critical illnesses, including cancer. As it became clear that these products were becoming increasingly popular among clients, more and more insurers began to “connect” to the service.
It is currently quite difficult to accurately measure the market size due to the fact that different companies attribute risks associated with oncology to different areas. Some include them as an additional option to the personal and corporate voluntary health insurance program (for example, at Ingosstrakh, this risk is included in the coverage under corporate voluntary health insurance agreements for 50 thousand employee clients). Someone - as a standard or additional risk in life insurance. Someone - as one of the risks in the treatment program abroad (IC "Welfare").
“We have not separately assessed the market volume, but we assess it as insignificant, and the market itself as very far from saturation,” says Elena Kovaleva, general director of IC Soglasie-Vita.
With the increasing interest of policyholders in such products, many companies in the last year have launched separate “oncology” programs or VHC programs that include oncology (VTB, Ingosstrakh-Life, IC Blagosostoyanie), and some have begun to actively sell such policies online, which should also boost the growth of the segment as a whole. In December 2016, VSK announced electronic sales, just the other day Soglasie-Vita announced, and plans to launch the MetLife online service in March.
According to rough estimates by the insurers themselves, the total capacity of the market for accident insurance, life insurance and voluntary health insurance, which may include risks of cancer, is currently no more than 5 billion rubles. This figure, in particular, is given by Oleg Merkulov, Deputy General Director of VTB Insurance. The company entered this market segment relatively recently - in 2013, but is very active: in 2016, it seriously expanded its line, due to which the number of contracts for this type of insurance increased almost 2.5 times - from 64 thousand to 2015 to 155 thousand for 2016.
Another relatively new participant in the health insurance market, Blagosostoyanie Insurance Company, also showed a 50 percent increase in 2016: a program for insurance against the risk of treatment and operations abroad, including cancer insurance, was launched in 2014. In 2016, another VHC program “Informed Choice” appeared. In just one year, the company collected about 100 million rubles in premiums for these two types of insurance.
The “old men”, who have already built up a portfolio long ago, do not, of course, demonstrate such rapid growth. The MetLife company can be considered a pioneer in critical illness insurance (CII), which began offering the inclusion of such risks to its corporate clients back in 2005, and to “physicians” in 2008. Over the years, the insurer has collected a huge portfolio of contracts including cancer insurance - 400 thousand. Now it has cancer risks included in voluntary medical insurance programs, accident insurance, and life insurance. In 2016, the increase in the number of contracts for VHC will be 5-6%, for corporate voluntary health insurance, including oncology, - 15%.
Other experienced players in this market include PPF Life Insurance, which began including cancer as an additional risk back in 2010. The insurer's portfolio includes more than 69 thousand contracts with the risk of “insurance in case of deadly diseases”.
“Oncology insurance has been one of the drivers of the life insurance market for several years,” notes Dmitry Dubina, technical director of PPF Life Insurance. “Our company is one of the leaders in this field, bringing new and innovative products to the market.” In 2014, IC PPF Life Insurance was one of the first to develop separate programs for cancer diseases in general and a special program for women.
MetLife also has specific “women’s” programs. In 2014, the company introduced the “Harmony” critical illness insurance program for women, which focuses on comprehensive protection when diagnosing female and other types of cancer for clients in the young age group, as well as specific women’s diseases, such as age-related osteoporosis, heart attack and stroke for women in aged 45 years and older. According to MetLife, 60-80% of critical illness insurance payments come from payments related to the diagnosis of cancer in the insured.
An original product that combines protection against the risk of cancer and endowment life insurance is offered by Ingosstrakh-Life: the program is designed for seven years, during which the insurance protection is valid. At the end of this period, if the insured event does not occur, the policyholder receives all of his contributions back.
The Edges of Health program has been supplemented with a comprehensive service component. “Our program has been valid for seven years and involves undergoing a check-up every two years, organizing and paying for treatment in the amount of up to 300 million rubles. By purchasing the program, the client can simply make one call to sign up for a check-up or report an insured event (diagnosing a critical illness), we take care of everything else,” says Vladimir Chernikov, General Director of the Ingosstrakh-Life company. - Namely: organizing a preventive examination in any clinic in the Russian Federation where the selected version of the program operates, obtaining a second medical opinion in case of diagnosing a critical illness, immediate organization of treatment, visa support, transfer, accommodation and even payment for prescribed medications that will be needed take after treatment."
For the rest of my life?
The dispersion of insurance coverage, tariffs, forms of payment of insurance compensation and services accompanying the service is so great that it is difficult to systematize.
The list of critical illnesses from the VHC can include from one to 40 diagnoses. The most common are cancer, myocardial infarction, stroke, kidney failure, paralysis, blindness, multiple sclerosis, Parkinson's disease, muscular dystrophy, coronary artery bypass surgery, vital organ transplantation. Insurance premiums vary from 3,900 to 39,000 rubles, and the size of the premium does not always directly depend on the sum insured. Other factors that increase the cost of insurance may be the age and gender of the insured, the range of risks and services. But not all companies have gender and age differences; some divide the conditionally insured into adults - from 18 to 64 years old - and children - under 18 years old. A number of insurers, for example IC Blagosostoyanie and MetLife, have children's programs that include oncology.
Usually increase with age. However, there are also programs in which, if you enter at a certain age, the premium remains unchanged throughout its duration. By the way, this is another argument in favor of long-term insurance (usually contracts for insurance contracts are concluded for seven, ten years or for life).
There is no point in insuring against short term disease or separately oncology for a year. “Naturally, when we talk about the future, we mean not one year, but a much longer period. If the annual policy is guaranteed to be renewed, it does not matter which policy you choose - annual or long-term, says Dmitry Maksimov, general director of Blagosostoyanie Insurance Company. “If the policy is only annual and repeated examinations or significant changes in the terms of insurance are expected next year, then you need to understand that such a program cannot be a solution to the problem.”
Under most health insurance contracts there is a waiting period (90-180 days), during which, if cancer or another health problem is diagnosed, no payment of the insured amount occurs. In this way, the company insures itself, reducing the risk that a person enters into an insurance contract already knowing or suspecting about the diagnosis. Malignant neoplasms discovered before purchasing an insurance policy, as well as the presence of HIV infection in the insured, are exclusions from insurance coverage under such programs.
Oleg Merkulov from VTB Insurance explains that a waiting period is necessary because conducting examinations at the stage of purchasing an insurance policy is long, labor-intensive and ineffective (the examination may not diagnose the disease). “If a person falls ill during the waiting period, the insurance amount is not paid to him, but the assistance system begins to work: we provide all kinds of legal and consulting support for routing the patient to provide treatment within the framework of state guarantees,” says Merkulov.
In cash or in kind?
The insured amount under VHC or oncology treatment contracts varies in different companies and for different types of contracts - from 500 thousand to 300 million rubles. The average amount of insurance coverage, according to MetLife estimates, is 700-850 thousand rubles. At the same time, the maximum payment made by this company under such insurance is 7.5 million rubles, and under the corporate program - 9 million rubles.
There are two fundamentally different approaches to paying insurance compensation: cash or payment of medical bills and additional services. Some companies (for example, Soglasie-Vita, PPF Life Insurance) upon the occurrence of an insured event (diagnosis of a critical illness and/or malignant tumor) practice a standard one-time non-target payment. As a rule, 500 thousand or 1 million rubles, depending on the agreement.
A person spends these funds at his own discretion: he can send them for treatment, pay for rehabilitation in Russia or abroad, purchase imported medicines, pay any current expenses. In “Consent”, if a disease is detected late, payments can be made twice: first upon diagnosis of the disease, and then upon death.
Other insurers have chosen the option of paying for the necessary medical care within the insurance amount provided for in the contract and, in some cases, service support for the insured. As a rule, this path is followed by insurance companies that are part of a large holding with a developed medical care system (for example, “Welfare”, part of the Russian Railways system) or that have partnerships with medical service companies (such as Best Doctors, Europ Assicstance, Chez Medical Tours) .
At VTB Insurance, if a disease is detected, the policy allows you to double-check the diagnosis in a good clinic with leading oncologists, develop a treatment plan, and choose a specialized clinic in accordance with the identified disease. The insured is under the supervision of doctors for three years - despite the fact that the policy validity period, taking into account the waiting period, is 18 months. Ingosstrakh-Life provides for full treatment of cancer patients within a year after the end of the contract period, if the start of treatment or the occurrence of an insured event occurred after the end of this period.
Most companies pay not only for verification of the diagnosis and the treatment itself, but also for regular examinations by an oncologist, tests and re-diagnosis, which are necessary for critical illnesses.
May include payment for the insured person’s travel to the place of treatment and accommodation of one accompanying person in a hotel, as well as payment for high-tech drugs for chemotherapy and blood-based drugs.
Whether all these options are included in the contract must be clarified in advance. It is also worth paying attention to how the company interprets the terms “oncological disease” and “precancerous condition”, and whether the detection of a benign tumor in a person is included in insurance cases.
General Director of IC Blagosostoyanie Dmitry Maksimov believes that if a person is well versed in medical services in Russia and abroad, he can choose monetary compensation. “But the majority, including myself, prefer policies that provide the service of organizing and paying for medical care,” the expert emphasizes.
The main target audience of various products that include cancer insurance are middle-aged people (35-45 years old), since they are the ones who need urgent treatment when malignant tumors are detected. And it is they who, when diagnosed at stages 1-2, can be helped to return to a full life. According to MetLife statistics, the most common insured event for SCZ is the diagnosis of oncology in the early stages with a favorable clinical prognosis. It is in such cases that insurance payments will provide serious financial support for the treatment of oncology for the insured.