Critical Illness (CI)
Asked on 09 Oct 2019
For context, Critical illness definition is going to be changed on 26 Aug 2020.
Are the old terms better than the new terms?
Whether or not the older terms are better than the newer terms can be a subjective one, but we can first address these concerns by examining the current definition vs. the new definitions.
Let's take a look at them:
1) Major Cancers:
"Major Cancer diagnosed on the basis of finding tumour cells and/or tumour-associated molecules in blood, saliva, faeces, urine or any other bodily fluid in the absence of further definitive and clinically verifiable evidence does not meet the above definition" has been added.
I'm no actuary, but it would seem that the requirement for confirming a major cancer is stricter now that you cannot use blood or bodily fluids to positively diagnose cancer. It will probably mean that a biopsy from the suspected cancer site is required.
"Skin confined primary cutaneous lymphoma and dermatofibrosarcoma protuberans" is specifically excluded now. The rationale was that it was easy to treat and does not fulfil the intent of severe stage coverage. In other words, if you happen to be diagnosed with this, it will not be claimable as opposed to now.
"All bone marrow malignancies which do not require recurrent blood transfusions, chemotherapy, targeted cancer therapies, bone marrow transplant, haematopoietic stem cell transplant or other major interventionist treatment; " are now excluded
Same as above, more exclusions
My opinion: Getting more specific and hence stricter on the claims. Well, you can definitely say that with fewer grey areas, a positive diagnosis would either lead to a claim or not, instead of having to debate back and forth with the insurer's doctors.
2) Heart Attack
The new addition of "Death of heart muscle due to ischaemia"
The old wording was "due to obstruction of blood flow". Again, getting more specific here. MyocardiaInfraction type 1 and 2 would be covered very specifically. The term "obstruction of blood flow" is rather vague if you look at it.
"With persisting clinical symptoms" has been removed from the definition. Rationale was that after surgery, a cut out tumour could be bleeding, but this is often as a result of the surgery, rather than the stroke. So it's more specific now. “Secondary haemorrhage within a pre-existing cerebral lesion” added as an exclusion. Hence, slightly lesser things to claim on.
4) Aplastic Anaemia
"Irreversible" has been added. Although I'm no doctor, it would seem that it is harder to claim now. Previously, the older definition would mean that although the anaemia due to bone marrow failure is chronic, you could just make a claim once you've proven it's chronic. Now you need to prove it is both chronic and irreversible.
"Medically induced coma" now excluded.
6) Deafness (Loss of Hearing)
It now has to be "irreversible" to a very specific definition of “cannot be reasonably restored to at least 40 decibels by medical treatment, hearing aid and/or surgical procedures consistent with the current standard of the medical services available in Singapore after a period of 6 months from the date of intervention ”. So if you lost hearing above 80 decibels permanently but could be restored to at least 60 decibels, you won't qualify under the new definition. Stricter in my opinion and harder to claim.
7) HIV Due to Blood Transfusion and Occupationally Acquired HIV
"The insured does not suffer from Thalassaemia Major or Haemophilia" has been removed.
An improvement, surprisingly. Previously, if you had Thalassaemia Major or Haemophilia, you would be excluded from this even if you had gotten HIV due to blood transfusion. However, Thalassaemia Major usually limited your life expectancy to 30 years unless you are one of the lucky few who can get a marrow transplant. Haemophilia (poor blood clotting) would limit your lifespan too. But at least these people have recourse now, should a blood transfusion cause them to get HIV. An improvement in my view.
8) Benign Brain Tumour
3 exclusions added (Abscess, Angioma, tumors of skull base). Stricter.
9) Viral Encephalitis
Well. What a surprise. The older version required "viral infection" as a cause, but now all causes can allow a claim. An improvement. However, they added the requirement of "confirmatory diagnostic tests", which is layman for saying that they need to do more tests on you to confirm the condition.
Added a very specific (and stricter line) "The blindness must not be correctable by surgical procedures, implants or any other means." It's almost future-proofing the definition in case bionic implants are invented in future. Well, we can't do what Thor did in Avengers: Infinity War any more (I hope you watched the movie). Thor would have qualified under the old definition, assuming he lost both eyes to Hela and Rocket Racoon had 2 implants available.
11) Progressive Scleroderma
You now need "equivalent confirmatory tests" but you would need it anyway, since under the old definition you needed a biopsy, and you can't do that on your heart or lungs.
Another criterion is “confirmed by a consultant rheumatologist”, which would just be a minor issue, although stricter (you specifically need to find a rheumatologist now)
12) Apallic Syndrome
It's now called "Persistent Vegetative State". Nothing's changed. Kind of like how Kentucky Fried Chicken (which used the full name previously) rebranded as "KFC". The chicken is still the same 11 herbs and spices.
13) Systemic Lupus Erythematosus with Lupus Nephritis
You now need "clinical and laboratory evidence" so it's slightly harder and probably more troublesome? They changed the classification of Lupus from using WHO to RPS/ISN since RPS/ISN is the more relevant body to classify Lupus. It's like benchmarking Singapore's SMRT to Hong Kong's MTR, you probably want to benchmark it to Japan's JR group since they are the gold standard for train service in most people's eyes.
14) Other Serious Coronary Artery Disease
Instead of "coronary angiography", you now need "invasive coronary angiography" to confirm it. So that rules out CT or MRI. It's stricter. "The branches of the above coronary arteries are excluded." just means less ambiguity.
You now need a diagnosis by "a consultant neurologist or specialist in the relevant medical field." Just slightly more requirements but not a major impact.
TLDR; A slight negative in my view, stricter conditions make it slightly harder to claim, but clearer definitions make it a definitive yes/no when it comes to claiming.
So now, the big question: Should you get a plan now or wait?
I would say that you should get a CI plan not because of the definitions becoming stricter, but rather because you need one. If you don't need one because you already have sufficient coverage, that's ok.
But if you have not reviewed your CI cover for a while, and you don't have sufficient coverage upon a review, you will want to get additional cover. Between now and 2020, you cannot say for certain that nothing will happen to you in terms of CI, and there's usually a 90 day waiting period for CI claims. You want to ensure that (touchwood) should you ever claim, your policy has already been in force more than 90 days. CI can strike without warning, my own aunt was ok until she had persistent stomach pains for a month in 2017, and then she was diagnosed with stage 4 stomach cancer and passed on in 6 months (she was 80+ and did not have CI cover, so the last 6 months was a bit of a stretch financially as we tried to make things more comfortable for her)
In the end, more people are diagnosed with cancer each day in Singapore than people who perish in a car accident (though traffic accidents tend to make the news). Critical illness, especially the big three (Cancer, Stroke, Heart Attack), is really a silent killer, and for those who survive, the funds they have to burn through can be substantial. I'd like to think that everyone has a plan when CI strikes; it's either a plan by default or a plan by design. By default meaning that you live life as normal, should CI strike, you burn through your resources, and have to turn to your loved ones for financial aid. By design meaning you design a strategy and take the right steps to mitigate risk by passing it on to the insurer, and should CI strike, your payout provides you funding and eliminates financial stress on you and your loved ones, and you retain your dignity. Would you prefer a plan by default or a plan by design?
I'm sorry if the answer is rather lengthy, but I just felt I needed to put my viewpoint forth in full.
As medical science advances, new medical definitions come up all the time.
The objective is to reflect medical changes and REDUCE ambiguity as they arise.
Analysis of the key changes by understanding the TOP 5 CI claims Do you know that 90 per cent of all severe stage claims received by life insurers are for five critical illnesses:
heart attack of specified severity
stroke with permanent neurological deficit
coronary artery bypass surgery
end-stage kidney failure.
This part is to examine how the new definitions reduce ambiguity by explicitly stating exclusions.
1) Major Cancer:
It is now specified that: "Major Cancer diagnosed on the basis of finding tumour cells and/or tumour-associated molecules in the blood, saliva, faeces, urine or any other bodily fluid in the absence of further definitive and clinically verifiable evidence does not meet the above definition".
There are cancer marker tests these days using body fluids but the conclusion is often with a scan. This is to specify that conclusive proof is needed NOT that it wasn't already previously.
In the exclusions list, MORE has been explicitly stated. I'd highlight two of them
A) Carcinoma-in-situ (Tis) or Ta;
Below is an image (on bladder cancer) to possibly help you understand more on Carcinoma in situ (Tis) or Ta since it is common these days.
Carcinoma in situ (also called CIS or Tis) means very early, high grade cancer cells. It is a non-invasive cancer of the flat urothelial or transitional cells. Source.
Ta is now explicitly stated to be excluded moving forward.
B) All grades of dysplasia, squamous intraepithelial lesions (HSIL and LSIL) and intra epithelial neoplasia.
This is to specifically state because dysplasia, squamous intraepithelial lesions (HSIL and LSIL) and intra epithelial neoplasia requires further testing.
Previously, the exclusion explicitly stated was only Cervical Dysplasia CIN-1, CIN-2 and CIN-3. NOT that HSIL and LSIL were previously payable.
2) Heart Attack of specified severity
The new definition is Death of heart muscle "due to ischaemia" vs "due to obstruction of blood flow".
Medical professionals use Ischaemia and medically it is the same thing.
LIA specified that it replaced “obstruction of blood flow” with “ischaemia” to reflect the intent to cover Type 1 MI and Type 2 MI.
I did some further reading and there is Type 3 MI which is actually for deaths due to heart attack before conclusions can be made. (source).
In any case, death to the patient happened before the CI survival period so it is not for discussion here.
3) Stroke with Permanent Neurological Deficit
From LIA: Deleted “with persisting clinical symptoms” as not necessary.
In my opinion, this simply is one less criterion which is good for claiming.
From LIA: Sometimes, after a cranial surgery, the pathological analysis of the resected tumour could show signs of “intra tumour” bleeding. Whilst there is intracranial or cerebrovascular bleeding, it is not a valid claim under the Stroke definition.
This is to remove ambiguity (by explicitly putting into exclusions) in my opinion for patients who exhibit stroke-like symptoms due to cranial surgeries. 4) Coronary Artery By-pass Surgery
No changes made.
5) End-stage kidney failure
LIA changed the header to reflect the intent of end-stage.
BUT new definitions or old is not the REAL QUESTION.
Moreover, there will likely be another "revised new definition" a few years later again.
If you have a shortfall in coverage, get insured NOW because critical illness (CI) can impact you from a sudden disease or a sudden trauma.
In addition, there is usually a further 90 day waiting period from your policy before you can claim for Critical illness (CI). Hope it helps.
In contrast with the other answers here.... I am an actuary.
While there are some corner cases which are covered in the other answers, overall from an insurance company point of view there is no expectation that the changes in definition would result in meaningful change in claims cost.
So, no need to wait just coz of definitions and just buy based on other factors
If you are sufficiently covered, there’s no need to rush to get a CI coverage just because of a few changes in definitions.
But if you’re already planning to get life insurance with CI coverage, you’ll want to consider whether the current definitions are more lenient and to your advantage.
Doesn't have to be everything now or everything later.
Get a small sum assured now to start some coverage
Get another sum assured later when your income improves and you have more responsibilities in your life :)
Interestingly, not all revised critical illness terms are an improvement. Some, like deafness, will become stricter to encompass irreversibility of loss of hearing instead of just purely loss of hearing (possibly to be temporary and improved). The only advantage in waiting is the saving of one year's premium.
That being said, it will be nearly a year before the new changes kick in, so it's not so much about how much stricter or comprehensive the definitions in 2020 are going to be, but rather on how you treat CI as a whole.
As an adviser, I will always recommend my clients to take up sooner than later, regardless of the changes for now.
Why? Because within the year, can you guarantee 100% that you will definitely be safe from any of the current 37 conditions within the year? I'm sure you've heard of people who go for annual checkups with nothing wrong last year and suddenly getting stage 3/4 cancers the year after.
Critical illnesses don't wait for you to get covered before happening. One day your body may go through sudden changes whether stress, binge eating, or just a sudden clot in your brain for no apparent reason.
Not to mention there is a 90-day waiting period for the illnesses to be payable in claims, with the added advantage that buying today at a younger age would mean lower premiums for your critical illness coverage.
I always tell people that every day is a dice roll; it just takes a single bad roll to ruin your life. So if you don't have much CI coverage, just take some up first. If the new definitions are really that much better, consider replacing in the future. But we leave things in the future for the future, because your present is the most important to you now.
Feel free to drop your response below. I will be happy to answer them here or even in person if you are ever up for it.
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