Various Aspects of Critical Illness Cover- Part 3

In part 2 of this article we looked at the critical illness definition recommended by Munich Re. We will now see the critical illness definition accepted by Munich Re.

A definition accepted by Munich Re may be as follows:
The death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area.
The diagnosis for this may be evidenced by all of the following criteria:
a) a history of typical chest pain
b) new electrocardiogram changes
c) elevation of infarction-specific enzymes.

This definition is challenging as it may be arguable as to whether those NSTEMI could be covered or not. Reading this definition it could be argued that a NSTEMI (Non ST Segment Myocardial Infarction) is excluded since the condition b) is not fulfilled (because there is no electrocardiogram change of the ST segment). It may therefore be necessary to make clear to insureds what kinds of infarcts are really covered under their critical illness product and hence avoid misunderstandings.

A critical illness definition rejected by Munich Re may be as follows:
The death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area.
The diagnosis for this may be evidenced by all of the following criteria:
a) a history of typical chest pain
b) new electrocardiogram changes.

This definition may turn out to be improper as there may be sharp heart attacks followed by temporary pain and ECG changes. This unfortunately may leave the blood values unchanged. This could therefore indicate that heart attacks that have not yet developed into myocardial infarctions may be accepted as claims. This may also mean that a critical illness claim has been made but its definition has not been met. Thus the critical illness claim may have a high risk to be turned down.

In addition to verifying all the critical illness conditions that apply with the three set of conditions, the insurer has also to specify the number of critical illness conditions a policy should include. Two types of critical illness cover exist. The basic cover and the extended cover. The basic cover may cover around three to six cases of critical illness. On the other hand, the extended cover may provide coverage for around 15 or more critical illnesses. Moreover, if a policy covers critical illness conditions such as heart attack, cancer and stroke, people may not be worried about getting protection against other diseases. In contrast, if another policy covers many diseases, then people may tend to be worried about which critical illness conditions have not yet been covered.

Furthermore, to handle all the critical illness claims made on extended covers may be a tedious and expensive task for the insurer. Some critical illness policies may include surgeries like angioplasty and bypass surgery. These critical illness conditions may at some point be non compulsory. But people having this option in their critical illness policies may be more willing to undergo the operation than others. Thus, to reduce the cost insurers may be exposed to, lowering the benefits on such conditions may turn out to be one possible solution to the problem.