Multiple sclerosis masterclass
Topics
1. About Multiple Sclerosis
2. Underwriting considerations
3. Comparing the market
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About Multiple sclerosis
What is Multiple sclerosis?
•
Multiple sclerosis (MS) is a condition where the protective
coating around nerve fibres is damaged. This coating is
called myelin.
•
Myelin damage is caused by the immune system mistaking
it for a foreign body and attacking it. This damages the
myelin, stripping it from the nerve fibres, either partially or
completely. This leaves scars known as lesions or plaques.
•
As well as myelin loss, there can also sometimes be
damage to the actual nerve fibres. It is this nerve damage
that causes the increase in disability that can occur over
time.
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How common is MS?
•
More than 100,000 people in the UK have MS.
•
Symptoms usually start in the 20s and 30s.
•
Multiple Sclerosis (MS) is one of the most common
neurological condition among young adults in the UK
•
It affects almost three times as many women as men.
•
Each week 100 people are diagnosed with MS.
Danny Wallace
Footballer
Aged 32
Jack Osbourne
TV personality
Aged 26
Richard Prior
Actor/comedian
Aged 46
Source: MS society, June 2014
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What causes MS?
•
No one knows the exact cause of MS, but it is
thought that a mixture of genetic and environmental
factors play a role.
•
MS is not directly inherited - there is no single gene
that causes it. It's likely that a combination of genes
make some people more susceptible to developing
MS.
MS risk by region
•
MS is more common in areas further away from the equator. It is virtually unheard of in
places like Malaysia or Ecuador.
•
There is also a growing amount of research suggesting that a lack of vitamin D could be a
factor in causing MS. We get most of our vitamin D from exposure to sunlight.
•
A number of studies have looked at smoking in relation to MS, and have found that smoking
appears to increase someone’s risk of developing MS.
Source: MS society, June 2014
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Signs and Symptoms of MS
•
•
•
MS can cause a wide range of symptoms and there is no definitive list of early signs.
Some of the most common symptoms include:
– extreme tiredness (fatigue),
– numbness and tingling,
– blurring of vision,
– problems with mobility and balance,
– muscle weakness and tightness.
People can have different symptoms at different times and, although some are very
common, there is no typical pattern that applies to everyone.
Fatigue
Depression
Increase
Cognitive
Function
Decreases
Exercise
Decreases
Cycle of
Symptoms
Spasticity
Constipation
Increase
Sleep
Decreases
Bladder
Problems
Increase
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Types of MS
This is key to understanding the relevance of definitions
•
•
•
Relapse remitting MS:
Around 85% of people with MS are diagnosed with this form of
MS.
– People with this form of MS have flare-ups of symptoms,
known as relapses. These can last from a few days to a few
months.
– These are followed by periods where symptoms are mild or
disappear altogether. This is known as remission and can
last for days, weeks or sometimes months.
Secondary progressive MS:
There is a steady worsening of your symptoms (with or without
relapses) in this form of MS. Around 65% of people with
relapsing remitting MS will go on to develop secondary
progressive MS.
Primary progressive MS:
The least common form of MS is primary progressive MS, with
10-15% of cases in this category. In this type, symptoms
gradually get worse over time and there are no periods of
remission.
Source: MS UK & Patient, June 2014
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Underwriting considerations
Underwriting considerations
What is the risk?
• Life Cover
• SIC
• IPC
What does the underwriter need to know?
• The type of MS (Primary progressive, progressive relapsing etc)
• Date of diagnosis
• Details of any neurological episodes prior to diagnosis
• Symptoms and course of diagnosis
• Treatment
• Current neurological status, degree of disability where present
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Underwriting requirements
Underwriting requirements
• GPR with details of symptoms, remissions and relapses.
Family history
• 4% of people with a first-degree relative with MS will develop the condition. 20% of MS
patients have an affected relative.
• 1 x family member- twin- LC+55%, SIC/WOP/IPC- MS Ex
• Otherwise-LC-Std rates, SIC/WOP/IPC - client <40 – MS Ex, >40 +50
• 2 x family members- LC as above
• MS Ex always to be applied on SIC/WOP/IPC
Symptoms
• Physical symptoms of MS might commonly include vision problems, balance problems and
dizziness, fatigue, bladder and stiffness and or spasms
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Underwriting outcomes
Possible underwriting outcomes
•
Life Cover:
Symptoms suggestive of MS- no firm diagnosis, nil residual abnormality
– Last episode within 1 year
+100%
– >4 years ago
Std rates
Definite diagnosis of primary progressive, secondary progressive or progressing relapsing MS
– Usually decline
Relapsing remitting MS with no current CNS symptoms
– Diagnosis < 1 year
Postpone
– Diagnosis > 1 year ago and most recent episode of symptoms < 1 year ago
+250%
– 1-2 Yrs ago
+200%
– > 5 years ago
+75% (can consider Std if no relapses since diagnosis).
•
•
The policy term may be restricted
SIC and IPV declined where definite diagnosis made
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Comparing the market
PruProtect – unrivalled cover for multiple sclerosis
Multiple sclerosis – with persisting symptoms
ABI definition
A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist. There must be current
clinical impairment of motor or sensory function which must have persisted for a continuous
period of at least 6 months.
85% of people positively diagnosed with MS have a relapse
and remitting type. So the requirement for symptoms to
have persisted for a continuous period creates an issue for
most people with MS. .
!
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PruProtect definition
Multiple sclerosis – resulting in current symptoms
•
A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist. There must be
current clinical impairment of motor or sensory function.
•
This definition covers those who have current symptoms at the time of diagnosis.
•
Severity D – 25% to a maximum of £750,000
Boosted to 100% if SIC Booster is included.
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PruProtect – a unique definition
Multiple sclerosis
•
A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist with evidence of
previous or current symptoms (even if these are not permanent).
•
This definition covers those whose symptoms are not present at time of diagnosis.
•
Severity F – 10% to a maximum of £300,000
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How the market compares
We are unique in not requiring current symptoms
Provider
Symptoms
for 6m
Symptoms for
3m
MRI and 2
attacks
3 months or 2
attacks

PruProtect
Aegon

Ageas


Aviva

Bright Grey

Friends Life

LV=

Legal & General

Scottish Provident

Skandia
Zurich
No specified
period

Majority of insurers still require symptoms to have persisted for a specified period before their definition is met.
Source: Based on PruProtect Analysis, June 2014
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We pay on diagnosis of all major neurological diseases
Unique cover
•
•
•
•
•
•
Alzheimer’s disease
Benign Brain Tumour
Coma
Creutzfeldt-Jakob disease
Dementia
Encephalitis
•
•
•
•
•
Motor Neurone disease
Multiple Sclerosis
Parkinson’s disease
Progressive Supra-nuclear Palsy
Traumatic Head Injury
Severity F – 10% to a maximum of £300,000
This is in addition to our Severity D definition for these conditions, where we also require
permanent neurological deficit and persisting clinical symptoms.
We pay all claims for major neurological conditions on
diagnosis.
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Unrivalled cover for MS and all major neurological
diseases
Matching customer expectations
• No requirement for symptoms to have persisted for a specified period. This means we are
more likely to payout that a plan using the industry standard definition.
•
Also our unique definition for Multiple Sclerosis at severity F means we pay out for all
people diagnosed with Multiple Sclerosis, even if their symptoms are not current.
•
The change to Multiple Sclerosis resulting in current symptoms definition was applied
retrospectively at no extra cost for those with Comprehensive cover.
•
Multiple Sclerosis resulting in current symptoms definition is boosted to 100% with SIC
booster.
•
Cover for all major neurological diseases on diagnosis.
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Thank you