Figure 2 shows the incidence of cardiovascular disease and stroke in the male population.
This was derived from Gen Re’s Dread Disease experience study covering the period 2012–2015 and 2015–2019 for Hong Kong, Singapore and Malaysia. As per the analysis from the leading insurance companies of the respective market, 43% of men in Singapore, 40% of men in Malaysia and 26% of men in Hong Kong had critical illness claims due to cardiovascular disease and stroke between 2015 and 2019. When compared with the 2012–2015 analysis, it was noted that there is an increase in claims by 3% in Singapore, 10% in Malaysia and 1% points in Hong Kong, which may be associated with overweight and obesity or simply an older portfolio.
Due to increases in body weight and medical complications, insurance companies may be confronted with increasing claims which will impact their profitability. To mitigate this cost, insurance companies may have to increase the premium so as to commensurate with this rising claim cost. This increase in price will impact on the healthy population.
Health insurance premium has doubled in the past 10 years, but it is unclear how much of this premium is sufficient to cover the financial burden of the obesity pandemic. The evaluation of existing and developing new health coverages related to obesity-related conditions is an important consideration for the profitability of the health insurance providers.14
The main concern of managers was that their assessors were, like the rest of the population, limited in terms of what they could do to unwind or use to escape due to lockdown restrictions and limited freedom. This contrasted with usual routines.
We asked about the impact of these concerns on the health of claims professionals. Absenteeism within claims teams varied across the companies and while sick leave increased slightly there did not appear to be any significant or concerning trends (Figure 6).
Gen Re is pleased to share the results from our latest U.S. Group Term Life Market Survey, an industry benchmarking survey covering the Group Term Life (GTL) and AD&D industry. The survey tracks sales and in‑force results as well as lapse rate and employee-paid data.
Twenty-one of the 29 companies participating in the 2021 survey have provided Group Term Life data over the past 10 survey years.
Twenty-nine companies provided GTL results for 2021. Twenty-seven provided AD&D results. On a combined basis, total GTL and AD&D in‑force premium reached $31.6 billion, with GTL representing the majority (94%) of the total. (Exhibit A)
For GTL in‑force premium, reported industry growth has ranged between 2% and 5% over the past 10 years. In 2021, in‑force premium grew by 6% compared to 2020.
After a five-year low of 1% growth in 2020, AD&D in‑force premium rose by 3% in 2021. (Exhibit B)
Second, one of the key drivers of these stable and low benefit ratios has been steady-to-declining rates of claims incidence. In a recent paper published by the SOA and co‑authored by Gen Re’s Jay Barriss, Individual Disability incidence rates were shown to have steadily improved over the 2005 to 2015 period, relative to the latest Individual Disability Valuation Table (IDIVT) incidence rate expectations.10 The favorable incidence rate trends have likely continued into at least into 2020 as Gen Re analysis on our reinsured blocks of disability business show continuing-to-stable incidence trends since 2015.
A number of studies have looked at the incidence of Long COVID, including a recently published state-of-the-art review of post-acute sequelae of severe disease.1 This indicates that 33% to 98% of survivors have symptoms or complications for at least a month. The most common of these are fatigue (28.3%‑98%), headache (91.2%), dyspnoea (13.5%‑88%), cough (10%‑13%), chest pain (5%‑42.7%), anxiety or depression (14.6%‑23%) and deficits in smell or taste (13.1%‑67%). The importance of understanding the long-term effects of COVID‑19 is vital in planning future care and management strategies. The National Institutes of Health (NIH) in the U. S. has recently allocated $470 million to build a national study population including diverse research volunteers and, to support large-scale studies on the long-term effects of COVID‑19. This is known as the NIH Researching COVID to Enhance Recovery (RECOVER) study.2
A recent study of the effects of the pandemic on anxiety and major depression has estimated a significant increase in the prevalence of both major depressive disorder, with an estimated additional 53.2 million cases worldwide, and anxiety disorders with an additional 76.2 million cases. These findings are particularly concerning because depression and anxiety were already leading causes of disability worldwide. By using the global burden of disease study model, the study gives estimates of additional disability-adjusted life-years (DALYS). Major depressive disorder caused 49.4 million DALYs, and anxiety disorders caused 44.5 million DALYS in 2020.9
Whether the increase in depression and anxiety can be solely ascribed to the effects of the pandemic or whether the disease itself can induce these conditions remains uncertain. Soon after the start of the pandemic, a UK‑wide surveillance study trying to identify neurological and neuropsychiatric complications identified patients with altered mental status, which fulfilled the clinical case definition for psychiatric diagnoses:10
21 of the 23 cases were new diagnoses.
10 had new onset psychosis.
6 had a neurocognitive syndrome.
4 had an affective disorder.
Author(s): Dr. John O’Brien, Life/Health Chief Medical Officer, London
The COVID Symptom Study App provides a first overview of who is more likely to develop Long-COVID after an acute infection. More than four million users have described their post-COVID symptoms here.
The first published evaluation of slightly more than 4,000 participants showed that one in 22 COVID‑19 cases is still affected by Long-COVID symptoms eight weeks later; every 44th person maintains symptoms after four more weeks.66
Risk factors identified here are an increased BMI and higher age, although any age group can be affected. In the younger age group, the risk for women seems to be higher than for men. Since males have a higher risk of a severe acute COVID‑19 disease, this raises further questions about the underlying differences. For Long-COVID, there may be a connection with the fact that chronic fatigue syndrome occurs more often in women than in men.67 Asthma is another risk factor for Long-COVID. In general, the probability for Long-COVID increased with the number of symptoms in the first week.
Author(s): Dr. Katharina Dorn, Life/Health Associate Underwriter, Cologne
As mentioned above, the selection of appropriate evidence is one of the most important steps in the derivation of evidence-based risk assessment guidelines. With little evidence available, this choice becomes easy, but the output may not always be satisfactory.
In the case of COVID‑19, it is not the lack of evidence as such, but the lack of long-term evidence that is a challenge. In contrast to this, the quantity of available short-term evidence is and has been record‑breaking.
This included numerous clinical studies. Since the beginning of the pandemic, new ones have been published seemingly almost every minute. While the quality of the studies may be good, they often look at small case counts only. In many instances, they were published in a preliminary stage to speed up the process of understanding the new disease. While this is reasonable to drive the scientific process, the level of certainty needed for decisions requires long-term evidence.
The Life insurance market in China has grown tremendously with premiums increasing nearly three-fold from RMB1.06 trillion in 2010 to RMB2.96 trillion in 2019. With a population now close to 1.4 billion, the insurance penetration – which has grown to 4.6% – is still far from that of developed countries. Together this represents a business development opportunity because we expect the trend of growth in the insurance market to continue.
In anticipation, insurers in China began to move their underwriting from a paper process to an online one approximately three years ago. Today the bulk of transactions are paperless, except for a small volume of bank channel applications. However, given the huge daily volume of new business, insurers still have an urgent need to improve their processes further. While we are not suggesting a major overhaul of underwriting is needed, there is room to incorporate innovative ideas that address various pain points, provide a smoother customer experience while still balancing risk management needs.
Author(s): Orchis Li, Life/Health General Manager, Hong Kong; Dr. Celia Zhang Ying, Life/Health Regional Chief Underwriter & Senior Medical Officer, Shanghai