Zurich has engaged with a campaign to create protection products for people suffering with sickle cell and highlighted there are widespread solutions available for carriers, but noted the complexity of the disease presents significant challenges to protecting those diagnosed with it.
However, advisers believe a product to support the community would be “incredibly welcomed” and suggested it could be combined with other less common diseases to support a wider customer base.
Zurich insurer stepped-up after Sheun Oke, an area sales manager at Wealthmax Financial Advisers, challenged the industry to live up to its talk about supporting more diverse communities by providing protection products for people with sickle cell.
Her call did not fall on deaf ears as Peter Hamilton, head of market engagement at Zurich, contacted Oke about the issue and pursued it with the insurer’s underwriters.
Hamilton (pictured) told Health & Protection about the complications around underwriting sickle cell and that cover will depend on the nature of the disease, but it was possible for standard rates to be offered to carriers.
Hamilton explained that the heterozygous form of the disease (HbAS) sickle cell trait generally does not affect life expectancy of carriers.
While there are case reports of sudden death in athletes competing in extreme conditions or activities, in most cases ordinary rates can be offered for all products, he added.
However in the homozygous form (HbSS) of the disease – sickle cell anaemia and sickle cell ßo/ß+ thalassaemia, life expectancy varies from near normal to death before age 40.
Hamilton noted that the prognosis depended upon the degree of anaemia, a history of ‘crises’ and the presence of end-organ complications.
This end-organ damage due to vaso-occlusive disease invariably occurs in adults, with cumulative end-organ injury often affecting bone, brain, kidney, spleen, lung, eye, heart and liver function.
And serious infection, particularly due to encapsulated bacteria is a leading cause of mortality in sickle cell disease.
So, terms for life cover will be based upon the age at application and the time since the last episode or crisis, Hamilton confirmed.
“As a general guide, the younger the applicant with fewer years since the last episode – the higher the loading,” he continued.
“Consequently, more favourable terms will be applied to older lives with a longer period – greater than five years – since the last episode or crisis.
“At the moment, due to the complications associated with this variant, we are unable to offer terms for critical illness (CI) and income protection (IP), and I recognise that is where one of the challenges lies,” he added.
Hefty exclusions and high loadings
And it certainly is a challenge to arrange protection insurance for people living with the disease, Alan Knowles, managing director at Cura Financial Services, agreed.
“In a nutshell, if the client just has a sickle cell trait which means they carry the gene but don’t have the disease itself then life, CI and IP are usually available without any adverse terms,” he said.
“If however, the client has sickle cell disease (SCD) it will be looked at based on the subtype, how the condition affects the individual and importantly when the last crisis was.”
According to Knowles, the good news is life cover can normally be secured for sickle cell sufferers but this will be subject to a moderate loading.
“Where cases are more serious or there have been recent crises then we approach specialist underwriters and the prices can be pretty high,” he continued.
“Critical illness is rarely available for people living with SCD as the loadings would be too high – that’s the reason insurers tell us; there are some plans where acceptance is guaranteed but these come with very hefty exclusions so it is not something we would normally offer to someone.
“Similarly, IP is usually a decline but there are some simplified plans on the market which exclude anything linked to pre-existing conditions – these can work quite well for some people as well as short term accident and sickness plans.”
‘Combine with underserved conditions’
Knowles maintained he would love to see increased availability for people living with SCD, but added he was not sure insurers would opt to develop a specific product for the condition due to the small population.
“We have seen diabetes specific plans in the past but these haven’t really worked out and there are over 4.8m diabetics living in the UK,” he said.
“There are currently around 15,000 people living with SCD which is a much smaller number for insurers to look at, and therefore I suspect it might be difficult for insurers to build something just for this condition.
“However, if you combine this with other underserved conditions like Ehlers Danlos, antiphospholipid syndrome, cystic fibrosis – to name a few – you could quickly get to higher numbers; so cover aimed at people with such conditions would be incredibly welcomed in the market.
“While insurers may suggest people won’t pay the prices needed or take out cover with exclusions, I would say the fact that firms like Cura who specialise in these markets show the polar opposite and actually when people struggle to get cover they tend to want it even more.”
As for Oke, her campaign continues as she maintains there is a clear need from people who continue to live their lives with sickle cell.
“I spoke to someone with sickle cell two days ago and she had not had a crisis in 15 years. So for people like that – why would you tar them all with the same brush?” Oke asked.
