Critical illness cover. An overview

Transcription

1 Critical illness cover An overview

2 Contents 4 Critical illness cover and what it does 5 ABI+ definitions 6 Partial payments 7 LV= enhanced benefit features 9 Children s cover 10 Claims paid in 2014 The most common causes of a claim 11 Cancer 12 Heart conditions 14 Stroke 2 15 Multiple sclerosis 16 Total permanent disability 17 LV= member benefits 18 Making a claim 19 About LV=

3 Introduction We believe that financial protection is a vital part of everyone s lifestyle and that s what s driven us to look after our customers and members since 1843 Our critical illness cover has been designed to provide fully comprehensive financial protection. Every condition covered is a potential claim, and financial security at a time when you need to focus on your health and recovery. Making our cover easy to understand In this guide we summarise the extensive financial protection offered by our critical illness cover. Ours is one of the most comprehensive policies available, covering 64 illnesses, conditions and treatments. We explain clearly what you re covered for, including our full payment definitions, partial payments, and our unique features. We give you more details about the cover we offer for the five most common reasons for a claim. We also talk about the service and support we can offer you and your family throughout the life of your policy. Important information: The headings we use in this document to describe the illnesses covered, are only a guide and refer to our current critical illness product. The full definitions of the illnesses covered and the circumstances in which you can make a claim, can be found in our policy conditions. If you d like a copy of our current policy conditions, please speak to your financial adviser. Critical illness cover An overview guide 3

4 Critical illness cover and what it does Protection for you and your family If you were diagnosed with a critical illness or suffered a serious accident, it could affect you physically, emotionally and financially. Cover with LV= aims to support you in all three of these areas. LV= Critical Illness cover is a long-term insurance policy that can also be added to a life insurance policy. It pays you money when you re diagnosed with one of the conditions or illnesses covered by our policy (and survive for at least 14 days). This payment is a lump sum for either the whole amount of your cover, or a partial payment of up to a maximum of 12,500 or 25,000. We explain more about partial payments later on. It s important to understand you re covered only for the definitions listed in our policy conditions. You can choose how you want to spend the money you receive, for example, you could; pay off all or part of your mortgage pay bills and outstanding loans and debts make alterations to your home that you may need to help you get around easier allow your partner or a family member to take time off work to support you at home pay for private treatment such as reconstructive surgery, rehabilitation or complementary therapies cover the cost of additional care or help around the home. 4

5 ABI+ definitions Means more comprehensive cover The Association of British Insurers1 (ABI) sets out standard industry medical definitions for 23 conditions to help people understand what they re covered for when they buy a critical illness policy This is known as the Statement of Best Practice for Critical Illness Insurance 2. We ve chosen to offer broader cover than the ABI definition for 19 of these conditions and we refer to these conditions as ABI+. The conditions listed below are all covered with an ABI+ 2 definition. The wording in italics is the same as in our policy conditions and tells you what s required for a claim to be paid. LV= ABI+ conditions Alzheimer s disease resulting in permanent symptoms Loss of hands or feet permanent physical severance Aorta graft surgery for disease or traumatic injury Major organ transplant Benign brain tumour Motor neurone disease resulting in permanent symptoms Cancer excluding less advanced cases Multiple sclerosis with persisting symptoms Coma - resulting in permanent symptoms Paralysis of a limb total and irreversible Coronary artery bypass grafts Parkinson s disease resulting in permanent symptoms Deafness permanent and irreversible Stroke - of specified severity Heart attack - of specified severity Terminal illness Heart valve replacement or repair Third degree burns covering 20% of the body s surface area or affecting 50% of the area of the face or head HIV infection - caught in a specified list of countries from a blood transfusion, a physical assault, or at work ABI (Association of British Insurers) represents the UK insurance industry with the government, regulators and policy makers in the UK, EU and internationally and sets out the standard medical definition for 23 of the main critical illness conditions we cover. 1 The current Statement of Best Practice for Critical Illness Insurance is dated 2011 and is being replaced in December 2015 with the Statement of Best Practice for Critical Illness Insurance Our ABI+ conditions are based on the current 2011 definitions. What you re covered for and what we would pay a claim for, are not affected. 2 You can find out more from your financial adviser or at abi.org.uk/news Critical illness cover An overview guide 5

6 Partial payments You can claim for less severe conditions and your policy remains in place In the past, critical illness cover provided protection against life threatening illnesses. A claim would be made and the policy would end. Medical advancements have now made some of these conditions less critical and whilst it s entirely possible to make a full recovery from some less severe conditions such as non-invasive cancer, the financial and emotional impact on you and your family can still be devastating. We offer 20 partial payment definitions, with payments of either 12.5% to 25% of your cover. And after we ve made a payment, your policy remains in place and for the full amount of your cover. A partial payment can help to relieve financial pressure so you can concentrate on your health and treatment. However, it s important to be aware that if you re diagnosed with a condition that meets our definition for both a partial payment and a full payment, we ll only pay the claim for the full payment condition, and your policy will end. LV= partial payments Accident hospitalisation cover - 25% of cover up to 25,000 Arteriovenous malformation of the brain - with specified treatment Carcinoma in-situ of the cervix uteri - with specified treatment Carcinoma in-situ of the urinary bladder - Carotid artery stenosis - treated by endarterectomy or angioplasty Central retinal artery occlusion - resulting in permanent visual loss Cerebral aneurysm - with surgery or radiotherapy Coronary artery angioplasty - 25% of cover up to 25,000 Diabetes mellitus type 1 - requiring permanent insulin injections Ductal or lobular carcinoma in-situ of the breast - with specified treatment 25% of cover up to 25,000 Non-severe cardiomyopathy - definite diagnosis 25% of cover up to 25,000 Ovarian tumour - of borderline malignancy/low malignant potential with surgical removal of an ovary Partial loss of hearing - of specified severity Partial loss of sight - permanent and irreversible Partial third degree burns - covering 10% of the body s surface area or affecting 25% of the area of the face or head Prostate cancer 25% of cover up to 25,000 Removal of one or more lobe(s) of the lung - for disease or trauma Severe crohn s disease - surgically treated Severe ulcerative colitis - with operation to remove the entire large bowel Testicular carcinoma in-situ - requiring surgery to remove at least one testicle Example: how our partial payments work - This is an extreme example but it s designed to demonstrate how our partial payments work alongside a full payment. Mr Smith takes out a critical illness policy with cover for 100,000. He suffers with two of the conditions covered by a partial payment, he then goes on to suffer and survive a heart attack. Condition Claim type Year of claim Amount he receives Prostate cancer partial payment ,000* Cardiomyopathy partial payment ,000* Heart attack full payment ,000 Even though his original cover was for 100,000, LV= would pay him a total of 150,000 * Payment is 25% of cover up to a maximum of 25,000 6

7 LV= enhanced payments We offer enhanced claim payments for 16 specified conditions Experiencing a critical illness at an earlier age or as a result of an accident can mean living with a life-changing condition for many decades. This could potentially affect your finances and lifestyle for the rest of your life. Our unique enhanced payment definitions have been designed to pay you more money than the original amount you ve insured yourself for. 150% of cover for neurological conditions diagnosed under age 45 We offer enhanced payments for six neurological conditions. We ll pay you one and a half times your cover (150%) if you re under the age of 45 and have been diagnosed with of one the conditions opposite. The enhanced payment can be up to an additional 200,000 on top of your original cover. Being diagnosed with a critical illness at any age is devastating but being diagnosed at a younger age can have an even bigger impact as you re more likely to; Enhanced payment neurological conditions Alzheimer s disease resulting in permanent symptoms Dementia (including senile dementia) resulting in permanent symptoms Motor neurone disease resulting in permanent symptoms be working and earning an income at the time of diagnosis have a partner who still works and so unable to look after you have dependent children have ageing parents who need caring for have been more physically fit and active have financial commitments, such as a mortgage or loan. Multiple system atrophy resulting in permanent symptoms Parkinson s disease resulting in permanent symptoms Progressive supranuclear palsy resulting in permanent symptoms For example Mr Smith has cover of 100,000; he s diagnosed with Parkinson s disease at age 38. He ll receive a payment from us of 150,000 (1.5 x 100,000). Mrs Brown, also aged 38 is diagnosed with Motor neurone disease and has cover of 450,000; she ll receive a payment from us of 650,000 (enhanced payments are limited to an extra 200,000). Critical illness cover An overview guide 7

8 200% of cover for accidents If your claim is as a direct result of an accident, and for one of the ten conditions shown below, we ll pay you twice the amount of your original cover, up to an additional 200,000. Generally speaking, an accident is an incident that occurs entirely by chance. There are a number of things we won t consider an accident. For example, an intentional self-inflicted act. For more details of what we do and don t consider an accident, please refer to our full policy conditions. Accident enhanced payment conditions Blindness - permanent and irreversible Coma - resulting in permanent symptoms Deafness - permanent and irreversible Loss of hands or feet - permanent physical severance Loss of independent existence - unable to look after yourself ever again Loss of speech - permanent and irreversible Paralysis of a limb - total and irreversible Surgical removal of an eyeball Third degree burns - covering 20% of the body s surface area or affecting 50% of the area of the face or head Traumatic head injury - resulting in permanent symptoms 8 An example of how the accident enhanced payment works Mr White has cover of 100,000 and has to have his leg amputated as a direct result of a car accident. He ll receive a payment of 200,000 (2x cover of 100,000). Ms Jones has cover of 500,000 and suffers a traumatic head injury after a horse riding accident. She ll receive a payment of 700,000 (enhanced payments are limited to an extra 200,000).

9 Children s cover Our children s cover is automatically added to your policy at no extra cost No one ever wants to imagine their child becoming critically ill, but sadly it does happen. Our children s cover is automatically included in your critical illness policy and even if you don t have children now, they ll still be covered if you have a family in the future. In % of our critical illness claims were paid to parents of very sick children with the majority of these claims relating to cancer and cancer related illnesses. The money gives parents options and breathing space. It can be used to; take time off work or leave work make necessary adjustments to the home or family car pay for private treatment or therapies pay for travel expenses What we cover We provide cover from birth up until their 21st birthday. And your children are covered for all the same conditions, illnesses and treatments as the main policy, except for total permanent disability and our partial payment for diabetes type 1. Jeremy, Nicola and family on holiday Everybody thinks it s never going to happen to them and we thought the same, but not anymore, it happened in the blink of any eye and in a moment everything changes. Jeremy and Nicola Krzystyniak Critical illness customers - children's claim Please note: We ll also pay a claim if your child is born with one of the conditions listed in the policy as long as the symptoms hadn t arisen before your policy started. What we pay Children s cover is similar to a partial payment in that a claim won t affect your main policy. We ll pay 50% of your cover up to a maximum of 25,000 for a single policy and 50,000 if you have more than one critical illness policy with us. Critical illness cover An overview guide 9

10 Claims paid in 2014 Five common causes accounted for nearly 95% of LV= critical illness claims in 2014 The top five reasons for paying a critical illness claim were; Cancer, Stroke, Heart attack (including other heart conditions*), MS and Total permanent disability. Together these accounted for over 95% of all critical illness claims paid in *Heart attack 7%, other heart conditions 5% (12%) Cancer 67% Stroke 9% Heart attack 7% Other heart conditions 5% Multiple sclerosis 5% Total permanent disability 3% Parkinson s and other neurological 2% Others 3% Overall claims Child claims accounted for 4% of all critical illness claims Due to rounding, figures do not add up to 100% 10

11 The most common causes of a claim Cancer Cancer is the most common cause of LV= critical illness claims, accounting for 67% of claims in 2014 We provide one full payment condition and six partial payment conditions relating to cancer. Macmillan cancer support estimate that by the end of 2016, there will be more than 1,000 people diagnosed with cancer every day in the UK. Breast cancer and prostate cancer are the most common female and male cancer claims we see. In 2014 breast cancer accounted for 54% of all female cancer claims and prostate cancer for 23% of all male claims. Depending on the severity of the cancer, it may be paid under a full claim payment or a partial payment up to 25,000. Full payment ABI+ condition - for more severe and advanced forms of cancer Cancer can affect any part of the body and our definition would give you a payment for the full amount of your cover. This definition is designed to cover more serious and invasive forms of cancer. Less severe forms, such as a carcinoma in-situ diagnosis, may be covered by one of our partial payments. Partial payments Ductal or lobular carcinoma in-situ of the breast - 25% of cover up to a maximum of 25,000. Prostate cancer - 25% of cover up to a maximum of 25,000. When prostate cancer is diagnosed it s usually given a severity level based on a number of clinical classifications and this would dictate whether we made a full or partial payment. What is Carcinoma in-situ? Carcinoma in-situ is a term used to describe a cancer that is only present in the cells where it started, and has not spread to any nearby tissues. For example, the earliest stage of breast cancer would be called carcinoma in-situ of the breast or the earliest stage of cervical cancer might be called carcinoma in-situ of the cervix. We provide cover for four carcinoma in-situ conditions. Name Partial payment Affects Ductal or lobular carcinoma in-situ of the breast Carcinoma in-situ of the cervix uteri Carcinoma in-situ of the urinary bladder Testicular carcinoma in-situ Prostate cancer (early stage) 25% of cover up to a maximum of 25, % of cover up to a maximum of 12, % of cover up to a maximum of 12, % of cover up to a maximum of 12,500 25% of cover up to a maximum of 25,000 Men/women Women Men/women Men Men Critical illness cover An overview guide 11

12 The most common causes of a claim Heart conditions Heart attacks account for 7% of our critical illness claims and other heart related conditions account for 5% of claims Heart attack - (ABI+) full payment condition A heart attack happens when one of the three arteries that feed the heart muscle become completely blocked. The area of the heart being supplied is damaged or dies. A heart attack is known medically as a Myocardial infarction and means damaged heart muscle. To accurately diagnose a heart attack a number of tests are carried out: An electrocardiograph (ECG) to show changes in the electrical activity of the heart (or findings on a heart scan) Blood tests to establish levels of cardiac enzymes or Troponins (proteins) If the ECG shows a change in the electrical activity of the heart and the enzymes levels rise, we accept this as evidence of a heart attack and do not require the rise to meet a specified level. Around 175,000 people suffer a heart attack in the UK each year*. *bhf.org.uk We provide nine full payment conditions and three partial payment conditions relating to heart and vascular conditions. Full heart conditions Aorta graft surgery - for disease or traumatic injury Cardiac arrest Cardiomyopathy - of specified severity Coronary artery bypass grafts Heart attack - of specified severity Heart valve replacement or repair Idiopathic arterial pulmonary hypertension of specified severity Open heart surgery - with surgery to divide the breastbone Pulmonary artery surgery - for disease only Partial payment heart conditions Non severe cardiomyopathy - definite diagnosis Carotid artery stenosis - treated by endarterectomy or angioplasty Coronary artery angioplasty 12

13 The most common causes of a claim Cardiac arrest - Full payment condition A cardiac arrest differs from (but can be caused by) a heart attack in that the heart stops pumping blood around the body. A cardiac arrest can happen to anyone at any age and a heart attack is usually linked to an unhealthy lifestyle or older age. The most common cause of a cardiac arrest is an abnormal heart rhythm called ventricular fibrillation. Ventricular fibrillation occurs when the electrical activity of the heart becomes so chaotic that the heart stops pumping and quivers or fibrillates instead. Cardiomyopathy - Full payment condition and Partial payment condition Cardiomyopathy is a disease of the heart muscle. There are four main types and dilated cardiomyopathy (DCM) is the most common. DCM can affect children and adults but is most common in middle-age men. About 2 in 10,000 people in the UK develop DCM each year*. *patient.co.uk/health Aorta graft surgery - (ABI+) Full payment condition The aorta is the main blood vessel in the body. Blood is pumped from the heart and passes across the aortic valve (one of four valves in the heart), and then through the aorta, where it is then distributed through a system of smaller arteries. Our definition includes grafts to the thoracic and abdominal aorta but not the smaller arteries that branch off of the main aorta blood vessel. Our definition includes surgery for traumatic injury as well as disease. Coronary artery bypass grafts - (ABI+) Full payment condition A coronary artery bypass graft (CABG) is a surgical procedure used to improve the blood flow and oxygen supply to the heart when arteries have become narrowed by the build up of fatty deposits. Each year around 17,000 CABG procedures are performed in the UK*. *bhf.org.uk Coronary artery angioplasty - Partial payment condition Coronary artery angioplasty is another procedure used to open narrowed or blocked arteries. The artery is widened when a stent (a short wire mesh tube) is inserted into the relevant artery to allow the blood to flow more easily. This is often used to relieve symptoms such as angina and shortness of breath. Heart valve replacement or repair - (ABI+) Full payment condition There are four valves in your heart making sure that blood flows in and out of the heart in the correct direction. There are two types of valve surgery: -- Valve repair: Often used when a valve leaks but is not seriously damaged. -- Valve replacement: The diseased valve needs to be removed and replaced with a new valve. Open heart surgery - Full payment condition Open heart surgery is any surgery where the chest is opened and surgery is done on the heart muscle, valves, arteries, or other parts of the heart (such as the aorta). The term open means that the chest is cut open. If the breast bone is divided and surgery is carried out, a full payment claim will be paid. Critical illness cover An overview guide 13

14 The most common causes of a claim Stroke In 2014, strokes accounted for 9% of all our critical illness claims For the brain to function, it needs a constant blood supply to provide vital nutrients and oxygen to the brain cells. A stroke happens when the blood supply to part of the brain is cut off and brain cells are damaged or die. Strokes affect people in different ways, it depends on the part of the brain that has been affected, the severity of the attack and how healthy the person was before the stroke. Half of all stroke suffers have a disability, such as weakness and paralysis, problems with walking and difficulty balancing. Other common problems after a stroke include communication, cognitive and emotional issues. Half of all stroke patients suffer with a disability, such as weakness, paralysis and difficulty with walking and balancing. Other common problems after a stroke include communication, cognitive and emotional issues, resulting in a significant change to the lifestyle previously enjoyed. Stroke - (ABI+) Full payment We ll pay a stroke claim on diagnosis, this means you won t need to wait for your money while the consultant decides if your symptoms are permanent or not. Before we pay you, all we require is that you ve been diagnosed as having had a stroke with 24 hours of persisting clinical symptoms. The stroke association estimate that 152,000 people suffer a stroke in the UK each year, that s one every 3 minutes and 27 seconds. They can affect young people, children and babies*. *stroke.org.uk 14

15 The most common causes of a claim Multiple sclerosis In 2014, multiple sclerosis accounted for 5% of all our critical illness claims Multiple sclerosis (MS) is a neurological condition affecting the central nervous system. The immune system, which normally helps to fight off infections, mistakes myelin (the coating around the nerve fibres) for a foreign body and attacks it. This damages the myelin and strips it away, either partially or completely, leaving scars known as lesions or plaques. This damage disrupts messages travelling along the nerve fibres meaning they can slow down, become distorted, or not get through at all. ABI+ full condition payment for multiple sclerosis Our definition will pay a claim after three months of persisting clinical symptoms or immediately on evidence of two or more attacks of impaired motor or sensory function. As long as this is evidenced with a MRI scan, a normal procedure when a diagnosis is being made. MS affects around 100,000 people in the UK and most people are diagnosed between the ages of 20 and 40. More women than men are diagnosed and it can also affect young children*. *ms-uk.org Critical illness cover An overview guide 15

16 The most common causes of a claim Total permanent disability Total permanent disability accounted for 2% of all the critical illness claims we paid in 2014 Our Total permanent disability definition is optional and can be included in your policy for an additional cost. This covers you if you have an illness or injury that leaves you permanently unable to work in your own job, or able to complete a number of everyday tasks, for the rest of your life. Please note: This definition is excluded from our children s cover. What are the risks of suffering with a serious illness and being unable to work? According to the LV= Risk Reality Calculator, a 41 year old female non- smoker has a 12% risk of suffering a serious illness and a 6% risk of dying, before retirement. A male at the same age and also a non-smoker, has a 15% of suffering a serious illness with a 7% of death before retirement. Ask your adviser to run your details through our Risk Reality Calculator to see your own personal results. 16

17 LV= member benefits Help, support and product discounts Every single customer who buys an LV= protection product automatically becomes a member of the society. Looking after and supporting our members is at the heart of everything we do. We care about you and your family and we ll try and help you whenever we can. We give all our members exclusive access to a range of support services that we feel offers you something that can make life flow a little easier when it s needed. You can find out more about membership in the About LV= section on page 19. LV= Health and Wellbeing Line Our health and wellbeing line is available 24 hours a day, 7 days a week, to support members with any health, medical or wellbeing questions. Health advice and telephone counselling You ll have access to a team of trained medical professionals who will be there to offer practical advice and support on any aspect of your health and wellbeing. This could be anything from childcare issues, to what to expect if you (or a member of your family) need to have an operation. Counselling Some people find it easier to talk to a stranger than to relatives or friends. Our experienced counsellors will be able to give you advice on how to cope with any issues you may be facing. Including things like relationship difficulties, bereavement or stress. To make things even easier, you can choose to work with the same counsellor on an on-going basis. Legal advice service Knowing your rights and what you re entitled to can make life a lot easier sometimes. Putting up with a noisy neighbour or a pushy landlord for example, can add unnecessary stress to your life. Our legal advice line gives you access to fully qualified solicitors and lawyers without the associated costs. The legal team have experience in over 100 areas of law, including; Employment - unfair dismissal, redundancy and discrimination Family law - child maintenance, divorce and domestic violence General law - civil litigation, motoring offences, debt advice and personal injury Property - nuisance neighbours, home purchase and access rights Private - client wills, trusts, powers of attorney and probate Your say in how LV= is run Once you ve been a member for over 12 months (and are over age 18), you ll be able to vote and attend our Annual General Meetings and have a say in how we run the company. Member discounts As a member you could save money on LV= car, home and travel insurance. To find out more about what it means to be a member of LV= please ask your financial adviser or visit us at LV.com/members Critical illness cover An overview guide 17

18 Making a claim Support before, during, and after a claim When you need to make a claim you can contact us in a number of different ways; phone, or letter. As soon as we receive your claim, we allocate you a personal claim consultant and they will start reviewing your claim immediately. We ll usually need some evidence from your doctor (or the medical practitioner who is treating you) to confirm your diagnosis. We may also need to get medical reports from your doctor. If we do, we ll send you a consent form for you to complete. Your personal claims assessor will give you their direct contact details and you can call or them directly whenever you have any questions. Our consultant will deal with all aspects of your claim, from the first phone call to making sure you receive your money as quickly as possible. On average we pay a critical Illness claim within 6 weeks. This can be a lot quicker if we receive all the medical evidence promptly. We understand that it s a very emotional time when you or a family member are making a claim. We ll support and guide you gently through the process and, where needed, chase your doctor for the relevant medical evidence so that you receive your money quickly. But remember, we re not just here for you when you need to make a claim. The LV= health and wellbeing phone line is available to you and your family 24 hours a day. 18

19 About LV= We re the UK s largest friendly society and a leading financial mutual company. We have over 6,000 employees, 1.1m members1 and 4.4m customers2 As a mutual we have no shareholders, so are truly focused on putting our members first and ensuring that they benefit from everything we do. Our roots go all the way back to And although LV= has changed a lot, our core values remain the same; to provide financial security to each and every one of our members and customers. If you buy a protection product or retirement and investment policy with us, you become a member and owner of the society with certain benefits and rights. Ask your adviser for more information about being a member of LV=. 1 You re a valued customer if you own one of our general insurance products such as home, car and travel insurance. 2 Important information: Our critical illness policy covers 64 conditions, illnesses and treatments as listed in the main policy conditions. More details are available from your financial adviser. Please note: This is not an investment product and if you stop paying your premiums, your cover could stop and you won t receive any money back. Critical illness cover An overview guide 19

20 Liverpool Victoria Friendly Society Limited: County Gates, Bournemouth BH1 2NF. LV= and Liverpool Victoria are registered trademarks of Liverpool Victoria Friendly Society Limited (LVFS) and LV= and LV= Liverpool Victoria are trading styles of the Liverpool Victoria group of companies. LVFS is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority, register number Registered address: County Gates, Bournemouth BH1 2NF. Telephone: /15