Kathryn (00:06):

Hi everybody. We are on season eight, episode nine, and today I have Paul Bevin and Rachel Edwards from Brisk With Me today. Hi

Paul (00:15):

Morning.

Kathryn (00:17):

Good morning. Today we’re going to be talking about the mix of travel insurance and medical conditions. This is the Practical Protection Podcast. So how are you both doing? Have you had a lovely kind of festive break

Paul (00:41):

All? Very good, thank you. Yes, great to be back and yeah, Christmas in the rear view mirror, but we’re looking forward to 2024 ahead.

Rachel (00:50):

Yes, thank you. Lovely break this end. Although looking forward to a busy year, so kicking the ground running.

Kathryn (00:57):

Yeah, absolutely. It’s always that weird thing, isn’t it? Stuff like really enjoying a break and then you just straight back into it and it is just kind of intense and sometimes I think for myself, I think would it have been easier not to have had a break sometimes, but I think we do need to make sure that we have those times, don’t we? But thank you. Obviously both of you so much are coming here. We often on this podcast it is a lot of the time we’re talking about medical conditions, really deep diving into them and from the underwriting side what it can mean. But really from the protection insurance side of things and what I often have, because I am somebody who does really help people with medical conditions and insurances, there is no end of need and want of travel insurance. So when I’m doing anything say like with charities or anything else and they’ll ask me to maybe speak to members and everything, I always start off with that caveat of sort of saying to people, I can come and chat to people.

(01:46):

I don’t do travel insurance. Make sure that you don’t promote this as a travel insurance thing. And then without a doubt I get there and every single question is about traveling shows. I always feel terrible like I can’t, I’m so sorry I can’t tell you about this but I can tell you about all this other stuff, which is wonderful. But people like holidays, they like to have a break and things, so I think what’d be really good, it’s obviously a good place to start is that say people want travel insurance. We don’t tend to have the same battle to convince people to take out travel insurance, whereas things like car insurance, home insurance, mobile phone insurance, pet insurance, travel insurance, people really want those things. Whereas on my side with the life insurance, people do really want it, but then there’s so many people where they really need it, but you do need to really lay it out for them as to why they would need it. So a lot of people that also have medical conditions will probably need to have these things considered. When it comes to the travel insurance application, it is sort like a very similar process as to the protection insurance. There’s going to be health questions, not all the same types, but your firm’s technology sits right in the middle of the medical underwriting part of a travel insurance application. So it can be really good to start off with. So how does it work? The travel insurance underwriting?

Rachel (03:06):

Well, thank you Kathryn. Well I think you are completely right. The purchase of travel insurance is such an important purchase for millions who are obviously very passionate about traveling and want to have a good experience while they’re overseas and an expectation is that people are covered for their medical conditions or anything that will cause a claim if needed in relation to their medical condition whilst traveling overseas. But it’s important in the context of travel insurance, it’s important to highlight that these medical claims are often thousands of pounds if not hundreds of thousands. And if some of these claims are occurring in the US for example, it’s not unusual to see a claim being over that million dollar pound mark or million pound mark, sorry. So there is a large exposure for travel insurers, but when you’re looking at the cost of travel insurance, the premium is much lower.

(04:00):

So particularly if you’re comparing that to health or life insurance, the cost of travel insurance is much lower, but the risk to insurers in terms of claims costs is significant. So it’s a really important product for lots of reasons, but also it’s important that the underwriting of medical conditions is accurate and can facilitate an inclusive approach to people For those with medical conditions, obviously as I mentioned, people with medical conditions want to get cover and there’s a good reason for that. If people aren’t covered for medical conditions when they’re overseas and they incur a claim, that can be quite catastrophic in terms of personal finances. So that is something that people don’t want to be dealing with, but people aren’t thinking about this type of thing quite often when they’re going overseas, they’re going overseas to have a good time, but there is these risks and not everyone is aware of this type of significant financial exposure that could present itself, particularly that’s influenced by where people are actually traveling to as well because the medical claims cost is so different depending on where in the world people travel from and travel to.

(05:19):

And I also wanted to highlight that travel insurance, it specifically covers claims related to emergency assistance. So that’s quite a significant difference when you’re looking at other protection policies. Emergency assistance claims means in general travel insurance looks to cover the claims that are associated with an emergency that are not necessarily bound to the ongoing maintenance or support of a condition, a chronic medical condition for example, it looks to support any emergency assistance, anything needs to be immediately treated medically. So in the past, a long time ago, particularly in the uk, medical conditions were generally excluded from cover and travel insurance. No one could really get cover when they had a medical condition. So policies, we usually had a general exclusion that meant you weren’t covered for any medical conditions. But that has evolved over time and I’m going to hand over to Paul as he was critical in that evolution of the market in the UK and get him to provide a bit of a background as to how that evolved and how he saw that need over 20 years ago.

Paul (06:40):

Yeah, thanks Rachel. Yes, so as Rachel said, what she was saying very politely was I go back a very long way in this business to the sort pre-digital era and in the distant past actually most travel insurance was distributed by tour operators and travel agents in a very manual way alongside the sale of a holiday. And partly as a result of that distribution methodology, there was no capability to do any sort of health underwriting for people who were purchasing this cover. And the fact was that many millions of policies were being sold every year for people going outbound from the UK on holiday and the average premium was very low as Rachel said, so that there was no money in the transaction that would allow a manual medical underwriting place to take place as people might be familiar with on critical illness or life insurance policies.

(07:52):

For example, the problem was for insurers that they would write a policy and price it on the basis that they were not covering preexisting medical conditions. Then somebody who didn’t read or had not had the small print pointed out to them by the agent who sold it to them would go on holiday, have a heart attack in Florida, and then realize that his previous cardiac history meant that he was excluded from cover and he was left holding the baby for a hundred thousand pound claim. The customer obviously didn’t like that situation, the seller of the policy definitely didn’t like it and neither did the insurer who ended up feeling pressurized by publicity and potentially by the regulators to pay the claims. So over a period of time what happened was that the regulators view crystallized into a question to insurers in those circumstances when this person bought this policy was it explained to them what any exclusions meant for them individually.

(09:08):

And if the answer to that was no, the insurers were going to be expected to pay the claims. So they were really forced into having to make an effort to do some underwriting on these large volumes of people who were buying the policies. I was working in the industry as a doctor at the time, actually focused principally on what happened downstream those people who did have heart attacks in the USA and how we would help them and get them back to the uk. So I had an understanding of what the issues were from distribution through to overseas claim and my colleagues began to develop an algorithmic process which was going to allow people who were buying cover to be able to declare their medical condition and then answer some simple questions and simple questions which would allow insurers to get an accurate understanding of the conditions that they had and the extent to which those conditions were a risk to the travel insurer.

(10:22):

Because we were from the start focused on a direct question and answer process with a customer and with no medical oversight of that process, we had to make sure that the questions were very accessible to somebody who had no medical knowledge. So we wouldn’t ask any complicated questions, they would be simple questions and all the answers were binary, yes, no or a number. There was no opportunity for free text. So we made some clear decisions right at the beginning about how we were going to do this, which I think have been born out over time to be a good set of decisions and the outcomes of the question and answer process would produce a medical risk score, which did to an extent take into account the destination that people were planning to go to and that medical risk score was a linear analog score, so the higher the score, the higher risk and insurers would use that score to determine thresholds of cover, so who they were prepared to cover and who they weren’t and price.

(11:42):

And over a period of time, more and more insurers got to trust these scores and actually the benefit of that was that more and more insurers would be prepared to offer cover to people with quite substantial medical problems. We’re now in a situation in the UK where the vast majority of preexisting medical conditions will be coverable by one or many insurers out there for a price. It may not be a price always that the customer wishes to pay, but there are very few conditions and we’ll probably go into this in a little bit more detail later on, but there are very few conditions out there which it isn’t possible to find travel insurance cover for because travel insurance is sold and underwritten in pretty similar ways in multiple different territories. We were able to take the concept that we had developed here in the UK and apply it and a number of other territories as well.

(12:42):

So now it’s sort of the default method of risk assessment for travel insurance in Australia, New Zealand, Canada, we have a few other European countries where we’re active as well. So I think it’s been a good thing. I mean my personal view is that travel insurance has led the way in insurances becoming much more available to people with significant medical problems. It’s much easier to find a travel insurance policy which will provide comprehensive cover than it is a private medical insurance policy or potentially a critical illness or life policy. Kathryn May beg to differ on that. So it seems to me that there are some good examples in here of good practice.

Kathryn (13:39):

Certainly I’m sure that there definitely will be. I mean what I have to say is for myself as someone with multiple health conditions, it’s a very big comfort to know that there is something out there usually for the majority of people. But I always sort of say that with a caveat because obviously I have high mobility syndrome to say that I will not be going skiing or snowboarding or anything like that. I’ll be staying well away from anything risky. I’ve always wanted to bungee jump, but clearly my body is not designed for that, so that’s certainly not going to be something I will be doing. But no, it sounds really good. I think in some ways it sounds, obviously it’s very different to protection insurance, but in some ways sounds similar in the sense of there’s usually an option for somebody for most situations out there.

(14:17):

But again, whether or not there’s the price is what’s okay for somebody is different and it’s always tough for that person when the price is in a sense it becomes too much or they can’t do something. But I think a lot of people think that there must be something going on somewhere if it is affordable and they’ve got lots of health conditions, there must be a trick somewhere in the words or something like that. But it’s, as you say, that destination aspect of it as well has got to be such a huge part of it. So obviously your system is used to underwrite millions of travel insurance applications every year. What are the most common health conditions that people are disclosing when it comes to travel insurance?

Rachel (14:58):

Well, it won’t be a surprise to hear that the conditions that we see declared through our environment broadly mirror most commonly diagnosed conditions across the UK population. But it is important to highlight that, excuse me, that it is broadly who declares medical conditions is determined by the insurer or the distributor of the product ultimately. So there are various things that consumers should be aware of when purchasing travel insurance to make sure there isn’t any exposure to the conditions not being covered. When I talk about it is the insurer that determines who should declare conditions. There are usually some layers during the travel insurance purchase process that consumers will go through to determine whether they need to declare their own medical conditions. The first thing to be aware of is some insurers will have free condition lists. So essentially those free condition lists represent conditions that a person can be diagnosed with but don’t subsequently need to declare ’em and go through that q and a process that Paul referred to earlier. But it is important to note quite often those free condition lists have caveats attached to the medical conditions with that are listed. So there will be essentially layers of stability associated with certain conditions and if those stability criteria aren’t fulfilled, then a declaration of that medical condition downstream may be needed. So some insurers do have a free condition list, not all, but it is one layer of how a medical condition may be covered or at least assessed for cover.

Kathryn (16:46):

And where, can I just check whereabouts would we see that if I was applying for insurance and that free caveat list, would that be as I’m going online, obviously a lot of people do this online, is it then there’s a list straight away or there should be a list straight away that says if you’ve got one of these you don’t need to worry about telling us unless would that generally be what we see?

Rachel (17:05):

Yes, I wouldn’t say it’s always that clearly shown. Quite often it’s in a link. So there will be a description that there is a free condition list that you will be, you may want to review and then select that and it pops up. There is a movement away from precondition because of the confusion it can add when it’s self-assessment of that stability criteria, but it’s something for people to be aware of and to know about if they are purchasing policies. Subsequent to that there will be what we call some medical warranty or we refer to them sometimes as trigger questions that essentially they’re questions again defined ultimately by the insurer that states that asks questions specific to the medical status of an individual. And those questions may usually refer to have you taken any prescription medications or have you been diagnosed with certain conditions, cardiac or the like over a certain period of time.

(18:14):

So again, that time period we are not defining that it is the insurer defining it and it will change from policy to policy from insurer to insurer. So again, they are key things in that customer journey that a consumer needs to be aware of and make sure that they assess each of those defining questions as to whether they are triggering. If the answer is no, then usually there is no need to declare a condition associated with that question. But if the question is yes, I do have a condition that relates to this question, then that will trigger a full declaration process within our environment. So a consumer will be asked to declare a condition that they’ve asked that the insurer has asked to have to be declared as part of that process. So those medical warranty questions are very important to understand who goes through a declaration process and who doesn’t need to declare conditions. So it’s really important where in travel insurance, whether someone’s had chicken pox when they’re five and then now 60, that’s not significant in terms of the risk informing an emergency assistance claim when traveling. But those time periods are important when it comes to what risk the insurer is trying to capture and subsequently who needs to declare certain conditions.

(19:38):

Once those few steps are followed, then we’re seeing who comes into our environment to declare a condition. So the message is it’s not always equal. The same people depending on what policy they’re purchasing, what free conditions are being offered under the policy, what medical warranty questions are being asked, they’re then, so we’re having different people being passed into our environment and being asked to declare different things. But generally speaking, there is a big trend as to what conditions are being declared in our environment. Conditions like hypertension, high cholesterol, asthma, I don’t think it’d be very surprised to hear they’re on our list. Diabetes, ischemic heart disease, so the condition that causes angina and heart attack, those conditions are high on our top 10 most declared conditions and arrhythmia, irregular heart rhythm, hypothyroidism, anxiety and depression are on our top clear conditions and other musculoskeletal conditions such as back pain, osteoarthritis.

(20:47):

I’ve also pulled our stats and had a look specifically at malignancies. Quite often that’s an area people are interested in and are most commonly declared cancers are breast cancer, prostate cancer and bowel cancer. But they do represent quite a low proportion of total medical declarations when you’re looking at the total. One area of interest most recently has well over the last few years, not just recently, has been mental health declarations and the focus on a more inclusive approach to that spot. And I’m going to hand over to Paul because he’s been actively involved in that as well.

Paul (21:25):

Fantastic, thanks. Yes, mental health, it’s a hot topic, certainly never been hotter than since Covid. And we do get asked about this a lot. Some of you your listeners may be aware of the recent report that was done by a money and mental health institute, which has had a fair amount of airtime where they looked at issues affecting people with mental health conditions, buying insurance and travel insurance was one of the things they really did focus on. Our approach to mental health conditions actually has always been rightly or wrongly to treat them exactly the same way as we treat physical health conditions. In other words, we look at these conditions from the perspective of the insurer as medical conditions which may or may not represent a significant risk to travel insurers for emergency claims, mental health conditions have always actually been of interest to travel insurers.

(22:33):

And I do remember a time going back where there was a very perverse wording, but one of the perverse sounding wording by one of the major travel insurers, which was that in the days where you could write blanket exclusions about health conditions, the old days when AIDS was a blanket exclusion for example, which you won’t see now, and they would say, we don’t cover claims related to mental health unless you are under the care of a psychiatrist. In other words, we are only going to look at claims which are apparently serious. And the reason they did this was because so many cancellation claims were based on people getting certificates from their GPS to say that they were not in a fit mental state to go on the holiday that they had planned. And there was a question mark in the insurer’s views about how much of that was disinclination to travel and how much of it was genuine mental health issues.

(23:40):

I say that really because I just want to make the point that actually some of those people will have had significant mental health issues which may travel impossible for them and cancellation as well as overseas medical expenses is an issue for travel insurers they focus on. And when it comes to conditions like depression and anxiety, I think insurers are more concerned perhaps about cancellation costs than they’re about overseas medical claims. As Rachel said, depression and anxiety are in our top 10 list of conditions that are declared and there were many other neurotic as opposed to psychotic. It’s a medical distinction of mental health conditions, obsessive compulsive disorder and phobias and so on, which are also frequently declared. And then there are conditions like schizophrenia and mania and hypomania which are much less frequently declared. And in general, people who declare depression and anxiety almost always get a very low risk score from our point of view.

(25:01):

And almost always we’ll be able to buy travel insurance cover from anyone with no or minimal increase in premium applied because the reality is they present this a very common condition and they present very little risk to insurers people with more significant mental health problems. People for example, who might have had to have been admitted to hospital who might be psychotically ill as in much more seriously mentally ill, they can represent a substantial risk to travel insurers. And those of us who’ve been in this business for a long time will remember any number of cases where major problems occur with some of these people when they go overseas to a set of unfamiliar stances and encounter a mental health service in the country to which they have gone, which may not be designed to get them better quickly. They can be very difficult cases to manage and very expensive for insurers.

(26:11):

But I want to stress that I’m talking about a very small minority of all of the people with mental health conditions who declare their conditions to us. So I have these conversations from time to time with the likes of money and mental health, the charity, and I say to them, we treat these conditions exactly the same as we would treat a physical condition. I’m never quite sure whether they think that’s a good thing or not, but from our point of view, it seems to me that it’s the only approach that we can take until such time as regulation makes it clear that mental health needs to be treated in some way differently from physical health conditions. With regard to insurance, I’m talking about whether people are charged additional premium or whether there is a threshold beyond which insurers are not prepared to cover. I’m not so much talking about the way that the assessments are carried out.

(27:12):

We try to be within the boundaries of asking binary questions, yes, no or a number. We try to be sympathetic in the way that we write our question sets. We try to use as few questions as we reasonably can in order to get to a conclusion about whether somebody is a significant risk to insurers or not. There are always some people who think we ask too few questions and there are always some people who think we ask too many questions. There are very few who say we ask exactly the right number of questions, but we ask the number of questions we think we need to get to the view of that individual’s mental health. So that’s our approach. I’m sure it can be critiqued, but so far I think it stood the insurer clients that we have in good stead and means that the vast majority of people with mental health conditions can access cover very simply.

Kathryn (28:17):

I was going to say there’s something you said as you’re going along there that kind of got me a little bit as you’re saying it because I am one of those people who’d made a claim in regards to, at the time it was mental health. Now I know it was a mix of mental health and autism, but it was 18 years ago, we were due to get married in St. Lucia and we had it all booked out and everything. We had family coming over and everything and without any mental health issue in the past, I suddenly developed a phobia and very seriously. So I won’t go into all the details because it’s upsetting, obviously remembering that kind of time. It was a long time ago now, but I developed that and there was no way I would’ve been able to get on the plane. I was barely able to leave the house and that lasted quite a long time.

(29:10):

And Dean shows at the time worked brilliantly. They really, really did. We got our claims back. But what you’re saying there about is it genuine, is it not genuine? And that’s got to be so hard at times. It’s got to be a gray area, really, really tricky. But then also I’ve been on holiday since I’ve had no issues getting insurance. So I think that’s hopefully something for people who are listening. Maybe with mental health there’s maybe a bit of comfort to sort of say that just because maybe something has happened in the past or you’ve had an experience in past which made travel not the easiest of things or maybe even if you had had a claim in the past due to mental health, it doesn’t necessarily mean that that’s going to hold you to it and that you’re not going to be able to travel again and then there’s going to be exclusions everywhere or anything like that. So I think that’s really important just to share that there. But it’d be really good to hear from you obviously. Thank you for all of those examples. It’s really good and it’s so positive to hear that as you say, anxiety, depression in themselves will have probably quite a low score. I imagine that possibly comes down to destination as well because obviously some places would be possibly a higher risk in terms of the support services that would be there. Yeah,

Paul (30:22):

Sorry. Of course you’re right. You were talking and I was going to give you an example of sometimes we think we get the risk right and don’t quite get it right. And you mentioned autism. I remember a case very well of somebody who declared autism and we didn’t think this was a significant risk to the insurer and gave them a very low score. This individual went to China and this was a long time ago, went to a remote part of China, China became disorientated, got violent, assaulted a policeman, ended up in a secure psychiatric institution in this small town in China, which caused us enormous difficulty in resolving that problem for them. And it brings all sorts of things into focus when you hear stories like that. In fact, the insurer was giving me a hard time because we hadn’t listed this person as being a particularly high risk because we didn’t think autism was a high risk.

(31:29):

And then sometimes things like that happen and it’s unfortunate for everybody and in those circumstances it would’ve been better if the individual had not traveled, but they did. And it’s not always predictable or easy, but yes, we do the best we can. Certainly what that does highlight is that, I mean this sort of specialist subject here, but when you go overseas and you have a psychiatric problem, you are then subject to the rules of the psychiatric laws in that country, not this country. And so we have a mental health act here which determines who can be admitted to hospital against their will and what the circumstances are and so forth. And every other country will have a similar set of rules or not over which we have no control. They’re subject to the rules of that country and that makes it extremely difficult to navigate and extremely difficult to help them if they get into trouble overseas.

(32:32):

And the other thing to remember is that whilst in this country, if somebody is in the uk, there is a clear set of rules which says what circumstances, sorry, what circumstances the psychiatric services can use to get them into a facility where they can be treated. There is no mechanism for the international transfer of somebody against their will. So if you do have somebody who has, let’s say, gone manic in a foreign country and is determined that they stay there and don’t come back, there is no legal mechanism for bringing them back against their will. There’s no international mental health act if you like, and that can cause huge problems. So I suppose I’m saying this just to try to make the point that although it may sound draconian, that we do take, we do seriously consider on behalf of the insurer the risks of people with significant mental health problems. There is a very good reason for it.

Kathryn (33:40):

Absolutely. And I’m noting not to go to China, obviously I’m not planning, I’m not planning on attacking any policemen in China, anything like that. But I don’t fancy it being locked up in a prison or anything. It’s just, yeah, I’m listening. I think it’s one of those things where for me, once I knew stuff like that, I thought I’m going to have to massively double check the structure that the country has just for me to feel like I could relax on holiday to sort of think. Right, okay. But I’m always planning route as well. I’m like right, if I didn’t want to get on the plane again, I could get a boat and then there’s a train from there to here. So I’ve always got my escape route. It’s one of those things that I do.

Paul (34:17):

Yeah, very sensible.

Kathryn (34:19):

Absolutely. So be really good to hear some examples where maybe medical conditions that are in a sense quite easy for the systems to go through. I appreciate the do need to caveat it just depend probably upon how extreme the condition is, the symptoms, the level. I always think of things like this. My dad has it and it’s really hard with Parkinson’s I find when I’m doing it as well for protection insurance because there are technically, I think technically I was going to say I think I believe there’s five stages of Parkinson’s. And one thing I find really fascinating is that you never told it when you’re a patient as to what stage you’re at. So it’s quite difficult to know that. But I’m not saying that Parkinson’s necessarily be here, but what’s the ones that you think are generally quite easy, probably going to be accepted straight away and then possibly other ones that people might not get a decision right there and then,

Paul (35:07):

So just on the stages of disease, I think you make a really good point there in that whilst there may well be diseases where there are clear medically defined stages and cancers will be a really good example of this, it may not be that individuals who’ve got those conditions know what the stages of those diseases are. So when we’re setting our questions, we take a pragmatic approach to this and make sure that we only ask people questions that we’re confident that they will know the answers to. There’s no value in asking somebody what their serum magnesium is if we don’t think they’re going to know the answer. It sort damages the point of sale process. And in fact, if they make up an answer and then they go and have a claim and the insurer says, well, you told me that the answer was X, and in fact it was Y, if the ombudsman thinks that the question wasn’t reasonable for that individual to have known the answer to, they will disregard it anyway. So there’s no value in asking people for more information. So for example, mean, and Rachel’s already mentioned breast cancer, we know that one of the prognostic indicators of breast cancer is what was the size of the tumor at diagnosis. But we don’t ask that question because we don’t think that people will necessarily know the answer accurately.

Kathryn (36:39):

I agree from a protection space, I completely agree that people just, they don’t dunno that. And I also find as well, it is unusual, but I have found before that people compartmentalize having had cancer sometimes and they can literally forget that they’ve had it. I think that’s more unusual, but it is really hard to get those specifics. So yeah, I appreciate what you’re saying there.

Paul (37:00):

Yes, I mean just in terms of those timeframes, I think Rachel’s going to come onto that a bit later on in the regulatory piece and so forth. But yeah, absolutely we are in favor of insurers being realistic about the timeframes that they expect people to go back and there is a move against ever. Questions have you ever had and a move towards having questions that are framed in a sensible timeframe in the last X years. Have you had,

Kathryn (37:27):

That’s that kind of right to forget, which I’m sure you guys are experiencing, especially in the European side of things.

Paul (37:33):

Yes, definitely. So I guess Rachel also mentioned that one of the commonest conditions declared is hypothyroidism. Hypothyroidism, once it’s been diagnosed, you can assume it’s being treated and the reason people declare it is because very often the medical warranty wording question will say, are you on any regular medication for anything? And somebody who’s hypothyroid will be on thyroid replacement therapy. So they’ll say yes to that question. They’ll declare hypothyroidism, we will ask minimal questions about hypothyroidism because I can’t ever remember a claim related to hypothyroidism in any way. Once it’s been diagnosed, it’s treated, it’s a non problem. So minimal questions straight through, no additional risk score sometimes

Kathryn (38:24):

Hypothyroid. I was going to say as a hyperthyroid, that’s good. I have that. I’m just going to go through the list of everything you’re saying and be like, haven’t got that, I’ve not got that.

Paul (38:36):

You’re a great person to have this discussion. So there are some conditions where we will ask a few more questions, but we will in most cases still provide a very low score. So asthma would be a good example of that. The vast majority of people with asthma are minimal risks to insurers because they’re not going to have an asthma attack, which is going to cause an emergency claim. There are a few people with severe brittle asthma who might have an emergency claim. So we’re trying to ask the questions to identify those people and it sometimes takes a few questions in order to do that. Just the act of asking more questions does not necessarily mean the score is going up. If you answer favorably to each question, then your score will not go up. Asthmatic will get a very low score.

(39:34):

So I think the answer is that the system is designed to get pretty much anybody straight through to an outcome after a series of questions, we do have a process by which we will forward from one question set to another. So for example, if you say you are diabetic, we will understand the cardiovascular complications of diabetes and we will ask a series of direct questions about do you also have, and if you say yes, we will forward to any of the associated conditions to ensure that those conditions are declared as well. So the process can sometimes appear a little longer for people who have slightly more complicated conditions. But the reality is we’re aiming to get everybody through the questions set in one sitting with questions that they can easily find answers to and that the outcome there will be from our point of view, a medical risk score, our insurer clients will take that score and translate it into an underwriting decision.

(40:39):

And then the vast majority of cases, that underwriting decision is either, I’m sorry, we can’t cover your medical conditions if it’s beyond their threshold to do so, or we can cover your medical conditions and the premium will be X. There are some insurers out there who specialize in people with lots, wrong with them, and those insurers actually sell through quite well recognized channels and people will have heard of them anyway. There are some who don’t use our system even who are specialists in cancer for example. It might be useful for you guys to know that there is an insurer out there called Ensure Cancer. They have a completely different approach to the approach that we take. It’s much more a that you’ll insurance consultant medical reports and a medical view taken of each case looking at all of those reports and they’re sometimes successful in getting coverage for people who’ve otherwise struggle. And then there are a number of signposting arrangements that are in place now for people who are struggling just before the pandemic, A process was put in place using the money and pension service, so people can go on the money and pension service site for travel insurance and they will be signposted to a number of providers on there who are specialist providers.

(42:16):

There are thresholds. So if somebody goes and looks for a travel insurance anywhere these days and they are quoted over a threshold premium, the seller of that product should offer them a signposting service anyway and tell ’em about, for example, the money and pension service. Bieber also provide a similar service. I

Kathryn (42:39):

Was going to say its Bieber, find a broker if anybody searches online for that and it’s really, really good. So I sit on the executive committee that oversees that and it is a really, really good process. And I’m not completely familiar with the maps one, but I know that obviously maps are involved in it as well. But with the beba one, what’s lovely is that all the firms in there that state that they’re specialists have had to be vetted by Bieber and show how specialist they are. You can’t just put your name forward and suddenly go on a list. You have to have been checked over. So it is a really good one for anybody who’s wanting to find something.

Paul (43:11):

Yeah, okay. I’m probably talking too much, but

Kathryn (43:16):

No, it’s really, really useful. But I was going to say, are there any particular disclosures that obviously I can protection insurance, there’s certain things where if somebody says something to me, I know immediately I’m going to have to go down this other route over here. We’re not going to be standard markets at all for a certain period of time. Are there any things that will come up in the system that somebody might apply for and they will be immediately, you know what, this does need to be assigned post or potentially that they just not as far as we’re aware, really they’re not going to be able to get cover.

Paul (43:47):

Yeah, so I think the main issue here is around, as Rachel described earlier on the medical warranty wording. So if you like the preamble that the insurers saying here are some non non-negotiables that we’re not prepared to cover. Some of them are fairly clear, are you a resident of the UK and Ireland, for example, if you say no to that, you might not be able to get it. Are you traveling in order to get medical treatment? Are you traveling against medical advice? These will often be a straightforward no. Then there are some slightly grayer areas about awaiting investigation or treatment for a condition. We have a particular view on this and another one that’s often quoted is terminal prognosis. Do you have a terminal prognosis? Now again, we have a view, our view is that you shouldn’t need to ask the question about terminal prognosis because if you are going to ask people to declare their medical conditions and we’re going to take them through a question and answer process, we’re going to provide those people with a score.

(45:06):

And if they are absolutely likely to not survive for a short period of time, then they will get an extremely high score as far as undiagnosed conditions are concerned. Our view on that is that if somebody knows, for example, they have ischemic heart disease and they are awaiting an angiogram as part of their treatment or awaiting an exercise test, then we’ll ask questions about that and we will factor that into our risk assessment. That for us is not a problem. What is a problem is if somebody has an undiagnosed condition, so they have abdominal pain, could be absolutely anything. We have no idea what it’s, that’s not risk accessible. So there are some subtleties in there, but those medical warranty wording as I think of them as the insurers non-negotiable warranty wording questions, they need to be taken into consideration. And that’s really interesting and I think those are the key ones. Yeah,

Kathryn (46:11):

Yeah, it’s really interesting when you’re saying that about if somebody had ischemic heart disease and they knew that they had that test coming up. So in the protection space that would be obviously with the majority of insurers it would be No, it’s not until, so it’s really interesting that travel insurance has much broader potential acceptance there because I wouldn’t have expected that. So that’s a really, really interesting thing to, yeah,

Paul (46:34):

Well, so we know these people have got ischemic heart disease, we know that. We know that they’re a risk for a future event, then we will take into consideration the fact that they are due to have an investigation. Sometimes that’s a completely routine part of their maintenance treatment. And if that’s the case, then we’re not too worried about it. And sometimes it might indicate that they’ve got particular problems in which case we’ll add some risk to it. But it doesn’t mean that we would say that they were beyond the pale from the insurer’s perspective. And we don’t really play the deferment game, which is another difference. So we don’t say, come back to us when you’ve had the investigation done because that doesn’t really work in travel insurance. People want to travel next week and it’s not very helpful to say, come back when you’ve had the investigation done. So we try to, again, it’s a pragmatic approach to produce a solution which works for customer and for the insurer.

Kathryn (47:32):

I was going to say that’s really positive as well, especially with the timeframes. I mean at the moment of the NHS, I’ve got somebody that I’m supporting at the moment and they’d had an investigation and a bowel polyp was discovered. There’s no concern whatsoever from the medical point of view. And it was just a case if we just want to go back in at some point and just double check and make sure it’s not changed. And insurance wise, on the protection side, I mean maybe this will be the same for the travel insurance, maybe I found the one where it would be a bit of an issue, I dunno, but on the protection assurance side case of no, we want to have this and we’re almost getting towards two years since the, and you’re kind of thinking well, and it’s obviously, well the consultants’ obviously not bothered by what they’ve seen when they’ve been in there because this appointment keeps getting delayed six months at a time.

(48:22):

But it’s a really, really interesting aspect to it. But we’re coming towards the end of the podcast now and I’ve got a couple of last things to go through. So I remember Paul, when we first met, it was I think a meeting with the institute and faculty of factories and you were chatting and you mentioned something I think about the annual travel insurance policies. And I think there was someone else myself there from protection insurance that went and we just didn’t do anything about it. And I think it’s so important for us to chat about it because there’s so many times where I meet so many people from different aspects of insurance and we literally have no idea what the other people are doing and what the rules are behind it and everything. And this fascinated me, especially because again, my dad Parkinson’s and the fact that he’s got annual travel insurance policies. So it is different though, isn’t it on the annual insurance versus just buying for a trip if your health changes. So do you mind just explaining that?

Paul (49:15):

Sure. Rachel’s Rachel?

Rachel (49:16):

Yeah, I can pick that one up if you’re happy. So obviously you can purchase single Tripp policies or annual multi Tripp policies and the vast majority of policies sold in the UK are a MT annual multi Tripp policies. But obviously there’s different risks to consider in the context of an annual multi tripp. So people can travel, usually they relate to the sale of travel to a region, so a collective number of destinations. Individuals can travel at any time of year to any one of those destinations at any point of time and also book their travel at any point of time. If you think of both medical emergency assistance claims as well as cancellation claims, it’s very hard to understand from an insurer perspective what risk relates to when and how much ultimately during that annual period. And when you have someone on top of that declare a medical condition.

(50:13):

Obviously when someone declares a medical condition where essentially looking at a snapshot in time, what is your medical condition and how stable is it now? And in certain situations where some medical conditions, the nature of that medical condition it during that 12 month period, we know that what is being declared today has a high likelihood of changing during that period. And coupling that with not having complete clarity on where and when the travel is occurring, we will take a view in our system to say that this medical declaration, this medical condition isn’t aligned for sale on an annual multi tripp policy because there’s a lot of unknowns here that the insurer would probably be uncomfortable with covering. However, in saying that it doesn’t mean that that wouldn’t be a condition that’s suitable for underwriting and covering on a single trip. So what we would say is if an annual multi tripp policy is being purchased and no cover for the medical conditions is being returned, we would encourage people to reassess on a single trip because the outcome is highly likely to be vastly different as a result of there is more understood about the risk being presented in relation to destination and when the journey is occurring and for how long.

(51:32):

And coupling that with a medical declaration, it’s something that is easier to quantify the risk and subsequently the insurer will have different terms in which to offer cover for those scenarios. In terms of when someone purchases an annual multi tripp with medical conditions covered, insurers will have different approaches to how to manage changes in the medical condition during that annual multi trip policy. So some will accept that snapshot today and accept that any change throughout that 12 month period to that medical condition prior to your travel is accepted. There is no need to inform the insurer of that change, but most or many will actually request that any material change in your medical condition during the life of the policy that they are informed about that change. And it may also trigger a reassessment of the medical condition at that point in time. So it is important that people who are purchasing annual multi Tripp policies understand the expectations of the insurer or policy, what the obligations are under that policy, and if there is a change to the medical condition, understand whether that change needs to be, whether the insurer or the policy needs indicates whether that change needs to be declared and subsequently reassessed.

(52:59):

And it’s an important factor. And hence you obviously mentioned how surprised you were because I don’t think many people are aware of that, but it’s an important element to the policy that are being sold out there at the moment.

Kathryn (53:11):

Absolutely, and it makes perfect sense that you would need to update because obviously the very nature of being more of a general insurance product and the kind of terms and conditions that it sits within, but I just don’t think it had ever tweaked to me. And I know there was somebody else there at the meeting as well who’s a good 30 odd years on more in the industry I think possibly a bit more. And they were exactly the same and they were just hang on a minute. And I just think it’s so important that we do share that if you do have annual policies, if you are taking them out just to make sure that you are keeping an eye on that. And again, I think for some conditions I always go back to Parkinson’s obviously because I’ve got such a link to it, it’s so difficult to know when is it changed enough to be notified.

(53:50):

And so I always think it’s such a good idea to have people like advisors there who can do those conversations with the insurers and potentially the underwriters to sort of say, right, well where are we at? Because I say with my dad, I know what staging he is in terms of Parkinson’s, but that’s only because I was at the Lucid conference early this year with the underwriting and there was a professor there about Parkinson’s discussing each of the stages. And so that’s just my own assessment of looking at him and seeing him and knowing because he just wouldn’t know otherwise. And obviously it’s very, very tricky. But I think some conditions it can be probably the acute conditions, it can be possibly easier in some ways even if they are lasting that kind of a timeframe. But the chronic ones, that progression very, very tricky. But I think we’re coming towards the end now. So the last thing is, and just for the joys of everybody, we’re going to go into regulation and legislation because why not finish it off on something joyful for all of us? But there’s quite a lot isn’t there for you guys to be on top of in terms of those kinds of things?

Rachel (54:51):

Yes, it’s definitely our job to understand, particularly given we’re in multiple territories. Paul mentioned that it’s not just the UK that we operate in. It’s a lot of other territories and it’s up to us to understand what key regulations influence and dictate how insurance can be sold and how medical conditions in particular for travel insurance can be underwritten. And in the UK we’ve got various things that influence how we approach the assessment of medical condition declarations in the context of travel insurance and we ensure we design our product around that. A really big influence on our product was quite a few years ago now with the introduction of the EU gender directive, which indicated that there was a limitation to how benefits could be adjusted or pricing could be adjusted as a result of anything related to gender, which also related to a woman’s pregnancy or complications related to pregnancy.

(55:56):

So that meant that we had to implement changes in our product that meant that there wasn’t any unfair assessment of risk that meant our clients weren’t complying with those requirements under that directive. And that continues on to this day, I think. But there’s obviously other things happening at the moment. You mentioned the right to be forgotten that that’s definitely being discussed at the moment. That’s putting a limit on timelines associated or time since treatment related to malignancies in particular. And that influences how our products can be used and implemented in different regions because that approach will not be adopted everywhere we operate. And so we need to be conscious of that and support our clients to be adherent to those regulations. And there are various other things happening at the moment in the UK that is very much focusing on what we’re doing and how we’re supporting our clients to adhere to those regulations as well. So very much central to us and making sure that we’re partnering and supporting our clients as best we can when those regulations change.

Kathryn (57:06):

Absolutely. I imagine it’s very, very complicated, especially with the different, I say different territories and what they ask. I know I started reading up on the white to be forgotten, I think it was a couple of years ago or something. Something started come out and it started. It was started, I think it was like in the Netherlands, I think it started and then it was France. And each one seems to have different things because sometimes it’s 10 years, sometimes it’s five years, and Ireland has it now as well. And obviously the UK doesn’t have that yet, but incredibly, I can’t even imagine the IT technical aspects of it in terms of the systems and making that work. So no, I think that would be absolutely fascinating to see what comes with that. So that’s everything. So thank you so much for both of you coming here and explaining that it’s been really, really fascinating and interesting. Next time I’m going to have Matt Ram back with me and we we’re going to be talking about heart valve disease and protection insurance. Is there anything that either of you’d like to finish the podcast on? Are we quite done? We’re quite done. We’re quite happy, I think.

Paul (58:08):

Yes, happy to answer any questions that do arise from this, but I think that that’s been great from our point of view. Thank you.

Rachel (58:15):

Yeah, thank you for having us, Kathryn. It’s really been a pleasure.

Kathryn (58:19):

It’s been lovely to have you both on. Well, for everybody, please do remember that you can access your CPD if you listen to this as part of your work on the website, practical height protection.co uk. And that’s thanks to our sponsors, the Okta members. Thank you so much, Paul. Thank you Rachel, and we’ll see you soon. Bye

Paul (58:36):

Bye.

Speaker 4 (58:37):

Bye.