In the fourth of a series of articles exploring the finer points of critical illness protection, CIExpert's Alan Lakey investigates heart conditions.
Apart from cancer, the most likely cause of a critical illness claim is a heart-related condition. Scottish Provident's 2011 figures show that these conditions were responsible for early 14.5% of its claims, while Skandia advised that between 1991-2007 heart conditions accounted for 23%.
Advisers need to consider the claims wordings for these conditions to assess which plans stand out and which show themselves to be inferior. One of the major differentiators is whether open-heart surgery is a requirement or whether thoracotomy and keyhole techniques are allowed.
This is of major importance, particularly as the use of minimally invasive techniques is increasing steadily. Table 1 highlights the possible conditions or interventions covered offered within critical illness plans and whether or not the major players include them.
Aorta grafts - More than 5,000 are carried out annually. Only about 30% are standalone operations, because in many instances the operation is performed alongside a bypass or other operation. Of the major insurers only Scottish Widows excludes surgery due to traumatic injury.
Cardiac arrest - Only Friends Life includes this condition, which must be accompanied by the insertion of a defibrillator to minimise further instances. The majority of victims die unless treated within five minutes, so the claim potential is quite low.
Cardiomyopathy - Describes a number of conditions that affect the heart. Some insurers require an ejection fraction of 35% or below. Ageas, Aviva, Bright Grey, Friends Life, L&G and Scottish Provident do not require a specific reading.
Coronary angioplasty - This used to be a staple condition until about 2002 when it was removed from most plans. Only Friends Life and LV= currently include this. They require a 70% narrowing of two or more arteries for a claim of up to £25,000 to be paid. In neither instance will a claim affect the sum insured. In a typical year, 6,500 first-time operations are carried out making this cover a valuable component.
Coronary artery bypass - About 24,000 operations annually of which only a minority use keyhole techniques. Nonetheless, those companies that extend their definitions to include non-open-heart surgery must be considered superior. These are Aegon, Ageas, Aviva, Bright Grey, Friends Life, L&G, LV and Scottish Provident.
Heart attack - The major differential is whether typical clinical symptoms (such as chest pain) is a requirement. There is no compelling evidence to prove or disprove this.
Heart valve repair or replacement - Some providers continue to insist on median sternotomy (surgery to divide the breastbone) as a claim requirement. Of the major providers shown only Scottish Widows and Zurich does this.
Open-heart surgery - Most open-heart operations are performed on children with about 85% of these being due to congenital conditions that are excluded by all but Friends Life. Friends is also the only provider to accept a claim where the thoracotomy technique is used.
Primary pulmonary hypertension - This is a relatively rare condition denoting a sustained rise in pulmonary artery pressure and can prove difficult to definitely diagnose. Only Friends Life and Scottish Widows fail to include this cover. Women are twice as likely to suffer and the condition is more likely to affect younger people.
Pulmonary artery surgery - This is another relatively rare procedure where the pulmonary artery must be both diseased and repaired with a graft. Friends, Legal & General and Scottish Widows fail to include this condition, while Ageas and LV= excel by not insisting on median sternotomy. As always, great care has to be taken when considering the merits of today's plans with those of yesteryear. Skandia and Scottish Provident, in particular offered plans that included keyhole procedures and full angioplasty cover.
Alan Lakey is director of CIExpert
