Deloitte Round Table - 26 October 2023*
From an insurance perspective, cancer belongs to those health risks which are usually categorized as “dread diseases”. Mandatory health social security systems offered by the state or public health services usually include any kind of medical treatment due to these dread diseases like cancer. So, the basic risk coverage of this particular disease should not give any major concern of exclusion or discrimination practices before or after a necessary medical treatment.
Therefore additional risk coverage against cancer as a dread disease is mostly offered as a supplementary voluntary insurance contract in three different ways: by supplementary health insurances, by life-insurances with particular coverage of dread diseases, or by standalone insurances. From our perspective any possible detrimental impacts for consumers may result from non-sufficiently transparent terms and conditions of the insurance contracts and in consequence from possible non-suitable products sold by intermediaries.
The basic mandatory health social security systems usually do not include any limit of the insured sum linked to medical treatment. Supplementary health or life insurances of dread diseases like cancer may offer additional lump sum payouts, medical treatment exclusively by the head of the medical staff (“Chefarzt”), or particular innovative medical treatments which are not yet reimbursed by the mandatory health systems.
But in all these cases, the devils is in the detail, i.e. in the small print: for example, are the additional benefits of the contract applicable from the very first diagnosis of the disease on, or only from a certain stage of the disease? Is this advanced stage of the disease unequivocally defined and outlined in the contract? Are actually all types of tumours included, or is the coverage limited only to certain types of cancer tumours? All these questions and explanations must fully be outlined by any intermediary before the contract conclusion by a prospective policyholder.
In case of a cancer survivor who wants to conclude a dread disease insurance contract, additional information duties occur as well for himself as for the intermediary: the cancer survivor has to fully inform the insurer with regard to the stage of disease and the medical treatments before, and the intermediary has to forward this complete information to the insurer. Only by doing so, the insurer is able to decide either on an additional risk premium or on the possible exclusion of this risk from the future contract.
Even in case of exclusion of this risk from the insurance coverage, this does not necessarily constitute any discrimination, but it is part of individualized risk assessment like for other critical diseases. From the perspective of the policyholders, of course, there is the ongoing fundamental problem that this risk assessment is not standardized by the insurers, i.e. each insurer has its own criteria of risk selection. So there is a crucial problem of understandability and comparability for the prospective policyholders.
For cancer patients or survivors and their insurance coverage, we mainly observe the risk of possibly not-sufficiently transparent terms and conditions of contracts covering dread diseases like cancer. In consequence, if the intermediaries do not fully align with the necessary pre-contractual information duties related to the demands and needs test and to the personal recommendation based on the regulations by the Insurance Distribution Directive (IDD), there may emerge cases of mis-selling. These two necessary conditions of a fair treatment of policyholders should definitely be part of the forthcoming Code of Conduct of financial services providers.
Thank you very much for listening!
* Revised Statement by Christian Gülich, Vice-President of Better Finance (Brussels) and EU Policy Officer of the German Association of Insured (BdV Hamburg).
European Health and Digital Executive Agency (HaDEA)
EU Commission DG Health