Masterclass - Coronary Heart Disease Competitor analysis correct at time of publishing

1VITALITY.CO.UK/LIFE

Masterclass - Coronary heart disease

For advisers only Competitor analysis correct at time of publishing

VITALITY.CO.UK/LIFE2

Agenda

1. The role of the heart

2. Anatomy of a heart attack

3. How critical illness defines a heart attack

4. How VitalityLife defines a heart attack

5. Underwriting considerations

6. VitalityLife - unrivalled cover for conditions affecting the cardiovascular system

VITALITY.CO.UK/LIFE

The role of the heart


• A normal heart beats 100,000 times a day or 3 billion times in an average lifetime

• Each day it pumps 5,000 gallons of life sustaining blood through a 60,000 mile network of vessels

• Blood takes approximately 20 seconds to circulate throughout the entire vascular system

The heart

Source: https://www.bhf.org.uk/heart-health/how-your-heart-works.aspx 2014

VITALITY.CO.UK/LIFE

Anatomy of a heart attack


1. A coronary artery becomes narrowed

2. It cannot deliver enough oxygen-containing blood to the heart muscle

3. The inside lining of the narrowed artery cracks, a blood clot may form over the cracks

4. This makes the artery even narrower and can quickly block off the artery

5. If the artery is blocked for more than a few minutes, the muscle cells in the heart may become permanently damaged

Often, the amount of muscle damage is small and, once the heart attack is over, there is enough good muscle left for the heart to carry on its work satisfactorily

Anatomy of a Heart Attack?


• Accounting for just under a third of deaths, cardiovascular disease (CVD) is one of the biggest killers in the UK

• Just under 50% of deaths due to CVD are from coronary heart disease. By itself, CHD is the biggest single cause of death.

• CVD is one of the main causes of premature death, accounting for 26% of premature deaths in men and 18% of premature deaths in women

Impact of cardiovascular disease

Source: British Health Foundation, Cardiovascular Disease Statistics 2014 (G608/1214/CHA)

Death by cause in men under 75 for the UK in 2010


Medical and demographic trendsHow heart disease has changed

Heart disease death rates halved since 1961

Over 17,000% increase in life saving prescriptions since CIC was launched

Source: British Heart Foundation, Trends in Coronary Heart Disease 1961 -2011 (published 2011) - (M129)


Preventing and treating a heart attackAngioplasty

Angioplasty can help to relieve angina symptoms and is also used as an emergency treatment for people who've had a heart attack


Angioplasty key factsThe importance of our unique definition

Dr Rod Stables, The Cardiothoracic Centre, accessed 2014

c 5 x the number of Angioplasty to CABG

Most angioplasty’s are performed on a single vessel

Most people who undergo angioplasty haven’t suffered a heart attack

Angioplasty (Coronary) or PTCA (Percutaneous Transluminal Coronary Angioplasty) – Severity F

PTCA or other percutaneous coronary artery procedures performed by a Consultant Cardiologist to dilate and treat a coronary artery stenosis. The procedure may or may not involve the use of a stent

VITALITY.CO.UK/LIFE

How critical illness defines a heart attack


Heart attack

The death of a portion of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction:

•typical chest pain;

•new characteristic electrocardiographic changes;

•the characteristic rise of cardiac enzymes, troponins or other biochemical markers; where all of the above shows a definite acute myocardial infarction

Other acute coronary syndromes, including but not limited to angina, are not covered under this

definition

ABI definition Pre 2006


• Death of heart muscle, due to inadequate blood supply, that has resulted in the following evidence of acute myocardial infarction:

• Typical clinical symptoms (for example, characteristic chest pain)

• New characteristic electrocardiographic changes

• The characteristic rise in cardiac enzymes or troponins recorded at the following levels or higher;

- Troponin T>0.2ng/ml

- Accu Tnl > 0.5ng/ml or equivalent threshold with other Troponin I methods

• The evidence must show a definite acute myocardial infarction

• For the above definition, the following are not covered:

- Other acute coronary syndromes

- Angina without myocardial infarction

Industry definition Heart Attack of specified severity

Source: ABI Statement of Best Practice December 2014


• The symptoms of a heart attack vary from one person to another

• They may feel tightness or pain in the chest

• For some people, the pain or tightness is severe

• Others may feel nothing more than a mild discomfort

• They may feel – light-headed or dizzy– short of breath– nauseous – vomiting

Typical clinical symptomsNot every person suffering a heart attack will have obvious symptoms


New characteristic ECG changes

Source: http://www.patient.co.uk/health/electrocardiogram-ecg | http://www.thrombosisadviser.com/en/acs/a-leading-cause-of-mortality/ - 2014

“Not all heart attacks can be detected by ECG”


• The current ABI levels were set in 2006

• Since then troponin assays have become significantly more sensitive , with some now measuring as little as a few picograms (a picogram being 1/1000th of a nanogram [ng]).

Characteristic rise in cardiac enzymes/troponins

VITALITY.CO.UK/LIFE

How VitalityLife defines a heart attack


Death of heart muscle, due to inadequate blood supply, that has resulted in the following evidence of acute myocardial infarction:

•New characteristic electrocardiographic changes, and

•The characteristic rise of cardiac enzymes or Troponins recorded at the following levels or higher;- Troponin T > 0.5 ng/ml- AccuTnI > 0.5 ng/ml or equivalent threshold with other Troponin I methods

The evidence must show a definite acute myocardial infarction

For the above definition, the following are not covered:

•Other acute coronary syndromes including but not limited to angina

Our definition Heart attack of specified severity

We pay MORE heart attack claims

Payable at severity C – 50% to a maximum of £1,500,000


Death of heart muscle, due to inadequate blood supply that has resulted in the

following:

Definite Diagnosis of an acute Myocardial Infarction by a consultant cardiologist,

which is supported by current medical reports, tests and investigations, as defined by

the recognised international standard* prevailing at the time of claim

For the above definition, the following are not covered:

• Other acute coronary syndromes including but not limited to unstable angina.

• Myocardial Infarctions that meet the international standard that occurred before cover commenced

*(International standard defined by the European Society of Cardiology or the

universal standard definition of Myocardial Infarction)

Our unique definition Heart Attack

We will pay ALL heart attack claims

Payable at severity D – 25% to a maximum of £750,000


Competitor overviewHighlighting VitalityLife’s unique cover for heart attack

Source: VitalityLife analysis

Provider Definition name Payout % Typical clinical

symptoms Troponin rise

required New ECG changes

VitalityLife Heart Attack 25% × n/a X

VitalityLife Heart Attack of Specified Severity50%

(100% booster)× 0.5ng/ml

Aegon Heart Attack of specified severity 100% × 1.0ng/ml

Aviva Heart Attack of specified severity 100% × Yes

AIG Heart Attack of specified severity 100% × Yes

Bright Grey Heart Attack of specified severity 100% × Yes

Friends Life Heart Attack of specified severity 100% × Yes

L&G Heart Attack of specified severity 100% × Yes

LV= Heart Attack of specified severity 100% × Yes

Scottish Provident Heart Attack of specified severity 100% Yes

Old Mutual Heart Attack 100% × Yes X

Zurich Heart Attack of specified severity 100% × 1.0ng/ml


• We will pay 25% on diagnosis of ALL art attacks– We do not require characteristic ECG changes

Why VitalityLife for heart attack


Heart attackWhat this all means

We cover ALL heart attacks

Traditional cover requires a heart attack to be a specified

severity

It’s the UK’s biggest killer

Consumers expect a heart attack tobe covered no matter

how severe

Most

Covering diagnosis of All heart attacks

More likely to payout

compared to industry standard definitions

45%

The need What we are doing

VITALITY.CO.UK/LIFE

Underwriting considerations


• Smoking

• High blood pressure

• High blood cholesterol

• Diabetes - Decline

• Being physically inactive

• Being overweight or obese

• Family history of heart disease

• Ethnic background

• Gender - men are more likely to develop CHD at an earlier age than women.

• Age - the older you are, the more likely you are to develop CHD.

• It is more acceptable for an older person to have a heart attack than a younger person and our ratings reflect this:- A 46 year old with heart attack +- 200%- A 66 year old with heart attack +- 125%

Underwriting considerationsRisk factors of CHD


• TGPR to include sight of all investigations and surgical procedures

• Date of onset and date of most recent symptoms

• Has there been more than one heart attack (increase rating if 2, but decline if more)

• Other risk factors present (as previously mentioned)

Better risk

• Older age, N/S, BP and Lipids all normal, single event, normal BMI, healthy lifestyle

Poorer risk

• Younger age, smoking, obese, more than one event, questionable lifestyle

Definite declines

• Combination of CHD and diabetes, client < age 40, >30 cigs pd, > 2 heart attacks

Underwriting considerations What does the underwriter need before making a decision?


Underwriting considerationsSome case studies

VITALITY.CO.UK/LIFE

Comparing the marketVitalityLife – unrivalled cover for multiple sclerosis unrivalled cover for conditions affecting the cardiovascular system


Unique cover Heart and artery Severity Unique to VitlaityLife

Congestive heart failure A Severe peripheral vascular disease A Severe vascular disease affecting multiple systems A Heart Attack - resulting in reduced ejection fraction A-B Heart Attack of specified severity C Heart Attack D

Any other cardiac condition resulting in a reduced ejection fraction A-B Aorta graft surgery B Cardiomyopathy resulting in a reduced ejection fraction B Coronary artery by-pass grafts B-C Endovascular repair of an aortic aneurysm D Heart valve replacement or repair D Surgical repair of a structural lesion of the heart D Balloon valvuloplasty E Femoral artery aneurysm repair E Iliac artery aneurysm repair E Pericardectomy E Surgery to correct carotid artery stenosis E Angioplasty F Angioplasty to correct carotid artery stenosis F Cardioversion for cardiac arrhythmia F Emergency intravenous anti-arrhythmic therapy for ventricular tachycardia or fibrillation F Infective endocarditis (restricted to one payment only). F Keyhole coronary artery bypass surgery F Permanent defibrillator insertion F Permanent pacemaker insertion F Surgery for cardiac arrhythmia F Surgical repair of an atrial or ventricular septal defect F


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Masterclass - Coronary Heart Disease Competitor analysis correct at time of publishing

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