Dread Disease Insurance towards local experience Wolfgang Droste - - PowerPoint PPT Presentation

A Berkshire Hathaway Company

Dread Disease Insurance towards local experience

Wolfgang Droste IAAHS - Colloquium 2004 29 April 2004

A Berkshire Hathaway Company

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3

Contents

1. Gen Re’s Survey 2. International Comparisons 3. Trends in Cancer Incidence 4. For Your Consideration

4

Contents

1. Gen Re’s Survey 2. International Comparisons 3. Trends in Cancer Incidence 4. For Your Consideration

5

Gen Re’s Survey

• Background information
• Claims analysis

– Admitted claims – Cancer claims – Declinature – Incidence rates

6 Market Survey and Product Features

Market Coverage

• Hong Kong (15), Malaysia (9) and Singapore (7)
• 4.0 million lives in force on 31.12.2000

Hong Kong 22% Malaysia 45% Singapore 33%

7 Market Survey and Product Features

In-force by sex

• Number of in-force policies issued to women > number of in-force

policies issued to men (for age 20 – 40)

10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 90,000

10 20 30 40 50 60 70

Age

Number of In-force Policies

Male Female

8 Market Survey and Product Features

Average Sum Insured

• Average claim amount < Average sum insured

As at 31/12/2000: $US Claims In-force Difference

– Hong Kong: 34,922 39,077

• 10.5%

– Malaysia: 9,102 9,338

• 2.5%

– Singapore: 20,672 23,698

• 12.8%

9 Market Survey and Product Features

Sales Volume

• No. of new policies stable

– Around 650,000 policies each year

• New business sum insured increasing

– US$12.5 billion (1996), US$14.5 billion (2000)

• Proportion of age 0 -19 policies (in-force) increasing

– 3% (1993), 17% (1998), 15% (2000)

10

Claims Analysis

• Background information
• Claims analysis

– Admitted claims – Declinature – Cancer claims – Incidence rates

11

Survey Basis

• 16,507 claims in total
• 13,832 Dread Disease claims (of which 87% admitted)
• 9,518 Admitted claims with cause of claim provided

Admitted claims (counted by number of policies):

Hong Kong 23% Malaysia 32% Singapore 45%

12 Cause of Claim

Cause of Claim by Territory

Cause of Claim by Territory

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Hong Kong Malaysia Singapore Overall Others Total Permanent Disability Other heart surgery excluding Coronary Artery Bypass Surgery Coronary Artery Bypass Surgery Kidney Failure Stroke Heart Attack Cancer

13 Cause of Claim

Cause of Claim by Duration

Breakdown by sex and duration

Sex Male Female Duration 1 2+ 1 2+ Number of Claims 727 720 2887 763 805 3616

Cancer 49.5% 53.6% 50.7% 81.8% 83.1% 84.9% Heart Attack 19.5% 19.3% 21.1% 1.6% 1.5% 1.8% Stroke 7.6% 9.3% 9.0% 4.2% 3.4% 4.1% CABS 4.3% 4.7% 4.4% 0.4% 0.4% 0.2% Kidney Failure 2.3% 3.2% 3.6% 3.0% 2.1% 2.2% Other heart surgery excluding CABS 2.8% 2.2% 2.1% 0.7% 0.5% 0.6% TPD 1.8% 1.5% 1.4% 0.4% 0.2% 0.6% Others 12.2% 6.1% 7.7% 8.0% 8.8% 5.5%

14 Cause of Claim

The Most Common “Other” Causes of Claim

“Other” Claims

Hong Kong Malaysia Singapore “Other” claims (cause reported) 168 217 142 1st place Benign brain tumor 14 (8%) Paralysis 20 (9%) Benign brain tumor 25 (18%) Encephalitis 10 (7%) 2nd place Paralysis 12 (7%) Benign brain tumor 19 (9%) Coma 10 (7%) Blindness 13 (5%) 3rd place Coma 10 (6%) Coma 13 (5%) Multiple Sclerosis 8 (6%)

15 Cause of Claim

Cause of Claim by Age – Males

Claims: 103 1781 2388 62

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-19 20-39 40-59 60+ Others Total Permanent Disability Other heart surgery excluding CABS Coronary Artery Bypass Surgery (CABS) Kidney Failure Stroke Heart Attack Cancer

16 Cause of Claim

Cause of Claim by Age – Females

Claims: 68 2297 2780 39

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 0-19 20-39 40-59 60+

Others Total Permanent Disability Other heart surgery excluding CABS Coronary Artery Bypass Surgery (CABS) Kidney Failure Stroke Heart Attack Cancer

17

Claims Analysis

• Background information
• Claims analysis

– Admitted claims – Declinature – Cancer claims – Incidence rates

18 Declinature

Declinature Rate

Declinature rate by calendar year

0% 5% 10% 15% 20% 25% 1996 1997 1998 1999 2000

Hong Kong Malaysia Singapore Overall

19 Declinature

Declinature Rate

Declinature Rate by Sex and Territory

12% 11% 9% 11% 18% 19%

0% 5% 10% 15% 20%

Female Male

Hong Kong Malaysia Singapore

20 Declinature

Declinature Rate

0% 5% 10% 15% 20% 25% 30%

Others Non-disclosure Within Waiting Period Definition Not Met Not Covered Suicide

Declinature Rate by Cause of Declinature

* Only 11% of declined claims gave the reason for declinature.

21 Declinature

Declinature Rate

0% 5% 10% 15% 20% 25% 30%

Others Kidney Failure Coronary Artery Bypass Surgery Heart Attack Stroke Cancer

Declinature Rate by Cause of Claim

22

Claims Analysis

• Background information
• Claims analysis

– Admitted claims – Cancer claims –Incidence rates

23 Cancer Claims

Selection Effect: Insured Lives’ Cancer Rates

• Comparing survey results with population statistics on cancer
• Notes:

– Population statistics may include more than one primary cancer site – No population data for Malaysia available – Source of population statistics:

• Hong Kong Cancer Registry – New cancer cases in year 2000 (all sites

excluding skin)

• Singapore Cancer Registry Report No. 5 - Cancer Incidence in Singapore

1993-1997 (all sites excluding skin)

24 Cancer Claims

Selection Effect – Hong Kong

Crude Cancer Incidence rates - Male

Insured lives (1996-2000) Population (2000) Insured lives/Population

• No. of Claims

Cancer incidence Cancer incidence Ratio Duration Duration (all sites but skin) Duration Age 2+ All 2+ All 2+ All 20-24 4 16 0.112 0.137 0.209 54% 65% 25-29 29 61 0.292 0.293 0.371 79% 79% 30-34 53 84 0.383 0.350 0.498 77% 70% 35-39 106 169 0.770 0.764 0.898 86% 85% 40-44 123 180 1.419 1.328 1.661 85% 80% 45-49 59 99 1.354 1.452 2.612 52% 56% 50-54 34 51 2.028 1.953 3.878 52% 50% 55-59 12 17 2.465 2.395 6.239 40% 38%

25 Cancer Claims

Selection Effect – Hong Kong

Crude Cancer Incidence rates - Female

Insured lives (1996-2000) Population (2000) Insured lives/Population

• No. of Claims

Cancer incidence Cancer incidence Ratio Duration Duration (all sites but skin) Duration Age 2+ All 2+ All 2+ All 20-24 15 33 0.337 0.239 0.235 143% 102% 25-29 53 82 0.423 0.339 0.417 102% 81% 30-34 107 165 0.765 0.694 0.758 101% 92% 35-39 169 248 1.465 1.282 1.373 107% 93% 40-44 154 247 2.131 2.01 2.302 93% 87% 45-49 93 156 2.274 2.215 3.237 70% 68% 50-54 53 76 2.949 2.528 4.015 73% 63% 55-59 29 38 5.107 4.517 5.073 101% 89%

26 Cancer Claims

Selection Effect – Singapore

Crude Cancer Incidence rates - Male

• No. of Claims

Cancer incidence Cancer incidence Ratio Duration Duration (all sites but skin) Duration Age 2+ All 2+ All 2+ All 20-24 7 8 0.0924 0.0773 0.174 53% 44% 25-29 21 26 0.1878 0.1776 0.161 117% 110% 30-34 38 52 0.3126 0.3244 0.301 104% 108% 35-39 51 74 0.4121 0.4530 0.508 81% 89% 40-44 66 84 0.6740 0.6542 1.107 61% 59% 45-49 50 62 0.8407 0.8067 2.572 33% 31% 50-54 42 54 1.7463 1.8026 3.025 58% 60% 55-59 27 31 3.5905 3.2425 5.179 69% 63%

27 Cancer Claims

Selection Effect – Singapore

Crude Cancer Incidence rates – Female

Insured lives (1996-2000) Population (2000) Insured lives/Population

• No. of Claims

Cancer incidence Cancer incidence Ratio Duration Duration (all sites but skin) Duration Age 2+ All 2+ All 2+ All 20-24 10 20 0.1201 0.1709 0.221 54% 77% 25-29 49 55 0.3732 0.3158 0.249 150% 127% 30-34 78 97 0.5974 0.5529 0.576 104% 96% 35-39 155 203 1.2260 1.1868 1.061 116% 112% 40-44 221 272 2.1095 1.9324 1.98 107% 98% 45-49 243 294 3.5937 3.2787 4.398 82% 75% 50-54 129 155 4.1693 3.9236 3.979 105% 99% 55-59 58 70 5.1019 4.7975 4.885 104% 98%

28 Cancer Claims

Site of Cancer (Insured Lives - Male)

4% 27% 8% 25% 12% 10% 14%

Bone and connective tissue, skin and breast Digestive organs and peritoneum Genitourinary organs Lip, oral cavity and pharynx Lymphatic and haematopoietic tissue Other and unspecified Respiratory and intrathoracic

• rgans

Hong Kong, Malaysia & Singapore

29 Cancer Claims

Site of Cancer (Hong Kong Insured Lives - Male)

3% 28% 7% 32% 10% 10% 10%

Bone and connective tissue, skin and breast Digestive organs and peritoneum Genitourinary organs Lip, oral cavity and pharynx Lymphatic and haematopoietic tissue Other and unspecified Respiratory and intrathoracic

• rgans

Hong Kong

30 Cancer Claims

Site of Cancer (Hong Kong Population - Male)

3% 34% 7% 29% 9% 5% 13%

Bone and connective tissue, skin and breast Digestive organs and peritoneum Genitourinary organs Lip, oral cavity and pharynx Lymphatic and haematopoietic tissue Other and unspecified Respiratory and intrathoracic

• rgans

New Cancer Cases in Year 2000 (Age 20-49)

31 Cancer Claims

Site of Cancer (Insured Lives - Female)

45% 11% 18% 6% 5% 10% 5%

Bone and connective tissue, skin and breast Digestive organs and peritoneum Genitourinary organs Lip, oral cavity and pharynx Lymphatic and haematopoietic tissue Other and unspecified Respiratory and intrathoracic

• rgans

Hong Kong, Malaysia & Singapore

32 Cancer Claims

Site of Cancer (HK Insured Lives - Female)

42% 12% 18% 10% 5% 9% 4%

Bone and connective tissue, skin and breast Digestive organs and peritoneum Genitourinary organs Lip, oral cavity and pharynx Lymphatic and haematopoietic tissue Other and unspecified Respiratory and intrathoracic

• rgans

Hong Kong

33 Cancer Claims

Site of Cancer (Hong Kong Population - Female)

38% 12% 20% 9% 6% 9% 6%

Bone and connective tissue, skin and breast Digestive organs and peritoneum Genitourinary organs Lip, oral cavity and pharynx Lymphatic and haematopoietic tissue Other and unspecified Respiratory and intrathoracic

• rgans

New Cancer Cases in Year 2000 (Age 20-49)

34 Cancer Claims

Female Breast Cancer Claims

0% 10% 20% 30% 40% 50% Overall Singapore Malaysia Hong Kong

% of Female Cancer Claims due to Breast Cancer

35 Cancer Claims

Female Breast Cancer Claims

0% 10% 20% 30% 40% 50% 60% 0-9 10-19 20-29 30-39 40-49 50-59 60-69

Age Hong Kong Malaysia Singapore Overall

Age distribution of female breast cancer claims

36 Cancer Claims

Female Cancer Claims

0% 20% 40% 60% 80% 100% All Dread Diseases All Cancers Classified* Cancers Breast Cancer duration 0 duration 1 duration 2+

In-force duration of female claims

*This refers to cancer claims for which the sites are available

37

Claims Analysis

• Background information
• Claims analysis

– Declinatures – Admitted claims – Cancer claims – Incidence rates

38 Incidence Rates & Actual/Expected Ratio Analysis

Acceleration Type Dread Disease Policies

Acceleration Type Benefit

20,000 Death cover 5,000 Dread Disease cover

Dread Disease

Payment of 15,000

Death

Payment of 20,000 Payment of 5,000

Death

39 Incidence Rates & Actual/Expected Ratio Analysis

Incidence Rates: Death with Acceleration DD – Males

Based on 2,301 actual claims

0.000 0.002 0.004 0.006 0.008 0.010 0.012 20 30 40 50 60 Age Incidence Rates Crude rates 2003 Graduated rates 2003 Graduated rates 2000

+9.4% ? in comparison with last DD survey (1993-1997)

40 Incidence Rates & Actual/Expected Ratio Analysis

Incidence Rates: Death with Acceleration DD – Females

Based on 2,291 actual claims

0.000 0.002 0.004 0.006 0.008 0.010 20 30 40 50 60 Age

Incidence Rates

Crude rates 2003 Graduated rates 2003 Graduated rates 2000

+17.9% ? in comparison with last DD survey (1993-1997)

41 Incidence Rates & Actual/Expected Ratio Analysis

Incidence Rates: Death with Acceleration DD

Death with Dread Disease Acceleration

0.0001 0.0010 0.0100 0.1000 20 25 30 35 40 45 50 55 60

Age

Incidence Rates (log scale)

Male Female

42 Incidence Rates & Actual/Expected Ratio Analysis

Incidence Rates: Acceleration DD only

Dread Disease only (Acceleration type)

0.0001 0.0010 0.0100 0.1000 20 25 30 35 40 45 50 55 60

Age

Incidence Rates (log scale)

Male Female

43 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, males

100% 2899 Duration 2+ 99% 655 Duration 1 110% 602 Duration 0 A/E No of claims All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

44 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, males

98% 100% 2899 Duration 2+ 91% 99% 655 Duration 1 93% 110% 602 Duration 0 A/E A/E No of claims Hong Kong All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

45 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, males

103% 98% 100% 2899 Duration 2+ 102% 91% 99% 655 Duration 1 135% 93% 110% 602 Duration 0 A/E A/E A/E No of claims Malaysia Hong Kong All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

46 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, males

99% 103% 98% 100% 2899 Duration 2+ 103% 102% 91% 99% 655 Duration 1 94% 135% 93% 110% 602 Duration 0 A/E A/E A/E A/E No of claims Singapore Malaysia Hong Kong All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

47 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, females

100% 3713 Duration 2+ 81% 743 Duration 1 90% 664 Duration 0 A/E No of claims All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

48 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, females

107% 100% 3713 Duration 2+ 85% 81% 743 Duration 1 86% 90% 664 Duration 0 A/E A/E No of claims Hong Kong All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

49 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, females

82% 107% 100% 3713 Duration 2+ 71% 85% 81% 743 Duration 1 96% 86% 90% 664 Duration 0 A/E A/E A/E No of claims Malaysia Hong Kong All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

50 Initial Selection

Initial Selection Effect by Territory

Acceleration DD, age range 20 – 60, females

109% 82% 107% 100% 3713 Duration 2+ 92% 71% 85% 81% 743 Duration 1 88% 96% 86% 90% 664 Duration 0 A/E A/E A/E A/E No of claims Singapore Malaysia Hong Kong All territories

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

51 Initial Selection

Initial Selection Effect

Additional DD,

100% 600 100% 412 Duration 2+ 80% 91 89% 75 Duration 1 73% 73 80% 60 Duration 0 A/E No of claims A/E No of claims Female (age 25-55) Male (age 25-60)

*Duration 0 exposure = No of lives * (1 – waiting period in days / 365)

52 Smoking

Analysis by Smoking Status

104% 471 94% 224

• Nonsmoker

185% 24 140% 109

• Smoker

Additional DD 93% 2174 91% 1206

• Nonsmoker

147% 91 142% 625

• Smoker

Acceleration DD A/E No of claims A/E No of claims Females Males

53 Smoking

Analysis by Smoking Status

Smoker/non-smoker differential by age group

0% 50% 100% 150% 200% 250% 20-29 30-34 35-39 40-44 45-49 50-54 55-60

Male Female

54 Trends

Analysis by Calendar Year – Males

A/E Ratios by Calendar Year

70% 80% 90% 100% 110% 120% 1996 1997 1998 1999 2000 Hong Kong Malaysia Singapore Overall

55 Trends

Analysis by Calendar Year – Females

A/E Ratios by Calendar Year

60% 70% 80% 90% 100% 110% 120% 130% 140% 1996 1997 1998 1999 2000 Hong Kong Malaysia Singapore Overall

56

Contents

1. Gen Re’s Survey 2. International Comparisons 3. Trends in Cancer Incidence 4. For Your Consideration

57 International Comparison

International Comparisons

• Hong Kong, Malaysia and Singapore (HKMS)

– Gen Re’s Survey (1996 - 2000)

• Taiwan

– Life Insurance Association (1996-1999)

• UK

– Report of the Healthcare Study Group (1991-1997)

• Australia

– Gen Re Australia – Trauma Experience Analysis 1998-2000

• South Africa

– Gen Re South Africa – Trauma experience Analysis, 1991-2002

58 Claims Experience

Cause of Claim – Gen Re’s survey

Hong Kong, Malaysia and Singapore

Sex Male Female Duration 1 2+ 1 2+ Number of Claims 727 720 2887 763 805 3616

Cancer 49.5% 53.6% 50.7% 81.8% 83.1% 84.9% Heart Attack 19.5% 19.3% 21.1% 1.6% 1.5% 1.8% Stroke 7.6% 9.3% 9.0% 4.2% 3.4% 4.1% CABS 4.3% 4.7% 4.4% 0.4% 0.4% 0.2% Kidney Failure 2.3% 3.2% 3.6% 3.0% 2.1% 2.2% Other heart surgery excluding CABS 2.8% 2.2% 2.1% 0.7% 0.5% 0.6% TPD 1.8% 1.5% 1.4% 0.4% 0.2% 0.6% Others 12.2% 6.1% 7.7% 8.0% 8.8% 5.5%

59 International Comparisons

Cause of Claim - Taiwan

Taiwan

Sex

Male Female

Year

1996 1997 1998 1999 2000 1996 1997 1998 1999 2000

Number of Claims

921 1,398 2,013 2,539 3,396 1,187 1,637 2,325 2,881 3,731

Cancer

76.8% 78.0% 75.2% 72.9% 73.3% 89.0% 90.2% 88.5% 88.3% 88.1%

Heart Attack

7.3% 7.5% 8.6% 9.3% 9.1% 0.6% 0.4% 1.0% 1.1% 0.9%

Stroke

4.1% 3.6% 5.0% 4.8% 5.4% 1.9% 1.5% 1.5% 1.6% 1.8%

Coronary Artery Bypass

1.4% 1.8% 2.5% 2.4% 2.3% 0.3% 0.5% 0.5% 0.5% 0.4%

Kidney Failure

7.3% 7.4% 7.0% 8.1% 7.5% 7.2% 6.4% 7.6% 7.2% 7.8%

Major Organ Transplant

1.3% 0.4% 0.3% 1.4% 0.4% 0.5% 0.4% 0.2% 0.6% 0.1%

Paralysis

1.8% 1.3% 1.3% 1.2% 2.2% 0.7% 0.7% 0.7% 0.9% 0.9%

60 International Comparisons

Cause of Claim - UK

UK

Sex Male Female Duration 1 2+ 1 2+ Cancer 43.2% 49.3% 41.1% 79.7% 79.4% 74.4% Heart Attack 34.6% 25.2% 31.2% 2.1% 2.7% 2.3% Stroke 7.1% 9.8% 8.6% 6.2% 7.0% 6.5% Coronary Artery Bypass Graft 6.6% 5.3% 7.1% 1.2% 0.0% 0.8% Multiple Sclerosis 3.1% 3.3% 3.6% 6.1% 3.8% 8.6% Kidney Failure 1.2% 1.6% 0.8% 1.6% 0.0% 0.5% Major Organ Transplant 1.2% 0.0% 0.5% 0.5% 1.0% 0.0% PTD 3.0% 5.5% 7.1% 2.6% 6.1% 6.9%

*** Claims from “other” causes made up about 2% of male and female DD claims

61 International Comparisons

Cause of Claim - Australia

Australia

Sex Male Female Duration 1 2+ 1 2+ Number of Claims 58 72 309 36 63 211 Cancer 46.6% 44.4% 43.0% 69.4% 84.1% 82.0% Heart Attack 1.7% 26.4% 27.5% 2.8% 1.6% 3.3% Stroke 6.9% 4.2% 1.9% 11.1% 4.8% 4.7% Coronary Artery Bypass Graft 6.9% 4.2% 7.8% 0.0% 0.0% 0.0% Kidney Failure 0.0% 0.0% 0.3% 0.0% 0.0% 0.0% Other 37.9% 20.8% 19.4% 16.7% 9.5% 10.0%

62 International Comparisons

Cause of Claim – South Africa

South Africa

Sex Male Female Number of claims 298 65 Cancer 29% 74% Heart Attack 57% 12% Stroke 7% 12% Other 7% 2%

63

Contents

1. Gen Re’s Survey 2. International Comparisons 3. Trends in Cancer Incidence 4. For Your Consideration

64 Trends

Population Trends in Cancer - UK

UK: crude rates (age 20+)

350 400 450 500 550 600 650 1989 1990 1991 1992 1993 1994 1995 1996 1997 Rate per 100,000

Male Female

65 Trends

Population Trends in Cancer - UK

60 80 100 120 140 160 1989 1990 1991 1992 1993 1994 1995 1996 1997

Prostate Lung Colorectal

UK: male by site

*** Age standardised rates adjusted to 100 in 1989

66 Trends

Population Trends in Cancer - UK

60 80 100 120 1989 1990 1991 1992 1993 1994 1995 1996 1997

Lung Breast Cervix Colorectal

UK: female by site

*** Age standardised rates adjusted to 100 in 1989

67 Trends

Population Trends in Cancer – Hong Kong

Hong Kong: crude rates

200 250 300 350 400

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Rate per 100,000

Male Female

68 Trends

Population Trends in Cancer – Hong Kong

60 80 100 120 140 160 180 200 220 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Prostate Rectum Nasopharynx Lung Stomach

Hong Kong: male by site

*** Age standardised rates adjusted to 100 in 1989

69 Trends

Population Trends in Cancer – Hong Kong

60 80 100 120 140 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Breast Nasopharynx Lung Cervix

Hong Kong: female by site

*** Age standardised rates adjusted to 100 in 1989

70 Trends

Population Trends in Cancer – Hong Kong

Age standardised incidence rates

150 200 250 300 350

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

Rate per 100,000

Male Female

71 Trends

Trends in Cancer – Hong Kong Insured Lives

Age Adjusted Cancer Incidence Rate (Age20-60)

20 40 60 80 100 120 140 160 1996 1997 1998 1999 2000 Rate per 100,000

Male Female

72 Trends

Trends in Heart Attack, Stroke & Heart Surgery

Age Adjusted Incidence Rate

Hong Kong Male Insured Lives (Age 20-60)

5 10 15 20 25 30 1996 1997 1998 1999 2000

Rate per 100,000

HA, Stroke, CABS, Heart Surgery

73 Trends

Population mortality by cause of death – HK

50 100 150 200 250 300 350 1971 1981 1991 1994 1995 1996 1999 2000 Malignant neoplasms Heart diseases Injury and poisoning Cerebrovascular disease Pneumonia, all forms All other causes

Mortality per 100 000 -- Age 45-64

74 Trends

Population mortality by cause of death – HK

5 10 15 20 25 30 35 40 45 50 1971 1981 1991 1994 1995 1996 1999 2000 Malignant neoplasms Heart diseases Injury and poisoning Cerebrovascular disease Pneumonia, all forms All other causes

Mortality per 100 000 -- Age 15-44

75 Trends

Population Trends in Cancer - Taiwan

Taiwan: crude rates

50 100 150 200 250 300 1991 1992 1993 1994 1995 1996 1997 1998 Rate per 100,000

Male Female

76 Trends

Population Trends in Cancer - Taiwan

Taiwan: age standardised rates

50 100 150 200 250 1991 1992 1993 1994 1995 1996 1997 1998 Rate per 100,000

Male Female

77 Trends

Trends in Cancer – Taiwan Insured Lives

Taiwan: crude rates

50 100 150 1996 1997 1998 1999 2000 Rate per 100,000

Male Female

78 Trends

Trends in Cancer – Taiwan Insured Lives

Taiwan: age standardised rates

50 100 150 1996 1997 1998 1999 2000 Rate per 100,000

Male Female

79 Trends

Trends in Heart Attack, Stroke & CABS

Taiwan insured lives: crude rates

5 10 15 20 25 1996 1997 1998 1999 2000 Rate per 100,000

Male Female

80 Trends

Trends in Heart Attack, Stroke & CABS

Taiwan insured lives: age standardised rates

5 10 15 20 25 1996 1997 1998 1999 2000 Rate per 100,000

Male Female

81

Contents

1. Gen Re’s Survey 2. International Comparisons

• 3. Trends in Cancer Incidence

4. For Your Consideration

82

For Your Consideration

• Shape of rates
• Definitions

83

For Your Consideration

Life-threatening Cancer Means the presence of one or more malignant tumours. The malignant tumour is to be characterised by the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered medically necessary. The following tumours are excluded:

• Tumours showing the malignant changes of carcinoma in situ (including cervical dysplasia

CIN-1, CIN-2 and CIN-3) or which are histologically described as pre-malignant;

• All skin cancers including hyperkeratoses, basal cell carcinomas, squamous cell

carcinomas and Melanomas of less than 1.5 mm maximum thickness as determined by histological examination using the Breslow method, unless there is evidence of metastasis;

• Non Life-threatening Cancers such as Prostatic cancers which are histologically described

as TNM Classification T1 or are of another equivalent or lesser classification, Papillary Micro-Carcinoma of the Thyroid or Bladder and Chronic Lymphocytic Leukaemia less than Rai Stage 3.

84

For Your Consideration

• Shape of rates
• Definitions
• Medical advance & trends

85

For Your Consideration

• No. of companies

% of in force policies Guaranteed Total Guaranteed – Hong Kong: 2 15 6% – Malaysia: 8 9 85% – Singapore: 6 7 69%

Reviewability of definitions

– None

Premium Rate Guarantee

86

For Your Consideration

Reviewability Clause Your policy cannot be cancelled by us due to a deterioration in your health or changes in your occupation or pastimes. Your Dread Disease Plan provides financial assistance in the event that you suffer a substantial loss as a result of one of the specified Dread Diseases defined in your Policy Document. Due to the continuing advances in medical treatment and diagnostic techniques, we may need to review the Definitions used in your Policy Document to ensure that in the future they:

• remain appropriate with regard to medical terminology and classification,
• take into account effective cures and vaccines and modern diagnostic

procedures,

• include diseases considered appropriate in the future,
• exclude diseases which are found to have become minor.

We reserve the right, therefore, to adjust your Dread Disease Definitions and/or premium.

87

For Your Consideration

• Shape of rates
• Definitions
• Medical advance & trends
• Effect on mortality studies

88

For Your Consideration

0% 10% 20% 30% 40% 50% S88/93 M83/88 HKA01

Death Claims cf. Mortality Tables

Male Female

89

? Questions ?