If critical illness is a three-headed monster and medical intervention is your sword, then insurance is like your armor. You need your sword to defeat the enemy, but your armor lessens the damage you take during battle, giving you better odds for survival.
In the Philippines, heart attack, stroke, and cancer are diseases that can claim lives if not treated properly and promptly. They can also lead to financial ruin. Critical illness can easily wipe out your entire savings, so it is important that you are adequately protected with the right financial tools.
Let us discuss the monsters, the swords, and the armor.
Heart Attack (Acute Myocardial Infarction, MI)
Fact: There is little correlation between the severity of chest pain and the seriousness of its cause.
Coronary artery disease (CAD) is commonly caused by a block in the coronary artery, the main artery supplying the heart. This obstruction is due to fat accumulation and subsequent narrowing of the blood vessel walls (atherosclerosis), creating poor blood flow and imbalance in the oxygen supply and demand of the heart. This imbalance can cause Angina Pectoris, felt as a squeezing pressure on the chest that can spread to the left arm and occurs during physical exertion or emotional upset (typical chest pain). In angina, the chest pain quickly goes away after resting or taking the medicine nitroglycerin, which is placed underneath the tongue. A person with CAD and angina may experience sweating (diaphoresis) and will have abnormal heart sounds, specific electrocardiogram (ECG) findings, and telltale signs on the stress test / exercise test.
Treatment of CAD depends on its severity, which is determined by doing Coronary Angiography, where a dye is injected to the blood vessels to better see the blockage. Angioplasty is the removal of the obstruction by widening the atherosclerotic blood vessel to improve blood flow. For severe cases, Coronary Artery Bypass Graft (CABG) can be done to redirect blood flow to other arteries to avoid the obstruction.
Causes of CAD include smoking, obesity, hypertension, diabetes, and high cholesterol in the blood (hypercholesterolemia). These underlying factors should be addressed to prevent CAD recurrence.
CAD can cause acute myocardial infarction (MI) or heart attack. Part of the heart muscle (myocardium) dies (infarction) as a result of poor blood flow. There is typical chest pain similar to angina, but longer (at least 30 minutes) and more severe, and it does not quickly go away with rest or nitroglycerin. The pain may also spread to both arms, neck, or back. A person with MI will experience diaphoresis, nausea, abnormal heart sounds, rapid heart rate, specific ECG findings, and increase in cardiac enzymes like troponin. Treatment includes control of underlying factors (similar to CAD), cardiac pacemaker for irregular heartbeat, medical therapy, and exercise.
Fact: 25% of all Myocardial Infarctions are clinically silent (no symptoms).
CAD and MI can lead to cardiac arrest, where the heart stops functioning properly and the blood stops circulating. The person loses consciousness and may die if cardiopulmonary resuscitation (CPR) is not given within 4-6 minutes. CPR can be a life saving measure that could be done while waiting for professional help.
Stroke (Cerebrovascular Accident, CVA)
Fact: Stroke is the leading cause of adult disability.
Stroke is the sudden onset of nervous system malfunction (neurologic deficit) as a result of bleeding (hemorrhage) or poor blood supply (ischemia) in the brain. These neurologic deficits last more than 24 hours and can worsen over time, which is why prevention and early treatment is important to limit disability and death. Treatment includes smoking cessation, medical therapy, surgical repair of the involved blood vessels, and aggressive control of hypertension, diabetes, and hypercholesterolemia.
Majority of strokes are ischemic strokes, where blocked blood vessels in the brain create ischemia in specific areas of the brain, causing neurologic deficits particular to those areas (focal neurologic deficits). The ischemic brain tissue rapidly loses function, but can still recover within a few hours. Hemorrhagic stroke is caused by ruptured blood vessels and bleeding in the brain. Vomiting is common, as well as sudden severe headache, temporary loss of consciousness, and focal neurologic deficits. Brain imaging (CT scan, MRI, angiography) is done to differentiate ischemic stroke from hemorrhagic stroke and to rule out other possible causes, like brain tumor. It also reveals the area and blood vessel/s involved.
Cancer
Fact: Cancer is the most common cause of weight loss in older persons.
Cancer is a malignant tumor, or an abnormal mass of cells that can spread and invade other tissues (metastasize). There are 2 essential features of cancer cells: uncontrolled growth and the ability to metastasize. Cancer cells underwent genetic changes that removed the safeguards that regulate cell growth and that introduced new features that enable them to metastasize (e.g. increased binding to cells, increased ability to break anatomic barriers, increased mobility, and increased ability to nourish itself by creating new blood vessels).
Cancer cells spread through the blood and lymph nodes. Having a family member with cancer increases your chances of getting one. People with cancer generally experience nausea and weight loss, and they are often diagnosed by taking a sample of the abnormal tissue and examining it (biopsy). Treatment can be one or a combination of the following: removal of the tumor, chemotherapy, and radiation therapy. Cancer severity is usually classified using the TNM staging system:
| TNM Staging System |
| T – tumor size / N – lymph node involvement / M – metastasis STAGE 0: Carcinoma in situ (there’s growth but no invasion)STAGE 1: Localized (with the invasion of surrounding cells) STAGE 2: Early locally advanced (with lymph node involvement) STAGE 3: Late locally advanced (with the invasion of nearby tissues) STAGE 4: Distant metastasis |
Liver Cancer (Hepatocellular Carcinoma) is the most common tumor, with a male:female ratio of 4:1. Its high incidence in Asia and Africa is related to hepatitis B and C infections. This condition develops around age 50 to 60, and it usually presents with dull abdominal pain, abdominal mass, fluid in the abdominal cavity (ascites), yellowing skin (jaundice), fever, and anemia.
Colorectal Cancer is the second most common internal cancer in humans with increased incidence after age 50. Hypercholesterolemia and CAD are risk factors, and it usually presents with rectal bleeding, blood in stool, abdominal or back pain, anemia, and changes in bowel habits like decrease in stool caliber (narrowing) or painful straining (tenesmus).
Lung Cancer is the leading cause of cancer death, accounting for 32% of all cancer deaths in men and 25% in women. Its peak incidence is at 55-65 years old, and it commonly presents with cough, blood in sputum (hemoptysis), noisy breathing, and difficulty in breathing (dyspnea).
Breast Cancer is the most common tumor in women, although men can also get it (150:1). This condition is hormone-dependent. Risk factors include: no experienced childbirth (nulliparity), early onset of first menstruation (menarche before age 13), late menopause (after age 55), and late pregnancy with first child (after age 30). Monthly breast self-examinations a week after menses can detect breast cancer early, as well as regular mammograms by age 40.
Endometrial Cancer is the most common gynecologic cancer. It is a disease of postmenopausal women, and risk factors include obesity, altered menstrual cycles, infertility, and late menopause. This condition usually presents with abnormal vaginal bleeding and discharge.
Cervical Cancer is a major cause of disease in underdeveloped countries. It is a sexually transmitted condition that is more common in lower socioeconomic groups, women with early sexual activity, multiple sexual partners, and in smokers. Cervical cancer is easily detected by Pap smear, and it commonly presents with abnormal vaginal bleeding and discharge.
Prostate Cancer is the most common malignancy in men, and it commonly presents with difficulty or pain in urination (dysuria), decreased urinary stream caliber and force, involuntary delay in urination (hesitancy), trickling of urine even after urinating (postvoid dribbling), urinating at night (nocturia), and inability to control urination (incontinence). Regular digital rectal exams (DRE) can help in early detection.
Are PhilHealth, SSS, and HMO Enough?
Fact: A family stricken with critical illness will need at least Php 765,000-Php 5,000,000 for recovery.
PhilHealth gives you a set amount based on medical condition and treatment, such as Heart Attack (Php 18,900), Chemotherapy (Php 7,280), and Stroke (Php 28,000). There are also benefits provided for specific critical illnesses, but they can only be availed at 23 hospitals. Examples of these include Breast cancer (Php 100,000), Cervical cancer (Php 120,000), Prostate cancer (Php 100,000), and CABG (Php 550,000).
Social Security Services (SSS) can provide sickness and disability benefits. Sickness benefits are daily cash allowances for the days you can’t go to work, and is equivalent to 90% of your average daily salary credit. The only caveat is that you must use up all your allowed leaves (sick leave, vacation leave, etc.). Disability benefits could be in the form of lump sum or monthly pension amount (Php 1,200 to Php 2,400) plus Php 500 monthly supplemental allowance.
Health Maintenance Organizations (HMOs) work with a network of doctors and clinics that provide health care services, basic surgeries, and laboratory / diagnostic tests. They pay directly to the hospital, and the benefits stop when you reach the maximum limit (Annual Benefit Limit, ABL) or when you resign from the company you are working for. Critical illness can easily exceed the ABL, especially those that require repeat tests or treatments, like cancer. Different HMOs offer different benefits and restrictions: there are cases where you cannot use more than one HMO at the same time, or certain procedures are not covered. And if your attending physician is not part of the network, your HMO cannot pay for his/her services.
How Critical is Critical Illness Insurance?
Fact: In 2010, 9 out of 10 deaths in the Philippines are caused by illness.
Critical illnesses are typically late-stage, life-threatening, and costly events. Without having millions in liquid financial assets, years of hard-earned savings could easily be drained within hours. Even after hospitalization, the expenses do not stop – monthly treatments on top of regular monthly bills take a financial toll, especially if you need to stop working for a while to recuperate. Having gone through a life-threatening event can also cause emotional turmoil. Surviving a critical condition leaves you a different person – physically, emotionally, and financially.
Critical illness insurance pays a lump sum amount upon diagnosis of a late-stage disease covered in the insurance policy. This lump sum can fill the gap in your health insurance, and protects you against the high cost associated with surviving a critical condition. It also helps you enjoy life’s little pleasures. Critical illness insurance can thus provide peace of mind, stability, and freedom of choice.
Critical illness insurance varies in cost and coverage among insurance companies. Here are the different benefits offered by ours:
Disability Riders
Disability riders are benefits that pay a lump sum amount if the insured becomes totally and permanently disabled due to bodily injury or disease. Total and Permanent Disability (TPD) is the inability to do any work for at least 6 months, or the inability to do at least 3 activities of daily living (ADLs) without assistance (feeding, moving, transferring from one place to another, continence, bathing, dressing), or when there is total and permanent loss of function or removal of both eyes, both hands, both feet, or one hand and one foot.
Accelerated Total and Permanent Disability (ATPD) pays a lump sum cash benefit that is deducted from the basic sum assured. Non-accelerated Total and Permanent Disability (NATPD) is offered for single-pay plans, and it pays a lump sum that will not affect the basic sum assured.
Premium Waiver
Premium waiver is a benefit that relieves the Payor from premium payment, because of death, disability, or critical illness. Our company shoulders the full premium during the waived period.
Waiver of Premium on Total and Permanent Disability (WPTPD) waives subsequent premiums if the life insured becomes totally and permanently disabled. Premium payment shall resume once the insured recovers.
Payor Waiver is a benefit that can only be attached to policies with children as the life insured. It waives subsequent premiums if the payor / policyowner dies or becomes totally and permanently disabled.
Life Care Waiver (LCW) waives all future premiums if the insured is diagnosed with or underwent surgery for any of the 36 critical illnesses (see table below). Our company shoulders the full premium even if the insured recovers from the critical illness.
Term Riders
Fact: A breadwinner will need 5-10x his/her annual income to help dependents get through a tragic loss.
Term riders temporarily increase the basic life insurance coverage for a limited period. Additional Term Rider (ATR) is a cash benefit added to the basic sum assured that is paid to the insured’s beneficiaries in case of his/her death. Payor Term Rider (PTR) is a cash benefit added to the basic sum assured that is paid to the payor’s beneficiaries in case of his/her death. The payor’s stated beneficiaries may not be the same as the insured’s.
Critical Illness (CI) Benefits
Fact: 31% of deaths caused by illness are due to heart-related diseases.
CI benefits pay a lump sum upon diagnosis or surgery of any of the listed critical illnesses. Crisis Cover Benefit (CCB) covers 15 critical illnesses and is deducted from the policy’s sum assured (see table below). CCB may be attached or combined with other CI benefits except with the Life Care Benefit. Life Care Benefit (LCB) covers 36 critical illnesses and is deducted from the policy’s sum assured. LCB may be attached or combined with other CI benefits except with CCB. Life Care Plus (LC Plus) covers the 36 critical illnesses without affecting the sum assured. LC Plus may be combined with other CI benefits.
Multiple Life Care Plus (MLCP) also covers the 36 critical illnesses without affecting the sum assured. It allows you to claim CI benefits up to 3x (one for each group), with the exception of terminal illness (see table below). It pays as much as 300% of the benefit and an additional 10% cash benefit in case the insured undergoes angioplasty or other invasive treatment for coronary artery before the first CI diagnosis.
Life Care Advance Plus (LCAP) covers the 36 critical illnesses, including 10 early stage critical illnesses (see table below). It advances 25% of the CI benefit upon diagnosis of any of the 10 early stage critical illnesses, and it is claimable up to 4x (provided that succeeding claims are for different early stage diagnoses). The CI claims, both early and advanced stages, are deducted from the basic sum assured. LCAP pays an additional 10% if the insured undergoes angioplasty or other invasive treatment for coronary artery, an additional 20% for diabetic complications, and an additional 20% for advanced stage cancer, which totals up to 150% of the sum assured. This benefit is effective as long as the early/advanced stage benefits have not been exhausted or terminated.
36 CRITICAL ILLNESS & SURGERIES
- Cancer
- Major Organ Transplant
- Renal Failure 1,2
- Medullary Cystic Disease
- Aplastic Anemia
- Primary Pulmonary Hypertension
- End Stage Lung Disease
- End Stage Liver Failure 2
- Fulminant Hepatitis
- Progressive Scleroderma
- Systemic Lupus Erythematosus with Lupus Nephritis
- Heart Attack 1,2
- Stroke 1,2
- CABG 1,2
- Heart Valve Surgery 1,2
- Aorta Surgery 1
- Paralysis
- Brain Tumor 1,2
- Brain Surgery 2
- Multiple Sclerosis 1
- Motor Neuron Disease 1
- Muscular Dystrophy 1
- Poliomyelitis 1
- Parkinson’s Disease 1
- Bacterial Meningitis 1
- Encephalitis
- Alzheimer’s Disease
- Apallic Syndrome
- Major Head Trauma
- Major Burns
- Coma
- Blindness
- Deafness
- Loss of Speech
- HIV (occupationally-acquired or due to blood transfusion)
- Terminal Illness
| Group 1: Cancer & Major Organ Failure Group 2: Heart-related & Stroke Group 3: Neuromuscular & Others 1 The 15 CIs covered by CCB 2 The 10 early-stage CIs covered LCAP |
Hospital Income (HI) Benefit
Fact: An average hospital bill is equal to 3x your monthly income.
Hospital income provides a cash benefit for each day of hospital confinement due to injury or illness. Daily Hospital Income Benefit (DHI) pays a daily cash benefit (Php 1,000-Php 5,000) for each day of hospital confinement due to an accident or illness (up to 365 days). Long Term Hospitalization Benefit (LTH) pays additional daily cash benefit (100% of DHI) due to continuous confinement (in excess of 30 days, until 335 days). Surgical Expense Benefit (SE) reimburses inpatient surgical expenses caused by an accident or illness (up to 15x of DHI). Intensive Care Unit Benefit (ICU) pays up to 200% of DHI when confined to the intensive care unit.
Conclusion
The core of financial planning is protection from life’s unforeseen events. Critical illness, which can affect anyone, is one of those events, and the best time to prepare for it is before it happens to you.
So shore up your defences, prepare for battle, and get the right armour for you. Visit our Solutions page, or talk to one of our financial advisors for more information.
Sources:
- Harrison’s Principles of Internal Medicine
- Surgical Recall
- Stedman’s Concise Medical Dictionary
- DWATCH
