Ľudia, ktorí prežili rakovinu sa môžu stretnúť s ťažkosťami pri zabezpečovaní poistného krytia a/alebo sa stretávajú s veľmi rozdielne stanovenými cenami poistenia v dôsledku odhalenia skutočnosti, že prežili rakovinu. Vo Francúzsku platí od roku 2016 zákon, ktorý zaviedol právo pacienta nezverejňovať informáciu o prežití rakoviny pre konkrétne finančné produkty (po 5 rokoch pre deti a po 10 rokoch pre dospelých).
Insurance Europe v súčasnosti vykonáva mapovanie situácie v členských štátoch s cieľom určiť, aké ustanovenia (legislatívne alebo iné) už existujú, vrátane tých, ktoré presahujú právo neuvádzať prežitie rakoviny a sú rozšírené aj na iné ochorenia. V rámci tohto mapovania Insurance Europe tiež zisťuje informácie o tom, aké riziká by mohli vzniknúť v budúcnosti z pohľadu poisťovní a ktoré produkty by najviac zasiahlo, ak by sa zaviedli takéto práva pacientov (napr. vzťahujúce sa na výsledky genetických testov, chronické ochorenia atď.).
Insurance Europe seeks input on existing legislative or voluntary provisions in member states that give policyholders the right to not disclose certain data (eg cancer survivorship, HIV etc) to insurers. IE also seeks input on what risks may lay in the future if provisions were introduced extending such rights (eg genetic testing results, chronic diseases, etc).
1. Which illnesses*/data would cause serious concern if covered in the future (*ie what would be a risk if covered in future)?
Without being aware of the previous health condition of insured, it would be a risk for insurance company to cover illnesses which cannot be covered for various reasons in products covering death, disability, critical illnesses, and long-term incapacity to work. Aforementioned illnesses include: obstructive pulmonary disease, HIV, cancer, stage 3 hypertension with high cardiovascular risk, severe kidney disease, acute post-stroke period, angina pectoris or severe psychiatric conditions such as schizophrenia etc. This also applies to illnesses which could be covered despite the pre-existing condition, but insurer needs to know the health condition of insured to be able to estimate the risk of any death and count it in to premium.
2. Which product lines would be most affected and how?
The most affected product lines would be the lines covering death, disability, critical illnesses or long-term incapacity to work such as life insurance covering death and also health insurance. The proposed change in legal provisions generally raises a risk of adverse selection caused by information asymmetry between the insurance company and the client (the client has more information relevant to the proper risk assessment compared to the insurance company). At the same time, the cancer survivor will be much more motivated to take out the insurance. As a result people with a high probability of occurrence of the insurance event will have a much higher share in insurance portfolio than is usual compared to standard population with average risk. Insurance companies will therefore have to introduce certain safety margins into their calculations, which will lead to higher premiums – particularly for critical illnesses, disability, long term incapacity to work and death cover.
It would be better for both the insured and the insurance company if the insurer knew about pre-existing health condition. This information is necessary for the insurer because of risk assessment and creation of sufficient reserves for claims. A person who survived a serious illness has a higher risk of death or disability because the probability of developing the illness (relapse) or related illness is not the same comparing to healthy person, who did not suffer any illness. Adoption of a regulation may lead to the fact that the insurance companies will not be willing to cover cancer (or such illnesses) – this illness could become a part of exclusions from insurance cover.
3. Other risks that could have a detrimental effect on product provision?
If the insurance company had to cover, for example, death due to pre-existing illness, then the definition of insurance event would lose its fundamentals – randomness and unpredictability as defined by Slovak Civil Code.
The introduction of proposed obligation would increase the costs of the insurance companies because they would have to deal with the modification of the product documentation (scope of coverage set in insurance conditions, contractual arrangements, definition of insured event, etc.), adjust the premium rates, change the process of risk evaluation as well as the claims management, and so on. This could be reflected in an increase in the price of the final product for clients.
This anti-discrimination proposal essentially introduces two cases of discrimination. As insurance companies will have more risky clients (the risk of which will not be able to assess due to lack of health information), it is likely that premiums will increase for all clients – healthy clients will be discriminated, they will pay higher premiums due to those who have survived the illness. Another fact is that the proposal should address people who have survived cancer. The question is why exclusively people who survived cancer should be protected. This would be discrimination against people who have survived other serious illnesses.
If the client has not provided information about the health condition, the consequences are regulated in the current legislation (claim refusal, withdrawal from the insurance contract, reduction of the insurance benefit). Therefore there could be risks of dissatisfaction and complaints from the client, reputational risk for the insurance company and possible litigation.