Multiple sclerosis masterclass

1. Multiple sclerosis masterclass

2. Topics • About Multiple Sclerosis • Underwriting considerations • Comparing the market

3. About Multiple sclerosis

4. What is Multiple sclerosis? Multiple sclerosis (MS) is a condition where the protective coating around nerve fibres is damaged. This coating is called myelin. Myelin damage is caused by the immune system mistaking it for a foreign body and attacking it. This damages the myelin, stripping it from the nerve fibres, either partially or completely. This leaves scars known as lesions or plaques. As well as myelin loss, there can also sometimes be damage to the actual nerve fibres. It is this nerve damage that causes the increase in disability that can occur over time.

5. How common is MS? More than 100,000people in the UK have MS. Symptoms usually start in the 20s and 30s. Multiple Sclerosis (MS) is one of the most common neurological condition among young adults in the UK It affects almost three times as many women as men. Each week 100people are diagnosed with MS. Danny Wallace Footballer Aged 32 Jack Osbourne TV personality Aged 26 Richard Prior Actor/comedian Aged 46 Source: MS society, June 2014

6. What causes MS? No one knows the exact cause of MS, but it is thought that a mixture of genetic and environmental factors play a role. MS is not directly inherited - there is no single gene that causes it. It's likely that a combination of genes make some people more susceptible to developing MS. MS risk by region • MS is more common in areas further away from the equator. It is virtually unheard of in places like Malaysia or Ecuador. • There is also a growing amount of research suggesting that a lack of vitamin D could be a factor in causing MS. We get most of our vitamin D from exposure to sunlight. • A number of studies have looked at smoking in relation to MS, and have found that smoking appears to increase someone’s risk of developing MS. Source: MS society, June 2014

7. Signs and Symptoms of MS • MS can cause a wide range of symptoms and there is no definitive list of early signs. • Some of the most common symptoms include: • extreme tiredness (fatigue), • numbness and tingling, • blurring of vision, • problems with mobility and balance, • muscle weakness and tightness. • People can have different symptoms at different times and, although some are very common, there is no typical pattern that applies to everyone. Cycle of Symptoms

8. Types of MS Relapse remitting MS:Around 85% of people with MS are diagnosed with this form of MS. • People with this form of MS have flare-ups of symptoms, known as relapses. These can last from a few days to a few months. • These are followed by periods where symptoms are mild or disappear altogether. This is known as remission and can last for days, weeks or sometimes months. Secondary progressive MS:There is a steady worsening of your symptoms (with or without relapses) in this form of MS. Around 65% of people with relapsing remitting MS will go on to develop secondary progressive MS. Primary progressive MS:The least common form of MS is primary progressive MS, with 10-15% of cases in this category. In this type, symptoms gradually get worse over time and there are no periods of remission. This is key to understanding the relevance of definitions Source: MS UK & Patient, June 2014

9. Underwriting considerations

10. Underwriting considerations What is the risk? • Life Cover • SIC • IPC What does the underwriter need to know? • The type of MS (Primary progressive, progressive relapsing etc) • Date of diagnosis • Details of any neurological episodes prior to diagnosis • Symptoms and course of diagnosis • Treatment • Current neurological status, degree of disability where present

11. Underwriting requirements Underwriting requirements • GPR with details of symptoms, remissions and relapses. Family history • 4% of people with a first-degree relative with MS will develop the condition. 20% of MS patients have an affected relative. • 1 x family member- twin- LC+55%, SIC/WOP/IPC- MS Ex • Otherwise-LC-Std rates, SIC/WOP/IPC - client <40 – MS Ex, >40 +50 • 2 x family members- LC as above • MS Ex always to be applied on SIC/WOP/IPC Symptoms • Physical symptoms of MS might commonly include vision problems, balance problems and dizziness, fatigue, bladder and stiffness and or spasms

12. Underwriting outcomes Possible underwriting outcomes • Life Cover:Symptoms suggestive of MS- no firm diagnosis, nil residual abnormality • Last episode within 1 year +100% • >4 years agoStd rates Definite diagnosis of primary progressive, secondary progressive or progressing relapsing MS • Usually decline Relapsing remitting MS with no current CNS symptoms • Diagnosis < 1 yearPostpone • Diagnosis > 1 year ago and most recent episode of symptoms < 1 year ago +250% • 1-2 Yrs ago +200% • > 5 years ago +75% (can consider Std if no relapses since diagnosis). • The policy term may be restricted • SIC and IPV declined where definite diagnosis made

13. PruProtect – unrivalled cover for multiple sclerosis Comparing the market

14. Multiple sclerosis – with persisting symptoms ABI definition A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist. There must be current clinical impairment of motor or sensory function which must have persisted for a continuous period of at least 6 months. 85% of people positively diagnosed with MS have a relapse and remitting type. So the requirement for symptoms to have persisted for a continuous period creates an issue for most people with MS. . !

15. PruProtect definition Multiple sclerosis – resulting in current symptoms • A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist. There must be current clinical impairment of motor or sensory function. • This definition covers those who have current symptoms at the time of diagnosis. • Severity D – 25% to a maximum of £750,000Boosted to 100% if SIC Booster is included.

16. PruProtect – a unique definition Multiple sclerosis • A definite diagnosis of Multiple Sclerosis by a Consultant Neurologist with evidence of previous or current symptoms (even if these are not permanent). • This definition covers those whose symptoms are not present at time of diagnosis. • Severity F – 10% to a maximum of £300,000

17. How the market compares We are unique in not requiring current symptoms Majority of insurers still require symptoms to have persisted for a specified period before their definition is met. Source: Based on PruProtect Analysis, June 2014

18. We pay on diagnosis of all major neurological diseases Unique cover We pay all claims for major neurological conditions on diagnosis. • Alzheimer’s disease • Benign Brain Tumour • Coma • Creutzfeldt-Jakob disease • Dementia • Encephalitis • Motor Neurone disease • Multiple Sclerosis • Parkinson’s disease • Progressive Supra-nuclear Palsy • Traumatic Head Injury Severity F – 10% to a maximum of £300,000 This is in addition to our Severity D definition for these conditions, where we also require permanent neurological deficit and persisting clinical symptoms.

19. Unrivalled cover for MS and all major neurological diseases Matching customer expectations • No requirement for symptoms to have persisted for a specified period. This means we are more likely to payout that a plan using the industry standard definition. • Also our unique definition for Multiple Sclerosis at severity F means we pay out for all people diagnosed with Multiple Sclerosis, even if their symptoms are not current. • The change to Multiple Sclerosis resulting in current symptoms definition was applied retrospectively at no extra cost for those with Comprehensive cover. • Multiple Sclerosis resulting in current symptoms definition is boosted to 100% with SIC booster. • Cover for all major neurological diseases on diagnosis.

20. Thank you