Survival of the fittest

Women are notorious for keeping a better check on their health than men. Regular screenings such as smears help to raise awareness of serious illness and encourage women to consider the implications should their health take a turn for the worst. But just because men tend to take a more 'head in the sand' approach to health risks, it does not mean they are any less at risk of contracting a life-threatening condition.

When advising male clients on critical illness (CI) insurance, it may help to know the true value this type of cover can provide. Hammering home a few facts about the risks men have of being diagnosed with certain conditions, may encourage more men to get the cover they need.

According to Doros Nicolaou, protection specialist IFA at Millfield Partnership, the number of male CI policyholders is not dwindling ' but the reasons for taking cover out are usually out of circumstance, rather then awareness of the value CI can provide.

'If a man is married and has children, it is usually him and not his wife who will have critical illness cover in place. However, a large proportion of my clients are women. They tend to have a higher awareness of critical illnesses than men, perhaps because they are more likely to have regular health check-ups,' he says.

Indeed, when you look at the protection market as a whole it is not unusual to see the number of male policyholders outnumbering women, especially in the intermediary market.

According to Nick Kirwan, chairman of the Association of British Insurers' (ABI) Critical Illness Working Party and head of product development at Scottish Provident, around 60% of CI policies sold through intermediaries are sold to men.

'Interestingly, sales of critical illness through different distribution channels do not replicate the same gender mix as is seen with intermediary sales. This tells us there are more male critical illness buyers in the IFA market and that perhaps advisers are better at selling policies to men than women,' says Kirwan.

Take-up of CI cover has increased rapidly with the booming mortgage market and it is fair to say many CI policies are sold at the same sitting in which the mortgage deal is signed. With rates over the past few years looking affordable, many borrowers sign up for CI on the simple premise that it gives peace of mind, without breaking the bank.

New priorities

However, times are changing. With some insurers increasing their guaranteed rates on CI by up to 50%, this type of cover may no longer be able to be successfully sold on price. Although reviewable rates are still looking competitive, clients historically prefer guarantees, which deliver the no-hassle approach to cover ' you can take the policy out and be sure the premium being taken out your bank account each month will stay the same.

All this boils down to is the fact advisers may need to strengthen their argument to clients to encourage them to take out CI cover if they are to achieve the same level of sales. And there is no stronger argument than when you take a look at the health risks every client could face.

According to Scottish Provident's latest claims figures, cancer is the most common CI payout for men, accounting for 42% of all male claims. Of these claims, testicular cancer is the most frequently claimed for condition, with the average age at claim of just 39. These figures make sense when you look at national figures for the occurrence of testicular cancer.

According to the Institute of Cancer Research, testicular cancer is the most common form of cancer in young men, diagnosed mostly between the ages of 20 and 35, but in some cases as young as 15. Incidence has been documented as rising by 70% over the last 20 years, with around 1,600 new cases a year in the UK.

The fact that testicular cancer is most likely to occur in men under the average claims age reported by Scottish Provident, shows the men most at risk of being diagnosed with this condition do not have cover in place. This represents a massive gap in sales that intermediaries and providers need to target.

It is understandable that CI cover seems more attractive as you get older, as it is then that you do become more aware of your deteriorating health. Indeed, many clients may believe it is not worth taking out CI cover when they are younger as the risk of being diagnosed with a serious illness is minimal. This mindset needs to be addressed. The very condition that sees the most claims is an illness that is most common among men under 36 ' three years younger than Scottish Provident's average claimant age for testicular cancer. Imagine how this figure would increase if more men took out CI cover at a younger age.

Kirwan agrees there are very few men in the 20 to 35-year age group who have CI cover in place. 'Younger men do tend to think they are immortal, but in fairness they also have less dependents so are less likely to think about protection. The average profile of an IFA's client base is also skewed to older men, as many critical illness polices are sold to clients who they have built a relationship up with over the years. There is no doubt if more young men got cover, claims for testicular cancer would increase even further,' he says.

It is worth noting that the risk of testicular cancer ' like many other forms of cancer ' has a strong genetic component. According to the Institute of Cancer Research, fathers or sons of testicular cancer patients have up to a 10-fold increased risk of developing the disease. Although underwriters may load premiums to acknowledge this risk, the chance of claiming is also increased, maintaining the policy's value. A high percentage of testicular cancers are also cured if treated at an early stage and there is a good cure rate for people with even the most serious cases.

To illustrate just how many cases of testicular cancer insurers deal with, Scottish Provident's latest data shows that it alone has paid out £5m to claimants with this condition since the launch of its CI benefit.

Changes to cover

Another male-specific cancer, and one which has been hitting the headlines with regards to CI cover, is prostate cancer. Due to the Government's nationwide screening initiative ' the Prostate Cancer Management Programme ' and new medical techniques that can detect the disease at an earlier stage, the ABI has changed the market's standard definition for CI cover to only include more aggressive and advanced forms of the disease.

The reasoning behind this move is that, if caught early, the condition is neither life-changing nor threatening and should not therefore be classed as a critical illness. Seeing as the medical world is expecting an increasing number of cases to be picked up at an early stage, insurers feel it is fair that only the more serious cases are covered or there could be a serious claims explosion, increasing the cost of cover for all men.

Insurers have until May this year to adapt their CI cover to the ABI's new definition, which excludes the less aggressive forms of the disease. Not all insurers have yet made that change and some may not decide to reduce cover until the latest possible time.

In the meantime, it is worth looking at the small print of definitions to check out whether less serious forms of the disease are covered. This means looking beyond the premiums. If your client does opt for a plan, which has adopted the reduced definition, it is vital the level of cover is explained thoroughly to avoid confusion should they be diagnosed with an early-stage prostate cancer and try to claim.

Despite positive advances to detect prostate cancer early and reduce the number of deaths it causes, the condition remains a very real threat to men. According to Kirwan, prostate cancer affects around 22,000 men each year in the UK and accounts for around 10,000 deaths. It is also on the increase and it is predicted it will become the most common form of cancer in men by 2006.

According to the latest statistics from Cancer Research UK, prostate cancer accounted for 12% of all cancer-related deaths in men in the UK in 2001 and was the second most common cancer diagnosed among men in 1998. So although cover for prostate cancer will be reduced, CI policies will still offer vital peace of mind, with benefits kicking in when the disease becomes a serious threat and the benefit paid out will be at its most valuable.

According to Cancer Research UK, lung cancer is now the most common cancer diagnosed among men. Although male lung cancer rates have been falling since the 1970s as more men give up smoking ' just three in 10 men in the UK now smoke, compared with eight in 10 at the end of the Second World War ' it is still a real threat. Health messages are still ignored by many men, meaning that smoking, the number one cause of lung cancer, is still managing to wreak havoc on the lives of more men than women.

Cancer Research UK's figures show lung cancer accounted for 25% of all cancer-related male deaths in 2001 ' a total of 20,350 men. Although the figure is still high, lung cancer claimed the lives of a comparably low 13,038 women during the same period.

Smokers will always be loaded more heavily than non-smokers, but with the added risk this dangerous habit brings, CI policies can prove to be a valuable investment.

One cancer that is less documented and which many men may be unaware of is penile cancer. Cancer Research UK says that 400 new cases of this cancer are diagnosed in the UK each year, but many men do not even know it exists. Firm causes of the disease are as yet unknown, but researchers believe it could be linked to poor hygiene and some types of human papilloma virus, which can contribute to the development of cervical cancer in women. If left untreated, penile cancer can be fatal and it currently kills around 100 men in the UK each year. However, according to Cancer Research UK, if caught early there is a 70% survival rate. With penile cancer, ignorance can, again, be the biggest killer in men. Too many men are unaware the condition exists or what its symptoms are, or are too embarrassed to go to the doctor and find out.

According to Scottish Provident's claims history, four times as many men as women claim for bowel or liver cancer, with an average age at claim of 45. Claims history shows it has paid out nearly £4m to policyholders with these conditions, with men making up an 83% of claimants. Cancer Research UK's figures show that in 1998, over 1,400 men in the UK were diagnosed with liver cancer and over 18,500 men were diagnosed with cancer of the large bowel. As these figures show, both bowel and liver cancer present a real threat.

Affairs of the heart

Away from cancer, the second largest claims area for male CI policyholders is heart attack. A total of 22% of male claimants with Scottish Provident's CI cover have suffered from a heart attack, a massive share when compared to just 2% of women. There have been positive developments to CI cover for heart attack sufferers. Along with the change in cancer definition, the ABI has also given a May 2003 deadline for all insurers to make changes to the heart attack definition, in a bid to make claiming easier and fairer.

Increasingly, hospitals are using troponin tests to detect whether someone has suffered a heart attack when they are brought into A&E. Troponin is a biochemical marker, which is released into the bloodstream when heart muscle dies. A simple blood test is required to test for troponin, which acts as valuable evidence that a heart attack may have taken place. The original heart attack definition does not mention troponin tests, meaning some people who had been tested for troponin levels in hospital could not use this as evidence to back up their heart attack claim. The new definition, which will shortly be in force for all new policies, will include troponin tests as part of the required evidence for heart attack claims.

According to the British Heart Foundation, someone suffers a heart attack every two minutes and coronary heart disease (CHD) causes approximately one in four premature deaths in UK men. Cardiovascular disease, which includes CHD and stroke, is the main cause of death in the UK. To put these figures into context, Scottish Provident has paid out over £20m in heart attack claims ' 94% of which went to men ' and nearly £9m in stroke claims, of which 74% went to men. Coronary artery bypass surgery is also a large male claims area, with 96% of the £6.5m claims paid out by Scottish Provident going to men.

Cancer and heart disease continue to be the main claims areas for men, but there are many other critical illnesses that male clients should be aware of. Total permanent disability, benign brain tumour, angioplasty, motor neurone disease, bacterial meningitis and kidney failure are just some of the conditions that CI claims history suggests are more frequently suffered by men.

Getting men to be more proactive about keeping a check on their health and recognising serious illness at an early stage is a battle in itself and an issue which is explored further in the article featured on the following pages. However, even if some conditions are picked up on, it is no guarantee they will not spiral into a critical illness, which will not just have a devastating effect on the client's health, but also on their wealth and the financial security of their family.

Despite some recent negative press surrounding the price hikes on CI cover and the changes we are seeing to product definitions, it is every protection adviser's duty to inform clients of the risk they face of suffering a critical illness and the effect this could have on their finances. It may be difficult to predict the future health of male clients, but with the right protection in place, you can help predict their future financial wellbeing.