COVID-19 poses challenges and opportunities for multiple industries all over the word. Timeous innovation allows companies and industries to ensure their products stay relevant when needs change unexpectedly.
I spoke to Gareth Friedlander, deputy CEO of Discovery Life and Dr Maritha van der Walt, Discovery Life’s chief medical officer, about their new Multi Organ Benefit, which is aimed at responding to the specific challenges COVID-19 poses to its clients.
Interestingly, Gareth said that Discovery modelling shows Gold and Diamond Vitality clients are far less likely to be hospitalised as they are generally healthier clients. However, while our Industry is trying to decipher what is happening and is mapping potential effects of the pandemic with each industry player reacting differently.
“From Discovery Life’s side we added no exclusion for COVID-19 for old or new business. Anyone that meets conditions as in the past will still have a claim paid. We then also asked ourselves whether there aren’t any further opportunities to provide benefits that will ensure our products deal effectively with any potential client needs,” says Gareth.
Does the Covid epidemic present an opportunity to expand our comprehensive severe illness Benefit even further?
Gareth explained that COVID-19 was originally thought of as a respiratory disease but it has become clear that it is more than that. It has become increasingly apparent that organ damage acroos multiple body systems is happening. When looking at the definitions in life products, we saw that the general market approach is very siloed. Benefits are listed under different silos like liver, kidney, heart and so on. With COVID-19, a client’s claim might not fit under one silo, as the impact of the disease is more severe due to it affecting multiple organs. He emphasised that multi-organ failure due to COVID-19 is far more life threatening than when just one organ is involved.
This led Discovery to develop the Multi-Organ Benefit, which has been embedded in all their severe illness benefits with criteria specifically designed for the impact of COVID-19, looking at the overall impact across body systems and the combined effect this has on an individual’s state of health, filling that gap created by the traditional siloed approach.
Dr van der Walt explained that the Multi-Organ Benefit is a Severe Illness Benefit enhancement, recognising that COVID-19 is not only a respiratory Illness, but is further complicated by cardiac, renal and liver injury as well as abnormal clotting. Usually, severe illness products focuses on one organ at a time, needing a certain level of impact on the body before a claim is triggered. This is what exposed the need for them to develop the multi-organ benefit, looking at the broader impact of COVID-19 on each patient. She said that the Multi-Organ benefit applies a method to calculate a composite figure, aggregating the impact on each organ. This composite figure is then used to determine payment of a claim. This scoring system is used for all patients in high care so the information is readily available for claims assessment.
“From a medical point of view many things about this virus are new. This enhanced benefit is for severely ill clients, where the condition is life threatening. Traditional cover states that the impact must be chronic or irreversible or permanent. The new benefit takes the sum total of the different organ system impairments during the acute phase of the illness into account,” says Dr van der Walt.
Current definitions in the market named ‘catch all benefits’ do not assist in getting claims paid for the severely ill. The corner stone of the catch all definitions is a permanent impairment or maximal medical improvement. A whole person impairment (WPI) calculation (according to the American Medical Association’s guide to the assessment of medical impairments) or an assessment of activities of daily living ( ADL) score have to be done. Both methods require assessments by third parties – either an occupational therapist for ADLS or a person trained in assessing the whole person impairment ( WPI) These benefits would therefore not assist in a very acute or life threatening situation.
“The current definition based on ICU admission and time on a ventilator is still in our ICU benefit, but ventilation is not always recommended for COVID patients, even at low oxygen levels. Non-invasive oxygen supplementation might have a better outcome in COVID patients. Furthermore, ventilators might not be available for all patients who would normally need them, so a new definition that does not take ventilation into account and is more specific for COVID patients would make sure that severely ill patients get compensated. This would not be the case with traditional severe illness products,” she adds.
Dr Van Der Walt concluded by saying that the scenarios with COVID-19 are so diverse between patients, being impacted by personal health, access to care and especially ventilators, that it became essential to reexamine how they cover severe illness.
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