LIFE INSURANCE COMPANIES TAKE LEAP OF FAITH

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2 LIFE INSURANCE COMPANIES TAKE LEAP OF FAITH

3 Cover for HIV positive and diabetic lives QED Actuaries & Consultants Craig Falconer 1 December 2017

4 OVERVIEW HIV Product Diabetes Product Key success Factors Application in Caribbean?

5 LIFE INSURANCE FOR HIV + PEOPLE LAUNCHED IN SOUTH AFRICA, 2005 Johannesburg - South African insurance product designer and administrator, AllLife, Wednesday launched the first ever affordable broad based life insurance offering for people living with HIV in this country. In a first time for South Africa, people living with HIV can now easily access life insurance cover for up to 1 million rand (about 70,000 US dollars). AllLife Managing Director Ross Beerman said in a country which constitutionalizes equality, HIV+ individuals have been routinely discriminated against by the insurance industry. Insurance policy applications by people living with HIV or those found to be HIV+ on application are consistently declined.

6 HIV PRODUCT What is HIV/AIDS? AIDS/HIV in South Africa AIDS/HIV in the Caribbean Description of the Product The Adherence Program

7 What is HIV/AIDS? HIV is a an auto-immune disease that attacks the immune system Reduces body s ability to protect itself from diseases People with HIV normally die from opportunistic infections such as TB, pneumonia, forms of cancer The CD4 count is used to test how advanced the HIV infection is Normal CD4 count is over 900 Once the CD4 count drops below 200 a person is considered to have full blown AIDS This therefore also coincides with evidence of various opportunistic infections

8 AIDS/HIV in South Africa South Africa has worst HIV epidemic in the world 18.9% prevalence among adults 7 million people are HIV positive (SA population is just under 50 million) 110,000 AIDS deaths in million AIDS orphans 55% of the population are on ARV s Largest ARV program globally 1.5 billion USD a year

9 AIDS/HIV in the Caribbean Second highest prevalence in the world after sub-saharan Africa 1% prevalence or around 250,000 people Has been declining Key reasons are mainly social vulnerability due to poverty, unemployment, sex tourism and stigma Females higher than male prevalence (only region outside Africa). Prevalence higher in men to men Mainly spread through heterosexual means Haiti highest at around 2%. Cuba lowest due to government interventions

10 Description of the Product Simple Whole Life Term, 5 and 10 year term and mortgage cover Disability Rider Direct Sales (website, internet, advertising) Fully reinsured GenRe No waiting period CD4 count above 200 to be eligible Affordable cover 2.5% to 8.5% annual premium (depending on age, smoking status, type of cover, etc) Claim not paid if Adherence program not followed

11 The Adherence Program Designed to extend the life and quality of life of the policyholder Policyholder must commit to it and stick to it Blood tests every 6 months (to monitor) May need to provide proof of purchase of ARV s Must commit to take the ARV s every 24, 12 or 8 hours depending on dosage (at exact same time each day) If CD4 or viral load deteriorates implies non-adherence of becoming resistant Triggers action i.e. change ARV program with their doctor If All Life is confident they are adherent and patient not responding to alternative ARV regime, will pay Will not pay if non-adherent (except accident claims) Policyholder can appeal. The appeal will be independently reviewed by the South African HIV Clinicians Society.

12 DIABETES PRODUCT What is Diabetes? Diabetes in South Africa Diabetes in the Caribbean Description of the Product The Adherence Program

13 What is Diabetes? Type 1 - the body does not produce any insulin Type 2 body produces too little or insulin doesn t work Insulin is needed to help the body process glucose for energy Too little insulin implies low energy levels and high glucose in the blood High glucose results in bacterial infections The body may burn fat for energy resulting in weight loss The kidney responds to try and flush out the glucose resulting in kidney complications Leads to heart disease, stroke, kidney failure, blindness, amputations Treatment includes exercise and diet to normalize glucose levels and insulin injections

14 Diabetes in South Africa 7% of SA adult population has diabetes Additional 4 million in early stages Incidence in Africa generally is around 7% but expected to double by 2030 Reasons are urbanization and obesity Diet changes to high fat, sugar and salt Lower exercise more sedentary lifestyle

15 Diabetes in the Caribbean Prevalence is 9.6% of adult population Haiti lowest at 7% Others at 14% Accounts for 14% of deaths Major public health challenge High incidence due to diet, sedentary lifestyle and obesity

16 Description of the Product Whole Life and Loan Protection Disability Rider Rates depend on type of diabetes And duration since diagnosed And normal rating factors (age, smoking status, gender) Only offered if HbA1c level is below 14%, cholesterol below 8.5 Standard exclusions such as pre-existing and suicide

17 Diabetes Control Program HbA1c blood test every 12 months If the level improves then premium reduces If the level deteriorates premium increases If test not received then premium increases Claim paid if demonstrate adherence

18 KEY SUCCESS FACTORS Market/need Technology Partners Product design

19 Technology Medical advances Technology supports the disease management and risk controls Facilitates quick acceptance and on-boarding Facilitates innovative risk assessment and ongoing underwriting Dynamic premium rating

20 Partners GenRe Smaller agile insurer Clinician Society and relevant medical bodies Blood clinics Funding partners

21 Product design Adherence program to manage risks Simple product Technology to make the processes efficient Risk managed using technology Direct sales distribution

22 APPLICATION IN CARIBBEAN? HIV also high but the prevalence no where near SA market so perhaps limited demand/need All Life success is also more in the middle to upper income (not lower mass market) Diabetes has more demand and need so is probably potential to offer this in some countries here Can visit All Life website and develop from scratch however technology will take time to implement Could consider partnership with All Life Regional collaboration to provide scale?

23 Thank You Any Questions? Craig Falconer QED Actuaries & Consultants (Pty) Ltd Tel: Heinrich Wessels QED Actuaries & Consultants (Pty) Ltd Tel: