Best practice among providers offering mental health cover

This is great - but how do those who suffer from a mental health condition get the support and advice they need every day? What happens when they apply for policies, or when they need to put in a claim?

Has the insurance industry gone far enough in helping people cope with and overcome mental health conditions? 

Support

Generally, according to financial advisers operating in both the group and individual protection space, the support offered to policyholders who suffer from mental health issues has become far better over the past few years.

Robert Harvey, independent protection expert for Drewberry, notes a "large number" of providers now offer access to helplines in one form or another, as one of their additional benefits."

For example, in March this year, Aviva launched a mental health service to help employees of its large corporate clients get quick, specialised support when experiencing a mental health condition.

There is generally a lack of appetite in the market to take on risk in this area for people who have suffered previous mental health issues. Robert Harvey

Available through the corporate health insurance product, Optimum, employees can get an assessment within 48 hours, and integrated end-to-end clinical treatment with a dedicated case manager.

They can self-refer at any time by calling Aviva's claims helpline, and will received an individually tailored treatment plan, with access to a wide range of specialists.

Then in April, Health Shield updated its Tailored Health Cash Plan by launching a mental health app, called Thrive, to help individuals identify, prevent and self-manage common mental health conditions.

According to Brett Hill, managing director for The Health Insurance Group: "As awareness of mental health issues has grown, many of the major insurers have increased the level of support available to customers."

For example, Axa PPP Healthcare offers a Stronger Minds service. Nicola Mohns describes this: "All that members who are experiencing stress, anxiety or other mental health concerns have to do is call our customer service team.

"They will check if the member is covered and, if they are, will pass them to a qualified counsellor or psychologies in our Stronger Minds team." After an initial assessment, the individual will be directed to suitable evidence-based treatment, which could be: 

• Counselling - face to face, by email or over the phone.
• Treatment with a psychologist.
• Referral to a specialist.
• Self-help.

So there is plenty of provision - but does this sort of additional support work? According to data from the Association of British Insurers (ABI) and Group Risk Development (Grid), 7,900 people were supported during 2017 by the insurance industry through referrals to help and support, funded by group risk insurers. 

The figures do not break down the support given by condition, but the message is that there is support available for those who need it.

Coverage of conditions

Many providers offer cover for mental health but some are more comprehensive than others, and it often depends on the type of plans - whether it is a medial insurance (PMI) plan or a group income protection plan.

For example, Axa PPP Healthcare offers cover for treatment of mental ill health on the medical insurance plan for individuals, as well as for members of large corporate company-paid schemes (more than 200 employees) and for small to medium sized corporate schemes (less than 200 staff).

However, as Mr Harvey states, even with the advances in support services for people with mental health conditions, the industry still has not gone far enough to provide adequate and comparable cover, especially when it comes to covering people who have already experienced a mental health condition.

He explains: "There is generally a lack of appetite in the market to take on risk in this area for people who have suffered previous mental health issues. 

As an industry, to help customers fully understand the access to insurance, we should give as much profile to underwriting acceptance rates as we do claims paid statistics. Scott Cadger

"Exclusions can be very extensive and it often takes some debate with providers for them to agree a review period for the exclusion."

That said, it is becoming more prevalent at point of protection take-up for people to disclose mental health conditions to their insurers, so the situation outlined by Mr Harvey may also soon become a thing of the past. 

Scott Cadger, head of underwriting and claims strategy at Scottish Widows, says this is a historic issue, however. "Traditionally, customers haven't known if they'll be covered for life or critical illness insurance until they have applied to a specific provider, and the full underwriting process has been completed. 

"Thankfully, things are changing."

He points to the UnderwriteMe quote comparison service, which allows financial advisers and insurance intermediaries to obtain a fully underwritten quote from multiple providers at the same time, enabling them to choose a provider before applying for insurance."

This represents a great technological advance that works not only to the adviser's advantage but also to the end client's.

But more still needs to be done to improve the way in which questions are asked. Phil Jeynes is head of sales and marketing for UnderwriteMe, and he comments: "Like any underwriting topic, mental health is constantly being reviewed by insurers to make sure they’re pricing fairly and accurately.

"Currently, our underwriting questions tend to be a little blunt on this topic, with questions asking customers if they’ve “suffered from stress” in the last few years.

"Perhaps in the past, customers instinctively recognised that this type of question was aimed at those who have found stress a debilitating factor, whereas now we recognise that everyone deals with stress in their lives to some degree and that those types of question are out-dated."

So providers and comparison sites are working on improving the sort of questions asked and technology is being improved to make sure premiums are fair, accurate and competitive.

But despite the importance of being able to use comparison sites, Alan Knowles, managing director of Cura Financial Services, comments: "There is no single 'best' insurer when it comes to offering cover for people with a history of mental illness.

"Speaking to somebody who has suffered with a mental health issue should be done with care and understanding, and just selecting the cheapest provider from a comparison site may not always be the most suitable choice."

Mr Cadger also states: "Mental health conditions represent the most frequent medical disclosure in financial protection applications at Scottish Widows, more so than back disorders, hypertension and asthma, and we consider these carefully and sensitively, in the same way we would for any physical health conditions."

Paying out

Figures from Grid and the ABI also revealed 11 per cent of claims paid out in 2017 for individual income protection were for mental illness.

This compares with 10 per cent for cancer and 30 per cent for musculo-skeletal. According to Ambika Fraser, head of proposition at Unum UK, "most providers pay out on claims for clinically diagnosable mental health conditions, when it prevents an employee from being able to do their job."

Yet when it comes to paying out, as well as for coverage, it is perhaps significant that Mr Harvey believes there is no one particular stand-out insurer working in this field.

He says: "There's no-one better at dealing with mental health than another. It all depends on the specific circumstances as to which insurer would be more favourable."

This is why Ms Fraser makes a distinction between providers who simply pay out - and those "quality insurers" who actually help companies "prevent mental health absences in the first place - and this is where employers can find the most tangible difference in providers", she notes. 

And again, this is starting to change. Mr Cadger comments: "There is a commonly held misconception that someone living with a mental health condition will not be offered insurance, or at worst, the provider will not pay out a claim."

However, he claims 95 per cent of consumers who declare they have a mental health condition will be offered life cover, "giving them reassurance they can still receive cover that will pay out at claim stage."

Education

But more needs to be done to get the message across to the public and to their financial advisers.

Mr Cadger adds: "As an industry, to help customers fully understand the access to insurance, we should give as much profile to underwriting acceptance rates as we do claims paid statistics.

Most providers pay out on claims for clinically diagnosable mental health conditions, when it prevents an employee from being able to do their job. Ambika Fraser

"We should also share case studies of people with health issues actually being able to get cover."

Mr Knowles says this is why financial advisers can really add value to the client relationship: "A specialist adviser will know when a direct online journey will be most beneficial to a client, with, say, more common disclosures such as stress, anxiety and depression.

"They will also know when to approach the more empathetic underwriters who can look at cases on an individual basis. It is rare there are no options available, and the key is showing empathy and understanding to the customer."

simoney.kyriakou@ft.com