“It’s not just travel insurance, it’s people’s lives, it’s people’s incomes. They are being refused that just because they have a mental illness … I don’t think that it’s fair.” -- (Ella Ingram)
In 2015, the Victorian Civil and Administrative Tribunal found that QBE insurance discriminated against Ella Ingram, twice. Firstly, when it issued her with travel insurance that excluded any coverage for mental health conditions and secondly when the insurer rejected her travel insurance claim when she was hospitalized with depression at the age of 17 and couldn’t go on a school trip to New York for which she had already paid.
In 2017, predominantly as a result of Ella’s case, a number of insurers reviewed their travel insurance policies removing blanket exclusions for mental health conditions. However, most travel policies or sales processes still contain some form of additional requirement for mental health, for example, a requirement to disclose pre-existing mental health conditions, or providing a copy of the insured’s mental health treatment plan.
Discrimination is not restricted to travel insurance. Personal insurances such as motor, home, income protection and Life insurance have challenges in adequately responding to the needs and expectations of people who have or are experiencing mental illness.
Consumer groups – the reality check
Consumer Advocacy groups have advised me of the following issues based on their observations from their casework:
Insurers include blanket mental health exclusions in their policies and rely on those exclusions to refuse to pay a claim in circumstances where the applicant for insurance had no history of a past or current mental health condition when applying for insurance but developed a mental health condition after purchasing the policy.
An applicant for insurance discloses a past or current mental health condition when applying for insurance and the insurer:
refuses to offer insurance;
offers insurance with a broad mental health exclusion, in circumstances where a more limited mental health exclusion would have been reasonable;
offers insurance without a mental health exclusion but with an unreasonably high premium loading; or
offers insurance with both a broad mental health exclusion and an unreasonably high premium loading.
For life insurance, an applicant discloses symptoms of a mental health condition in their application but has never been diagnosed with a mental health condition and the insurer:
imputes a mental health condition that is not supported by the information provided in the application or by medical practitioners; and
refuses to offer insurance, offers insurance with a broad mental health exclusion, offers insurance with a premium loading or offers insurance with both a broad mental health exclusion and a premium loading.
How have we reached such a position of consumer detriment when the consumer is at the heart of all insurers strategies?
The law has driven behaviors
In 1992, the Commonwealth Disability Discrimination Act 1992 (DDA) was enacted to eliminate discrimination against persons on the ground of disability in a number of areas including the provision of insurance. However, there is an insurance exemption which basically states that its ok to discriminate if you have actuarial or statistical data to support the discrimination.
For the past 25 years, or so, the insurance industry has been focused on the problem of capturing, validating, maintaining and analyzing data to enable reliance upon the exemption in the DDA.
Of recent time, insurers have shifted their focus to achieving fairer consumer outcomes via the industry Life and General Insurance Codes of Practice as the vehicle for change, however, such change has been frustratingly slow.
It’s time for a human approach to a human issue
How would insurers respond, if the insurance exemption under the DDA was removed? What if the law prohibited insurers discriminating against people with a disability – full stop, no exemptions, no carve-outs? What would a mental health human-centered design model look like?
The World Health Organization defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
A human-centered approach would, therefore, start with the needs of people who have experienced mental illness and ends with new solutions focused on their wellbeing.
A mobile app
Pega, describe the essential components of a customer support application as follows "(customers) expect interactions to be fast, easy and right the first time, and to be available 24/7 on any channel or any device. Even more importantly, customers expect your team to understand their history, their context and their needs – without having to retell their story every time they reach out to you." -- (my emphasis)
Imagine a future state for a person who experiences sporadic anxiety.
"Amy" - a case study
Amy has signed up to ‘MyWellbeing2.0’ a mobile app provided by ‘WeCareInsurance’ recommended to her by her general practitioner. The app has been professionally evaluated and is also endorsed by organizations such as Black Dog Institute and Beyondblue. At Amy’s fingertips, she has easy access to her medical records, treatment plan, a wellness toolbox containing mindfulness and relaxation applications, wearable technology and 24/7 access to trained listeners and licensed therapists and professionals.
The app contains a wealth of data about Amy’s daily behaviors and wellbeing presented as a dashboard. Amy uses the dashboard as a normal part of her daily life through her insurer provided wearable device. The app also includes a number of products and services, including insurance, tailored to Amy’s needs and expectations designed using data from user’s behaviors.
19-year-old Amy decides to take an overseas holiday to New York. Upon landing, she is contacted on her wearable device by her assigned wellbeing coach who had advance notice of her travel plans asking ‘are you ok?’. Likewise, her on-demand travel insurance product (without a pre-existing medical condition question or policy exclusion) was automatically triggered. Whilst overseas she has a mild anxiety attack and contacts the 24/7 helpline, where a licensed professional provides support & care, and she is able to continue with her holiday.
Amy’s wellbeing chatbot coach checks in on her on a daily basis or more frequently depending upon behavioral indicators monitoring her social media feeds and the language she is using to her friends and family back home. If Amy needed to fly home urgently due to her anxiety, emergency assistance was a simple click away. Amy doesn’t receive claim forms or questions from her insurer (requiring her to relive her anxiety episode or causing her further anxiety). The insurer is well informed through the real-time data it is receiving based upon Amy’s prior consent where certain personal and sensitive data are only available to the insurer upon certain events happening.
‘WeCare insurance’ is an authorized general insurer and has entered into strategic partnerships with a life insurer, a superannuation provider, a workers compensation insurer, and a health insurer offering white-labeled insurance on-demand in a modular format. Rich information (think telematics and the Internet of Things) from all sources feeding into the mobile app is subject to detailed analysis by multiple professional streams to continually improve the wellbeing services and insurance products being offered based upon behavioral indicators.
An ecosystem that builds trust
‘MyWellbeing2.0’, ‘Amy’ and ‘WeCare insurance’ are fictitious, however, the technology referred to is currently being applied to mental health, which I will detail later.
The stumbling block to ‘MyWellbeing2.0’ becoming reality is the lack of trust existing in the current insurance ecosystem. Asking consumers questions about pre-existing mental conditions and placing restrictions on coverage does not build trust. Insurers would argue that the current loss ratio and claims frequency and cost increase for income protection insurance are due to a lack of incentive to return to work and includes a fraud component. They rightfully argue trust is a two-way street.
I propose that an ecosystem that primarily cares about the health and well-being of a person and places insurance as a secondary consideration, over time, will build trust. Analytics can be used to detect fraud with behavioral nudges removing the motivation for deception. In situations where a person is off-work due to a mental illness, the environment created is based on concern for their wellbeing not from a suspicion of fabrication.
Current technology supporting mental health
Dr. Simon D’Alfonso and Associate Professor Mario Alvarez from the University of Melbourne identified 4 ways in which technology can help mental health:
- learning about psychological states from phone use – ‘digital phenotyping’ is a new term which means constructing a person’s real-time psychological state and overall profile based on their interactions with their smartphone. Already mental health professionals are flagging that this approach could offer “largely untapped potential for the early detection of various conditions.”
- Analysing the language of mental health - using social media feeds and AI we can learn how someone is feeling which will assist to identify the onset or presence of mental health conditions.
- Chatbots for mental health.
- Online social therapy.
The US National Institute of Mental Health NIMH have identified the following current trends in App development:
- Self-management apps
- Apps for improving thinking skills
- Skill-training apps
- Illness management supported care
- Passive symptom tracking
- Data collection
- Research via smartphone
Imagine an App that combines many of the above elements and designed to complement general and life insurance coverage without any mental illness restrictions.
The technology uses in a mental health context
There are currently numerous digital applications being used independently of insurance or in connection with health insurance.
Australian start-up Uprise provides a preventative mental health solution for businesses that improve employee engagement, retention and performance by enhancing psychological well-being. It is designed for employers and is a digital program that teaches emotional health skills with access to a specialist coach if needed.
American firm Quartet provides a library of behavioral healthcare solutions that facilitate collaboration between patients and providers with an aim toward stopping major health crises before they start. It is driven by a robust data engine and strong relationships with various health plans and systems.
Psious is a Spanish and American behavioral health technology company whose main product is the Psious Toolsuite, a virtual reality platform aimed at bringing value to mental health treatment. The platform provides mental health professionals with animated and live environments they can use in their clinical practice. The various scenarios provided within the platform comprise over 50 resources (Virtual reality and augmented reality environments, 360º videos, etc.) employed for the treatment of anxiety disorders, fears, and phobias, as well as for the practice of Mindfulness and relaxation techniques.
7cups founded by psychologist Glen Moriarty in July 2013 provides free support to people experiencing emotional distress by connecting them with trained listeners. The listener, trained in active listening, interacts with the person seeking help via an anonymous and confidential chat.
Talkspace, a New York based HealthTech and online therapy company, offers a systematic approach customized to user needs and has over 300 licensed therapists in its network. New users can take a free assessment and work with Talkspace to get matched to the right provider, starting a long-term mental health journey on the right foot.
US based Provata health is a digital health company revolutionizing workplace wellness through the delivery of clinically proven health promotion programs including virtual reality preventative care to employers, health plans, and hospital systems.
IBM is awaiting regulatory clearance to take blockchain deployment to a consortium of general insurance companies in India, after a pilot designed to facilitate easy transfer of medical records between insurance companies.
Mental illness has proven to be a challenge for the general and life insurance industry who have historically approached the issue from a regulatory compliance perspective. Looking at mental health through a social purpose lens and designing an Insurtech ecosystem founded on trust will not only facilitate wellbeing but will also drive efficiency and effectiveness for insurers and enable profit targets and shareholder returns to be achieved.
“I would like for insurance companies to treat mental illness the same as any other physical illness and for them to not just base their reasons on stereotyping. We’re in the 21st century and it’s great that people like myself are speaking out about mental illnesses and it’s time that they (insurers) get up with the program.” -- (21-year-old Ella Ingram)