Critical illness (CI) insurance was first introduced in 1983, by Crusader Life in South Africa. Initially designed to provide financial protection against four major conditions: Heart attack, stroke, cancer, and coronary artery bypass surgery, this pioneering product has since grown into a cornerstone of health protection insurance across many markets, particularly in Asia.
Understanding the inherent risks associated with CI insurance is essential to ensuring its long-term sustainability. Since 1993, Gen Re has conducted the CI Data Insights Study (known also as the Dread Disease Survey), delivering valuable actuarial perspectives on claims experience, underwriting practices, and product design. The study provides a robust analysis of the experience of insured lives and continues to serve as a trusted reference for insurers and actuaries navigating the complexities of CI product development. Today, it covers more than 400 million exposure years and two million claims.
In recent years, the study has expanded to include Mainland China, Hong Kong, Malaysia, Singapore, and Thailand, a diverse set of markets that differ in insurance maturity, consumer behavior, and regulatory frameworks. As shown in Chart 1, these regional perspectives offer rich lessons for refining CI product design and enhancing risk management strategies.
Chart 1
Information from Gen Re’s Market Study [1]
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Source: Copyright General Reinsurance AG, 2025 and printed with its permission.
In the sections that follow, we will explore key factors that contribute to the sustainability of CI products, drawing on insights from the wealth of data collected in the study. These include:
- Evolving demographic and medical screening trends;
- The role of CI definitions and product structure; and
- Wellness and lifestyle factors that influence CI risk.
By combining actuarial analysis with market intelligence, this article aims to provide a holistic view of how CI insurance can continue to meet the evolving needs of consumers across Asia while effectively managing product risk.
Evolving Demographic and Medical Screening Trends
Advances in medical technology and the expansion of population health screening programs have had a clear impact on the disease incidence rates observed in CI insurance. Breast cancer offers a notable example. Many countries now offer subsidised or publicly funded mammogram screening services, making early detection more accessible and affordable.
According to the World Health Statistics 2023[2] report by the World Health Organization (WHO), approximately 59% of countries worldwide have implemented formal early detection programs for breast cancer, highlighting the global commitment to proactive screening and its impact on disease outcomes.
Research further supports the effectiveness of these initiatives. A 2023 study by Guthmuller et al[3] found that organized screening programs (OSPs) increased mammogram uptake by 25% and raised breast cancer incidence rates by 16% within five years of implementation.
This trend is also reflected in insured populations. We observed a steady rise in the Age-Standardized Incidence Rate (ASIR) for females in Hong Kong, Malaysia, and Singapore between 2009 and 2019, as shown in Chart 2.
Chart 2
Age-Standardized Breast Cancer Incidence Rate (per 1,000) in Hong Kong, Malaysia and Singapore [4]
Enhanced breast cancer screening efforts have been closely associated with improved detection and earlier intervention, leading to a reduction in late-stage (Stage III and IV) breast cancer and lower mortality rates. This trend is evident when comparing population-level data with findings from Gen Re’s CI data insights, as illustrated in Chart 3, where markets with higher screening uptake tend to show a smaller proportion of late-stage diagnoses.
Chart 3
Relationship Between Mammogram Screening and Late-Stage Breast Cancer [5]
The Role of CI Definitions and Product Structure
CI definitions are the cornerstone of sustainable product management. Clear benefit triggers help policyholders understand how claims are assessed and build trust in and enhance the reputation of the insurance industry.
From an insurer’s perspective, CI definitions must align with the product’s intent while adapting to evolving screening practices and medical advancements. For instance, a comprehensive CI product may reasonably include both early- and late-stage conditions, whereas a basic CI product should focus only on severe, late-stage conditions. Over time, CI definitions have been updated to ensure that conditions classified as late-stage remain severe considering medical advancement. Timely reviews and proactive adjustments are therefore essential for long-term sustainability.
To illustrate this point, we examine how thyroid and prostate cancer definitions have evolved to better manage CI risk.
Case Study: Thyroid Cancer
Thyroid cancer, a condition commonly covered in CI insurance, may be classified as either a major or minor claim. A major claim would typically result in significantly higher payouts. The importance of CI definitions in maintaining sustainability is well illustrated by the Mainland China market.
In 2007, China introduced its first set of standardized CI definitions, classifying all thyroid cancer as a major cancer. Following a review in 2019, this approach was revised in 2021: American Joint Committee on Cancer Stage I thyroid cancer is now excluded from the major cancer category. This change reflects both the high survival rate of thyroid cancer and the need to keep CI coverage focused on severe conditions and affordable amid rising incidence rates as shown in Chart 4.
Chart 4
Age-Standardized Thyroid Cancer Incidence Rate (per 1,000) in Hong Kong and Mainland China by Calendar Year [6]
Beyond Mainland China, Hong Kong has also seen a notable rise in thyroid cancer incidence, although to a lesser extent. In response, insurers have progressively strengthened exclusions in their CI definitions. Some insurers moved to exclude only T1a micropapillary carcinoma while other insurers excluded all T1 thyroid cancers from the late-stage cancer category.
These changes reflect a broader industry effort to align product definitions with clinical severity, ensuring that CI coverage remains both relevant and sustainable.
Case Study: Prostate Cancer
Prostate cancer is another condition commonly covered in CI insurance, with definitions differing across Asian markets. These variations highlight the criteria insurers apply when determining whether a case qualifies as a major cancer claim (Chart 5).
Notably, Singapore, which adopted a relatively less stringent definition in 2003, has since moved toward a more rigorous classification.
Chart 5
Prostate Cancer Definitions Across Markets [7]
We have seen a consistently rising trend in prostate cancer incidence rates, with Singapore showing comparatively higher rates (Chart 6). This highlights the importance of monitoring both the pace and extent of this trend. For insurers, such vigilance is vital to maintaining product sustainability and ensuring that benefit structures remain aligned with evolving risk profiles.
Chart 6
Rising Incidence Rate of Prostate Cancer Across Markets [8]
To this end, the rising five-year survival rate of prostate cancer combined with the high proportion of Stage T1c cases compared with other T1 stages has prompted markets such as Singapore to tighten CI definitions by excluding all T1 prostate cancers. This adjustment helps ensure that CI products remain both affordable and sustainable, aligning benefit structures with clinical severity and evolving epidemiological trends.
Wellness and Lifestyle Factors that Influence CI Risk
Beyond cancer, CI insurance encompasses a broad spectrum of cardiovascular disease (CVD). Body mass index (BMI) is one of the most discussed lifestyle-related risk factors, with numerous studies consistently showing that individuals in the overweight or obese range face a substantially higher risk of developing cardiovascular conditions.
This trend is also evident within insured populations, even among standard lives when using BMI at the point of underwriting. For example, data from the Mainland Chinese market in Gen Re’s Dread Disease Survey – 8th Edition show a pronounced variation in incidence rates across male BMI bands, with differences of up to 3.7 times (Chart 7).
Chart 7
Age-Standardized Incidence Rate for Heart Attack, Coronary Artery Bypass Graft and Stroke by BMI Bands and Gender [9]
Our machine learning analysis further underscores the predictive strength of BMI. In the Mainland China market, a gradient boosting machine (GBM) model achieved an accuracy rate of 96%, ranking BMI as the fourth most influential variable in assessing CI risk, after age, province, and sum assured bands and, notably, ahead of gender (Chart 8). This finding reinforces BMI’s importance as a key factor in evaluating cardiovascular risk among insured lives.
Chart 8
Ranking of Factors Influencing the Incidence of CVD in Mainland China [10]
Given these insights, it is essential for insurers to actively promote healthier lifestyles among their insured populations. Collaborative efforts in prevention and early detection are central to reducing the risk of CVD. At the same time, effective disease management and well-designed insurance solutions remain key to supporting affected individuals, ensuring better health outcomes and long-term financial protection.
Concluding Remarks
As highlighted throughout this article, managing CI risk requires a multi-dimensional approach grounded in robust experience monitoring. By consistently and systematically tracking claims data, insurers can identify emerging risks and assess the impact of wellness initiatives.
We have explored how shifts in medical screening behavior can significantly influence incidence rates, how regular reviews of CI definitions help manage the effects of advancements in clinical practice and diagnostics, and how lifestyle improvements can reduce the likelihood of claims. These insights are essential for insurers when pricing and designing CI products that remain relevant, affordable, and responsive to evolving health trends.
Ultimately, experience monitoring is not merely a supporting tool. It is the foundation that enables insurers to adapt, innovate, and sustain CI insurance in a dynamic healthcare landscape. Gen Re has continued CI studies since 1993, which provide valuable insights that can shape the future of CI insurance across Asia and beyond.
This article is provided for informational and educational purposes only. Neither the Society of Actuaries nor the respective authors’ employers make any endorsement, representation or guarantee with regard to any content, and disclaim any liability in connection with the use or misuse of any information provided herein. This article should not be construed as professional or financial advice. Statements of fact and opinions expressed herein are those of the individual authors and are not necessarily those of the Society of Actuaries or the respective authors’ employers.
Samuel Lim leads Critical Illness (CI) Analytics at Gen Re Life/Health Asia, where he oversees CI research and pricing initiatives across the region. He also heads Gen Re’s CI Data Insights Study for Asia. Samuel can be contacted at Samuel.Lim@genre.com.
Endnotes
[1] Infographics from Gen Re’s CI Data Insights https://www.genre.com/gl/lifehealth/research-surveys
[2] World health statistics 2023: monitoring health for the sustainable development goals https://www.who.int/publications/i/item/9789240074323
[3] Effects of organized screening programs on breast cancer screening, incidence, and mortality in Europe https://www.sciencedirect.com/science/article/pii/S0167629623000802
[4] Understanding Breast Cancer in Asia – Awareness and the Importance of Screening https://www.genre.com/us/knowledge/publications/2023/october/understanding-breast-cancer-in-asia-en#accordion-5123718d70-item-f849c8fef9
[5] Screening rate Citation:
Hong Kong Breast Cancer Screening: The Government of the Hong Kong Special Administrative Region, the People’s Republic of China, Report of Population Health Survey 2020‑21 (Part I), https://www.chp.gov.hk/files/pdf/dh_phs_2020-22_part_1_report_eng_rectified.pdf
Malaysia Breast Cancer Screening: National Institutes of Health (NIH) Ministry of Health Malaysia, National Health and Morbidity Survey 2019, https://iku.moh.gov.my/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-NCD_v2.pdf
Singapore Breast Cancer Screening: Epidemiology & Disease Control Division, Ministry of Health, Republic of Singapore, National Population Health Survey 2020, https://www.moh.gov.sg/docs/librariesprovider5/default-document-library/nphs-2020-survey-report.pdf
Late-stage Diagnosis Citation:
Hong Kong: Hong Kong Cancer Registry, https://www3.ha.org.hk/cancereg/default.asp
Malaysia: National Cancer Registry Department, Institut Kanser Negara, Summary of Malaysia National Cancer Registry Report 2012‑2016, https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/2012-2016%20(MNCRR)/Summary_MNCR_2012-2016_-_06112020.pdf
Singapore: Ministry of Health, Singapore, 50 Years of Cancer Registration, https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/thespore-cancerregistry_commerativebook_-1.pdf?sfvrsn=231fce6e_0
[6] Insights from Gen Re’s 9th Edition of Critical Illness Data Insights – Hong Kong Market https://www.genre.com/gl/knowledge/publications/2025/july/critical-illness-data-insights-hong-kong-market-en
[7] Men’s Health – Exploring Prostate Cancer in Movember https://www.genre.com/gl/knowledge/publications/2023/november/mens-health-exploring-prostate-cancer-in-movember-en#accordion-9426c44f27-item-5f8e0d735c
[9] Body Mass Index as a Predictor of Cardiovascular Health https://www.genre.com/us/knowledge/publications/2024/august/body-mass-index-as-a-predictor-of-cardiovascular-health-en