Provision for cancer care differs widely under corporate private medical insurance policies

24/10/08

New treatments for cancer are continually improving recovery rates while assisting both quality and expectancy of life.

But these can be expensive and is leading to increased significant variances in the cover provided by Insurers.

Research demonstrates that few employers are aware of their specific cover with the majority also saying they would change insurer if staff who have, or have had, cancer were excluded from cover.

To help inform employers The Association of British Insurers have a new range of common definitions for implementation by Insurers by December 2008. The most significant change is the specific inclusion of cancer to improve the clarity of cover.

This is welcome as we believe that employers should be able to make fully informed decisions and questions to be asked of insurers include:

• What overall provision is there for cancer care?
• Are there any cancer treatments that are excluded?
• Are secondary cancers covered?
• When does cover cease? (e.g. is cover only for curable conditions?)
• Are there any specific time limitations?
• Are new drugs covered regardless of cost?
• Are there additional counselling and support services?

Some major points of difference in cover with guide examples of potential minimum and maximum cover include:

Overall Treatment

The background to Private Medical Insurance is to provide treatment of acute medical conditions (a medical condition that is likely to respond to treatment leading to a recovery).

Otherwise conditions can be deemed as "chronic” and excluded from cover.

Minimum Provision

The condition is classified as Chronic even at the point of diagnosis and cover ceases.

Maximum Provision

Generally cover is continued through all stages including palliative care during terminal stages

Treatment Period

Minimum Provision

Treatment may limit Chemo and Radio Therapy Treatments to a total period of 12 months inclusive of treatment that has already been provided via the NHS or an earlier insurer.

Maximum Provision

There is no limit to the treatment period regardless of any earlier treatment.

New Treatments

All drugs have to be “licensed” on a clinical basis.

Within the NHS drugs also need to be approves as “cost effective”. This is completed by The National Institute of Clinical Excellence (NICE).

Minimum Provision

Cover is only for NICE approved drugs in line with the NHS.

Maximum Provision

Decisions are not made on the basis of cost so drugs not approved by NICE may be funded.