Insurers urged to be clearer about when cover will cease
"Grey areas" continue to cause confusion for employees making cancer claims on private medical insurance (PMI) policies, according to Mercer.
The consultancy has published a new survey of the cancer cover offered by ten providers and is warning that claimants need to be informed from the outset of treatment about what their policy will and will not cover.
"I do not think it is imperative that people buy the most comprehensive cover out there but there has to be clarity about what is and what is not covered," said Naomi Saragoussi, principal at Mercer and author of the survey, which she presented to employers at HCA International's London Bridge hospital yesterday.
Mercer has had queries about "grey areas" including reconstructive surgery, stem cell surgery and Cyberknife, she reported. Although she welcomed the template for cancer cover literature produced by the Association of British Insurers, she warned that this failed to cover "complex procedures".
She also warned that employers tended not to take a proactive approach to reviewing cancer cover and the liability that it presents.
"We have to be clear that many people start reviewing cancer costs at the point when they have a cancer claim but that is like bolting the stable door after the horse has bolted," she said. "We need to understand what measures we can take before these claims take place and to ensure that what is in the handbook and what happens in practice is consistent."
Although several providers offer employers options about the extent to which cancer is covered, most employers simply follow the "default" option offered by the insurer (for example, treatment with biological therapies for 12 months only), according to Saragoussi
The survey of providers indicates that little has changed since 2008, when Mercer conducted a similar survey in partnership with the charity CancerBackup (now Macmillan Cancer Support). Most providers still say that they do not cover palliative care or treatment for terminal cancer and Mercer believes that there is still a lack of clarity about when treatment will cease.
Impact of NHS reforms
Saragoussi also provided an overview of Mercer's predictions for the impact of NHS reforms on PMI cover.
"GPs [when they take responsibility for commissioning care] will prefer that patients are funded by the private sector so that they have a larger pot [of budget]," she predicted. "We will see people being sent down the private route."
Although she said that the NHS is "very good" for cancer treatment, she highlighted a report from the Rarer Cancers Foundation which indicates that one in four rare cancers is diagnosed late. Drugs not approved by the National Institute for Health and Clinical Excellence (NICE) are also a driver of private sector cover, she said.
"We find that some of the care that is needed cannot be provided whereas in the private sector if there is evidence that a treatment works then it can be provided," she said. "But they are expensive so it can have quite a large impact. From our expectation and experience what we see is that people in the private sector have a longer life expectancy and I would say that is very much tied with the treatments being received."