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CANCER & INSURANCE

As modern medicine develops more advanced ways of screening, treating and managing cancer, more people are being diagnosed early and successfully treated and cured. However, cancer survivors still pose a higher risk because their cancer may reoccur or because of the long-term side effects of their treatment. It is these factors the insurance company will take into account when a cancer survivor applies for any type of insurance post diagnosis.

So how is your history of cancer likely to affect the following types of insurance?

  1. Life cover
  2. If you have a life insurance policy before you were diagnosed with cancer, it is likely they will honour the policy on condition the policy terms do not exclude a cancer diagnosis and you did not fail to disclose any relevant factors in relation to your medical history. At this stage, it is vital that you continue to pay your monthly premiums and do not let the policy lapse, as it will be easier for a survivor to continue paying than attempt to take out a new life insurance policy. Most life insurance products and companies are unlikely to give life insurance to a cancer survivor within three years of completing their treatment. After this three-year-period, the insurer will investigate the type, staging and prognosis or likelihood of a recurrence. However, it is likely that if they grant you cover at this point, the premiums for the cover will be higher (this is known as a premium loading), due to there being a greater risk of recurrence. In the case of a survivor who has been cancer clear for 10 or more years, it is probable that no loading will be applied to a policy. This is because the risk of recurrence decreases as time goes on.
  3. Critical illness
  4. If you develop one of the multiple illnesses for which the policy covers you, like cancer, you will be paid out a lump-sum. It should be noted that some types of cancer and earlier stages of cancer can be excluded from this type of insurance or, if you are the age at which some cancers start to become more common, it is important to ascertain these exclusions when purchasing this type of insurance. With some insurance providers, once you claim for a specific dread disease, your benefits will end and the policy will realise no further benefits should you be diagnosed with another dreaded disease. However, most policies do make allowance for multiple pay-outs. This could mean that just the disease you have already claimed for may be excluded and the policyholder may be permitted to claim for other conditions. When purchasing cover, you should clarify this with your broker or financial adviser.

    Post diagnosis, there are some insurers who will provide critical illness cover to a cancer survivor. However, it is very likely that a cancer diagnosis or condition resulting from your initial cancer treatment will be excluded in the terms and conditions of the policy.

  5. Disability
  6. Some larger companies offer a disability programme or insurance for employees. If you feel you are unable to continue working in the short term, it may be an idea to explore this option with your HR department. Depending on the plan, you may be eligible to apply for short-term disability early on in your treatment. You will have to complete a large amount of paperwork, undergo additional medical testing and demonstrate that you are unable to work to your normal ability.

    Individual disability insurance that you take out yourself covers your known financial obligations or needs (like monthly household, childcare, healthcare needs, as wells as covering outstanding debt) in the event of an illness or injury stopping you from working and generating an income. You can insure yourself against an event that stops you from working temporarily, and or on a permanent basis. You can also choose if you want the cover to pay as a monthly recurring pay-out or a once-off lump sum pay-out. Typically, just cancer stage 4 and 3 are considered severe enough to trigger a permanent pay-out, whilst a temporary pay-out can arise (depending on the product purchased) from any condition, provided you are unable to work for a period exceeding your chosen waiting period (an initial period in which you will not be paid a claim for being unable to work)

  7. Gap cover
  8. The reality is that it is unlikely that any medical scheme will cover 100% of your cancer treatment. You may therefore wish to investigate other forms of health insurance. Your broker or financial adviser will be able to explain the various health insurance options available that could act as “gap” or “top-up” cover should you be diagnosed with a life-threatening disease. It should be noted that some gap cover products exclude a cancer diagnosis all together. In some cases, consumers may have to purchase a separate policy to cover a diagnosis of cancer.

  9. Medical aid cover
  10. A substantial cancer benefit will consist of an overall annual limit of about R300 000 to R400 000 per beneficiary. Most plans have limits and may exclude cover for certain new or expensive treatments.. It’s important to read the fine print.

    Some schemes’ lower or “cheaper” benefit options offer between R90 000 or R150 000 cancer cover for each family. With this amount of cover, you and your family will be provided with treatment in line with the regulated Prescribed Minimum Benefits (or PMBs), equivalent to what you would have received if you went to a government hospital for your cancer treatment or care.

    Many schemes’ provide limited or no funding for certain cancer treatments, including specialised medicines or biologics. As a result, you may have to pay for a portion or all of the cost of these new medicines from your own pocket. Many of these newer medicines do not yet have cheaper generic alternatives. Some of these medicines can cost anything between R100 000 to R500 000 for their prescribed course.

Cancer and PMBs
Not every type of cancer is classified as subject to the PMBs. Your cancer will be categorised as a PMB if:

However, having a PMB-classified cancer does not entitle you to unlimited treatment. The medical scheme’s policies, rules and protocols must still be taken into account.

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Always talk to a medical professional, broker or your Medical Scheme about your concerns.’