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Insurance policies lacking clarity on cancer care

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12/06/2008

Cancer insurance policies have been criticised for a lack of clarity that may result in people being excluded from treatment, according to Mercer.

The study, conducted in conjunction with charity Cancerbackup, surveyed 11 major UK private medical insurance (PMI) providers to assess each of their main corporate medical insurance policies for cancer, including issues such as scope and standard of cover, treatments included within the cover and limits on cover.

Steve Clements, principal in Mercer’s health & benefits team, said: “One in three people in the UK will be diagnosed with cancer at some stage in their life. Some of the new and sometimes expensive treatments which are now emerging are, as yet, unavailable through the NHS. So understandably, cancer cover is an area of focus for companies purchasing private healthcare.

“PMI providers are using it to differentiate themselves from their competitors. While there have been substantial improvements, there is continued ambiguity over what is and isn’t covered in some cases. Eligibility rules for chronic conditions, for example, can sometimes mean cancer treatments will effectively be excluded or cut short. Transparency and clarity must be improved.

“New therapies are coming into the market. Some of these will lead to long-term treatments where the goal is to slow the spread of the disease, prolong life or improve the quality of life by easing the symptoms, rather than to cure. PMI providers must be clearer about whether or not these will be covered in their policies.”

Most PMI providers who completed the questionnaire said that they did not cover palliative care or treatment for terminal cancer. Some PMI providers, however, were less specific. Rather than ceasing cover when cancer reaches a certain stage, they apply eligibility rules to specific cancer treatments, so they fall under the chronic rules and are therefore not covered. The report noted that most PMI providers did not actually define cancer as a chronic condition.

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