Private Medical Insurance : Cancer Cover

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There has been a lot of discussion and argument over what the NHS will provide on cancer treatment

Some leading insurers have been concerned that cancer treatment has been available privately, but not under the NHS,  and several have moved to include such cover in their policies.

Unfortunately, this fragmented approach has meant that each insurer- and often different policies from the same insurer but sold via different distributors, has their own unique approach to what types of cancer they cover, what cancer treatments they will allow, what the policy will pay, and for how long.

The ABI has sought to get order out of this confusion and from October  2007  insurers have to start introducing common definitions.

This does not mean that all insurers will offer the same cancer cover.

It will be into 2008 before policy wordings and other documents catch up.

The golden rule remains, if unsure what cover an insurer will offer on cancer -ASK

Definition of cancer

The agreed definition of cancer is

Cancer 

• A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue'

Insurers must have a distinct section in their policy documents to explain the cover  for cancer.  To allow for flexibility in approach, they may consider having a  separate leaflet, or a separate section in a leaflet, to explain the cover for cancer.   The explanation of the cover for cancer must be available at point of sale.    

Insurers must explain clearly what would be covered, including limits on time periods, cycles of treatment, maximum payments, and  circumstances in which they would not provide cover. 

Place of treatment 

• hospice 

• hospital 

• at home 

Diagnostic

• consultation

• test 

• scan 

• genetics

Surgery Preventative

• screening

• surgery 

• vaccines 

Drug therapy 

What types they cover?

• chemotherapy

• to maintain remission 

• maintenance therapy 

• biological therapy 

Radiotherapy

•  including when given for pain relief

Palliative  

• maintenance therapy 

Terminal 

• maintenance therapy

 Monitoring 

 Other 

Is there a level of cover that is specific to cancer?

• experimental treatment / advanced therapy / prelicensed / NICE appraisal

• clinical trials   

When referring to cancer, insurers may use terms such as 'preventative',  'maintenance', and 'palliative'.  In order to increase clarity, they must  avoid  using the common definitions 'acute condition' or 'chronic condition' within this  explanation of cover for cancer.