Cancer insurance policies offered by private medical insurance providers have been criticized for lack of clarity and ambiguous terminology that may result in people being excluded from treatment, according to a study by Mercer and Cancerbackup, the cancer charity.
The study 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.
The report highlights that, while PMI providers have a similar view on how cancer care should be covered in the context of private medical insurance, the cover varies from one PMI provider to the next.
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.
The report also noted that PMI providers often use the phrase ‘active treatment’ for cancer to govern their decisions on cover for a particular course of treatment. This allows certain treatments to be covered for very specific reasons but others to be excluded. The term active treatment is often only loosely explained in the policy document. Mercer also noted that the term is not currently recognized by the Association of British Insurers.
Steve Clements, principal in health and benefits team at Mercer, said: It’s vital that companies seek clarity from the PMI provider on how cases will be managed when employees reach the limit of their cover but still need treatment, particularly if this treatment is unavailable through the National Health Service.
Most of the PMI providers we surveyed do have some flexibility around the cover they provide in this area, and so may be able to offer tailored solutions so that clients can strike the right balance between comprehensive cover and affordability.