Cancer screening and treatment – how well does your medical insurance cover you?

The New Zealand Herald recently ran a five part series, “Cancer – the cost of a life”, investigating controversies in cancer testing and treatment. Cancer is a scary diagnosis and it is important to have an accurate understanding of the role that medical cover can play in terms of access to different treatments.

The cost of cancer treatment can be high, and not all of the drugs that are available to help in the fight are currently funded by Pharmac. That means people can be left to pay privately for the medicines that may give them their best chance.

You may have seen, or even contributed to, private campaigns to raise money to help fund cancer treatments not covered by Pharmac. Some of these medicines can buy people a little more time – such as in the case of Jared Noel, an Auckland doctor with bowel cancer who wanted to meet his daughter. However others, such as the new Keytruda treatment for melanoma (at about $300,000 for two years), may make the difference in actually beating the cancer.

While we do have good access to cancer screening and treatment in New Zealand, and generally expect treatment to be covered by the public system, the media coverage these fundraising campaigns have received has made us more aware that this may not always be the case. Pharmac, New Zealand’s Pharmaceutical Management Agency, is a government agency that decides which pharmaceuticals to publicly fund. The reality is that they are not going to be able to cover everything for everyone.

When reading these stories and contributing to private campaigns, those among us with medical cover probably feel a bit relieved that, should we find ourselves in this situation, we will not have to rely on donations from strangers to afford the medicine we need.

Unfortunately it just isn’t that simple.

Some medical insurance providers do cover cancer treatments that aren’t funded, however many don’t. Whether your insurer will or won’t provide this kind of cover will be in the fine print of your policy. If you are buying your insurance through a broker, they will know which do and which don’t – here at Plus4Group we only sell those that do.

Most policies have an upper policy limit of $200,000 per claim per year and will be covered if the treatment is recommended by a specialist.

It isn’t just medical cover that can help out with a cancer diagnosis; trauma cover can pay out a lump sum which can make a big difference with medical expenses and lost income.

As insurance brokers it is our job to know the ins and outs of every policy so we can help you get the very best cover, with no disappointing surprises at claim time. If you want to discuss your medical cover, or any other cover, get in touch with one of our brokers.