Cancer hopes in PMI

With medical advancements, cancer has moved from being a completely bleak diagnosis to one that has been newly defined by insurers, as HR adopts new sensitivities to these ‘disabilities’, says Kate Donovan

Some 90,000 people of working age in the UK are being diagnosed with cancer each year, according to the charity Cancerbackup, so employers may well find that they have to deal with an employee who develops the disease.

In these cases, employers may also find that employees try to draw on the healthcare benefits they provide and, therefore, they should be clear on whether cancer treatment is covered. But cancer cover is complex. So that private medical insurance (PMI) providers give clear information about the cancer cover they offer, the Association of British Insurers (ABI) re-published its Private medical insurance common definitions with an additional cancer-specific definition in October 2007.

Previously, depending on the insurer, cancer was either defined as an acute condition, which accounts for illnesses likely to respond quickly to treatment, or as a chronic condition, which includes illnesses that need ongoing treatment and, or, have no known cure, or which can relapse.

Rachel Rowson, quality and public affairs manager at Cancerbackup, explains: “Depending on where the PMI provider put cancer between those two definitions meant cover could really vary between different providers.”

Ensuring employers know what they are getting from the cancer cover they buy is vital because under the Disability Discrimination Act (DDA) they have a duty of care to deal with cancer as a disability. Everyone with cancer is classed as disabled under the DDA, which makes it illegal to discriminate against people with disabilities.

The change to the ABI guidelines has been welcomed by the PMI market as it accommodates the numerous types of cancer and varying treatment requirements. Ann Dougan, marketing director at Cigna Healthcare, says: “Cancer has moved from being a completely bleak diagnosis to this principle of people living with cancer. Therefore, new definitions [have] evolved to reflect the nature of the disease.”

The guidelines also now require all PMI providers to complete a standard example of how they cover cancer and to what extent they would cover a patient, including, for example, information on whether there is a limit on the amount they will pay for a treatment.”Some insurers may not, for example, fund the newest technology [or] the newest drugs coming out on the market. Some will have a limit to what they fund,” says Rowson.

When looking at what type of cover they should offer to staff, employers will be better equipped to make the decision if they are fully armed with the facts. Some providers and consultants, therefore, are working to educate employers around the issue. Cancerbackup, the HR-focused not-for-profit body Working with Cancer and Mercer, for example, have published Purchasing corporate healthcare: making informed purchasing decisions on cancer. This aims to help employers make informed purchasing decisions about the cancer treatment that will be available to staff should they need it, identifying key questions employers should ask of their PMI provider.

Marco Bannerman, head of intermediary sales at Bupa, adds that to be certain they have transparency and clarity around cover, employers should check whether pre-existing conditions are covered, what cancer drugs are excluded from the cover, and whether palliative care is included. “It could be crushing if your policy stopped cover because say you haven’t understood the small print about the license of a drug,” he explains.

Despite much media coverage over the past year, the provision of cancer drugs such as Herceptin and Avastin still remains an issue for a number of patients due to the cost involved. Although some providers do cover the cost of these drugs, others are more reluctant to do so. It is important, therefore that they advise employers of their position on the matter.

Employers can help employees come to terms with the shock of a cancer diagnosis by providing an employee assistance programme (EAP) or counselling service, particularly if this is available to both staff and their families.

As well as requiring emotional support, employees may also have financial concerns if they are faced with lengthy periods of absence from work. In this instance, some group risk benefits, such as critical illness insurance or group income protection cover can provide peace of mind for staff by giving them a source of income during this time.

If you read nothing else read this…


  • The Association of British Insurers has adapted its guidance so that private medical insurance providers offer further clarity around the cancer cover they offer.

  • If PMI providers don’t supply sufficient information to make their cover transparent, then employers should ensure they ask the right questions.

  • Once they have made an informed purchasing choice, employers should thoroughly communicate the benefits to employees.