Guide to cancer and health insurance
- Some health insurance policies will cover the use of cancer diagnosis equipment and consultant fees
- A private diagnosis may lead to referral for treatment at an NHS hospital, especially if the equipment needed to treat you isn't available at private facilities
- Health insurance may include NHS cash benefit for cancer patients, as well as payments towards wigs and prosthetics if needed
In 2014, 356,860 people were diagnosed with cancer in the UK, according to Cancer Research,† so if you receive this dreadful news you're certainly not alone.
The NHS gives you access to an increasing range of treatments and therapies, but if you already have health insurance in place when you're diagnosed, you'll often have the reassurance of faster and more extensive treatment.
Full cancer cover on a private medical insurance (PMI) policy may include:
- Ground-breaking and expensive cancer treatments beyond what the NHS can provide
- The flexibility to be treated in an NHS hospital, plus receive NHS cash benefit
- Monitoring cancer when in remission
- Controlling cancer with drug and hormone therapy
- End of life palliative care
Cancer diagnosis and screening
The initial diagnosis will come from an NHS consultant or a self-funded private consultant.
Unless you have a strong family history of cancer and an inherited gene has been identified you’ll probably need to pay for a cancer screening privately.†
Diagnostic testing will usually form part of a health insurance policy, and specific screening for different strains of cancer may also fall within the remit of your cover.
Some policies will also include the use of diagnostic equipment:
- Computerised axial tomography (CT) uses X-rays to calculate the density of tissues and organs
- Magnetic resonance imaging (MRI) allows oncologists to see detailed images of tissues and organs
- Positron emission tomography (PET) gives a three-dimensional picture of the how well the organs inside the body are working
Need more information?
However, the medical interpretation and diagnosis post-scan may not be included in your health insurance policy, so check your consultant fees are covered before committing to purchase.
How does cancer screening affect health insurance?
The Department of Health has a long-standing agreement with the Association of British Insurers (ABI) that bans insurers asking customers to disclose the results of genetic testing, called the Concordat and Moratorium. This has been extended until 2019.
However, insurers can still ask about family histories and you might face higher premiums if your family members have had the disease.
If you've had genetic screening and the results were negative, you might choose to voluntarily share the results with your insurer.
Waiting times for NHS and private cancer treatment
Following a cancer diagnosis in England you have a legal right to choose† certain facets of your medical care:
Be aware that lower-premium providers may stipulate that if the NHS can see you within a six-week time frame, you’re obliged to wait and accept its care and treatment
- Your desired hospital, either private or NHS
- A preferred consultant and the medical team administering the treatment
At the referral stage, your GP should tell you what options are available and ask how you would like to proceed.
For suspected cancer, the maximum wait time† for referral in the NHS is two weeks from the date of your appointment or when the hospital receives your referral letter.
A health insurance policy might let you skip the queue, giving you faster access to treatment.
Some insurers will even offer molecular testing upfront to find the most suitable cancer treatment for your condition.
Be aware that lower-premium providers may stipulate that if the NHS can see you within a six-week time frame, you’re obliged to wait and accept its care and treatment.
NHS cash benefit on health insurance policies
Your PMI policy may offer you cashback known as NHS cash benefit.
It's usually calculated per day for a set time frame and provides extra financial support if your preferred oncologist or hospital is part of the NHS and you opt to have NHS treatment instead of private hospital care.
Do you get better cancer care with health insurance?
Your health insurance policy may include radiotherapy and chemotherapy as standard, but you may need specialised equipment which is generally not available in private hospitals - one reason, why you may choose NHS care with cash benefit, rather than a private clinic.
Did you know?
- According to research conducted by Macmillan Cancer Support in 2015,† there are almost 2.5 million people living with cancer, and it’s expected to rise to four million people in 2030
- In 2012 Macmillan predicted that people aged 65 and older will account for 77% of all people living with cancer by 2040
But health insurance can also give you access to drugs and treatments that sometimes fall outside of the NHS remit and budget.
Specific strands of cancer that rely on hormones to grow and develop can be fought and blocked with hormone therapies.
For example, if a prostate cancer patient wanted to avoid radiotherapy, hormone treatment can limit the production of testosterone to shrink and control a tumour.
It can also be used to fight against breast cancer, ovarian cancer, womb cancer and kidney cancer.
Hormone therapy is also viable for patients with aggressive and advanced cancer, where treating to cure is no longer viable, in palliative treatment as a sickness control and pain relief.
Targeted treatments, otherwise known as biological therapies, could stop cancer cells from growing, attack dangerous cancer cells and prompt the immune system to attack cancer cells, too.
Health insurance can also give you access to drugs and treatments that sometimes fall outside of the NHS remit and budget
Your PMI policy may include biological cancer therapies, depending upon your level of cover.
Insurers may offer access to ‘super’ or ‘smart’ drugs, such as the bowel, kidney and colon cancer drug, Avastin.
Sometimes known as ‘macromolecules’, smart drugs attack specific molecules on the cancer cell’s surface.
Alternatively, bisphosphonate medication - drugs that prevent cancer spreading to bones, and slows down bone damage - might be the most reliable treatment for your cancer.
They’re usually available through the NHS, but they may also be offered as an option for PMI patients with myeloma, breast cancer, prostate cancer and lung cancer.
There are various other treatments which may be applicable to your diagnosis:
- T-cell transfer therapy increases the number of cells able to fight cancer. The cells are grown in a laboratory and transferred back into the patient’s immune system
- Gene therapy is used to boost the immune system, block the cells that protect cancer cells, and make cancer cells more sensitive and receptive to other treatment
- Oncolytic virus therapy infects the body with a virus that can kill cancer cells and tumours
- Bacillus Calmette-Guerin (BCG) therapy is an immunotherapy drug which prevents cancer returning to the bladder lining
These types of treatment are expensive, so there may be a limit on the length of time you’ll be covered by your health insurance, and there could also be a cap in your policy that defines how much is payable per person.
Health insurance policies that cover wigs and prosthetics
Your policy may also come to your aid at extremely difficult times during your treatment.
Chemotherapy, radiotherapy, hormone therapy and targeted biological therapy may cause hair loss.
Macmillan has a hair care guide for during and after treatment,† but many patients also purchase a wig.
A wig can cost thousands of pounds, so bear in mind that your health insurance policy may cover the cost of, or contribute towards, the price.
There may also be a set budget for external prosthetics during the lifetime of the plan.
If you need assistance after treatment, some PMI policies will provide you with home nursing immediately after you return from the hospital, or for a set time frame across the duration of the policy.
You may be subject to a health assessment before you’re offered the care, so check the terms of your insurer to see what help is available.
A nurse will help with daily essentials such as getting washed and dressed and assist with taxing chores, such as changing bed clothes and even the tidying up.
Cancer cover post-diagnosis
Just as with any other pre-existing medical condition, arranging health insurance after you’re diagnosed with cancer is more problematic because making a claim is more likely.
It’s not impossible to get cover, but insurers may offer you a health insurance policy with a raised premium.
If you’re in remission, post-diagnosis, or have incidents of cancer in your family history, the premiums may also rise.
Certain insurers won’t raise the premiums for patients in remission if they have a clean bill of health within a certain timeframe before starting the policy.
For example, the patient must be clear of consultations, symptoms, medication and tests within two years of starting the policy - but you’ll have to shop around to find them.
You can reduce the premium by paying a larger excess but make sure its value is realistic, otherwise making a claim could be an expensive mistake and extra worry you don’t need.
Don’t be tempted to withhold information from the insurer - missing out details in your application could invalidate your insurance.