Getting to grips with cancer and your healthcare finances

By: Martin Rimmer, CEO of Sirago Underwriting Managers

The many cancer awareness days and months throughout the year are a reminder of just how prevalent this insidious disease has become in our modern lifestyles.  There is hardly a family that has been untouched by a cancer diagnosis of a loved one or close friend during their lifetime.  

There are over 200 different types of cancers affecting one in four South Africans and there is absolutely no discrimination across age, gender or social class when it comes to who is affected.  Every year, over 100 000 South Africans will hear the words ‘you have cancer’, and six out of ten will survive their diagnosis, according to CANSA. 

Protecting yourself against the impact of a health crisis is all about taking preventative action.  Living as healthy a lifestyle as possible will lower your risks for cancer, while going for regular annual check-ups lead to early detection and treatment which has a far better prognosis than a cancer that is only detected at an advanced stage.  It’s also about sound financial planning to ensure that should you ever face a health crisis, you’ll be able to focus all your energy on your treatment and recovery, and not have to worry about managing the potential financial hang-over that comes with a cancer diagnosis and treatment.

Surviving the financial challenges

Managing the physically and emotionally demanding treatment regimen and returning to health should be your top priority.  Yet studies show that almost a third of cancer survivors experience financial burdens and significant out-of-pocket costs and shortfalls associated with cancer treatment in their healthcare funding strategies. Another significant factor is that many people are having to downgrade their medical scheme options during these tough economic times, which means a commensurate reduction in benefits, including possible reduced cover for cancer treatment.

 Earlier detection and treatment mean that the prognosis for surviving cancer is now better than ever.  However, the cost of funding the treatment can be a major debilitating factor, even if you are a member of a registered medical scheme.  While medical schemes typically cover the cost of certain cancer treatments as a Prescribed Minimum Benefits (PMB’s), depending on what option you are on, your costs of treatment might not be covered in full and you could face onerous out of pocket expenses, co-payments and shortfalls.

Certain medical schemes might also only fund certain treatments partially like biologicals, if at all.  If it’s a matter of life and death and you need these treatments, some medical schemes will allow you to upgrade your option immediately, but in the instances where you are not able to upgrade and your medical scheme options does not allow for the appropriate cover, you could be forced to sacrifice your life savings or future financial security to gain access to these treatments. 

Costs are incurred even before diagnosis

What many people don’t consider is that diagnosing suspected cancer may involve expensive diagnostic tests and procedures such as PET scans, MRIs, biopsy and blood tests which medical schemes may impose co-payments or sub-limits on, costing you thousands of unbudgeted rand upfront. 

Comprehensive gap options provides an ‘Initial Cancer Diagnosis’ benefit that pays you a lump sum of cash upon the initial diagnosis of malignant cancer which can immediately go towards recouping some or all of your upfront costs on the charges related to the cancer diagnosis.  

Medical scheme options typically fund cancer treatment in one of two ways – either up to a certain annual limit or up to a certain Rand value for the entire treatment.  Once these limits are reached, large co-payments of up to 20% are incurred on any further treatment. Gap cover provides additional cancer benefits which cater for these Cancer Co-payments once your medical scheme cancer benefit has been reached and treatment co-payments are applied, including those related to biological drugs.  Depending on your gap cover option, these co-payment benefits are limited to the available Overall Annual Limit available on your option.  In some instances, when the medical scheme has a rand amount limit for their cancer benefits, certain gap options, like Sirago offers,  make provision for an annual Hospital Booster benefit, providing for an additional R100 000 (option dependent) per beneficiary, per annum.  The trigger for any cancer benefit from your gap cover policy is that the member must belong and participate on the registered treatment plan as determined by their medical scheme.

When it comes to breast cancer, breast reconstruction, if considered, is an important part of the recovery process and some medical schemes now cater for this either through risk benefits or via ex-gratia applications, but with varying limits.  A Cancer Breast Reconstruction Benefit (option specific), like the one offered by Sirago, covers the gap portion of this reconstructive surgery up to 300% of the claim and in addition to this, we also make a substantial amount of money (option dependent) available for the reconstruction of the non-affected breast.

A cancer diagnosis has a profound effect on your emotional, physical and mental wellbeing and typically impacts your whole family and close circle of friends. During this time, make sure that your healthcare funding such as medical scheme benefits and gap insurance work hand-in-glove to provide you with access to the best quality healthcare and treatment in order to mitigate as far as possible the need to delve into your monthly disposable income or life savings.

We always advise clients to talk to an accredited financial services advisor, to put together a well-rounded healthcare funding plan to carry them through a possible health crisis, thereby ensuring that their only concern is a return to health when and if it happens.