Breast cancer is a consistent news story we all see, in more recent times we've seen the challenges people face with their insurance company's getting breast reconstructions done.

This 2016 article in the New Zealand Herald, 11th Hour Shock, for Anna Jobsz who is having a preventative mastectomy and breast reconstruction is pretty typical of what we see.

This follows on from the high profile treatment Angelina Jolie had when she found out she was exposed to a high chance of developing breast cancer.

The challenge for Anna, is she has come up against one of the challenges of medical insurance, preventative treatment. As she hasn't been diagnosed with cancer, her mastectomy and reconstruction falls in to the preventative treatment category. In Southern Cross's terms, the benefit paying here is the prophylactic (preventive) benefit not the surgical benefit. Which is an important distinction. The prophylactic benefit with Southern Cross is still quite unique, but it has a lifetime allowance that ranges from $30,000 to $50,000, depending on the Southern Cross plan.

With Anna, she has come up against this limit on her plan. While she has a plan that doesn't have a limit on surgery, that is for medically necessary surgery. Unfortunately for her the limit only covers the mastectomy and about half of the breast reconstruction costs, leaving Anna to pick up the rest.

What needs to be put in perspective is the approach of the rest of the medical insurance industry. In 2016 as this is a preventative treatment, without exception, none of the other providers presently were paying for this procedure in this situation. In some ways, Anna is lucky she had her cover with Southern Cross and she is able to claim it.

What's the reality?

Since 2016 we have seen a distinct change in the approach of medical insurers and now 4 out of 5 insurers I've reviewed provide for prophylatic treatment in some way. (I have not included or reviewed UniMed or the NZ Police Medical schemes at this stage)

Southern Cross was the first in 2016, with $30k - $50k (plan dependant) for prophylatic preventative treatment, Accuro has added up to $80,000 on their plans and Partners Life & AIA have provided for prophylatic following a cancer diagnosis under their surgical or cancer treatment benefits.

Anna from the story was lucky she had the cover she had at the time, today many people with older medical policies have had this benefit applied retrospectively under policy passback, where new definitions are applied to old policies. 

This is particularly good for older AIA policyholders on their Real, Superiour Health, Absolute Health and MajorCare products that have been superceeded with AIA's Private Health policy currently available.

Where to from here?

With nib being the last of the big retail providers to add this, I expect, as the noise and profile of this sort of treatment becomes more prevalent and normal, they too will come to the party. Likely initially with a requirement for the policyholder to prove, through genetic testing, at their cost, that the surgery is needed or in a similar way to AIA and Partners Life where cancer has been diagnosed and it's provided from there.

What can you do right now?

If you don't have medical insurance and this is a concern for you and you haven't had the genetic testing done, then putting cover in place should be relatively straight forward. However if you have family members with strong breast cancer history or you have family members who have had genetic testing that is positive for this sort of breast cancer, you need to disclose it to the insurer. Which may result in exclusions on the benefit you're looking for.

Specifically we're looking at BRCA1 and BRCA2 positive gene testing.

If you already hold medical insurance, as I stated in 2016, wait for a bit. The market runs through a review of terms and conditions on a regular basis and new things get added so that benefits to remain competitive.

If you have a medical policy with providers other than the ones stated above with benefits, you need to have a chat with us as these policies to assess the risk of waiting for this benefit to be added, or look at eitehr new cover or additional cover to address this risk. There are additional risks aroudn cancer to concider and holdign your existing cover for pre-existing conditions reasons is part of the consideration too.

If you want to know more about the subject of breast reconstruction and insurance these two articles are worth a follow up read: 

Breast cancer reconstruction hits the headlines again and

The earlier article Breast cancer and breast reconstruction after mastectomy

If you want to have a chat about how to sort this for you, give us a call