Medical Insurance Treatment Myths and Realities

My share of my blog post on Movember got a really good reply with some well thought out points that I come across with clients every day. Some are well founded and understood, others things have changed as has the approach. I felt it was worth a blog post by itself.

Susan’s original post:

Good on you Jon-Paul, admirable cause, but it is my view that Health insurance company don't do Health prevention, you have to pay for this type of health service even if you have a mastectomy your health insurance won't pay for a re-build for want a better word, apparently its plastic surgery and its not covered to have you looking normal after going through harrowing surgery and treatment...

This is what we achieved for one of our clients without getting creative on cover levels and types of cover, the creative bit is likely to be another $2-3000 per annum ongoing.

So what have we achieved?

We've managed to achieve a $2,500 per year average saving on what they were previously doing and this applies to what they do going forward. Add to this an additional $2000 per annum after restructuring how they're covered, giving an expected savings of $4,500 per annum ongoing.

Significant in most people's book, so how did we achieve this?

When the subject of medical insurance or cancer treatment comes up, the discussion on non-Pharmac medicines usually follows.

What are non-Pharmac medicines?

Non-Pharmac medicines are where the government does not fund the drug or treatment being prescribed or recommended for a treatment and you will have to find the money to pay for it.

It does not matter what the stats are, if you are someone who needs a treatment and the government does not fund it, you want to be able to access it. Which is why, dollar for dollar you take the medical policy with coverage over the one that does not, even if it is a bit more expensive you probably still should.

By posting this, I’m going to raise a contentious topic. One that clients often do not understand, advisers generally avoid discussing, providers publicly discourage but operationally encourage and the Financial Markets Authority (FMA) is starting to have a closer look at.

I have stated the previous parties in a very specific order, from most impacted to the one with the stick they can use, and the players in between.

ACC have published the new motor vehicle levies and they make interesting reading.

ACC have gone through and assigned a rating system from L1 to L4 for most vehicles, L1 being the most expensive and L4 being the least. If yours is not defined then the levy works on a year of manufacture basis. L1 for older vehicles and graduating though to the cheapest L4 for newer vehicles.

The reason I’m writing this is I disagree with some of the assertions in the NZ Herald article. ACC have done this review based on claims risk from actual injury data not vehicle safety. Injury’s drive ACC’s costs, not vehicle safety. Yes safer vehicles generally means less injuries and less ACC cost, but that doesn’t always translate directly from vehicle safety testing.

The short answer: depends.

The longer answer: maybe, maybe not.

No I am not trying to be difficult, it does depend on the policy you have so maybe, maybe not.

The simple answer:

If you have indemnity or loss of earnings yes, it is tax assessable. If you have agreed value, it is generally not tax assessable. But there's more, no not a set of steak knives, really there's more.

Interesting question, up there with what's the best value income protection?

The answer to both questions is a good quality income protection solution. It will both work at claim and give you great value as a result. The way to do this is talk to a good adviser who will arrange this for you, that's me.

If you mean best value equals cheapest premium, then you have to ask the question do you expect to claim? If not, why have it? Cheapest like most things in life usually translates to inferior.

Ok, I have raved about this in other blog posts. I have had an idea, a general concept, that access to medicine was becoming a problem—a real problem—with one of the four pillars of New Zealand society: Health, Education, Justice, and Social Support.

Now with this latest report, there is a clear indication we’re well behind with Health funding. Education, Justice and Social support all have their challenges, I am sure, but Health is an area I spend a lot of my time working with on behalf of my clients.

If you are a regular reader of my blog you will have come to realise that there more to life insurance than just having a policy, dying and getting some money.

I have touched on this subject in other posts; this is another post that explores this much more deeply. Level premiums are a somewhat lesser used but potentially considerable part of your insurance planning.

I’ve got insurance this under insurance thing doesn’t apply to me? It probably does apply to you

What I’m referring to by underinsurance are the various studies around the world, that are pretty consistent with saying about 70% of the population are under insured when it comes to life insurance.

Why do I say it probably does apply to you?

This is where as an adviser, I’ve sat down across the table and the eye’s have rolled, saying here we go again.

You know what, it probably is a good idea, she has been thinking what if?

Especially 'what if you're not here?'

Something that often pops up in the insurance industry and media, but what does it really mean for you.

Over insurance is where you are carrying more protection than you need and under insurance is when you have less than you need.

This is not about you having insurance or not, it is about you having the right type of insurance, at the right level for your situation.

Looking at the numbers, most households will have some form of insurance. It might be House, Contents or Car cover, it may also be Life or Medical Insurance.

What the numbers do tell us though, about 80% of households, possibly higher, will have exposure if someone was to be disabled and 75% of you would have to use the public system for medical treatment, or pay your own way for private medical treatment.

A posting on LinkedIn got to the crux of this quite succinctly. If your business cannot run without you for 30 days, you do not have a business.  You have a J-O-B with a very expensive sign that has your name on it. When you can sit back and say ‘my business will work without me’, you probably have a strong business and a succession plan.

KPMG International’s 2014 Global Audit Committee Survey has highlighted some positive things about the management and structure of New Zealand companies, specifically around the role of CFO.

It has also highlighted issues with succession planning. When it comes to succession planning, New Zealand is doing just as poorly as the rest of the world.

Breast cancer, or for that matter any form of cancer, with women gets a reaction in the media. Breast cancer has certainly been the one that has had the majority of attention over the years.

In 2003, there were large headlines about access to Herceptin and its costs, especially as the Aussies had access to it from an early stage.

• Here in NZ, the budget at the time just didn't have the capacity to handle the cost.
• On the insurance side, there were only two medical insurers at the time able to offer cover, one that stopped not long after Herceptin hit the market, leaving 1 insurer providing non-Pharmac cover for new policies for nearly 10 years.

Now that we've got over most of the funding discussion on herceptin, it's partially funded rather than fully funded; other areas around cancer treatment are getting attention.

Exclusions and policy terms, another good reason to regularly review your insurance coverage

An unfortunate fact of life is; time marches on and we all get that little bit older. This also means the policy you took last year, five years or ten years ago may not be quite as appropriate now as it was at the time you first took it.