For a long time, I have discussed the need for unfunded medicine coverage. Ideally, this coverage is baked into your medical policy, but that's not always the case.

In the middle of last year, I wrote this piece for GoodReturns highlighting a significant issue in the way unfunded medicines claims are handled by most insurers.

As I said in the article, this isn't about demanding a change to policy wordings. While it would be nice, we are also talking about an area of claims that is very expensive for insurers.

I have been discussing managing medical premiums for quite some time. This article I wrote in 2016 is the start where I discuss the life cycle of medical insurance for the typical household. This discussion and approach is still quite valid.

However, with Covid, challenges with the public medical system and cost of living pressures, medical insurance remains an essential tool to ensure you have access to the medical care you need, but it's a whole lot more expensive than it used to be.

This is an update to a similar article I wrote in 2016, and this shows in the seven years since, medical insurance premiums have mostly doubled and what has changed since then. Added to that is access to public health services is at an all-time low, with around 2/3 of people not being seen in required Ministry of Health time frames.

Don't take my word for it; you can check out Public Health services delivery response that is linked, though this hasn't been updated since before the 2023 election. Click time series view, and it will show you how well current public health delivery is achieving to expectations.

Have you had an injury or medical event, and you have found you haven't been treated as quickly as you expected, with the result you are now living with some level of permanent impairment?

Over the years, this situation has arisen regularly, prompting some interesting responses from our medical and health systems.

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.

Where do I start with this? There are so many things wrong that it's not easy to pick on one thing.

Having been involved with life, disability, and medical insurance for over two decades I've seen a thing or two.

Just to quantify what I'm talking about before I launch into a ranting tirade about our medical system from some middle aged stale pale male, let's have a look at what I have seen more recently.

It's been ten years since insurers started adding breast reconstruction after cancer surgery to medical insurance. At the time, insurers had a hard time with the subject, but over the last ten years, all insurers, with the exception of some older employer plans, now have the benefit.

The article, which you can read here, only mentioned four of the 10 providers of medical insurance benefits in the New Zealand market at the time, which does the market a disservice as it does provide valuable benefits to policyholders in need with 8 out of 10 at the time having some response to breast reconstruction after surgery.

So you have existing medical insurance coverage, but you are concerned about unfunded and non-Pharmac subsidised medicines, especially for cancer.

You are concerned because your present cover is either limited or non-existent for this area of your medical treatment. 

If you are fit and healthy, then this is not quite the issue it could be, and moving to a plan that does cover this is relatively straightforward. 

But that’s not the reason you are reading this either.

Some watching may have noticed that updates here have been a bit sparse. There are some good reasons.

Some of them are claims, and there are lots of claims. Two years ago, we managed about 85 claims for the year, mostly medical claims.

2022 that ticked up markedly with Covid and the Public Health system struggling.

Medical insurance is a changing landscape, not only with policy terms and conditions but with the providers now. 

10 years ago, we had 10 different medical providers; we now have 6 and likely that there will be more mergers in the market.

Medical insurance is a product that typically is not reinsured, so the money for claims, operating the insurer, marketing & sales all come out of the same pot.

It's well known that gender identity issues have fallen under the scope of mental health. The recent media activity around the subject has brought it into mainstream awareness.

From 1 January 2020, the WHO updated their ICD (International Classification of Disease) to version 11 and put it online with exciting changes.

Babies have been the key subject at home in the last few weeks with a new addition. A previous comment about medical insurance has got me thinking.

Those things around Babies and New Family members you need to be aware of that can trigger a need to have a chat with us.

Continuing the discussion around diabetes I started in this article about the reality people with T1D Diabetes (T1D) deal with and what the associated costs are like.

Some of this will cross over for context, but not enough. If you don't know the detail you may want to read this first.

Having been an adviser for 10 years and in the industry for over 20, it's not often I come across things with insurance that I haven't seen before.

And while diabetes in the insurance realm is nothing new, it has typically focused on the top-level diagnosis for underwriting rather than the reality people are going through. 

I've written before about the blunt approach medical insurance and the insurance industry as a whole have when it comes to mental health. However, things do change, and some things have a contribution.

One of the areas that I have become significantly more aware of is the plight of those that are non-neurotypical or, better put, neurodiverse. These are possibly new terms for many readers and ones that they know by different names like ADD, ADHD, & ASD.