Medical Insurance for Cancer

Private health insurance can cover cancer treatment.

Depending upon the policy you take out, you could have full cover for cancer care, subject to our cancer care guidelines.

 

Cancer as a condition does not easily fit into the acute and chronic definitions used to categorise other illnesses. We want you to have a clear understanding of what is covered (eligible treatment) and what is not covered (non-eligible treatment) for cancer treatment under your policy.

If treatment for cancer is ever necessary, then you will have the personal support of your own Freedom adviser. We will authorise
your claims, guide you through your treatment programme and explain what treatment is covered under your policy. Your adviser will be there to support your care.

What is covered?

• Surgery, chemotherapy, radiotherapy and support services that are administered to achieve cure or to reach remission. Treatment plans and surgery must be widely recognised as safe and effective treatments
• Chemotherapy for drugs licensed by the European Medicines Agency (EMEA). They must be used for the purpose for which they are currently licensed and widely available within the NHS. Combination drug therapies will only be considered if widely recognised for use within the NHS. All drugs must also be agreed by National Institute of Health and Clinical Excellence (NICE)
• Hormonal and biological therapies, eg. Monoclonal antibodies, such as Herceptin, if licensed with the EMEA. They must be approved by the National Institute of Health and Clinical Excellence (NICE) and be used for the purpose for which they are currently licensed and widely available within the NHS. If used in combination with other drugs, hormonal and biological therapies will only be considered if these combinations are widely recognised for use within the NHS
• Benefit for follow-up consultations and monitoring for a period of 5 years once treatment to achieve cure or to reach remission has ceased
• Breast reconstruction and surgery to improve symmetry, following a mastectomy or lumpectomy. We will pay for such operations for a period of up to 24 months following initial surgery

 

What is not covered?

• Drugs that are still under trial or trials of combination drug therapies. These can be defined as experimental
• Surgical and non-surgical treatment of cancer that is not recognised for treating that particular type of cancer
• Maintenance or long-term therapies where the condition is stable, remains in remission, or remission cannot be achieved.
• Treatment of cancer where the intent is to provide relief of symptoms
• Treatment costs that exceed the Procedure limits or Policy limits (if applicable)

 

Guidance

If your cancer comes back, Freedom will assess your medical condition and proposed treatment as a new episode of treatment and
will follow the same process in assessing the eligibility of your claim. Where you have a recurrence of cancer, we will ask your specialist for specific information about the intent of treatment to determine whether your claim remains eligible for benefit.
Where the intent of treatment is to provide relief of symptoms, rather than attempting to affect the growth of cancer, benefit will cease. We will always talk to you and your specialist if this situation arises to ensure a smooth transition from private to NHS healthcare and that you do not experience a break in treatment.

 

Cancer Claim Examples

 

Beverley has been with Freedom for five years when she is diagnosed with breast cancer. Following discussion with her specialist she decides to have the breast removed followed by breast reconstruction. Her specialist also recommends a course of radiotherapy and chemotherapy. In addition she is to have hormone therapy tablets for several years. Freedom would cover the cost of mastectomy and breast reconstruction. Freedom would then cover the course of radiotherapy and chemotherapy drugs provided that these are used within normal clinical practice. Acceptable chemotherapy drugs are drugs that have been approved for use in the NHS by NICE (National Institute for Health & Clinical Excellence), are used within their licensed indications, as licensed by EMEA (European Medicines Agency) or MHRA (Medicines & Healthcare products Regulatory Agency) and for combinations of drugs, the drugs must have been shown to be effective in actively treating the type of cancer she has.
The hormone tablets would not be eligible for benefit as these are outpatient drugs and she would need to obtain these by
prescription from her GP.

 

Cara has previously had a breast cancer which was previously treated by lumpectomy, radiotherapy and chemotherapy under her
existing policy. She now has a recurrence in her other breast and has decided to have a mastectomy, radiotherapy and chemotherapy. Will her insurance cover this?
Freedom would cover her for the mastectomy, radiotherapy and chemotherapy. The course of radiotherapy and chemotherapy drugs would be covered provided that these are used within normal clinical practice. Acceptable chemotherapy drugs are drugs that have been approved for use in the NHS by NICE (National Institute for Health & Clinical Excellence), are used within their licensed indications, as licensed by EMEA (European Medicines Agency) or MHRA (Medicines & Healthcare products Regulatory Agency) and for combinations of drugs, the drugs must have been shown to be effective in actively treating the type of cancer she has.

 

Monica, who was previously treated for breast cancer under her existing policy, has a recurrence which has spread to other parts of
the body. Her specialist has recommended the following treatment plan:
• A course of six cycles of chemotherapy aimed at destroying cancer cells to be given over the next six months.
• Monthly infusions of a drug to help protect the bones against pain and fracture. This infusion is to be given for as long as it is
working (hopefully years)
• Weekly infusions of a drug to suppress the growth of the cancer. These infusions are to be given for as long as they are working
(hopefully years).
Will her insurance cover this treatment plan and are there any limits to the cover?
Freedom will provide benefit for the six cycles of chemotherapy provided that these are used within normal clinical practice
and where the treatment is given with curative intent and is not experimental. Acceptable chemotherapy drugs are drugs that have been approved for use in the NHS by NICE (National Institute for Health & Clinical Excellence), are used within their licensed indications, as licensed by EMEA (European Medicines Agency) or MHRA (Medicines & Healthcare products Regulatory Agency) and for combinations of drugs, the drugs must have been shown to be effective in actively treating the type of cancer she has.
Freedom does not provide benefit for preventative treatments such as the monthly infusions as described. However, whilst undertaking chemotherapy we would provide funding as necessary.
In this particular scenario, Freedom would not provide benefit for the weekly infusion under the terms and conditions of the plan as the drug is not being given with curative intent.

 

John would like to be admitted to a hospice for care aimed solely at relieving symptoms. Will his insurance cover this and are there any limits to the cover?

As the admission to the hospice is aimed solely at relieving symptoms, and not at curing his condition, Freedom will be unable to provide benefit for his admission to the hospice.

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