Ben­e­fit is based on Al­trisk di­rec­tor’s per­sonal ex­pe­ri­ence

Weekend Argus (Saturday Edition) - - GOODPOSTER -

Al­trisk de­vel­oped its ad­di­tional ben­e­fit for stage zero can­cer fol­low­ing its un­der­writ­ing di­rec­tor’s per­sonal ex­pe­ri­ence of pre-ma­lig­nant can­cer.

Da­lene Allen had a check-up with a der­ma­tol­o­gist, who dis­cov­ered a mole that had to be re­moved.

The mole turned out to be a melanoma (tu­mour of melan­in­pro­duc­ing cells) and re­sulted in Allen un­der­go­ing a ma­jor skin graft and mak­ing nu­mer­ous vis­its to the der­ma­tol­o­gist and a plas­tic sur­geon.

There­after, she had nu­mer­ous tests, screen­ing pro­ce­dures, scans and vis­its to a ra­di­ol­o­gist and a spe­cial­ist on­col­o­gist.

As part of the stan­dard screen­ing pro­ce­dure, Allen also had to have a chest X-ray, which re­vealed a shadow on one of her lungs. To de­ter­mine if the shadow on her lung needed to be treated, Allen had to have a very ex­pen­sive scan, which was not cov­ered by her med­i­cal scheme. For­tu­nately, her lungs were fine. In to­tal, Allen spent close to are in­creas­ing, and peo­ple with stage zero can­cer are likely to sur­vive the or­deal.

But Al­trisk ar­gues that re­ceiv­ing the treat­ment you need may come at a price, de­pend­ing on how com­pre­hen­sive your med­i­cal scheme cover is (see “What you can ex­pect your med­i­cal scheme to cover for stage zero can­cer”, be­low), and you may have other fi­nan­cial needs while you un­dergo treat­ment for stage zero can­cer.

Al­trisk says that screen­ing tests for stage zero can­cer are just as oner­ous and ex­pen­sive as those for the more ad­vanced stages of can­cer, and the di­ag­no­sis may be no less emo­tion­ally dev­as­tat­ing.

Stage zero can­cer does not fea­ture on the Stan­dard­ised Crit­i­cal Ill­ness Def­i­ni­tions Pro­ject (Scidep) grid drawn up by the As­so­ci­a­tion for Sav­ings & In­vest­ment SA (Asisa).

Life as­sur­ers who are mem­bers of Asisa have agreed to use the grid R70 000 on tests, screen­ings and surgery. About 75 per­cent of this amount was re­cov­ered from her med­i­cal scheme, al­though Allen had to set­tle the ac­counts up­front and there were a good few thou­sand rands that were not paid by her scheme.

Allen’s crit­i­cal ill­ness pol­icy did not pay out, be­cause the depth of her melanoma was not se­vere enough to qual­ify for a ben­e­fit.

Allen then re­alised that stage zero can­cer di­ag­noses are on the in­crease, but peo­ple may not be cov­ered fi­nan­cially for be­ing dili­gent and go­ing for reg­u­lar check-ups.

Had Allen en­joyed the ben­e­fit of Al­trisk’s add-on ben­e­fit for stage zero can­cer, she would have qual­i­fied for a R50 000 pay­out on di­ag­no­sis.

Al­trisk’s stage zero can­cer ben­e­fit is an an­cil­lary ben­e­fit on its crit­i­cal ill­ness pol­icy.

The ben­e­fit cov­ers 17 in-situ car­ci­no­mas (can­cers that be­gin in a tis­sue that lines the in­ner or outer sur­faces of the body), which are to show you, as a pol­i­cy­holder or po­ten­tial pol­i­cy­holder of a crit­i­cal ill­ness pol­icy, what they will pay out for each of the four stan­dard­ised sever­ity lev­els of the four main crit­i­cal ill­nesses. One of the four main ill­nesses is can­cer.

‘MIN­I­MAL IN­TER­VEN­TION’

Peter Dempsey, deputy chief ex­ec­u­tive of Asisa, says the pur­pose of crit­i­cal ill­ness poli­cies is to pro­vide cover for life-chang­ing events.

Stage zero can­cers are not on the grid, be­cause they are seen as “fully cur­able with min­i­mal in­ter­ven­tion and cost”, he says.

How­ever, life as­sur­ers are free to of­fer ad­di­tional ben­e­fit lev­els should they so choose, Dempsey says.

Dr Peter Bond, Old Mu­tual’s chief med­i­cal of­fi­cer, says many life as­sur­ance com­pa­nies do of­fer cover for breast can­cer at stage zero in their crit­i­cal ill­ness poli­cies, but this cover is typ­i­cally at a lower typ­i­cally ex­cluded from crit­i­cal ill­ness pol­icy ben­e­fits. It pro­vides a sum as­sured of up to R100 000 – 50 per­cent payable on di­ag­no­sis with treat­ment and 100 per­cent if you need an or­gan re­moved.

Allen says the ben­e­fit may be im­proved once the claim­ing pat­terns for it are es­tab­lished.

Al­trisk says your fi­nan­cial ad­viser should make sure that you un­der­stand what is and is not cov­ered by a crit­i­cal ill­ness pol­icy, and this in­cludes mak­ing you aware that many poli­cies do not pro­vide cover for stage zero can­cer. per­cent­age of the sum as­sured.

As a re­sult of reg­u­lar check-ups, you may be di­ag­nosed with a stage zero can­cer of the breast, blad­der or cervix, or a melanoma may be found, Bond says.

How­ever, gen­er­ally you would be for­tu­nate to be di­ag­nosed with any other can­cer at stage zero, be­cause there are no symp­toms that would lead to a di­ag­no­sis, he says.

If you re­quire surgery as a re­sult of a di­ag­no­sis of stage zero can­cer, you are likely to be cov­ered by your med­i­cal scheme, and surgery re­sults in 99 per­cent of such cases be­ing cured, Bond says.

Dr Maritha van der Walt, chief med­i­cal of­fi­cer at Dis­cov­ery Life, says Dis­cov­ery’s crit­i­cal ill­ness poli­cies cover breast can­cer in-situ that is treated with a mas­tec­tomy, as well as pro­phy­lac­tic mas­tec­tomies, be­cause of the life-chang­ing ef­fect of such mas­tec­tomies.

Dis­cov­ery Life’s crit­i­cal ill­ness

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