The many cancer awareness days and months throughout the year are a reminder of just how prevalent this insidious disease has become in our modern lifestyles.  There is hardly a family that has been untouched by a cancer diagnosis of a loved one or close friend during their lifetime.  There are over 200 different types of cancers affecting one in four South Africans and there is absolutely no discrimination across age, gender or social class when it comes to who is affected.  Every year, over 100 000 South Africans will hear the words ‘you have cancer’, and six out of ten will survive their diagnosis, according to CANSA.

“Protecting yourself against the impact of a health crisis is all about taking preventative action.  Living as healthy a lifestyle as possible will lower your risks for cancer, while going for regular annual check-ups lead to early detection and treatment which has a far better prognosis than a cancer that is only detected at an advanced stage.  It’s also about sound financial planning to ensure that should you face a health crisis, you’ll be able to focus all your energy on your treatment and recovery, and not have to worry about managing the potential financial hang-over that comes with a cancer diagnosis and treatment,” says Martin Rimmer, CEO of Sirago Underwriting Managers, a Gap Cover Insurance provider underwritten by GENRIC Insurance Company Limited.

Surviving the financial challenges

Studies show that almost a third of cancer survivors experience financial burdens and significant out-of-pocket costs and shortfalls associated with cancer treatment in their healthcare funding strategies. Another significant factor is that many people are having to downgrade their medical scheme options during these tough economic times, which means a commensurate reduction in benefits, including a possible reduced cover for cancer treatment, thereby significantly elevating the associated risks.

“Earlier detection and treatment mean that the prognosis for surviving cancer is now better than ever.  However, the cost of funding the treatment can be a major debilitating factor, even if you are a member of a registered medical scheme.  While medical schemes typically cover the cost of certain cancer treatments as a Prescribed Minimum Benefit (PMB), depending on what medical scheme option you are on, your costs of treatment might not be covered in full and you could face some onerous out of pocket expenses, co-payments and shortfalls.  Certain medical schemes might also only fund certain treatments partially like biologicals, if at all.  If it’s a matter of life and death and you need these treatments, some medical schemes will allow you to upgrade your option immediately, but in the instances where you are not able to upgrade and your medical scheme options does not allow for the appropriate cover, you could be forced to sacrifice your life savings or future financial security to gain access to these treatments,” adds Rimmer. 

Costs are incurred even before diagnosis

What many people don’t consider is that diagnosing suspected cancer may involve expensive diagnostic tests and procedures such as PET scans, MRIs, biopsy and blood tests which medical schemes may impose co-payments or sub-limits on, costing you thousands of unbudgeted Rands upfront. 

“Comprehensive gap options like Sirago’s Ultimate and Plus Gap, provides an ‘Initial CancerDiagnosis’ benefit that pays you a lump sum of cash upon the initial diagnosis of malignant cancer which can immediately go towards recouping some or all of your upfront costs on the charges related to the cancer diagnosis,” says Rimmer.  

Medical scheme options typically fund cancer treatment in one of two ways – either up to a certain annual limitor up to a certain Rand value for the entire treatment.  In order to access these benefits, you are required to register on the schemes Cancer Treatment Plan. Once these limits are reached, large co-payments of up to 20% are incurred on any further treatment during the annual cycle. Sirago’s Ultimate, Plus and Gap Assist gap cover options provides additional cancer benefits which cater for these Cancer Co-payments once your medical scheme cancer benefit has been reached and treatment co-payments are applied, including those related to biological drugs.  Depending on your Sirago gap cover option, these co-payment benefits are limited to the available Overall Annual Limit available on your option.  In some instances, when the medical scheme has a rand amount limit for their cancer benefits, certain Sirago gap options make provision for an annual Hospital Booster benefit, providing for an additional R100 000 (option dependent) per beneficiary, per annum, on the proviso that the exact same protocols as prescribed in the medical scheme’s Cancer Treatment plan are maintained.  The trigger for any cancer benefit from your gap cover policy is that the member must belong and participate on the registered treatment plan as determined by their medical scheme,” adds Rimmer.

When it comes to breast cancer, breast reconstruction, if considered, is an important part of the recovery process and some medical schemes now cater for this either through risk benefits or via ex-gratia applications, but with varying limits.  “A Sirago Cancer Breast Reconstruction Benefit (option specific) covers the gap portion of this reconstructive surgery up to 300% of the claim and in addition to this, we also make up to R25 000 (option dependent) available for the reconstruction of the non-affected breast,” explains Rimmer.

A cancer diagnosis is unfortunately a “family diagnosis” and has a profound effect on your emotional, physical and mental wellbeing and typically impacts your whole family and close circle of friends.  During this time, make sure that your healthcare funding such as medical scheme benefits and gap insurance work hand-in-glove to provide you with access to the best quality healthcare and treatment in order to mitigate as far as possible the need to delve into your monthly disposable income or life savings.   Always talk to an accredited and independent financial advisor, to put together a well-rounded healthcare funding plan to carry you through a possible health crisis, thereby ensuring that your only concern is your return to health when and if it happens” concludes Rimmer.

For more information go to www.sirago.co.za

Information provided is general in nature and does not constitute financial advice. 

Sirago Underwriting Managers (Pty) Ltd (FSP: 4710) is an authorised Financial Services Provider. Underwritten by GENRIC Insurance Company Limited (FSP: 43638), an authorised Financial Services Provider and licensed non-life Insurer.