Cancer cover explained

Existing policies:

If you already have a Plan with PHC the table below may not apply to your policy. If you wish to clarify the cover provided for cancer under your policy, please contact us on 01923 770000 and quote your certificate number.

Plan 4:

For a summary of the cover provided under Plan 4 please contact us on 01923 770000.

New Policies:

For a summary of the cover provided for cancer under Plan 1, Plan 2 and Plan 3, please see below. The table of cover is applicable to policies incepted on or after 1st January 2012.

The following table is a summary of the cover provided for cancer under this policy and should be read alongside the rest of the handbook, including the benefits table. This table follows the format required by the Association of British Insurers (ABI) to help you understand your cover for cancer more clearly.

Plan 3 only - Please note any out-patient consultations or diagnostic tests for cancer will not count towards the £1,000 out-patient limit.

Cancer cover for Healthcover4life Plans 1, 2 & 3

Place of Treatment
Treatment of cancer at a private hospital, day-patient unit or scanning centre listed in our Directory of Hospitals.
Intravenous chemotherapy received at home in the circumstances shown in the benefits table.
There is a charitable donation payable for each night spent in a hospice or for each night you are receiving hospice at home.

Diagnostic
Consultations with a specialist, diagnostic tests ordered by a specialist, CT, MRI and PET scans and surgical procedures.
Cover for genetic testing proven to help the selection of appropriate chemotherapy.
Genetic screening required to establish a genetic predisposition to certain forms of cancer will not be covered as this would be considered preventative.

Surgery
Surgical procedures for the treatment or diagnosis of cancer, as shown in the 'Your cover for certain types of treatment' section of your membership handbook when that treatment has been established as being effective.
If you would benefit from a new or experimental surgical procedure please contact us. We will discuss your proposed surgical procedure with you and agree the level of benefit we will pay in writing before your treatment starts. Please note that we will only pay up to the equivalent non-experimental surgical procedure as listed in the schedule of procedures and fees.

Be aware:

There is no cover for complications that arise as a result of authorised experimental and unproven surgical procedures.

Preventative
There is no cover for preventative treatment, for example:
  • Screening undertaken as a preventative measure where there are no symptoms of cancer. For example, if you receive genetic screening, the result of which shows a genetic predisposition to breast cancer, you would not be covered for the screening or a prophylactic mastectomy to prevent the development of breast cancer in the future.
  • Vaccines to prevent the development or recurrence of cancer, for example Vaccinations for the prevention of cervical cancer.

Drug Therapy
Drug treatment of cancer (such as chemotherapy drugs, hormone therapies and biological therapies) where the drug has been licensed for use by the European Medicines Agency or the Medicines and Healthcare products Regulatory Agency and is used within the terms of that licence.
There are some drug treatments for cancer that are typically given for prolonged periods of time. Such prolonged treatment normally falls outside benefit. However in the case of treatment of cancer we make an exception (subject to the limits detailed below) for chemotherapy drugs and biological therapies such as trastuzumab (Herceptin) and bevacizumab (Avastin). These drug treatments will be covered when they are used within the terms of their licence, and up to the period of the drug licence.

There are also some drug treatments given to treat conditions secondary to cancer, such as erythropoietin (EPO), which will be covered whilst you are undergoing eligible chemotherapy for cancer.

Please note: changes in drug licensing mean that cancer drug treatments covered under this policy will change from time to time. For further information on licensed cancer treatment please contact our claims team.
Experimental drug treatments for cancer will be covered as part of a randomised clinical trial which has been approved by the appropriate ethics committee, and the costs are agreed by us in writing before treatment commences.
Cover for chemotherapy and/or biological drug treatment given to prevent a recurrence of cancer or for maintenance of remission.
Bisphosphonates used to prevent bone damage in cancer, where the drug has been licensed for use by the European Medicines Agency or the Medicines and Health products Regulatory Agency and is used within the terms of that licence.
Chemotherapy and/or biological drug treatment for cancer given solely to relieve pain.
Out-patient drugs and/or drugs prescribed by your GP are not covered by your policy. For example, hormone therapy tablets (such as Tamoxifen) are out-patient drugs and therefore are not covered by our policies.

Radiotherapy
Radiotherapy, including when used to relieve pain.

Palliative
Treatment needed regardless of whether the intention of this treatment is to cure, to prolong life or to relieve symptoms.

End of life care
In addition to the palliative treatment shown above, we will make a charitable donation if you are being cared for in the end stages of life at a hospice or if you are receiving hospice at home.

Monitoring
Follow up consultations and reviews of cancer will be covered as long as you have a PHC private medical insurance policy with an appropriate cancer benefit. Cover will be subject to the terms and conditions of that policy at the time.

Limits
There are no time limits on your cancer treatment. Your policy provides cover throughout your active treatment and for any follow up consultations and reviews while you are a member of PHC.
There are no monetary limits that apply to your cancer treatment.

Other benefits
Stem cell treatment and bone marrow treatment, including the reasonable costs incurred for a live donor to donate bone marrow or stem cells as shown in the 'Your cover for certain types of treatment' section of the membership handbook.
There is cover for the provision of external prosthesis up to the benefit limit shown in the benefits table.
There is cover for the provision of wigs up to the benefit limit shown in the benefits table.
There is no cover for related administration costs (such as, but not limited to, transport costs and the cost of a donor search).
There is no cover for the harvesting and storing of sperm or eggs.

Examples of Cancer Cover

The following are typical examples of cancer claims and how we would usually deal with them. These examples are based on a policy which offers a full range of in-patient and out-patient benefits and that the condition is not excluded under the underwriting terms.

Beverley has been with PHC 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.

Will her insurance cover this treatment plan and are there any limits to the cover?

Benefit would be provided for the removal of Beverley's breast along with reconstructive surgery.

We would also provide benefit for radiotherapy and chemotherapy, including benefit for experimental drug treatment if it is part of a randomised clinical trial and the costs have been agreed by us before treatment commences.

We would not provide benefit for Beverley's hormone therapy tablets as these are given on an outpatient basis.

Cara has previously had a breast cancer which was 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 and are there any limits to the cover?

Benefit would be provided for the removal of Cara's breast along with reconstructive surgery. We would also provide benefit for radiotherapy and chemotherapy, including benefit for experimental drug treatment if it is part of a randomised clinical trial and the costs have been agreed by us before treatment commences.

Monica, who was previously treated for breast cancer under her existing policy, has a recurrence which has unfortunately 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?

  • Benefit would be provided for Monica's chemotherapy, including benefit for experimental drug treatment if it is part of a randomised clinical trial and the costs have been agreed by us before treatment commences.
  • Benefit would be provided for Monica's monthly infusions to help the bones against pain and fracture, whilst it is used within the terms of that drug's licence.
  • Benefit would be provided for Monica's weekly infusions of a drug to suppress the growth of the cancer whilst it is used within the terms of the drug's licence.

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

Hospice benefit is only available if Sharon's cancer has reached the terminal stage. In this event, we would donate £75 per day to the hospice for a maximum of 15 days. In addition, we would pay Sharon a cash benefit of £75 per day for a maximum of 15 days.