Private medical insurers are creating uncertainty for members of PMI schemes because they have differing approaches to cancer therapies.
Watson Wyatt is warning employers and especially those that operate self-funded arrangements to ensure they are aware of the PMI providers’ stance on cancer treatment as it could impact financially on scheme members.
The use of Herceptin and other treatments are increasing but their cost is an issue for the NHS and PMI providers may also have financial reasons why they do not cover the use of these drugs.
Watson Wyatt head of Healthcare and Risk Consulting David Cross says: “Our guidance to all employers offering private medical benefits, and particularly those operating self-funded arrangements, is to ensure that such decisions are being taken using the best governance principles.
“As such, employers need to understand the position of their own plan rules and benefit design with regard to cancer, ensuring that any decisions taken with regard to cancer benefits are formally supported by both the current financial and clinical evidence available. It should, however, be appreciated that employer decisions in this area are very possibly going to be subject to future challenge from claimants if benefits are to be restricted.”