Breast cancer:? Are you covered?

2013-11-03 14:00

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Specialists such as oncologists can charge more than medical aid rates, so it makes sense to consider buying a severe illness cover that can help whenever there’s a shortfall, writes Neesa Moodley-Isaacs

Contracting a dread disease such as breast cancer is likely to have a devastating effect on your lifestyle.

Apart from the physical and emotional trauma, you are likely to face financial pressure as a result of high medical bills and time off work.

You will face intense treatment, often with debilitating side effects, sky-high medical bills, time required off work and psychological adjustment.

June le Roux, a housewife in North West, was recently faced with huge bills when she was diagnosed with breast cancer.

“Thankfully, my medical aid covered all my treatments and medication. I also had severe illness cover with Old Mutual that paid out within two weeks of my diagnosis.” says Le Roux.

“A few years ago, when my financial adviser spoke to my husband and I about the value of having this cover, I knew it was not to replace our medical aid, but to cover any shortfalls, should there be any, and to make recovery more pleasant.”

She can only consider breast reconstruction two years after she completes her radiation treatment, so she has invested the payout from Old Mutual in case she decides to have the operation in the future.

Dr Peter Bond, the chief medical officer at Old Mutual, says: “Medical aids are generally excellent when it comes to illnesses such as cancer.

“Most will cover 100% of the medical aid rates and some even 200% and 300%, depending on the plan you have.

“The problem is that superspecialists, such as oncologists, can charge significantly more than medical aid rates, and people who are on more basic medical aid plans often have to

pay the difference out of their own pockets. The answer is to have either severe illness or gap cover

to cover these shortfalls.”

Apart from covering treatment shortfalls, severe illness cover can also pay for home adjustments such as ramps for wheelchair access, recuperation getaways or even replace your income while you recover.

“Or, as in the case of Le Roux, it can be reinvested for future treatments or reconstructive surgery,” adds Bond.

What you need to check for when buying severe illness, dread disease cover

1 Is your claim based on the diagnosis of a disease, or on the degree of permanent damage or impairment sustained?

2 Does your cover reduce each time you claim or will you be allowed to claim the full benefit in the event you contract a second, unrelated illness? Will your policy allow you to make a full claim in five years or will cover be reduced as a result of breast cancer claim?

3 Is the cover a fixed amount or is it calculated according to a sliding scale?

4 Check for benefits such as a “waiver of premium” – this means that if you are unable to work due to a severe illness or dread disease, your premiums will be covered by your insurer. This is usually for a period of six months.

5 Will a change of occupation, income or part-time activities affect your benefits and/or premiums at a later date?

6 Some policies will give you the option of a fixed premium for a fixed benefit that does not increase each year.

This may suit your budget but make sure you compare the cover with the cover you would have if you paid a yearly increasing premium.

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