Insurance

Insurance advisers face non-Pharmac poser

Wednesday 29th of August 2012

Jones said he is in the process of contacting all of his clients that have health insurance - but not pre-existing conditions - to recommend they switch to a policy that includes cover for non-Pharmac benefits.

"If my client got even a whisper that there was a product out there that could help and he's sitting there paying $300 a week for his medication, he would be naïve not to at least explore legal channels," he said.

"I'd want someone's head on a platter."

He said he was aware of clients with trauma cover taking payouts and travelling to Australia for cancer treatments unavailable in this country, and that under the current adviser regulations, he believed not recommending non-pharmac health insurance was just too risky.

He said he would write to each client recommending non-pharmac cover, and if they decline, send a second letter confirming the fact they were offered the option.

However, QuoteMonster's Tim von Dadelszen said care needed to be taken when recommending a client change a policy - especially health insurance.

"The level of complexity at claim time, you've got to be pretty nervous and have pretty good reasons to transfer a client from one policy to another."

Chatswood Consulting's Russell Hutchinson raised another concern around the value of non-pharmac cover.

"Although there was a lot of fuss over Herceptin, it's a narrow treatment that is unsuitable for lots of clients - that's common with non-funded treatments. If they are really useful, they tend to get funded."

For Jones however, the regulatory climate justifies the effort.

"It'll just take the slightest thing [to prompt legal action] in this day and age," he said.

"I don't want to be on the front page of any paper."

Comments (10)
Steve Wright
Totally agree with Mark. Access to funding to pay for treatment not publicly funded is the reason clients pay for medical insurance. If you are not discussing the issue with your clients and giving them sufficient information to make an informed decision on the issue you are likely to find Section 9 of the Fair Trading Act becomes your worst nightmare - just ask Mr Hartles. I disagree with Russell's attempts to trivialise the problem because while the need for non-funded drugs may only arise in a relatively few cases (how do we know this? Do insurers keep track? I doubt it)the costs involved are enormous - exactly why insurance is needed. In addition, my understanding is that there are many drugs not funded and in particular many new ones not funded because it takes Pharmac many years to research and approve new drugs. While there are insurers out there willing to cover non-funded drugs, in my view it is a breach of any number of laws not to raise it with your client and give them the options. It's all about looking after the client, not justifying what might be convenient to the adviser.
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12 years ago

Simon Rule
Agree with Mark. This discussion is just all about making our clients "aware" that some health insurers offer non pharmac benefits AND guaranteed wordings whilst other health insurers don't. I would have thought that most advisers would view these kind of policies as a "golden opportunity" to have a conversation with their clients about the benefits of health insurance?
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12 years ago

Giles Thorman
I have been providing Medical Insurance for my clients for nearly 22 years in NZ. During that time I have had countless claims via a variety of different Insurers, and I have had different claims service and different claims paying attitude from those different Insurers. However never once in that time have I had a claim for Non Pharmac drugs. THAT DOES NOT MEAN I NEVER WILL, however to somehow make it the only criteria for where a Broker places a medical policy I find worrying. I also find it disturbing that this Industry seems incapable of rational debate unless we have some outlandish scaremongering thrown in for good measure. We now have the twin bogeymen of the FMA and Grey suited Lawyers to scare us all witless.
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12 years ago

Kevin Wike
I think as a client I'd rather have the policy that covers all available treatments...especially if the premiums are the same - why not? Surely we are talking about future proofing ones' access to private medical care and who knows what sort of treatments will be available in 20 years time?
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12 years ago

Broker Broker
@Dirty Harry 'I know that one major insurer who has soap-boxed the drugs thing to death is losing millions of dollars a year paying those claims. It blatantly cross-funds its health product by requiring health be sold attached to life or other cover.' Pretty bold statements here - would you like to tell us all who this insurer is?
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12 years ago

Broker Broker
@ 6ftndr : yeah exactly, so are insurers getting a lot of non-pharmac claims or aren't they? If they are then that discounts what most advisers are saying that it isn't a benefit worth having. If they aren't getting a lot of claims then it's clearly an affordable benefit for the insurer to offer.
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12 years ago

Giles Thorman
Hmmmm. 6ftndr seems to think that a company providing a benefit other Insurers do not and subsequently (supposedly) losing millions of dollars is sustainable; where is the money going to come from other than from policyholders via increased premiums? Whether OnePath is "losing millions" on this product I suggest is a question best directed at them rather than hypothesised upon here, unless of course Dirty Harry can tell us how he knows this "fact"? OnePath do charge 10-15% more for the deluxe version that includes guaranteed wordings and non Pharmac drugs, so we have a choice to give our clients. A question though for Mark Jones before he embarks on his crusade is, do all of his clients have full disability cover? Which type of protection is most important to a clients limited premium dollar? Surely a question as part of a full review rather than one size fits all??
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12 years ago

Simon Rule
Can't believe we are even debating this folks! Non Pharmac drug cover IS a health benefit worth having. Would be like giving a client income protection and only having the policy payable for 12 months (versus paying to age 65) Yes, the likelihood of the client needing a non Pharmac drug is remote (and so is the client needing that monthly income benefit from the insurer to age 65) but what if they do….??? Insurance is supposed to be all about protecting our clients against a "worst case" scenario. Why else take cover to begin with? I ask those advisers who question the worth of having non pharmac cover to put themselves in the shoes of an adviser who has to say to their client that the health policy they sold them 2 years ago won’t now cover the $100,000 worth of experimental drugs (year one) that their partner or child needs. Now swing that round and imagine been the adviser who tells that same client “guess what, your health insurer is going to be paying for the full treatment programme recommended by your specialist” Not sure about you lot but the second scenario is why I work in this industry. As far as the long term sustainability of non pharmac cover is concerned I agree with Kevin’s comments.
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12 years ago

Steve Wright
By having this debate every adviser is on notice to make an honest, objective and rational investigation into the extent of the problem so that they are able to honour their obligations to their clients (and I'd suggest you keep a detailed record of your findings for that defence you might have to put up one day)and provide unambiguous, accurate and objective advice. My understanding is that there are many drugs that are not funded and even when they are they are not always funded for the purpose required by the client. Even Herceptin is not universally funded for every client for whom it might be recommended. Good professionals know what they are talking about and don't make convenient assumptions.
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12 years ago

Steve Wright
I agree with Graeme about taking a holistic view, but that also includes fairly considering all providers and not creating convenient, spurious, arguments because you don't want to sell OnePath or Partners. What Jane's story proves is that the Pharmac issue is a real one and a significant one which cannot be ignored when discussing risks and insurance with clients. Not raising the issue and discussing with it with clients (giving them sufficient information to make an informed decision)will almost certainly be misleading in terms of section 9 of the Fair Trading Act, actually read Gilmour v Decision Makers and Hartles if you don't believe me and HOLD ON TO YOUR WALLETS!
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12 years ago

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