Cancer Cover - Excess baggage

The risk profile of cancer has changed, although many travel insurance providers still seem reluctant to insure someone affected by the disease, including those in remission. Alwynne Gwilt moves to dispel the myths of cancer and breaks down insurers' approach to writing this risk

The reality of cancer is changing. The simple facts are that more people are being diagnosed with the disease in its various forms including younger people, namely those under 65. However, more people are now also responding well to treatment and going into remission. Either way, say politicians, charities and specialist underwriters, the numbers cannot be ignored. As such, most believe the general insurance market ought tore-examine the high prices of travel insurance products for cancer patients - including those in remission - to reflect this changing risk profile.

Jonathan Buttery, director of broker Voyager, which owns specialist provider Able 2 Travel, says: "It's an area that has been seen too rigidly. Many people with cancer are not that bad a risk, so claims performance needs to be kept under review to make sure the additional premiums charged are reasonable."

But striking that balance is difficult and this is not an area many insurers would necessarily want to invest in, according to Peter Hayman, head of PJ Hayman and Company, a travel insurer that includes Free Spirit, which insures people with pre-existing medical conditions. "If you want to get involved in this area it can be an expensive learning curve," he says.

Mr Hayman and others point out that because they have developed their companies around specialty insurance, with the capital to back them if they receive a high-cost claim, this makes the provision of insurance for those with cancer more feasible.

Krish Shastri, director of Insure Cancer - a specialist travel underwriter covering in-depth cases, including terminally ill patients - uses the analogy that a person would not go to a GP but an oncologist to treat their cancer. "So why would you go to the high street for your specialist cancer travel insurance?" he asks. Yet even if those involved in this market realise the difficulties high-street providers may face, it does not ease the frustrations they feel on behalf of the clients who eventually reach them after being refused repeatedly elsewhere.

But this doesn't mean the industry itself is completely ignorant of the issues. With approximately one in three people being diagnosed with cancer at some point in their lives, it is not surprising that someone working in insurance will have experienced the same frustrations as those of the general public. Three years ago, Fiona MacRae, an Equity Insurance executive, faced these difficulties first-hand when she was diagnosed with breast cancer. "It seemed to be a broad-brush approach. They'd say, 'You've got cancer - that's dangerous and scary and it's going to cost you a lot of money'," she says of her own experience trying to obtain travel insurance.

Unexplained loadings

Ms MacRae has since created Insure Pink and Insure Blue, Equity's products specifically tailored for people with breast and testicular cancer. In her experience, insurers were often loading premiums by up to 300%, even though she was already in remission from the disease. "No one could explain to me where the risk was. However, this was just not acceptable. Once you've had your treatments and all has gone well, you're the same as any other person," she comments.

Of course, Ms MacRae had the benefit of 20 years of insurance knowledge behind her when she started calling up high-street insurers for quotes. But, as she and others specialists point out, the unfortunate reality for most of the public is they simply do not realise why they are being put through a long, often tedious, process to obtain something they feel they should be entitled to before travelling.

"In many instances, the experience of the customer can be a very bruising one and often comes at a time when they're in the battle for their lives," explains Dr Shastri. "They're seeking to take a therapeutic break only to find the insurance industry is unsympathetic; it's emotionally damaging for the patient."

Added to this is the fact many patients will travel on a normal policy without realising they are not, in fact, covered. Sharon Hodgson, the Labour MP for Gateshead East and Washington West, raised the issue in parliament through an early day motion in November last year. In it, she stated: "The travel insurance industry should be more sensitive in dealing with those who have been diagnosed with breast cancer, including those in remission, and who sometimes face unreasonably high charges for travel insurance, sometimes making it too expensive to enjoy a holiday."

One year on, she has 58 signatures on the EDM and is keeping the issue on the agenda of her All Party Parliamentary Group on Breast Cancer. Through that, she says, she has been shocked to learn how many people are unaware of the issues. "Even a spokeswoman who had a double mastectomy didn't realise she wasn't covered. It's not a widely known fact and often people just want to recuperate and go on a holiday," Ms Hodgson says.

She is now working with Ms MacRae - who will speak at the next parliamentary group meeting - and hopes that by keeping this issue in the public eye, more people will become aware of the caveats most policies include. "It's not something we can legislate for," she points out. "I just want as many people as possible to find out this is an issue that needs to be considered."

Others outside the insurance industry are also calling for change. Charity Macmillan Cancer Support has produced a document entitled Recovered But Not Covered. In it, the charity outlines that people should be aware of companies' duties under the Disability Discrimination Act if they are being refused travel cover. According to Macmillan: "It is unlawful for someone with cancer to be discriminated against in terms of access to good facilities and services."

So what should travel insurers do? Most specialist underwriters recognise that not everyone is going to get involved in this area, since it requires significant investment of time and money. Not only do staff need to be trained in call centres to be empathetic and understanding of the issues at hand but systems such as the Helix - a commonly used technical underwriting system for medical conditions - need to be implemented with a preparedness to pay large claims if they arise.

Mr Hayman adds: "There's a danger of going down the aggregator route with price being driven down. As soon as we get the likes of Money Supermarket or Confused involved in this area, you'll get people that don't understand. The key is proper assessment to generate a fair rate for underwriter and customer alike."

While not resistant to new entrants, Dr Shastri says simple referrals would be a big step forward: "There are hundreds of thousands of customers not travelling because they've been refused by five insurers on the high street and no one has had the decency to refer them to a specialist underwriter that can cover them." It would make a massive difference, he adds, if confused customers were directed to providers that can solve their problems.

Sensible signposting

Mr Hayman agrees, saying the industry could make progress simply by being sensible. "You don't have to be an insurer that accepts young drivers in sports cars but you can signpost them to where they can get cover," he says.

However, if an insurer or broker is willing to enter this market, Dr Shastri says sensitive points must first be considered. He cites one major faux pas commonly asked by generalists, namely whether a patient has received a terminal diagnosis from a doctor. "It's a tick-box operation and a call-centre employee has to do that before moving on, so they're really twisting the patient's arm by forcing them to say 'Yes' or 'No'," he explains.

This issue is contentious. Ms MacRae says she did not want to know from her doctor because that was a part of her coping mechanism. "You'd be asked that question and then say, 'No, I didn't ask,' and then they say, 'Well, can you go and ask?'. I would say, 'No, I don't want to know'," she says.

But other companies suggest it is in the best interest of the policyholder to be as honest as possible. "If they don't know, the policy is to refer them back to their GP," explains Diane Caplehorn, a unique account manager at Heath Lambert. "It's imperative the individual makes a full declaration - but our staff are trained by a number of medical charities so they are able to ask such questions in an empathetic way."

Without this information, Ms Caplehorn says the insurer would not be providing a proper policy and a claim might fail at a critical stage. "Everyone is quoted a premium based on their declaration," she explains. "But we focus on making the customer journey as easy as possible."

At Able 2 Travel, Mr Buttery comments that if a patient says a diagnosis has not been given, it will leave it at that. "That, in itself, does not preclude them from getting cover," he says.

What everyone does agree on, however, is that doors must be kept open for the benefit of the industry and its clients. "It's about looking at the risk, rating it correctly and Treating Customers Fairly," emphasises Ms MacRae - and yet even the Financial Services Authority, as enforcer of the TCF regime, does not see travel cover for people diagnosed with cancer as a cut and dried issue. A spokeswoman for the regulator says this is a difficult arena for it to get involved in and may be beyond its remit. "It wanders into price regulation," she says about the high premium prices. Asked about the frustration experienced by potential customers when repeatedly refused cover, she simply says: "It's part of the shopping around process for consumers."

However, Ms MacRae raises the point that repeatedly ringing insurers is not the same for a healthy consumer as it is for one with cancer: "It's a soul-destroying exercise. I thought, 'I don't want to share very personal information with some kid on the other end of the line'. All you want to do is go on holiday. You don't want to be reminded that you have cancer."

All the risk factors

Fully understanding the reality of such risks is fundamental before writing them. Mr Hayman reveals that, this year, his company took a close look at the rates it was offering. "We found we could reduce rates by 30% and did so," he says. This came in a large part from simply looking at the book and discovering there was less of a risk than previously thought. "What insurance providers say is that cancer represents primarily a cancellation risk, more than a medical risk, but in the big high-street schemes there's less of an understanding of this."

Another big help would be for the industry to start working together, adds Ms MacRae. Equity spent two years researching breast and testicular cancer in order to write the risks properly. "You've got to look at each cancer individually and it takes a long time to get the question sets right," she explains. "This is not done overnight so it would be great if another insurer researched and took on a different cancer, and so forth. Then we could pool our knowledge. Otherwise, with 200 different cancers, it's going to take a long time."

Dr Shastri concludes by reiterating the need for better signposting: "What insurers are not doing is following TCF by saying, 'We can't provide this cover but you might like to call someone who can'. This is the one area where the industry can redeem itself in the eyes of the public by making a meaningful contribution to a patient's quality of life."


Pauline Marren:

When Pauline Marren received the news from her oncologist that she could travel, she was overjoyed. It would give her and her husband time together in order to regain some sense of normality and closeness in their lives. But, she says, this proved no easy task. "I needed to obtain travel insurance, surely not a difficulty having had the specialist's opinion and encouragement. What subsequently transpired became a nightmare for me."

Despite receiving a list of insurers that were meant to be able to provide cover, even for those with a terminal diagnosis, none would accept her after they had heard about her condition. "The information I provided over the phone had been put through a computer, which issued a refusal. I became increasingly more depressed at having to give the same information over and over again," she says.

For someone who had enjoyed a full and busy life, with a responsible job, she says she was shocked to suddenly find herself transformed into a "faceless number". After receiving quotes as high as £2360.61 - more than the cost of the holiday - she was convinced by her husband to return to the drawing board and ended up coming across Insure Cancer, which was able to provide cover at a much lower cost.

"I hope insurers will try to see the complete person and work with cancer support groups to give patients a better, more compassionate and humane service in the future," she concludes.

Tessa Burton:

Tessa Burton has become a bit of an expert in trying to negotiate travel insurance territory. After being diagnosed in 2004, Ms Burton says she has been through multiple hoops as her condition changed over the years.

This year, she decided to fulfil a long-held desire to travel to the Rocky Mountains in Canada. But she was already keenly aware of what that could mean. "You know before you start that you're not going to get anywhere but I was so determined to go on holiday that I just kept trying. It was so frustrating to talk to people who had no medical knowledge," she says.

Some specialist providers were unable to help, as her condition had progressed beyond the boundaries of what they would insure. But then luck seemed to strike, she says. She rang a recommended insurer and received a quote for £81. Not believing a company could provide the proper cover, she says she wrote down every element of her condition and repeated it to the call-centre employee. The agent still promised it was just fine and, although Ms Burton was skeptical, she waited to receive the papers in the post. Upon opening them, she discovered the agent had written down her medical condition as pelvic inflammatory disease. "He'd got it wrong. They had to listen to the tape, which was in South Africa, but they were very honest," she says.

The company agreed to pay for the cover after Insure Cancer stepped in and worked with them to create a proper premium.

Her message to the industry is to understand the risks in a competent way, before attempting to enter this market: "People with cancer are able to travel and, after going through chemotherapy and radiotherapy, they need a holiday. That's what people work towards: to go away and have something special and it's very important to be able to have that."

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