Pre-exisitng conditions
Sadly, for many people living with cancer, the issue of pharmaceutical funding has raised its ugly head yet again. The scary thing is that even if you have health insurance you may not qualify for treatment with non-funded drugs – and for some people that can mean the difference between life and death. 
What’s the story?

In August 2016 pharmaceutical management agency Pharmac finally agreed to fund Keytruda for the treatment of melanoma. After showing real promise in the treatment of lung cancer, an application for funding was submitted in February 2017 – and patients are still waiting for an answer.

In the meantime many patients have been heartbroken to find out that their health insurance doesn’t cover the use of this potentially lifesaving drug. Since cancer rates are still on the increase, it is especially relevant that you take the time to make sure you are covered.

Is your Kiwisaver losing you money?
So what about the health cover I already have?

Simply put, not all health insurance is created the same.

Some health insurance companies, including the most popular, will only cover a small amount of non-PHARMAC funded chemotherapy treatment and may also have maximums on funded chemotherapy.

For example, the most popular health insurance company in New Zealand will only cover $10,000 of non-funded chemotherapy treatment (and will only cover a maximum of $60,000 for chemotherapy), yet another well-known company will offer unlimited cover.

Is your Kiwisaver losing you money?
What are my options?

Maybe changing your policy is an option. If you have been ill or injured however, and you don’t want to lose the cover you already have, then this probably isn’t feasible. Yet for others, their health insurance is through their employer and it’s just not financially sensible to change. Here are the steps that you should look to take:

1. Contact Your Provider
First of all contact your insurance provider and ask them about the limits for cancer cover on your policy. Ask them specifically about “PHARMAC” and “non-PHARMAC” covered treatments, and bear in mind that 12 months treatment with a drug like Keytruda will most likely top $120,000.

2. Talk To Your Boss
If your health scheme is through your work and you find out that it has shortfalls you should point this out to your company. It is unlikely that your manager wants to spend money every month on a benefit that isn’t going to work. You may be doing the boss a favour – and consequently helping yourself.

3. Take Out Complementary Cover
If you have a hole in your cover you can always take out extra health insurance rather than changing your policy. Taking out cover which complements your existing employee policy probably won’t be as expensive as you think.

4. Look At Trauma Cover
Another option is to take out some type of trauma cover which would give you a lump sum in an event to top up treatments. For an office worker aged 40, severe trauma cover of $100,000 will cost less than a coffee a week. For life saving products the government won’t supply, this seems like a bargain option to me.

It seems like the restrictions on the availability of medicines in New Zealand are here are here to stay.  Furthermore, new and potentially lifesaving products will almost definitely be kept from the NZ public due to cost. If you are changing your insurance policies it is especially relevant to take this into account. If you find you are stuck with a lesser product, look to reinforce it.

Since getting the balance right isn’t as straightforward as it seems, I recommend speaking to an adviser so that you don’t waste your money or time. Finally then you will be able to rest easy knowing you and your loved ones are covered.

You can see all of the personal insurance on offer here. Maybe you’ve got pre-existing conditions? No problem – check out my blog 3 Ways to Get Health Insurance For Pre-Existing Conditions – I can probably help you with those too.

Get in touch now to talk through your options by calling 0800 COVER YOURS or filling out the form below.  No obligation – just straightforward advice.



Marc Hamilton
Principal Adviser/Director


P: 0800 COVER YOURS (0800 268 379) M: 022 040 7117


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