Ambledown boosts cancer coverage in gap policies

Ambledown Financial Services has extended benefits and increased cover for its gap cover policyholders.

At its annual benefit update this year, Ambledown revealed it will cover additional cancer drugs and increase casualty and co-payment benefits to make it one of the most progressive and comprehensive coverage solutions in the SA market.

Along with its existing immunotherapies for cancer treatment, Ambledown has extended its cover to include five additional cancer medications, and targeted therapy now includes small-molecule cancer drugs. 

The casualty ward benefits have been increased from R10,000 to R11,000, and the co-payment benefit for the use of a non-designated service provider has been increased from R13,000 to R15,000.

The overall annual limit is R198,660, which will be increased to match the amount published by the Council for Medical Schemes during the year. Ambledown will increase premiums by an aggregate of 9.5% for 2024.

Another advancement lies in the enhanced efficiency of the claims processes for both providers and members. Payment procedures have been fine-tuned to benefit healthcare providers and members alike.

Furthermore, a new virtual assistant powered by ChatGPT will soon be available to provide members and brokers with instant responses to their queries.

Focus on cancer treatment

The significance of expanding the scope of cancer treatments becomes evident when considering cancer-related mortality in Africa.

Cancer mortality rates have doubled over the last 30 years in Sub-Saharan Africa, according to a report from The Lancet Oncology Commission.

Unless this progression is halted, the annual cancer death toll could hit 1-million by 2030, and the mortality rate could double again by 2040.

Egypt, Nigeria and SA (in that order) are the top three countries for cancer cases and deaths on the continent.

Researchers say that factors driving these figures include infection, ageing populations, behavioural changes, exposure to environmental triggers and genetics.

Public education programmes can be successful if tackled in the right way, but Africa looks likely to follow in the footsteps of the developed world, where less healthy but more pampered lifestyles have led to high rates of cancer.

On the plus side, spending on oncology worldwide is on a strong upward curve. Statista figures indicate that spending on oncology, including supportive care, rose from $61bn in 2013 to $193bn in 2022, and is projected to rise to $253bn in 2024.

All of this spending is leading to increasingly effective medical interventions to prevent, treat or cure the disease. 

These treatments include: 

• Nuclear medicine scans: Help oncologists detect tumours and see the spread of cancer much more effectively and earlier. Better information is making treatment decisions more precise.
• Immunotherapy: Could be seen as the “good guy” to chemotherapy’s “bad guy”. Chemotherapy kills fast-growing cells everywhere in the body, both cancerous and non-cancerous. Immunotherapy seeks to boost the body’s own immune system so it can identify cancer cells better and then destroy them. Chemotherapy and immunotherapy can be used together, alone, or in combination with other treatments.
• Hormone and targeted therapy: Used in cases of hormone-sensitive breast cancer. It can reduce the recurrence of these cancers and greatly reduce their spread. Hormone therapy can be used in conjunction with targeted therapy. 
• Photodynamic therapy: Combines light energy with a drug designed to destroy cancerous and precancerous cells. It is increasingly being used to halt the spread of certain types of localised cancers and improve quality of life.
• Stem cell transplants: Replace blood-producing cells destroyed by treatments such as chemotherapy and radiation. 

The importance of gap cover

Africa’s challenge of rising cancer mortality rates could potentially be addressed by the growing numbers of treatments.

However, for the majority, they are unaffordable. Even for those who have medical cover, rising costs have created a substantial gap between what medical aids pay and what service providers charge. 

“As its name suggests, gap cover was created to bridge this difference. Gap cover is not a medical scheme, and the cover is not the same as that of a medical scheme. Gap cover is not a substitute for medical scheme membership,” Michael Emery, Ambledown Financial Services marketing executive, points out.

“Gap cover insures medical scheme members against discrepancies between what the medical scheme pays and what the medical service provider charges for in-hospital procedures and specific outpatient procedures.

“It clearly has a key role to play, but only if the insurer is alert to the issue and takes proactive steps to include these new treatments, and others that will surely follow, in its benefits.”

Emery adds: “We look closely at every aspect of the healthcare sector to ensure our members are covered.

To watch the product launch, click here. For more information, visit www.ambledown.co.za 

This article was sponsored by Ambledown Financial Services.