The C Word and Your Benefits Plan

I was recently asked to speak at an event , and I’m quite excited about it. Everyone who has worked with me knows I love a captive audience.  I don’t get to talk about what I do very often.

L Reitmeier
“I will do my part to help my clients manage their plans to support their employees” – Lizann Reitmeier, Health Practice Leader

The topic is benefit plans and cancer. It’s a tough one: cancer is an emotional topic for many of us. According to the Canadian Cancer Society, almost 200,000 cases of cancer were diagnosed in 2015, and approximately 78,000 people died from cancer. Cancer has touched the lives of everyone I know in one way or another. It will be difficult to speak to a group knowing there will be survivors in the crowd who know, firsthand, so much more than I do.

As a benefits practitioner, what do I know about cancer?

  1. Survival rates are increasing. Many more people will survive a cancer diagnosis in 2016 than ever before. According to the Canadian Cancer Society, between 1992–1994 and 2006–2008, survival rates increased from 56% to 63% for all cancers combined. This is outstanding news! And it’s the result of wonderful research that has brought better detection methods and better treatment.
  2. These new and improved treatments cost employer plans more. These treatments include some miraculous drugs that have turned previously terminal cancers into chronic illnesses, treated much like high cholesterol—but with a higher price tag. Many plan sponsors are now worried about protecting their drug plans from the cost of these drugs. For employees in Ontario and Atlantic Canada, for example, there is limited provincial coverage for oral cancer drugs.
  3. Pool charges are escalating at a rapid rate. As the cost of cancer treatment increases and shifts from government plans to employer plans, the pool charge insurers use to exclude high-cost claims from the employers’ experience are increasing rapidly. In a recent renewal, we saw the pool charge almost doubling, even though the employer had a $50,000 pooling level and no high-cost claims.
  4. Cancer treatment leaves patients out-of-pocket for several thousand dollars. A typical course of cancer treatment requires multiple hospital visits, meaning costs associated with time missed  from work, transportation, outrageous hospital parking fees and, possibly, childcare.  As if the illness isn’t enough, the extra costs for a family with a cancer patient can be a terribly stressful burden.

As a benefits practitioner, what can I do about cancer?

  1. Encourage my clients to review their drug plans and pooling arrangements. Pooling arrangements should reflect the employer’s risk tolerance. With increasing risk of a high-cost claim, employers may find they prefer a predictable pool charge for better protection and a lower pooling limit.
  2. Recommend Critical Illness offerings to my clients. Critical Illness coverage pays a lump sum benefit to covered plan members in the event of an eligible diagnosis. Cancer is covered under even the most basic critical illness policies, although there may be restrictions regarding what qualifies as a “covered cancer”. A lump sum payout supports plan members by offsetting the out-of-pocket costs not covered under their benefit plans. Depending on the size of the benefit, it could support employees seeking treatment or medication not covered by the provincial health plans or employer plans. Critical Illness can be added to the plan either as a mandatory offering or as a voluntary benefit elected by and paid for by employees want it. While Critical Illness coverage may not change the course of cancer treatment, it can help alleviate stress from the financial pressures, allowing patients to focus their energy on getting well.
  3. Promote wellness programs that encourage lifestyle changes to help avoid cancer. Cancer may not be avoidable for some people due to genetics. However, studies show that some key health metrics increase the risk of developing cancer. Wellness programs that help employees quit smoking, maintain a healthy weight, stay physically active and eat more fruits and vegetables will help reduce cancer risk. Education is key: focusing on these health triggers will help employees reduce not only cancer risk, but also the risks associated with many chronic diseases. Tools such as fitness trackers, behaviour coaches and incentives may increase participation and the program’s success rate.
  4. Continue to investigate pharmacogenomics. Pharmacogenomics involves using genetic testing to determine how successful a particular treatment will be for a particular individual. As genetic testing comes with many concerns, including privacy and discrimination, this is an area that needs careful oversight as it develops. Identifying the best course of treatment this way may mean an employer won’t be covering the costs of drugs that are not appropriate and may reduce the duration of absence. I think this is a win for all sides and goes beyond the purely financial benefits, as good physical health goes hand in hand with good mental health. Governments are currently reviewing the implications of DNA testing, and insurers are considering how to incorporate it into benefit plans. It’s important that this type of testing is allowed, while the rights of the individual are protected.

Of course, it goes without saying that I hope for a cure for cancer in the near future. But, in the meantime, I will do my part to help my clients manage their plans to support their employees and meet their corporate financial obligations. And, as Hugh Jackman advises: I will wear sunscreen.

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