A question that is often asked, ‘So will the insurance company actually pay?’ Yes they do, they pay valid claims.

This is the issue, defining valid claims. Valid claims are claims that are both covered by the policy and the policyholders have been complete in their disclosure.

For example a cardiac event, similar to a heart attack, but isn’t severe enough to qualify as a heart attack under the definition of a heart attack on the trauma policy wording. This isn’t a valid claim, as it didn’t meet the definition of the policy document.

Also, for leukaemia too, if the commentary in the media is to be believed. This new medicine on the market, approved for use in New Zealand, is currently not funded. The indications from the commentary, this medicine is one of the only options for melanoma patients to be successfully treated. 

I am not clear on the survival rates, but the results to date appear to be miraculous when standard chemotherapy has been less than useful in treating melanoma to date according to the many articles on the subject. The problem is the cost, somewhere in the region of $300,000 over two years to access this new treatment.

Insurance and shades of grey, no not 50 shades but certainly something most people don't like to hear when it comes to insurance. Most people want to hear black and white. My experience is every claim has shades of grey and they are rarely cut and dried. There is always something that pops up; most are foreseeable, some not so much.

Where I am going with this is the differing effects different policy wordings have at claim time.

For example there are a few insurance company trauma policies where a good angina attack could almost qualify for a trauma claim and then there are others where you have to be half dead and not working, probably not working in a manual job ever again, before you could claim.

The New Zealand Herald kicked off their five-part series on cancer today. Martin Johnson investigates the controversies in cancer testing and treatment and the moving stories of people diagnosed with cancer.

I've mentioned many times, here in my blog and many times to clients and frankly anyone that will listen, our public health system while good in many areas, often falls short in many areas too.

Managing medical expenses is a large area of risk management. It is also an area where people often don't spend a lot of time on managing. Public health is an area where the government has the largest spend, ($15 Billion for 2015) which should be an indicator you need to consider your options here as well. 

Medical Insurance Treatment Myths and Realities

My share of my blog post on Movember got a really good reply with some well thought out points that I come across with clients every day. Some are well founded and understood, others things have changed as has the approach. I felt it was worth a blog post by itself.

Susan’s original post:

Good on you Jon-Paul, admirable cause, but it is my view that Health insurance company don't do Health prevention, you have to pay for this type of health service even if you have a mastectomy your health insurance won't pay for a re-build for want a better word, apparently its plastic surgery and its not covered to have you looking normal after going through harrowing surgery and treatment...

Here we go again, more medical insurance updates and changes

We have:

• A company offering $500,000 cover per person per year
• Addition of non-Pharmac cover taking us to 6 providers
• Another sorting it's congenital conditions cover and bringing it in line with the rest of the market
• The addition of guaranteed wordings, making it three that do.
• The addition of home-based non-Pharmac coverage that is new across the board.
• Another with had a pre-existing conditions cover offer, including the usual big-ticket conditions normally once you have them you can never get them covered. Heart, hips and cancer.
• The Same provider was also covering congenital conditions, except what they class as chronic conditions, which is a short list, but nasty conditions. (November - December 2015)

This is what we achieved for one of our clients without getting creative on cover levels and types of cover, the creative bit is likely to be another $2-3000 per annum ongoing.

So what have we achieved?

We've managed to achieve a $2,500 per year average saving on what they were previously doing and this applies to what they do going forward. Add to this an additional $2000 per annum after restructuring how they're covered, giving an expected savings of $4,500 per annum ongoing.

Significant in most people's book, so how did we achieve this?

Ok so this is right off the life insurance beaten track and into bleeding edge technology. For those that know me, not really that unusual for me, having played in the technology space in a previous life.

Again, from those that know me, also know me as a bit of a petrol head. The last week had suggestions I had taken leave of my senses, as I gave up my car to the panel beaters, long story but was not me, and jumped into an electric vehicle or EV for short.

Most people when discussing income protection for the first time assume it automatically covers job loss, it doesn't and often it's not an option for income protection. Over the last 5-10 years, this has changed with mortgage repayment often now having the option and some income protection now has it as an option too. The point I am making is things change, but this article is not about redundancy, more on redundancy here.

What I am talking about is a new product that has been released by Asteron that is quite different to the normal income protection approach.

When the subject of medical insurance or cancer treatment comes up, the discussion on non-Pharmac medicines usually follows.

What are non-Pharmac medicines?

Non-Pharmac medicines are where the government does not fund the drug or treatment being prescribed or recommended for a treatment and you will have to find the money to pay for it.

It does not matter what the stats are, if you are someone who needs a treatment and the government does not fund it, you want to be able to access it. Which is why, dollar for dollar you take the medical policy with coverage over the one that does not, even if it is a bit more expensive you probably still should.

At the National Advisers Conference Gala Dinner last Thursday night, 11 June, the hotly contested Professional Advisers Association Excellence Awards were announced.

The PAA Excellence awards are designed to recognise PAA members who demonstrate the founding values of the Association:  client advocacy, diligence in their work, compliance with relevant regulations and professional development. 

“Our winners exemplify what it takes to be a quality adviser, every day and in all interactions with clients: energy, commitment, professionalism and an absolute focus on doing the best for their clients. They thoroughly deserve the acknowledgement of these awards,” says Rod Severn, CEO of the PAA. 

The PAA was delighted to recognise Jon-Paul Hale from Willowgrove Consulting in Auckland as the winner of New Insurance Adviser of the Year.

 We are proud and privileged to have received the PAA New Insurance Adviser of the year award for Jon-Paul. The PAA is the Professional Advisers Association and helps advisers to better themselves and their businesses.

The award is for adviser professionalism based on how the adviser works and how they give advice. It is not one of sales targets or sales volumes as some awards sometimes are.

The assessment process reviewed two client files for how the advice was put together and given. With the way we conduct business this was not a difficult request, aside from the printing and copying.

For us the most challenging part of this was ensuring client privacy protection, as every document needed to be sanitised for names and identifying information. As a client, you will appreciate how many that is.

By posting this, I’m going to raise a contentious topic. One that clients often do not understand, advisers generally avoid discussing, providers publicly discourage but operationally encourage and the Financial Markets Authority (FMA) is starting to have a closer look at.

I have stated the previous parties in a very specific order, from most impacted to the one with the stick they can use, and the players in between.

An interesting question that is often asked. In a nutshell, whatever you like, just that it gets deducted from your ACC weekly compensation claim.

ACC weekly compensation is there to cover loss or replace a loss of income. You earn something that loss is reduced; your ACC payment will be reduced too.

How does this work?

ACC have published the new motor vehicle levies and they make interesting reading.

ACC have gone through and assigned a rating system from L1 to L4 for most vehicles, L1 being the most expensive and L4 being the least. If yours is not defined then the levy works on a year of manufacture basis. L1 for older vehicles and graduating though to the cheapest L4 for newer vehicles.

The reason I’m writing this is I disagree with some of the assertions in the NZ Herald article. ACC have done this review based on claims risk from actual injury data not vehicle safety. Injury’s drive ACC’s costs, not vehicle safety. Yes safer vehicles generally means less injuries and less ACC cost, but that doesn’t always translate directly from vehicle safety testing.