Private cancer cover dispute
Deputy Collins described a constituent’s dispute with Laya Healthcare after a costly policy refused cover for pembro despite advertised cancer benefits. The Minister said insurance cover is governed by the individual contract and urged people to scrutinise policy terms if insurers exclude treatments.
Laya Healthcare provides many different levels of private health insurance. One of my constituents purchased one of its plans at a substantial cost of €1,470 per year. Regarding cancer care, the policy clearly stated that it covers treatment to stop the spread of cancer and, where possible, to remove it entirely. All of the company's schemes have comprehensive cancer cover and best in class approach advertised. Despite all this they refused to cover pembro, as it is commonly known. Pembro is a recommended cancer treatment by the European Medicines Agency and is now part of the comprehensive treatment plan and prescribed by consultants who specialise in cancer treatment. Laya Healthcare, in refusing to cover the cost of pembro, is questioning the European Medicines Agency. Is Laya Healthcare, in its refusal to cover the cost of pembro, mis-selling its schemes by not telling current and potential members that they do not have cover? By doing this, Laya Healthcare is selling comprehensive healthcare products, but when you pay Laya and need a product, it is refused to you, scamming innocent people. Healthcare insurance companies are regulated by the Health Insurance Authority, which is under the Central Bank. How, if properly regulated, has Laya been allowed scam the innocent public?
Comment on this
That is an upsetting account that the Deputy has had to give about a constituent who has been paying their private healthcare for years and was then told that pembro is not covered. The Health Insurance Act regulations require insurers to require a minimum level of cover to every insured person. Beyond that, in terms of what specific issues are covered or not, that is set out in the agreements entered into between the individual and the healthcare insurer or provider. It is certainly the case that people should look closely. If Laya Healthcare is precluding cover for this, and other entities are providing cover, that is something that should be publicised.