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Which Insurers Will Cover Genetic Testing?

Pacific Prime recently consulted several of its top international insurers – Bupa International, Now Health International, Cigna and InterGlobal – in aims of discovering to what extent they would each cover BRCA genetic testing.

Angelina Jolie recently made controversial waves in the media world when she had a double mastectomy performed after results from a genetic test showed an 87% chance that she could develop breast cancer. As news of Jolie’s actions has spread, more women have considered taking similar tests.

The genetic test used to detect the risk of breast or ovarian cancer in women is performed by a DNA analysis via a blood sample to search for mutations in the BRCA1 and BRCA2 genes. While possessing a mutated gene does not necessarily guarantee the development of cancer, both men and women who do carry the mutation are at a much higher risk than those who do not.

Available since 1996, this particular form of genetic testing has undoubtedly grown in popularity since Jolie’s precautionary actions. In light of this, Pacific Prime consulted several of its top international insurers – Bupa International, Now Health International, Cigna and InterGlobal – in aims of discovering to what extent they would each cover BRCA genetic testing and the preventative care that often follows such tests.

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Firstly, Pacific Prime wanted to find out whether or not a new client would be required to reveal the results of a BRCA genetic test when applying for a policy. InterGlobal, Cigna and Bupa all claimed that it would be necessary for a client to note down whether they had knowledge of their higher than normal risk of cancer but Now Health International does not require such a declaration.

InterGlobal requires clients to declare any results from genetic testing but currently, a declaration in itself would not affect a policyholders overall insurance premium unless results could be related to a previous medical condition. Cigna provides new clients with a medical questionnaire and expect clients to note down any results from genetic testing. Similarly, Bupa requires an explanation of a client’s medical history and provides a section for customers to note down any medical issues they expect to experience in the future.

Pacific Prime then wanted to find out the insurer’s procedure if a client has been advised by their doctor to undergo a BRCA test. Bupa indicated that if a doctor has recommended the BRCA test in order to further determine a medical condition, the test would be covered as long as the clients' plan offered diagnostic procedures as part of the coverage options.

InterGlobal’s Wellness benefit will provide coverage for BRCA tests as well as routine mammograms up to the previously stated benefit limit. If a positive diagnosis of cancer is revealed, ensuing treatment will be covered in full within the oncology benefit limits however if no diagnosis is observed, any preventative procedures would not be covered.

Both Cigna and Now Health International reported that due to their exclusions on genetic testing, BRCA assessments would not be covered. If a client has a hereditary cancer risk, Cigna will cover a preventative surgery cost and will provide coverage for other preventative treatments but genetic testing itself is not included.

In regard to inpatient, outpatient and oncology services, Pacific Prime then asked the insurers for their response to covering a patient on an inpatient plan who has been advised to get an outpatient genetic cancer assessment and whether this service would be covered under oncology care.

All four insurers indicated that if a client has not yet been diagnosed with cancer, oncology coverage could not be applied. Cigna and Bupa both specified that a patient could not be eligible for cancer benefits until after a diagnosis and InterGlobal reported that a doctor-recommended genetic test for cancer may be covered, but only as part of preventative treatment benefits rather than an oncology service and therefore, a test would not be eligible for coverage on an inpatient only plan.

Finally, the insurers were asked how they would handle the following situation whereby if an existing client underwent a BRCA test and results indicated a very high risk of developing breast cancer (at least 90% or higher but still without a cancer diagnosis), would they still be eligible for preventative care benefits?

InterGlobal clarified that care would not be covered for a patient at high risk of developing cancer due to preventative treatment exclusions. Likewise, Cigna explained that due to the limits on their preventative treatments benefits, preventative care would not be covered until a clinical diagnosis of cancer has been provided but that evidence of hereditary illness could allow for preventative surgery to be covered.

Neither Now Health International nor Bupa specifically addressed preventative services coverage although Bupa did indicate that mammograms could be covered under a client’s wellness benefits if results from a genetic test revealed the patient to be at high risk of breast cancer.

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