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

At its annual benefit update this year, Ambledown revealed that 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 South African 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 Regulator 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 the ChatGPT engine will soon be available to provide members and brokers with instant responses to their service-related queries.

Focus on cancer treatment

The significance of expanding the scope of cancer treatments becomes evident when considering the concerning trend of 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. More than 500 000 people died of this disease in 2020; unless we are able to halt this progression, the annual cancer death toll could hit 1 million by 2030, and the mortality rate could double again by 2040.

The overall incidence is 128.2 per 100 000, exceeding the average of 115.7 per 100 000 people and 108.5 per 100 000 for countries in the low and medium human development index regions globally. Egypt, Nigeria and South Africa (in that order) are the top three countries for cancer cases and deaths in the continent.

Researchers say that factors driving these figures include infection, aging populations, behavioural changes (such as diet, alcohol use and smoking), exposure to environmental triggers, and genetics. Public education programmes can be successful if tackled in the right way, but the sad truth is that 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 – 295.3 cases per 100 000 people in very high human development index countries, and 190.5 in countries that fall into the high category.

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 $61 billion in 2013 to $193 billion in 2022, and is projected to rise to $253 billion in 2024. All of this spending is leading to increasingly effective medical interventions to prevent, ameliorate or cure the disease.

These treatments include:

Nuclear medicine scans (also known nuclear imaging, radionuclide imaging, and nuclear scans) are helping oncologists detect tumours and see the spread of cancer much more effectively and early. Better information is making treatment decisions much more precise. For example, nuclear medicine is helping create tailored treatment plans across multiple disciplines for patients suffering from prostate cancer.

Immunotherapy could be seen as the “good guy” to chemotherapy’s “bad guy”. Chemotherapy kills fast-growing cells everywhere in the body, cancerous and non-cancerous. It’s very much a reactive therapy. By comparison, immunotherapy seeks to boost the body’s own immune system so that it can identify cancer cells better – and then destroy them. Chemotherapy and immunotherapy can be used together, alone, or in combination with other treatments. Chemotherapy has an immediate effect, while immunotherapy can help the body continue attacking the cancer once treatment is concluded.

Hormone and targeted therapy is being 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, medicines that attack specific chemicals in cancer cells.

Photodynamic therapy combines light energy with a drug designed to destroy cancerous and precancerous cells. It is increasingly being used to halt the spread certain types of localised cancers, and improve sufferers’ quality of life.

Finally, 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 is potentially able to 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 the medical aid pays and what service providers charge for treatments.

“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.”” Emery 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 out-patient 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 says: “We look closely at every aspect of the healthcare sector to ensure our members are covered.

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Ambledown Financial Services is authorised Financial Services Provider No.10287

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