This year, award-winning starlet Angelina Jolie underwent a double mastectomy, after genetic testing showed an 87 percent chance that the actress would develop breast cancer. In light of Jolie's very public medical announcement, many women with a family history of cancer considered taking a similar genetic test.
Available since 1996, this particular genetic test assesses a woman's risk for developing breast or ovarian cancer. With a small blood sample, DNA analysis can be performed, looking out for mutations in the BRCA1 and BRCA2 genes. Having a mutation in either of these genes doesn't guarantee that cancer will occur; however, women and men with the mutation do carry a much higher than average cancer risk. BRCA1 and BRCA2 mutations are responsible for 5 to 10 percent of all breast cancer cases, and 10 to 15 percent of all ovarian cancers.
So, to what extent do insurers cover the cost of BRCA genetic testing, and ensuing preventative care? Globalsurance conducted a survey with four insurance providers - Bupa International; Now Health International; Cigna; and InterGlobal - to learn more.
To begin, Globalsurance wanted to know if new clients were required to reveal results of a BRCA genetic test when applying for a policy. Bupa, Cigna and InterGlobal all indicated that if a client had knowledge of a genetic cancer risk before starting the plan, that information should be noted.
When Bupa asks new applicants to explain their medical history, there is a section to include any medical issues that the applicant expects to experience in the future. If a client's BRCA test revealed a high likelihood of developing cancer, this potential medical issue should be declared. Cigna likewise provides a medical questionnaire in which a customer would be expected to reveal the results of a genetic test. InterGlobal noted that a new client would need to declare any cancer risk discovered through genetic testing, but at the moment, that declaration itself would not affect insurance premiums (unless related to other mentioned medical history). Lastly, Now Health International would not require a client to inform them about test results.
Next, all four insurance providers were asked if they would cover a BRCA test for a client advised by his or her doctor to undergo the genetic assessment. InterGlobal reported that their Wellness benefit would cover routine mammograms and the BRCA test up to the stated wellness benefit limit. Any other treatments or procedures after that would not be covered if there is no positive diagnosis of cancer, though covered in full to the oncology limits if cancer is discovered. Bupa said that a customer with a plan offering diagnostic procedures would be covered for a BRCA test; but only if a patient's doctor has recommended the genetic test in order to determine or assess a medical situation. Furthermore, the test would also be covered if the patient has an active disease and testing is required to provide a definite diagnosis or suggest treatment, as long as these types of tests in general are included on the client's chosen plan.
Now Health International and Cigna both responded that due to exclusions on genetic testing, a BRCA assessment would not be covered under preventative care services. Now Health International does not cover the costs of a genetic test to discover if the client might be predisposed to developing a condition such as breast cancer, and Cigna excludes genetic testing in its coverage of preventative treatments. Cigna did note that its policy will pay for preventative surgery if there is a hereditary cancer risk; however, the cost of a genetic test used to discover such a risk will not be covered.
Globalsurance was also curious about inpatient, outpatient and oncology services: if a client had an inpatient only plan, but was advised to get an outpatient genetic cancer assessment, would this service be covered under oncology care?
All four insurance providers surveyed signaled that oncology coverage would not apply to procedures for a patient not yet diagnosed with cancer. InterGlobal said that doctor-recommended genetic testing for cancer might be covered, but under the listed benefits for preventative treatment rather than as an oncology service (meaning it would not be covered on an inpatient only plan). Both Cigna and Bupa noted that a patient is not eligible for cancer benefits until after the disease has been diagnosed.
Finally, each of the four insurance providers were presented with a hypothetical situation: if an existing client took a BRCA test which uncovered a very large risk of developing breast cancer (90 percent or higher, without actually receiving a diagnosis) would that client be eligible for preventative care?
In response to this query, Cigna referred once more to limits on preventative treatment; indicating that until a patient has been given a clinical diagnosis of cancer, preventative care will not be covered - although in the case of a family history of illness, surgery is included as part of the policy's preventative coverage. Similarly, InterGlobal explained that due to preventative treatment exclusions, no such care would be covered for a patient having discovered a high genetic risk of developing cancer. Neither Bupa nor Now Health International specifically addressed the coverage of preventative services; however, Bupa did note that mammogram coverage under a patient's wellness benefits could be used if genetic testing revealed a high risk of breast cancer.