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Health cover against cancer: Check policy for exclusions, sub-limits

Cancer-specific policies, which only cover cancer, are available as indemnity-based or fixed-benefit plans

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Sanjay Kumar SinghKarthik Jerome

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January is observed as cervical cancer awareness month. Cancer is also in the news because hospitalisation claims for this disease rose by 12 per cent in 2024, according to the Indian Healthscape 2024 report by MediAssist Healthcare Services, the country’s largest health insurance third-party administrator (TPA), which processes over a fifth of all hospitalisation claims.
 
“In India, one out of every nine people is likely to be diagnosed with cancer in their lifetime,” says Parthanil Ghosh, director and chief business officer, HDFC Ergo General Insurance.
 
Options to cover cancer
 
Cancer can be covered through several types of policies. Indemnity-based covers pay for hospitalisation expenses. “Now, insurers have also designed hospitalisation covers for people who have been diagnosed with cancer,” says Siddharth Singhal, head of health insurance, Policybazaar.com.
 
 
Critical illness plans are a second option. “These are fixed-benefit plans that cover several critical illnesses, including cancer,” says Kapil Mehta, co-founder, SecureNow.
 
Cancer-specific policies, which only cover cancer, are available as indemnity-based or fixed-benefit plans. Fixed-benefit plans offer a lump sum payout upon diagnosis and sometimes include an income benefit. “If the breadwinner gets diagnosed with cancer, the insurer may offer a pre-decided sum of money at intervals to help the family cope with the loss of income,” says Ghosh. Fixed-benefit plans don’t cover individuals who already have cancer.
 
Cancer-specific policies typically cover all stages of the disease. “They may cover a stage or two earlier than what a hospitalisation policy would pay for, so there is a slight benefit to owning them,” says Mehta.
 
Start early for better coverage
 
Purchase health insurance early while you are disease-free. “It might become very difficult to get a comprehensive health cover for someone who has already had cancer,” says Aayush Dubey, co-founder and head of research, Beshak.org.
 
Insurers may reject proposals or issue policies with restrictions and higher premiums. Dubey adds that insurers might also exclude cancer permanently from coverage. Singhal highlights that healthy individuals have a wide range of policy options, while those diagnosed with cancer must choose from a limited range.
 
Mehta recommends buying a broad hospitalisation cover first, ideally with a high sum insured. “If you have to undergo treatments such as immunotherapy, they can cost as much as Rs 30–40 lakh in a metro,” he says.
 
For those unable to afford a high cover, combining a basic hospitalisation cover (Rs 10–20 lakh) with a critical illness policy (or a cancer-specific plan) can be cost-effective. 
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Key considerations
 
When buying a hospitalisation cover, individuals with a history of cancer must review the coverage carefully. “Based on medical history and the current stage of cancer, the insurer’s underwriters may take a call on what is to be covered,” says Singhal.
 
Hospitalisation policies for those already diagnosed often include waiting periods. “Waiting periods for pre-existing diseases have now been standardised and cannot exceed three years,” says Singhal.
 
Fixed-benefit plans, especially critical illness plans, may have a survival period clause, usually of 15 days, which can sometimes extend to 30–60 days. “If the disease is vicious, the patient may not survive for a long period,” says Mehta. He advises avoiding policies with longer survival periods. Dubey stresses checking indemnity-based policies for co-payment clauses and sub-limits on room rent, specific diseases, and treatments.

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First Published: Jan 14 2025 | 10:48 PM IST

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