India Cancer health insurance plans

Different Stages of Cancer

There are different insurance policies that cater to the different stages of cancer. The four stages of cancer are mentioned below.

• Carcinoma In Situ(CIS)
• Early stage
• Major stage
• Critical stage

The main factor the people have to keep in mind while opting for an insurance plan is whether the plan covers pay-outs at all the stages. Taking into account of the benefits that are applicable stage wise is also a good option to compare policies. Cancer insurances are generally meant to cover the medical expense related to the treatment of cancer and often does not offer death benefit.

Benefits under Cancer Insurance Plans

Benefits for Cancer insurance as offered by various insurers differ from one to another…some of the benefits offered under these plans include:

• In-Patient Hospitalization
• Conventional treatment
  • Chemotherapy
  • Radiotherapy
  • Organ transplantation, as part of Cancer treatment
  • Surgeries for excision of cancerous tissue or removal of organs/ tissues (Onco-surgery)
• Day Care Treatment
• OPD Expenses
• Chemotherapy & Radiotherapy Cover
• Organ Donor Cover
• Alternative Treatments
• Pre Hospitalization & Post Hospitalization – 30 / 60 days
• No Claim Bonus - If there are no claims during the year, the sum assured increases by a pre-specified percentage
• Annual Health Checkup
• Quick Recovery Counselling
• Doctor On Call
• International Second Opinion
• Room Rent Modification
• Air Ambulance
• Ambulance Cover
• Premium waiver is available under certain conditions like early stage cancer diagnosis
• Insurance cover is not ceased after first diagnosis
• Tax benefits under section 80D of the Income Tax Act

These plans cover expenses at multiple stages of cancer and a lumpsum is paid out on cancer diagnosis.

Factors to Consider Before Buying Cancer Insurance Plan

Most of us rarely spend much time in comparing health insurance plans prior to deciding on one, like we would spend on something like a television or refrigerator etc…It is advisable to evaluate options before taking a cancer insurance plan. Below are some of the factors that need to be considered before making a decision to go for a specific cancer insurance plan:

Sufficient Sum Assured – With double digit medical inflation, it is important to keep in mind rising costs of medical treatment while deciding on the sum insured that one want to have under their policy. Cancer treatment takes time and it costly, so it is advisable to opt for a cancer insurance plan with high sum assured. This will provide satisfactory financial support when the illness strikes.

Family History – Given that genetic factors / family history is one of the reasons for cancer to attack an individual, it may be prudent to keep this in mind while deciding to first go in for a cancer related plan and then arriving at a suitable coverage plan.

Waiting Period and Survival Period - It is important to check on the waiting period (normally mandatory waiting period is 30 days and cancer related waiting period is 90 days) i.e the amount of time you will have to wait before the policy will start coverage and survival period, which is the time after cancer diagnosis the policy holder has to be alive in order to claim benefits of the policy.

Exclusions under the Plan – While it is important to be aware of what’s covered, it is equally important to be aware of what’s excluded under such plans…go through the exclusion list prior to making a decision on the optimum plan for your requirements.

Duration - A policy having a long duration is beneficial to the applicant to ensure protection for a longer duration. Also with waiting periods to be considered, the full effect of the coverage will be available after crossing the waiting period. Another important factory is since there is lifelong renewability, one should invest early in this coverage and remain insured, because as the data suggests, there is a 10% possibility of men/women contracting cancer before the age of 75 years, and getting a coverage in the alter years will be an issue with other pre existing medical conditions.

Existing Health Insurance Coverage - Having a comprehensive health insurance policy plus a separate cancer insurance plan does not necessarily mean that one gets double the benefits. Most insurance policies come with a ‘coordination of benefits’ clause, stating that one plan will not cover expenses that the other plan does.

Claim Settlement Under a Cancer Plan – An ideal plan should offer coverage for all stages of cancer. A Cancer care plan will make payment of 25-30% on early stage diagnosis and remaining 70-75% on major stage or the entire on major stage whichever is earlier.

Premium Payment Options - The premium payment option for the Cancer Insurance Plan would vary from one insurer to another. Typically, the premiums can be paid either annually, quarterly or monthly basis.

Exclusions in a Cancer Insurance Plan

Some of the general exclusions under this plan are as follows. This is not an exhaustive list, please go through the same in the policy wordings available with your policy kit :

• Skin cancer
• Any kind of cancer directly or indirectly caused by or contributed to by sexually transmitted diseases, HIV, or AIDS
• Cancer resulting from any congenital condition, pre-existing condition; biological, nuclear, or chemical contamination; contact with radiation or radioactivity from any non-diagnostic or therapeutic source
• Convalescence, general debility, run-down condition or rest cure, Nutritional deficiency states.
• Psychiatric, mental and behavioral disorders
• Intentional self injury
• Use of intoxicating substances, substance abuse, drugs / alcohol, smoking and tobacco chewing
• Venereal Disease and Sexually Transmitted Diseases,
• All expenses arising out of any condition directly or indirectly caused due to or associated with Human T-cell Lympho Trophic Virus type III (HTLV- III) or Lymphadenopathy Associated Virus (LAV) or HIV/AIDS
• Treatment arising from or traceable to pregnancy, childbirth, family planning, miscarriage, abortion and complications of any of these (other than ectopic pregnancy)
• Treatment for Sub-Fertility, Assisted Conception and or other related complications of the same.
• Expenses incurred on weight control services including surgical procedures such as Bariatric Surgery and /or medical treatment of obesity
• Treatment of Sleep apnea, treatment for genetic and endocrine disorders
• Expenses incurred on High Intensity Focused Ultra Sound, Uterine Fibroid Embolisation, Balloon Sinoplasty, Enhanced External Counter
• Charges incurred on diagnostics that are not consistent with the treatment for which the insured is admitted in the hospital / nursing home
• Naturopathy, Unconventional, Untested, Unproven, Experimental therapies.

Some of the Cancer Insurance plans available in the market are below:

Star Cancer care gold	Religare Cancer mediclaim	HDFC ERGO Women Cancer Plus
BUY NOW	BUY NOW	BUY NOW
Policy Term
1 year	1/2/3 years	Upto 3 years
Eligibility Criteria
Persons between the age of 5 months and 65 years, who have already been diagnosed with Cancer (Stage 1 or Stage 2) can avail this insurance.	5 years to 50 Years on Individual Basis	18 to 65 years
Sum Insured (SI)
Rs.3,00,000/- and Rs.5,00,000/-	10 Lakh | 25 Lakh | 50 Lakh | 1 Crore | 2 Crore	3 Lakhs to 1 Crore
Coverage
Section Sum insured (Rs.) Sum insured (Rs.) Section 1 – Lumpsum benefit-when there is a recurrence / metastasis and / or a second cancer 1,50,000/- 2,50,000/- *Section 2 – Indemnity Cover – Surgical and Interventional Therapy 1,00,000/- 1,50,000/- *Section 3 – Indemnity Cover - Non Surgical and Non Interventional Therapy 50,000/- 1,00,000/- Total 3,00,000 /- 5,00,000/- *Applicable only for accidents & diseases other than Cancer and its related ailments	Individual : Maximum up to 6 Persons	Individual and Family Floater
Pre hospitalization
Up to 30 days prior to the date of admission	30 days	-
Post hospitalization
Up to 60 days prior to the date of admission	60 days	-
Day care treatments
All day care treatments	Listed as per the Plan, Up to Sum Insured	-
Ambulance cover
Emergency Ambulance charges for transporting the Insured person to the hospital up to a sum of Rs.1500/- per hospitalization and Rs.2000/- per policy period.	Up to Rs. 3000 per hospitalization	-
Renewal
Lifelong Renewability	Lifelong Renewability	Lifelong Renewability
General waiting period
Section 1: 30 months waiting period : Treatment must have commenced only after waiting period for an admissible claim under this section Section 2 and Section 3: 30 days waiting period ( Not applicable for accidents) 24 months waiting period for specified illness/diseases/treatments 48 months waiting period for pre existing diseases.	Initial Waiting Period: 90 days Specific ailment Waiting Period: Not Applicable Pre-existing diseases Waiting Period: 4 years	90 days and 180 days as per the illness specified in policy wordings 1 year for Pregnancy and Newborn Complications. 4 Years for all Pre-existing Conditions declared and/or accepted at the time of applying first policy with us.
Co-pay
10% co-pay shall be applicable on each and every claim under Section 2 and 3 if you are aged above 60 years during first inception of this policy. Such co-payment shall be applicable for renewal also. If your age is upto 60 years during first inception of this policy then co-payment condition shall not be applicable	Up to SI*; only for SI* >=1Cr (Limited to In-Patient Care and Day Care treatment) with a Co-payment of 10% per Claim	-
Claims procedure
For Section 1: a) Certificate from the Treating Doctor confirming the recurrence/metastasis / second malignancy of Cancer b) Clinical, radiological, histological, pathological, histopathological and laboratory reports in support. For Section 2 and Section 3: · Call the 24 hour help-line for assistance-1800 425 2255/ 1800 102 4477. Inform the ID/Policy number for easy reference · In case of planned hospitalization, inform 24 hours prior to admission in the hospital · In case of emergency hospitalization, information to be given within 24 hours of hospitalization · Cashless facility can be availed in all network hospitals wherever possible · In non-network hospitals payment, must be made up-front and then reimbursement will be effected on submission of documents if claim is found admissible	No Claims Bonus - 50%/25%/25%-Corresponding increase in SI* for 1st, 2nd and 3rd continuous claim-free Policy Years respectively, Max up to 100% of SI*	-
Advantages
1) No Third Party Administrator, direct in-house claims settlement. 2) Faster and hassle – free claim settlement. 3) Cashless facility wherever possible in network hospitals.	1)Pre and post hospitalization medical expenses covered 2)Chemotherapy & Radiotherapy Cover 3)No specific ailment waiting period	Cancer Cover, Carcinoma in Situ, Major Illnesses Covered, Minor Illnesses Covered

* - subject to underwriting approval
** - upto Sum Insured of 20 lacs and Age of 55 years. Above this PPC is required
*** - upto 50 years of Age. Above this PPC is required
And more than 70-80% is caused due to environmental factors as opposed to the belief that cancer is due to genetical factors.