Cancer has become the most dreaded and least understood medical threat. It also appears much more prevalent than ever before. What is pretty clear is the havoc it plays with lives, lifestyles and finances. Cancer treatment can be prolonged and its high cost warrants proper planning.
Cancer insurance can be in the form of benefit policies or indemnity policies.
An indemnity policy reimburses hospitalisation and treatment expenses within the policy scope. It can be renewed in the usual course after a claim and will continue to offer coverage. Examples of indemnity policies covering cancer are Star Health Insurance Company Limited’s pilot product, Star Cancer Care Gold, and HDFC ERGO Health Insurance Company Limited’s iCan cancer insurance. The latest in this stable is Cancer Guard launched by The New India Assurance Company Limited. The policy covers expenses related to cancer treatment and is available in sums insured of ₹5, 10, 15, 20, 25 and 50 lakh and anyone from 18 to 65 years of age is eligible for coverage.
A benefit policy pays the SI on diagnosis of cancer with no reference to expenses, and coverage ceases once the claim is paid. The payout can be one lump sum or over several years in a pre-specified manner.
Aditya Birla SunLife Insurance Company’s ABSLI Cancer Shield is a benefit policy, as are ICICI Pru Heart/Cancer Protect and HDFC Cancer Care.
So, it is important to be aware of the type of policy you are finalising. Usually, life insurance companies offer benefit policies and non-life insurance companies offer indemnity policies.
A person can avail one in each type of policy and claim under both — the combination offering added protection. Many indemnity policies now have an inbuilt lump sum benefit as well.
Specialised cancer policies cover multiple types of cancers, including lung cancer, breast cancer, ovarian cancer and prostate cancer, and coverage is available at multiple stages of the disease. In most benefit policies, a lumpsum is paid on diagnosis and further premiums are waived under certain conditions. A monthly income is paid for a specified number of years for certain conditions.
Critical illness policies also pay for cancer treatment, but cover cancer only at an advanced stage and do not offer benefits like waiver of future premiums. While they do pay for hospital treatments, regular hospitalisation policies do not offer the robust financial support needed for cancer treatment. Indemnity type policies are more complex than benefit policies.
Complications arising from cancer, cases where cancer symptoms manifest within 90 days, skin cancer and any cancer due to sexually-transmitted diseases, HIV or AIDS are not covered, and neither are cancers due to congenital conditions, pre-existing conditions and biological, nuclear or chemical contamination.
Age at entry determines the maximum sum insured and renewal is available on an ongoing basis. Most policies have no pre-underwriting medical check-up.
Once a positive diagnosis of cancer is made, claims for outpatient, inpatient and day-care expenses will be payable. Hospitalisation claims have their usual requirements and 30 days’ pre-hospitalisation and 60 days’ post-hospitalisation expenses are also within the ambit of the policy.
Some companies cover hospitalisation expenses to the insured and the donor in case of organ transplant as part of cancer treatment, within the SI limit. The cost of the organ is excluded.
Reconstruction of the affected body part to restore essential physical functioning is covered.
Some policies offer an additional lumpsum benefit if the insured is diagnosed for the first time with Stage IV cancer or advanced metastatic cancer.
(The writer is a business journalist specialising in insurance & corporate history)