5 things you need to know about cancer coverage in health insurance for women

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Cancer is one of the leading causes of death among women in India. According to some startling statistics revealed by the National Institute for Cancer Prevention and Research in May 2021, one woman dies every eight minutes from cervical cancer, and one in two women diagnosed with breast cancer y succumbs.

But that’s not the only way this deadly disease wreaks havoc on us! Cancer treatment, in itself, is demanding and time-consuming, involving various screening tests, oncologist consultations, and careful therapies like radiation, chemotherapy, and invasive procedures, all of which are expensive. Vivek Narain, Health Insurance Specialist, SANA Insurance Brokers Pvt. Ltd., says, “Organizing the funds to pay for cancer treatment out of pocket can be daunting for most people. This can be avoided by having a comprehensive health insurance plan that also covers cancer treatment.

Vivek shares five factors women should consider when looking for cancer coverage in their health insurance.

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#1 Type of policy with cancer coverage

There are three categories of health insurance plans:

  • Basic health insurance, i.e. indemnity-based plans that provide cancer coverage as specified in the policy; note additional endorsements for hospitalization or treatment due to accident or other illness (as per coverages listed)
  • Critical illness insurance plans, i.e. benefit-based policies that cover common listed illnesses as well as cancer
  • Cancer-specific plans, which are also benefit-based but designed to address that particular disease

“Cancer-specific plans would be a good option to consider, along with a basic health insurance plan, as they would cover broader aspects not just limited to hospitalization expenses. Indeed, ancillary expenses relating to cancer screening, OPD consultations and other non-hospital health insurance would also be covered,” advises Vivek.

Cancer-specific plans are recommended for women who have a genetic predisposition to this disease. So take the time to understand the risks and costs involved. Remember that these policies are long-term plans that offer a lump sum payment for attentive health care expenses or as compensation due to loss of regular income.

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#2 Sum insured and forms of payment

Opt for a higher sum assured, preferably with an applicable restoration benefit for the same illness treatment (since cancer treatment would be regular and extended) to maintain sufficient coverage at all times. The majority of cancer insurance policies offer a lump sum upon first diagnosis, which can be used to pay treatment costs or to pay off any loans or debts. In some cases, the insured may be paid on a reimbursement basis for the treatment costs incurred.

#3 Waiting period and survival period

The waiting period for cancer coverage would vary from plan to plan and insurer to insurer. This is the stipulated period of time that must necessarily be served before becoming eligible for coverage. The survival period is specific to critical illnesses such as cancer, in which the insurance company prescribes a certain time interval that the patient must survive to get payments. In either case, the shorter the time period, the better.

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#4 Types and stages of cancer, other exclusions

Women should especially learn about cancers specific to women such as breast cancer, endometrial or uterine cancer, ovarian cancer, cervical cancer, etc. for global coverage and maximum security. In addition, there may be limitations on the stages of cancer that are covered by some insurers (notably in the case of supplementary cancer or critical illness insurance), although most cancer-specific plans do not impose this clause. Ideally, select a plan that considers all minor and major milestones, so that early and late detection cases can be accounted for. Other terms such as maximum age at entry, exclusion of certain related treatments or resulting illnesses, etc. should also be consulted before finalizing a plan.

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#5 Coverage ceilings

Some insurers take a copayment from the insured, which means that a certain percentage or amount of the treatment will have to be borne by the insured himself. Alternatively, there could be upper caps or sub-limits imposed on the amount of processing fee the insurance company will pay, while the differential amount would have to be paid by the insured person. Considering the constant increase in the cost of oncology treatments, it would be wise to look for cancer coverage offering maximum reimbursements up to the sum insured.

“There are multiple nuances and complexities when it comes to cancer coverage and insurance. Always read the fine print for better knowledge and to avoid any surprise claim rejections at a later stage. When in doubt, it is best to consult professional insurance brokers who have the knowledge to guide you with unbiased and accurate information for informed decision-making,” advises Vivek.

Also Read: Cancer Clears in Patients in Drug Trials Using Dostarlimab

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About Evelyn C. Heim

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