12 factors to consider before buying cancer health insurance - Economic Times

By Vivek Narain

While buying a health insurance policy for protection against cancer here are the 12 factors you should consider.

Benefit vs indemnity: There are two kinds of policies available in the market. Benefit policies are those where sum insured is paid upon the discovery of cancer and successfully passing the survival period. In an indemnity policy, the claims are payable after the waiting period is over and are reimbursed in accordance with the amount spent towards cancer treatment charges.
Sufficient coverage amount: It is no secret that cancer treatment is extremely expensive and a long-term ordeal. The cumulative cost incurred on diagnostics, radiation, chemotherapy and surgery would cause a significant dip in your personal savings if they were to be borne out-of-pocket. Going by the age-old adage, “Better to be safe than sorry”, it would be more beneficial if one were to opt for a higher sum insured amount that would take care of high-cost procedures for a slightly higher premium.
Prior history of cancer: People who have been diagnosed with and treated for cancer earlier should be prepared to face rejection at the time of application for health insurance (whether critical illness policies or cancer care plans). Most insurance companies are not likely to cover cancer patients considering the high risks involved.
Other pre-existing diseases: Whether one opts for a critical illness policy that also covers cancer, or a cancer care plan, it is imperative to declare all previous and/or existing medical conditions and ailments at the time of purchasing the policy. One should also truthfully answer any questions pertaining to genetic predisposition or a family history of any forms of cancer. Non-disclosure would not just impact the claims related to any cancer-specific treatment undergone, it would also lead to rejection of any other non-cancer treatment expense claims.
Waiting periods: Every health insurance plan defines a waiting period for certain conditions and treatments including cancer. These specific waiting periods differ across policies and insurers, so it would be wise to ascertain the time period for the chosen critical illness or cancer care special plan during which one will not be qualified to raise medical claims. Preferably opt for a policy that has a low waiting period to expedite the eligibility. The waiting period is only on first time purchase.
Co-payment: Few health insurers impose a co-payment clause (i.e., a percentage of sum insured amount) on cancer treatment expenses which have to be borne by the policyholder. Choosing such a policy would mean that a certain percentage of the costs will always be paid on your own.
Sub-limits: Some insurers stipulate an upper cap or sub-limit on the amount of coverage offered for cancer treatment. For example, the critical illness plan might be for a sum insured of Rs 50 lakh, but cancer treatment would get covered only up to Rs 5 lakh.
Exclusions: All health insurance policies – whether critical illness or cancer specific – outline a list of exclusions which are conditions and procedures that the insurer is not liable to pay for. Those looking for cancer-related health insurance should, of course, ensure that cancer is not excluded from coverage. Additionally, this list of exclusions might mention a specific type/s or stage/s of cancer that would be omitted from coverage.
Experimental treatments: Exponential and continuous advancements in cancer therapy have led to novel treatment methods being discovered. Most health insurance plans cover traditional and new age treatments that are approved by medical councils. Radical therapies and unproven treatments would not be covered.
Survival period: Insurers specify the minimum number of days for which the policyholder must survive post diagnosis or treatment of cancer. The health insurance benefit will be accrued only upon successfully passing the survival period. This is a crucial point to be aware of to avoid any future surprises.
Features that aid in increasing the sum insured amount: Restoration benefit for the same disease would be an ideal policy feature to have, as it would lead to reinstatement of the original coverage amount upon exhaustion due to single or multiple claims submission. Additionally, no-claim bonus for claim-free years would also help in augmenting the sum insured amount, which would eventually prove useful at the time of seeking expensive cancer treatment.
Renewability of the policy after the discovery of cancer: The policy may not be renewed once cancer specific feature is invoked. The benefit is usually payable once in the lifetime of the insured.