Did you know that the existing health insurance cover by way of a critical illness plan does not fully cover the costs of cancer treatment (which may stretch for a longer time). Once a person is diagnosed with cancer, there are insurance  policies that cover treatment only in advanced stages of the ailment. The  additional   financial burden   that cancer brings  may be more than  what the patient/ patient’s family is able to bear, even after taking their existing insurance policies into account.

 When buying a policy, the insured sum and the premium to be paid are decisive factors. At the same time, a host of other factors also come into play, such as the type of plan chosen; the age of the individual buying  the same; and one’s expectations from the plan.

As of now, only five life insurance companies offer cancer  insurance plans. Almost all of them offer non-linked (not  linked to market for growth as indicated in units) and non-participating (no bonus or any other benefit)  insurance plans.

How Are The Payouts Done Or Claims Paid In Case Of A Person Is Afflicted With Cancer?

  • All  policies  offer lump-sum  payouts once the policyholder is afflicted with the disease.
  • Lump-sum payouts are given at early stage (also called minor/mild stage), major stage (also called moderate  stage), and severe stage (also called critical stage) of cancer. 
  • The lump-sum payout at any stage will be reduced to the extent of any payouts at an earlier stage. For example, if 25 per cent has been paid in the early stage,  the same will deducted and only 75 per cent of the sum insured will be get paid at another stage.
  • There is an initial waiting period of 180 days from the date of commencement of the policy or from the  date of reinstatement of the policy, for the diagnosis and valid claim to be admissible under this policy.
  • There is no death benefit. If a patient dies within the waiting period, 100 per cent of the premium is refunded to the family.
  • In  some plans  there is a mandatory  seven-day survival period,  according to which a cancer patient has to survive for seven days from the date of diagnosis to make an insurance claim.
  • While some plans offer waiver of future payouts of premium (also called waiver), some offer death benefit to the nominee.
  • While most of the companies also offer surrender benefit  (after a specific lock-in period), some offer a loan  on assignment basis to meet the insured individual’s need  (for which they could be surrendering the policy).
  • Once  a lump-sum  payment has been  made for treatment (for any stage of cancer), the policy gets extinguished.
  • Some  companies  offer a combination  of heart diseases cover and cancer cover, with the option to receive monthly income for prolonged treatment for both ailments.
  • No  claim  is entertained  within 180 days  of the policy date – this is called the waiting period and it starts immediately after the policy has been bought.
  • The maximum entry age under this plan is 65 years.

What Is Not Included In The Cancer Insurance Policy Or What Are The Exclusions Of A Cancer Insurance Plan?

  •  Sexually  transmitted  diseases (STD),  AIDS or HIV
  • Any preexisting condition c)  Any congenital condition
  • Any critical illness or its signs or symptoms having occurred  within the waiting period of 180 days from policy commencement
  • Complications  arising due to  the influence of narcotic drugs, alcohol or other such psychotropic substance not prescribed by the treating doctor
  • Treatment for injury or illness caused by activities wherein  chances of getting injury are high. For example, injuries   caused during activities like hunting, mountaineering, racing, scuba diving, and aerial sports like hang-gliding and ballooning are not included under the cover
  • Unreasonable  failure to seek  or follow medical advice, or delayed medical treatment in order to circumvent the waiting period or other conditions

Takeaways For Consumers

  • Go for a plan that offers a combination of death/nominee benefit with maximum benefit during the three stages of the disease (such as gold/platinum plans).
  • Go for maximum sum assured with minimum exclusions and maximum inclusions.

 Not many know that the health insurance plan that you have does not cover cancer. Because of the high mortality rate, only 5 companies in India offer cancer insurance coverage. Consumer VOICE experts compared all of these and have built a comparative chart for you to know which is the best cancer insurance policy.


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