Health insurance FAQ for cancer patients

Cancer is an absolutely debilitating disease. If caught early the disease can be controlled and treated, but doctors believe that a person once diagnosed with cancer is always capable of suffering a recurrence. A recent news piece suggested that the number of claims of cancer have shot up markedly leading analysts to believe that the number of people suffering from the disease is on the rise. So here are some important questions you should ask in order to be prepared for the onslaught.

What kind of claims can a cancer patient make?

When a person is ill or notices some symptoms, he/she may avail of his/her life insurance policy to help with the expense of undergoing diagnostic tests and hospitalization for certain tests like a biopsy etc. While most  normal health insurance policies cover only hospitalization expenses and will not pay for diagnostic tests, some might cover that expense as well. A policy holder may apply for either use of his or her medical insurance policy or ask for a reimbursement of their critical illness claim.

What is a critical illness claim? Can I buy it once I am diagnosed with cancer?

A critical illness claim is a type of policy that covers you in case you suffer from a grave illness that could cause death. This also covers cancers. The good part about this policy is that it pays off all your expenses including treatment and hospitalization cost. In some cases it might even look after the cost of appointing a nurse or caretaker after the treatment is over. The downside is that this policy offers a onetime lumpsum payment, which when once used up cannot be renewed. Albeit, the cover amount or sum insured can be raised while the policy is still useable.

There are a few things that may hinder the use of this policy, they are:

1. If your illness is diagnosed within 90 days of commencement of the policy
2. If your cancer is found to be in the early stages. You will only be reimbursed if your cancer is in the advanced stages. This will lead to termination of the policy.
3. If you are already a cancer patient you cannot buy this policy anew.

What happens to my existing policy once I am diagnosed with cancer?

If you already have a health insurance policy chances are that it will cover your hospitalization expenses to a certain extent. That is till your sum insured runs out. After that you will have to pay for your medical expenses on your own. Also, since these policies do not cover the expenses for diagnostics and treatment you will be left bearing the load of the most expensive part of your treatment.

Therefore it is wise to at least include a critical illness policy along with your current health insurance policy since it will help take care of the onetime lump sum payment.

In some cases if you have been diagnosed during the waiting period of your health insurance policy (usually ranges from 30 days to a year after the commencement of the policy) you policy becomes void and stands cancelled.

What types of cancer are not covered?

While most cancers are covered by a health insurance policy there are some that are not covered, they are as below:

1. Leukemias where the exact location of the origin of the leukemia cells is not from blood forming bone marrow.
2. Malignant tumours that show signs of carcinoma- in-situ (where the cells have not yet spread to the surrounding cells). This distinction also holds good for cancers that have been categorized as pre-malignant (likely to become malignant in the future) and cervical dysplasia CIN-1, CIN-2 and CIN-3.
3. All types of skin cancers, unless it is a result of spread from another type of cancer. Conversely skin cancer that is a malignant melanoma, greater than 1.5mm maximum thickness (when determined by a specific test called the Breslow method) can be covered under the policy.
4. Non life threatening cancers,  like prostate cancer that has been classified as T1 (very early stage) under TNM (tumour, nodes and metastasis system of classification) Classification.
5. Papillary micro-carcinoma of the thyroid is also not covered: This is a condition that affects the thyroid gland. It is  a fairly common and affects women more than men.
6. Cancers that are a result of lifestyle factors or other conditions: These are cancers that occur out of pre-existing diseases like HIV/AIDS and abuse of drugs without a doctors prescription.
7. Those cancers that arise due to self harm or due to ignoring medical advice
8. The insurance policy also does not cover cancers that have been initially diagnosed outside India. While some policies will accept a patient who has been diagnosed in certain countries like the US and Canada, others might not allow this.
9. You will also not be covered by your health insurance policy if you get your cancer treated using alternative medical fields , i.e; those treatment options other than allopathy.

What insurance policy options do I have once I have cancer?

With the number of people suffering from cancer increasing there are some insurance providers that have fashioned policies specifically for cancer patients. Some of the options you have are:

1. Cancer Insurance Policy: This is a policy brought out by a tie up between the Indian Cancer Soiety and New India Insurance. It is fairly inclusive of all cancers and is useable by both the insured and his/her spouse. It covers all medical expenses including medication, hospitalization and treatment. It also covers two dependent children and does not require the ailing person to undergo any tests; all he/she needs is a letter from their treating doctor. The catch here is that if one spouse suffers from the condition, the other person cannot avail of the policy. Another clause is that you cannot opt for this policy after the diagnosis of the disease. For more information you can visit: Indian Cancer Society
2. ICICI cancer care plus: Another inxurance policy for people with cancer, this policy has been floated by ICICI health insurance. This policy also excludes those who already have the disease, but pays for both advanced and initial stages of cancer. Some other clauses of the policy are that the patient must wait for up to 6 months after diagnosis in the case of advanced cancer and 12 months in the case of early detection. It also deems that the person must be able to survive for 28 days after the diagnosis for the policy to be applicable. The good part about this policy is that it pays for diagnosis, surgery and any treatment you might need and waves off future premiums in the case of advanced cancers. For more information you can visit: ICICI Cancer Care Plus
3. CPAA and National Insurance: A policy brought about by the tie up of the Cancer Patients Aid Association and the National Insurance company, this policy can be used by those suffering from the disease provided they did not have a hereditary predisposition to the disease. Usually a test id performed to check for this and once cleared you can avail of their policy. One catch is that this is a onetime payment and lasts for one year. This means that beyond one year you cannot avail of the benefits. For more information you can visit: CPA India