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Not only in India, but there is an alarming increase in the number of cancer cases across the world and given the lifestyles of the current generation, this is likely to keep on increasing. Even if diagnosed early, it is important to be aware that the treatment can be pretty expensive for any individual/family and the stress is physical, mental and financial. While the physical and mental stress and anxiety is something that each individual/family needs to be prepared for, the financial burden is one that can be planned for and this is where Cancer Insurance comes into the picture.

The Big C… The word itself still instils fear and anxiety in the minds of every Indian citizen, irrespective of age, sex and social strata. The key to be prepared for this illness, should it unfortunately target any individual is to be ready - physically, mentally and financially – to fight this deadly disease. Cancer can affect anyone at any time.
cancer

Quick points of note according to the National Institute of Cancer Prevention and Research (NICPR) :

  • There are more than 100 types of cancers; almost any part of the body can be affected
  • The five most frequent cancers (ranking defined by total number of cases) in India in men and women are breast, cervical, oral cavity, lung and colorectal
  • Cancer is the second most common cause of death in India (after cardiovascular disease)
  • Use of tobacco products (e.g. smoking cigarettes) are the single most preventable cause of death worldwide
  • More women in India die from cervical cancer than in any other country
  • Breast cancer is the most common cancer in women in India and accounts for about a quarter of all cancers in women in Indian cities
  • Cancers of major public health relevance such as breast , oral , cervical , gastric , lung and colorectal cancer can be cured if detected early and treated adequately.

Different Stages of Cancer

There are different insurance policies that cater to the different stages of cancer. The four stages of cancer are mentioned below.
  • Carcinoma In Situ(CIS)
  • Early stage
  • Major stage
  • Critical stage
The main factor the people have to keep in mind while opting for an insurance plan is whether the plan covers pay-outs at all the stages. Taking into account of the benefits that are applicable stage wise is also a good option to compare policies. Cancer insurances are generally meant to cover the medical expense related to the treatment of cancer and often does not offer death benefit.

India health insurance companies offering coverage for Cancer
Star Health Travel Insurance Plans Religare Insurance Plans Apollo Munich Insurance Plans New India Insurance Plans Raheja QBE Insurance Plans Icici Prudential Ageon Max Life

Some Statistic related to Cancer Prevalence in India

According to NICPR, the following are some telling statistics relating to Cancer in India:
  • Estimated number of people living with the disease in India (2018) : around 2.25 million (22.5 lacs) and increasing
  • Every year, new cancer patients registered: Over 11.57 lacs
  • Cancer-related deaths in 2018 : 7,84,821
    • Men: 4,13,519
    • Women: 3,71,302
  • Risk of developing cancer before the age of 75 years
    • Male: 9.81%
    • Female: 9.42%
  • Risk of dying from cancer before the age of 75 years is
    • Males : 7.34%
    • Females : 6.28%
  • One woman dies of cervical cancer every 8 minutes in India
  • For every 2 women newly diagnosed with breast cancer, one woman dies of it in India
  • Mortality due to tobacco use in India is estimated at upwards of 3500 persons every day
  • Tobacco (smoked and smokeless) use accounted for 3,17,928 deaths in men and women in 2018
  • Cancers of oral cavity and lungs account for over 25% of cancer deaths in males and cancer of breast and oral cavity account for 25% cancers in females
  • The top five cancers in men and women account for 47.2% of all cancers; these cancers can be prevented, screened for and/or detected early and treated at an early stage. This could significantly reduce the death rate from these cancers
Men Women
Lip / Oral Breast
Lung Lip / Oral
Stomach Cervix
Colorectal Lung
Oesophagus Gastric


The objective of putting up these statistics is not to scare the reader of this article, but to make everyone aware of the actual prevalence of Cancer in India and more importantly that while one can’t totally prevent cancer attacking, we can be better prepared in case of the an unfortunate eventuality.

Cancer Insurance is a specialised type of a health insurance policy designed to offer financial assistance to those diagnosed with the disease post the free look and mandatory waiting period as per the policy’s terms and conditions. A cancer-specific policy offers cover for associated costs related to cancer diagnosis and treatment, including hospitalization, chemotherapy, radiation, surgery, etc. Most policies are designed to release monies at various stages of the diagnosis process and this being a fixed benefit policy, these benefit payments are not related to the actual expenses incurred by the insured for treatment during these stages.

To qualify for cancer insurance, the insured cannot be suffering from pre-existing cancer conditions. Also, those previously diagnosed and treated for cancer are ineligible for cancer insurance. Some plans however allow for coverage if one has been treated and recovered completely and has served the designated waiting period afresh. The most obvious reason for one to invest in a cancer insurance policy is to prepare oneself for the financial impact of this disease should it strike oneself or anyone in the family.

Benefits under Cancer Insurance Plans

Benefits for Cancer insurance as offered by various insurers differ from one to another…some of the benefits offered under these plans include:
  • In-Patient Hospitalization
  • Conventional treatment
    • Chemotherapy
    • Radiotherapy
    • Organ transplantation, as part of Cancer treatment
    • Surgeries for excision of cancerous tissue or removal of organs/ tissues (Onco-surgery)
  • Day Care Treatment
  • OPD Expenses
  • Chemotherapy & Radiotherapy Cover
  • Organ Donor Cover
  • Alternative Treatments
  • Pre Hospitalization & Post Hospitalization – 30 / 60 days
  • No Claim Bonus - If there are no claims during the year, the sum assured increases by a pre-specified percentage
  • Annual Health Checkup
  • Quick Recovery Counselling
  • Doctor On Call
  • International Second Opinion
  • Room Rent Modification
  • Air Ambulance
  • Ambulance Cover
  • Premium waiver is available under certain conditions like early stage cancer diagnosis
  • Insurance cover is not ceased after first diagnosis
  • Tax benefits under section 80D of the Income Tax Act
These plans cover expenses at multiple stages of cancer and a lumpsum is paid out on cancer diagnosis.

Why Does One Need a Cancer Insurance Plan?

Like any other insurance plan, there is always the question which arises on the need for investing in such a cover. While many are reasonably convinced relating to a more common and regular Indemnity based Health insurance plan, a specialised plan like Cancer insurance still needs some convincing. But some of the reasons as to why one should invest in a cancer insurance policy are :
  • Rising prevalence of various types of Cancer among the Indian population
  • Astronomical cost of treatment at various stages of cancer influenced also by rising medical inflation – this could have damaging impact on the finances of a family once diagnosed. Important to be financially safeguarded against exorbitant expenditures of medical treatments like radiotherapy, chemotherapy and surgery, in case such a need arises.
  • Have a history of cancer related illnesses among close family members
  • Extensive Coverage - Cancer insurance policies cover a wide range of cancers, and are currently available at an affordable premium
  • Lump Sum Payment - Cancer insurance policies offer a guaranteed lump sum payout in case of an early diagnosis of the illness. This payout generally ranges between 20% and 25% of the pre-decided sum assured, and varies among health insurance companies. This provides financial succour to the family
  • Waiver of Premium (WoP) Benefit – Some life insurance companies offer this benefit where the insured can stop paying premium, but the coverage will continue
  • 70-80% of Cancers are caused by environmental factors as opposed to the belief that cancer is due to genetical factors – if one is exposed to such environments (such as radiation etc), it is advisable to invest in this plan
  • Tax Benefits - Policyholders of cancer insurance plans are eligible for tax deductions of up to Rs. 25,000 as per Section 80D of the Income Tax Act, 1961. Senior citizens may be able to avail a higher tax deduction.

Factors to Consider Before Buying Cancer Insurance Plan

Most of us rarely spend much time in comparing health insurance plans prior to deciding on one, like we would spend on something like a television or refrigerator etc…It is advisable to evaluate options before taking a cancer insurance plan. Below are some of the factors that need to be considered before making a decision to go for a specific cancer insurance plan:

Sufficient Sum Assured – With double digit medical inflation, it is important to keep in mind rising costs of medical treatment while deciding on the sum insured that one want to have under their policy. Cancer treatment takes time and it costly, so it is advisable to opt for a cancer insurance plan with high sum assured. This will provide satisfactory financial support when the illness strikes.

Family History – Given that genetic factors / family history is one of the reasons for cancer to attack an individual, it may be prudent to keep this in mind while deciding to first go in for a cancer related plan and then arriving at a suitable coverage plan.

Waiting Period and Survival Period - It is important to check on the waiting period (normally mandatory waiting period is 30 days and cancer related waiting period is 90 days) i.e the amount of time you will have to wait before the policy will start coverage and survival period, which is the time after cancer diagnosis the policy holder has to be alive in order to claim benefits of the policy.

Exclusions under the Plan – While it is important to be aware of what’s covered, it is equally important to be aware of what’s excluded under such plans…go through the exclusion list prior to making a decision on the optimum plan for your requirements.

Duration - A policy having a long duration is beneficial to the applicant to ensure protection for a longer duration. Also with waiting periods to be considered, the full effect of the coverage will be available after crossing the waiting period. Another important factory is since there is lifelong renewability, one should invest early in this coverage and remain insured, because as the data suggests, there is a 10% possibility of men/women contracting cancer before the age of 75 years, and getting a coverage in the alter years will be an issue with other pre existing medical conditions.

Existing Health Insurance Coverage - Having a comprehensive health insurance policy plus a separate cancer insurance plan does not necessarily mean that one gets double the benefits. Most insurance policies come with a ‘coordination of benefits’ clause, stating that one plan will not cover expenses that the other plan does.

Claim Settlement Under a Cancer Plan – An ideal plan should offer coverage for all stages of cancer. A Cancer care plan will make payment of 25-30% on early stage diagnosis and remaining 70-75% on major stage or the entire on major stage whichever is earlier.

Premium Payment Options - The premium payment option for the Cancer Insurance Plan would vary from one insurer to another. Typically, the premiums can be paid either annually, quarterly or monthly basis.

How You Can Prevent Cancer

One can reduce the risk of getting cancer with simple, lifestyle changes that include maintaining a healthy weight, eating foods that prevent cancer, getting immunized and getting regular cancer screening tests. Important actionables include:
  • Quit Smoking
  • Get Regular Exercise
  • Use Sunscreen when moving around in the sun
  • Eat Fruits, Vegetables, Whole Grains and Beans Daily
  • Maintain a Healthy Weight though dietary control and remaining active
  • Get Hepatitis B & HPV Vaccines
  • Do Regular Self-Exams & Get Cancer Screenings

Exclusions in a Cancer Insurance Plan

Some of the general exclusions under this plan are as follows. This is not an exhaustive list, please go through the same in the policy wordings available with your policy kit :
  • Skin cancer
  • Any kind of cancer directly or indirectly caused by or contributed to by sexually transmitted diseases, HIV, or AIDS
  • Cancer resulting from any congenital condition, pre-existing condition; biological, nuclear, or chemical contamination; contact with radiation or radioactivity from any non-diagnostic or therapeutic source
  • Convalescence, general debility, run-down condition or rest cure, Nutritional deficiency states.
  • Psychiatric, mental and behavioral disorders
  • Intentional self injury
  • Use of intoxicating substances, substance abuse, drugs / alcohol, smoking and tobacco chewing
  • Venereal Disease and Sexually Transmitted Diseases,
  • All expenses arising out of any condition directly or indirectly caused due to or associated with Human T-cell Lympho Trophic Virus type III (HTLV- III) or Lymphadenopathy Associated Virus (LAV) or HIV/AIDS
  • Treatment arising from or traceable to pregnancy, childbirth, family planning, miscarriage, abortion and complications of any of these (other than ectopic pregnancy)
  • Treatment for Sub-Fertility, Assisted Conception and or other related complications of the same.
  • Expenses incurred on weight control services including surgical procedures such as Bariatric Surgery and /or medical treatment of obesity
  • Treatment of Sleep apnea, treatment for genetic and endocrine disorders
  • Expenses incurred on High Intensity Focused Ultra Sound, Uterine Fibroid Embolisation, Balloon Sinoplasty, Enhanced External Counter
  • Charges incurred on diagnostics that are not consistent with the treatment for which the insured is admitted in the hospital / nursing home
  • Naturopathy, Unconventional, Untested, Unproven, Experimental therapies.

Documents Required for Cancer Insurance Claims

The important documents to be submitted to the insurance company at the time of filing a claim under Cancer insurance include :
  • Accurately filled Claim form
  • Identity Proof
  • Age Proof
  • All Medical and diagnostic test reports that indicate the stage of the disease and treatment required and carried out
  • Treating physician’s reports
  • Any other document that the insurance company may ask for while processing the claim made against cancer insurance.

Some of the Cancer Insurance plans available in the market are below:

star religare HDFC Ergo Insurance Plans
Star Cancer care gold Religare Cancer mediclaim HDFC ERGO Women Cancer Plus
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Policy Term
1 year 1/2/3 years Upto 3 years
Eligibility Criteria
Persons between the age of 5 months and 65 years, who have already been diagnosed with Cancer (Stage 1 or Stage 2) can avail this insurance. 5 years to 50 Years on Individual Basis
18 to 65 years
Sum Insured (SI)
Rs.3,00,000/- and Rs.5,00,000/- 10 Lakh | 25 Lakh | 50 Lakh | 1 Crore | 2 Crore 3 Lakhs to 1 Crore
Coverage
Section Sum insured (Rs.) Sum insured (Rs.)
Section 1 – Lumpsum benefit-when there is a recurrence / metastasis and / or a second cancer1,50,000/-2,50,000/-
*Section 2 – Indemnity Cover – Surgical and Interventional Therapy1,00,000/-1,50,000/-
*Section 3 – Indemnity Cover - Non Surgical and Non Interventional Therapy50,000/-1,00,000/-
Total3,00,000 /-5,00,000/-
*Applicable only for accidents & diseases other than Cancer and its related ailments
Individual : Maximum up to 6 Persons Individual and Family Floater
Pre hospitalization
Up to 30 days prior to the date of admission 30 days -
Post hospitalization
Up to 60 days prior to the date of admission 60 days -
Day care treatments
All day care treatments Listed as per the Plan, Up to Sum Insured -
Ambulance cover
Emergency Ambulance charges for transporting the Insured person to the hospital up to a sum of Rs.1500/- per hospitalization and Rs.2000/- per policy period. Up to Rs. 3000 per hospitalization -
Renewal
Lifelong Renewability Lifelong Renewability Lifelong Renewability
General waiting period
Section 1: 30 months waiting period : Treatment must have commenced only after waiting period for an admissible claim under this section
Section 2 and Section 3:
  • 30 days waiting period ( Not applicable for accidents)
  • 24 months waiting period for specified illness/diseases/treatments
  • 48 months waiting period for pre existing diseases.
  • Initial Waiting Period: 90 days
  • Specific ailment Waiting Period: Not Applicable
  • Pre-existing diseases Waiting Period: 4 years
90 days and 180 days as per the illness specified in policy wordings
1 year for Pregnancy and Newborn Complications.
4 Years for all Pre-existing Conditions declared and/or accepted at the time of applying first policy with us.
Co-pay
10% co-pay shall be applicable on each and every claim under Section 2 and 3 if you are aged above 60 years during first inception of this policy. Such co-payment shall be applicable for renewal also.
If your age is upto 60 years during first inception of this policy then co-payment condition shall not be applicable
Up to SI*; only for SI* >=1Cr (Limited to In-Patient Care and Day Care treatment) with a Co-payment of 10% per Claim -
Claims procedure
For Section 1:
a) Certificate from the Treating Doctor confirming the recurrence/metastasis / second malignancy of Cancer
b) Clinical, radiological, histological, pathological, histopathological and laboratory reports in support.
For Section 2 and Section 3:
· Call the 24 hour help-line for assistance-1800 425 2255/ 1800 102 4477. Inform the ID/Policy number for easy reference
· In case of planned hospitalization, inform 24 hours prior to admission in the hospital
· In case of emergency hospitalization, information to be given within 24 hours of hospitalization
· Cashless facility can be availed in all network hospitals wherever possible
· In non-network hospitals payment, must be made up-front and then reimbursement will be effected on submission of documents if claim is found admissible
No Claims Bonus - 50%/25%/25%-Corresponding increase in SI* for 1st, 2nd and 3rd continuous claim-free Policy Years respectively, Max up to 100% of SI* -
Advantages
1) No Third Party Administrator, direct in-house claims settlement.
2) Faster and hassle – free claim settlement.
3) Cashless facility wherever possible in network hospitals.
1)Pre and post hospitalization medical expenses covered
2)Chemotherapy & Radiotherapy Cover
3)No specific ailment waiting period
Cancer Cover, Carcinoma in Situ, Major Illnesses Covered, Minor Illnesses Covered

* - subject to underwriting approval
** - upto Sum Insured of 20 lacs and Age of 55 years. Above this PPC is required
*** - upto 50 years of Age. Above this PPC is required
And more than 70-80% is caused due to environmental factors as opposed to the belief that cancer is due to genetical factors.

FAQ’s on Cancer Insurance

The minimum and maximum age eligibility for purchasing cancer insurance differs between insurance companies, but the average age is between 5 months and 65 years. Also the policy allows lifetime renewability.

Cancer insurance policies may be purchased individually or as a supplement with your health insurance. You would not be eligible for a cancer insurance policy if you already have been diagnosed with cancer. Cancer insurance usually pays a lump sum amount on the diagnosis of the illness which is towards medical or treatment expenditures and the rest at ongoing stages of treatment.

Yes, normally there is a waiting period of 30 days is applicable for cancer insurance policies.

One can claim a tax exemption on the premium paid. Also no tax is paid on the claims settlement received if there is a claim filed with the insurer. Cancer insurance plans are eligible for tax deductions of up to ₹25,000 as per Section 80D of the Income Tax Act, 1961. Senior citizens may be eligible for higher tax benefits.

Yes, since the coverage is complimentary to an indemnity based health insurance plan, one can buy this plan along with your existing health insurance plan to have extra coverage against this disease.

Health insurance companies may offer cancer insurance to individuals with a family history of cancer, but generally at a higher premium. Such applicants have a higher scope of being diagnosed of the disease, thus, making insurers quote a higher premium.

The minimum and maximum sum assured for cancer insurance varies between insurance companies and cancer insurance plans but varies within the ranges of ₹1 lac upto ₹50 lacs. Check the same with your insurance company before purchasing a cancer insurance policy.

No, cancer policy does not cover pre-existing illness. There is a waiting period (normally 24 months) before these diseases get covered.

Yes, smokers and drinkers can apply for cancer insurance plans. However, they will be offered a comparatively higher premium rates by insurers.

Yes, most your regular health insurance plan may offer coverage for cancer and its related treatment expenses.

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