Cancer planCancer insurance advertisements are practically everywhere. You as a consumer are being constantly reminded about how you need to buy cancer insurance when you watch YouTube videos, rant on social media and switch on the TV for the daily dose of news-tainment.

Cancer insurance plans aim to provide you with financial protection. But, there are just too many cancer insurance products around. Many choices make selection of a cancer insurance plan seem all the more confusing. While the regular medical insurance policy only pays/reimburses actual costs and wants actual bills as proof, fixed-benefit plans like cancer insurance don’t need any bills for claims. Just the diagnostic report is enough. From this perspective, cancer plans are easier in terms of claim experience (since there is no hassle of bill submission etc.). But, as the saying goes there is many a slip between the cup and the lip. RupeeIQ tells you what to look for while choosing a good cancer insurance plan.

Cancer insurance can protect you from financial problems due to cancer. Let us understand what are the financial problems due to cancer.

1. Cancer treatment costs
2. Employment/income loss during cancer treatment
3. Travelling, lodging costs of cancer patient and any person accompanying them if cancer treatment is happening outside home state/city/town/village.

Cancer insurance is a good solution to address the above problems. It pays a lump sum insurance payout on detection and without any medical bills. The cash payout can help to pay for your medical costs and can also ensure that your income never stops and so on. You can argue that regular medical insurance or critical illness policies could do the same job, but a disease-specific policy works much better.

10 things to look for in a cancer insurance plan

Here are key 10 things you should focus on while buying cancer insurance for you and family members.

1. Minimum entry age and maximum entry age – A good cancer insurance policy should allow the policyholder to get coverage at any age they want. We don’t know when cancer will strike. A 15% cancer patients are children. Some cancer insurance plans have a minimum entry age of 18. Such plans can’t cover children. There are some plans that cover minor lives (1 year age to 17 years age) such as Future Generali Cancer Protect plan. So, if you are thinking of covering your children, do select such plans.

2. Nationality status – Check if the cancer insurance plan is for resident Indian nationals only. If you fall under NRI, PIO, OCI or foreign nationals of Indian Origin, then you may not be eligible for many plans.

3. Survival period – Some cancer insurance plans have a survival period clause. This means the cancer patient policyholder has to survive for a fixed number of days between the date of cancer diagnosis and the date of eligibility of benefit payment. No benefit is payable under Minor Stage Cancer and Major Stage Cancer if the insured person has survived for less than the required period following the date of first diagnosis of Minor Stage Cancer and Major Stage Cancer respectively by any medical practitioner/pathologist.

In case of plans like Max Life Cancer Insurance Plan and HDFC Life Cancer Care, there is a seven day survival period. This survival time period is required from the date of diagnosis of cancer for the claims to be eligible. A confirmed diagnosis or test leading to histopathological diagnosis of cancer is usually performed when life insured is still alive for the eligibility of claim. SBI Life Sampoorn Cancer Suraksha plan has a survival period of five days only. Reliance Nippon Life Cancer Protection Plus and PNB MetLife Mera Heart and Cancer Care have no survival period requirement.

In essence, a very long survival period requirement is not good. Because advanced major stage cancer patients can succumb within a few weeks/days. Quick death removes the treatment cost factor from the cancer insurance, but if the family hoped to get some money from insurance due to cancer diagnosis, that could be a problem. A separate life insurance policy will anyhow pay them the sum assured.

4. Find out how the policies define cancer – Every policy brochure or policy document will define cancer. There are three stages that we know of.

a. Carcinoma In Situ (CiS) – Carcinoma-in-situ shall mean first ever histologically proven, localized preinvasion lesion. Here, cancer cells have not yet penetrated the basement membrane or invaded (in the sense of infiltrating and / or actively destroying) the surrounding tissues or stroma in any one of the covered organ groups.

Some cancer insurance plans do not cover carcinoma in situ of skin and prostate. So, kindly check the brochure and policy wording. If you don’t understand medical terms well, try to seek medical help.

b. Specified Early Cancer – This shall mean first ever presence of one of the malignant conditions specified in the policy. The diagnosis must be based on histopathological features and confirmed by a pathologist. If the insurance company accepts the diagnosis, only then will they pay the claim amount.

c. Major Stage Cancer – First ever malignant tumour characterised by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy and on a pathology report and confirmed by pathologist/oncologist. The term cancer includes leukaemia, lymphoma and sarcoma, but has some exclusions.

5. Pay attention when cancer claims will not be paid – There are situations when cancer claims may not be paid by the insurance company despite valid cancer diagnosis. Cancer insurance plans do not pay any benefit in respect of any Major Cancer, Carcinoma-in-situ or Early Stage Cancer resulting directly or indirectly from or caused or contributed by (in whole or in part) by the following:

* Sexually Transmitted Diseases AIDS or HIV
* Any congenital conditions
* Any pre-existing condition (any cancer condition diagnosed or for which medical advice/treatment was received within 48 months prior to the policy issuance, would not be covered)
* Intoxication by alcohol or narcotics or voluntarily taking or using any drug, medication or sedative unless it is an “over the counter” drug, medication or sedative taken according to package directions;
* Nuclear, biological or chemical contamination (NBC),
* If diagnosis or signs or symptoms (related to the diagnosed cancer) first occurred during the waiting period.

6. Waiting period – Waiting period is that time period within which no policy claims are admissible. No benefits shall be payable under cancer insurance policy for any stage of cancer diagnosed or with the signs/symptoms of which first occurred within the waiting period. Most cancer insurance plans seem to have a 180-day waiting period.

7. How are benefits paid – On clean diagnosis and claim acceptance, policies pay you the benefits in two forms broadly.

a. Lumpsum Benefit – Here the claim money is paid in one-shot.

b. Lumpsum + Monthly income Benefit – Here the benefits are in two parts. Firstly, you get a lump sum. Secondly, the policyholder or their nominee after policyholder death gets a monthly income of 1-2% of sum assured for a period, say five years, from the date of diagnosis of critical/severe/major stage cancer.

On the first diagnosis of any covered cancer situation, the lump sum payment will depend on cancer level. For minor condition, pay-out (as % of sum assured) is 20-30%. For major condition, the pay-out is 100% after deducting earlier minor condition claim pay-outs, if any.

Do note that some policies like PNB MetLife Mera Heart and Cancer cover cancer in 3 stages – mild, moderate and severe. In mild stage the pay-out is 25%, in moderate stage the pay-out is 50% and 100% is paid in severe stage. In case of SBI Sampoorn Cancer Suraksha (enhanced option), 150% lump sum benefit is paid on diagnosis of advanced stage cancer.

8. Relapse benefit – Some policies let you make any number of claims for a minor condition within the maximum sum assured limit. Some plans pay a maximum of two claims of early stage cancer or CIS (of different organs), sometimes subject to fixed limit per claim.

But, what if there is cancer relapse in the same organ? Reliance Nippon Life Cancer Protection Plus on the diagnosis of the second instance of the early stage cancer or CIS of the same organ, following an earlier diagnosis of the same early stage cancer or CIS, pays an additional lump sum benefit of 25% of the basic sum insured. This benefit shall be paid only once during the policy term and shall be subject to a maximum limit of Rs 10 lakh. The relapse of cancer benefit shall be paid only if the second diagnosis is done after a complete remission period of five years of treatment for the earlier claim of early stage cancer or CIS. Complete remission means there is no clinical, histological, radiological or biochemical evidence of malignant activity in any part of the body. Also, for availing the relapse of cancer benefit, the life insured should have already undergone the required medical treatment for the first diagnosis of early stage cancer or CIS.

ICICI Pru Cancer Protect pays out at every stage. Suppose if the cancer was of minor stage to start with, policy pays out 25% of the total cover for treatment and recovery. If, unfortunately, cancer comes back from remission to affect the person again at a higher severity (major stage), the policy pays out the rest of the cover amount for treatment and recovery.

9. Waiver of premium benefit – Waiver of premium is given usually free of cost to cancer insurance policyholders.

Some plans, like Max Life Cancer Insurance, will pay the rest of your future premiums if you are diagnosed even with a minor condition. This means that you enjoy full cover at no cost or zero premiums.

But, there are conditions attached to some policies. For instance, in some policies like HDFC Life Cancer Care, future premiums shall be waived for next three years in case of valid claim of early stage cancer or CIS or relapse of cancer. In case of SBI Sampoorn Cancer Suraksha, five years annual renewal premium is waived in case of first valid minor stage cancer claim.

10. Premium cost – It is important to compare apples to apples when you consider two cancer insurance plans. A Rs 20 lakh coverage can cost a 25-year old Rs 2,500 while another company offers the same for Rs 1,200. What’s the catch? The first one charges Rs 2,500 because it includes add-on covers like income benefit and increasing sum assured benefit. The Rs 1,200 option is a bare-bones policy, without those add-on covers.

Some cancer insurance plans will come in form of silver, gold, and platinum (it is like basic, medium and advanced). Companies give the basic cancer insurance policy in the base plan, and start adding other benefits one by one in the higher options.

Cancer plan Payout (% of sum assured)
ICICI Pru Heart/Cancer Protect Minor – 25%, Major – 100% (net of earlier claims)
PNB MetLife Heart and Cancer Care Gold plan: Mild – 25%, Moderate – 50% and Severe – 100% (net of earlier claims)
Reliance Nippon Life Cancer Protection Plus Gold option: Early stage – 25% and Major stage – 100% ( irrespective of any claim of early stage cancer or CIS or relapse
of cancer)
LIC’s Cancer Cover Early stage – 25% and Major stage – 100% (net of earlier claims)
SBI Life Sampoorn Cancer Suraksha Classic: CIS or early stage – 30%, Major – 100% and Advanced – 150% (net of earlier claims)
Future Generali Cancer Protect Plan Lump sum cover: Minor – 25% and Major – 100% (net of earlier claims)
HDFC Life Cancer Care Early stage & CIS – 25% and Major cancer – 100% (net of earlier claims)
Max Life Cancer Insurance Early stage & CIs – 20% and Major stage – 100% (net of earlier claims) *
Shriram Life Comprehensive Cancer Care Initial stage – 25% and Critical stage – 100% (net of earlier claims)
Aegon Life iCancer Insurance Minor stage – 25%, Major stage – 100% and Critical stage – 150% (net of earlier claims)
Source: Company brochures, policy wordings as available * % of indexed sum insured

One last thing to remember about premiums is that the policies bought via the online channel are cheaper than the offline channel. For example, if the premium of Max Life Cancer Insurance via the online channel is Rs 1,700/- per annum, the costs more than 15% more i.e. Rs 1,960/- per annum in offline channels. So, if you want to pay cheaper premium, buy your cancer insurance policy online. Some insurers also offer an additional discount if you and your spouse are both covered, and another discount is given to existing customers.

Author
Kumar Shankar Roy

Kumar Shankar Roy is contributing editor with RupeeIQ. He can be contacted on kumarsroy@rupeeiq.com