Cancer treatment costs Rs 30-40 lakh: How health insurance can help

The cost of diagnosis of cancer, which can go up to Rs 50,000-60,000 is not included in the health insurance policies

Cancer cases are increasing rapidly. In 2020, the Indian Council for Medical Research (ICMR) estimated 1.39 million cases across the country. Hospitals are reporting a surge in patients with lung, breast, cervical, and colon cancers. Treatment is not only difficult but also expensive—Policybazaar estimates costs ranging from Rs 30 lakh to Rs 40 lakh. With such high expenses, how well does India’s health insurance sector cover cancer treatment?

 

"All types of cancers with their primary occurrence or recurrence are covered across most of the comprehensive health indemnity products across the industry. Cancer as a disease is not differentiated in terms of coverage and is covered fully like all other illnesses. The standard waiting period, which is applicable across the policy for all other illnesses requiring hospitalisation, applies. For example, in the initial year of coverage commencement, a comprehensive health policy has an initial waiting period of 30 days for non-accidental claims. Hence, we can broadly say that no specific waiting period is applicable for cancer," said Priya Deshmukh, Head of Health Product, Operations & Services, ICICI Lombard.

 

 

Siddharth Singhal, Head of Health Insurance at Policybazaar, said, "Coverage availability may depend on the type and stage of cancer, with early-stage diagnoses typically having broader options. Some insurers assess medical history and treatment progression before offering coverage."

 

Eligibility criteria for cancer coverage under health insurance policies

 

"Cancer care policies range from critical illnesses, including comprehensive coverage for early-stage cancers (Category A) and cancers of specified severity (Category B), often with a designated limit on the sum insured," according to Bhaskar Nerurkar, Head of the Health Administration Team at Bajaj Allianz General Insurance.

 

"The cost of cancer treatment has been steadily rising due to factors such as advanced medical technologies, the demand for specialised care, and the increasing prices of prescription medications. To safeguard against potential financial setbacks, individuals can plan ahead by opting for cancer coverage, providing protection and peace of mind in the event of a diagnosis. Individuals seeking cancer coverage have two product options to choose from: indemnity insurance, which covers the treatment costs for cancer, and benefit insurance, which provides a lump sum payment upon the first diagnosis of the disease.

 

Eligibility criteria vary depending on the product and are determined according to the insurer's underwriting guidelines.

 

For instance, TATA AIG Criti MediCare offers coverage against 100 critical illnesses, including ‘cancer of specified severity’ on a benefit basis. The product also has a dedicated section, 'Cancer 360 Degree-Indemnity Cover,' to cover medical expenses payable for treatment of cancer (including in-situ cancer or any pre-cancerous lesions). TATA AIG MediCare Premier is an indemnity health insurance plan that covers medical expenses related to the treatment of illnesses and injuries, including cancer. The product also covers medical expenses of the insured person incurred outside India, provided that the diagnosis was made in India," said Dinesh Mosamkar, Senior Vice President - Consumer Underwriting, TATA AIG.

 

PolicyBazaar's Singhal lists some common eligibility factors:

Age limits: Most policies allow enrolment from 18 to 65 years, with some plans extending coverage to older individuals.

Medical history: Applicants may be required to provide details of their medical history for underwriting purposes.

Waiting period: General health insurance policies usually have a 30 to 90-day waiting period before cancer coverage becomes active.

Pre-existing conditions: Coverage for individuals with pre-existing cancer is subject to medical underwriting, with some insurers offering coverage based on individual risk assessment.

 

Amount insured

 

"The sum assured options generally range up to Rs 50 lakh for individuals aged 18 to 65, while those entering the policy between 61 and 65 usually have a limit of up to Rs 10 lakh, subject to individual circumstances and policy regulations. Eligibility criteria for cancer coverage usually mandate a minimum entry age of 18 for adults and three months for children and a maximum entry age of 65 for adults and 30 for children. Additionally, some policies may not require pre-policy medical tests for the cancer care section, provided no adverse health conditions are present," said Nerurkar.

 

How do insurers handle cases of cancer recurrence?

 

"Most health and cancer-specific insurance policies provide continued coverage for cancer recurrence, ensuring long-term financial protection," said Deshmukh.

 

Some common policy structures include:

Comprehensive health insurance plans: These cover hospitalisation and treatment for recurrent cancer as long as the sum insured is available.

Cancer-specific policies: Some specialised policies offer structured payouts for recurrence or metastasis after a specified waiting period.

 

Choosing a policy with a high sum insured ensures sufficient coverage in case of recurrence, while add-ons like critical illness riders provide lump sum payouts to help manage expenses.

 

Available plans and cost estimates

 

There are two primary types of insurance plans that cover cancer treatment:

Comprehensive health insurance plans – Standard policies covering cancer treatment along with other major illnesses. They typically include hospitalisation, chemotherapy, and surgery.

Cancer-specific insurance plans – Dedicated policies providing financial support for cancer treatment, including lump sum payouts upon diagnosis.

 

PolicyBazaar shares insurance policies for a 40-year-old individual in Delhi:

 

Care Health – Care Supreme

Coverage: Rs 25 lakh

Annual premium: Rs 19,243

 

Niva Bupa – Reassure 2.0 Bronze+

Coverage: Rs 25 lakh

Annual premium: Rs 17,668

 

Aditya Birla – Active One

Coverage: Rs 25 lakh

Annual premium: Rs 15,577

 

ICICI Lombard – Elevate

Coverage: Rs 25 lakh

Annual premium: Rs 15,478

 

Star Health – Super Star

Coverage: Rs 25 lakh

Annual premium: Rs 14,954

 

HDFC Ergo – Optima Secure

Coverage: Rs 25 lakh

Annual premium: Rs 21,411

 

Star Health – Cancer Care Platinum

Coverage: Rs 10 lakh

Annual premium: Rs 31,081

 

Manipal Cigna – Prime Senior Elite

Coverage: Rs 10 lakh

Annual premium: Rs 23,888

 

"Before buying insurance, applicants should carefully review any sum insured limitations, disease-wise restrictions, room category limits, exclusions on advanced treatments, geographical restrictions, cost-sharing provisions, and waiting periods," said Mosamkar.

 

Does insurance cover advanced cancer treatments?

 

"Yes, depending on the conditions of the policy, some health insurance plans cover cutting-edge cancer therapies like immunotherapy and targeted therapy. These treatments may be subject to sub-limits or exclusions under standard policies. Comprehensive products such as TATA AIG Criti MediCare offer coverage for these advanced treatments up to the sum insured," Mosamkar said.

 

"While purchasing any health insurance policy, it is imperative that customers declare all current and previous health conditions, treatments or surgeries already taken, and any ongoing medication. Not disclosing or misrepresenting health conditions, which is material information, may lead to rejection of claims in future," said Deshmukh.

Do note that the cost of diagnosis, which can go up to Rs 50,000-60,000 is not included in the health insurance policies.