Limited tailored health insurance policy options for cancer survivors

Regular plans, if offered, may permanently exclude cancer from coverage

Delhi resident Ananya Singh (name changed on request), a cancer survivor for over five years, has faced multiple rejections in her quest to buy a health insurance policy. According to her doctor, now that her cancer has been in remission for so long, she is at as much risk of contracting the disease as anyone else. And yet, she says, insurers turn down her proposals citing internal policy.

Risk of recurrence

Insurers’ hesitance stems from the risk of recurrence of the disease and the cost burden it may impose on them. Claims for cancer can go as high as Rs 20-Rs 40 lakh.   

Says Kapil Mehta, co-founder, SecureNow, “Buying health insurance becomes a challenge when a person has had problems in any of her core body systems — respiratory, endocrine, cardiac, and so on. Cancer is one ailment that impacts several core systems.”

A cancer survivor may have undergone chemotherapy, a common treatment for this ailment. “Chemotherapy can affect the kidneys, liver, and so on,” says S Dheeraj Krishnaa, head, wellness and telehealth, Star Health and Allied Insurance.

One might assume that obtaining a policy would get easier with the passage of time, but this is not guaranteed. “Insurers are usually more willing to offer a cover if a person’s cancer has been in remission and she has not undergone any major treatment for the past three to five years,” says Siddharth Singhal, business head, health insurance, Policybazaar.com. He adds that in reality, cancer survivors usually have limited choices.

According to Rahul M Mishra, co-founder and director, PolicyEnsure, “Factors such as duration of remission, cancer type, and overall health play a role. However, there is no guarantee that a survivor will obtain coverage easily as insurers vary in their policy towards cancer survivors.”

Available options

Star Health and Allied Insurance offers Cancer Care, a health insurance plan meant for cancer survivors. It comes with a 30-month waiting period.

Singhal points out that Manipal Cigna offers a plan for the elderly that accepts people who have suffered from stage one or two cancer, provided they have been symptom-free or have not undergone any treatment for the past three years. The plan comes with a two-year waiting period. “The final decision depends on the underwriter’s approval,” he adds.      

Some insurers may agree to issue a regular health cover to cancer survivors. “Cancer could be a permanent exclusion in such plans,” says Mehta.

Scope of coverage

Tests: Cancer survivors require periodic tests, which are costly, to ensure their well-being. Such tests done for the purpose of screening may not be covered by the health insurance plan. “However, if a person is diagnosed with cancer, admitted into a hospital, and then asked to undergo these tests, our plan will cover the costs,” says Krishnaa.

Many plans these days offer a free annual health check-up, but these usually include only basic tests. Says Mishra, “Some policies offer only routine check-ups, while others require co-payment or have limitations on what gets tested,” he says.

Doctor consultations: If a policy offers outpatient department (OPD) cover, then doctor’s consultation gets covered.

Star Health’s plan does not offer OPD cover, but it offers free telemedicine consultations with oncologists.

Chemotherapy: Experts say that if the insurer has agreed to cover cancer, then chemotherapy will get covered as a day procedure.       

Alternative avenues  

A cancer survivor who is unable to obtain a standard health insurance policy can explore a few alternatives. “Try to buy a policy with a lower sum assured or one with a deductible. Those whose spouses work for companies must get themselves enrolled into the employer’s group health cover. Some public-sector banks also offer group health covers to those who open a savings account with them,” says Mehta. Pre-existing diseases get covered immediately in such plans.

Krishnaa recommends Ayushman Bharat, a government plan that offers a limited sum insured. Mishra suggests going for healthcare financing if the need arises.

Finally, cancer survivors fortunate to get a cover must submit all their medical records so that the underwriting is transparent and the risk of claim rejection gets minimised.