Be­cause Can­cer Is Can­cer

There is exclusive in­sur­ance for it

Consumer Voice - - Contents -

The bot­tom line is, un­til we're help­ing peo­ple to stop smok­ing, screen­ing for breast can­cer, giv­ing Pap sm ears, giv­ing pre­na­tal care to preg­nant women, we should not go into pub­licly pay­ing for the ar­ti­fi­cial heart, which will ben­e­fit at great cost only a few peo­ple.

~ Richard Lamm

An in­ter­est­ing com­mer­cial from an in­sur­ance-sell­ing por­tal has been on the air for a while now. It starts with a joy­ful doc­tor telling a pa­tient that he has been suc­cess­fully treated for can­cer. The pa­tient, in­stead of be­ing happy, ap­pears to be re­morse­ful and says, “I should have bought can­cer in­sur­ance…” (He is sad be­cause he had to spend all his life's sav­ings for the treat­ment.) Let's face it. Can­cer in­stils fear, yet it is a mod­ern-day re­al­ity. It comes unan­nounced and any­body can fall prey to it. The fight against this dreaded dis­ease is tough and only the suf­fer­ers and their car­ers can tell how can­cer breaks them not just phys­i­cally but men­tally and fi­nan­cially as well. De­pend­ing on the form of can­cer, its stage and treat­ment op­tions, one has to shell out any­where be­tween Rs 5 lakh and Rs 50 lakh for treat­ment and care. Helpless as the sce­nario may look, one can con­sider tak­ing up an in­sur­ance plan that will at least help in han­dling the ‘fi­nan­cial'

stress. If you thought your ex­ist­ing health in­sur­ance or crit­i­cal ill­ness plan will come to your res­cue, you must know that those plans do not cover can­cer. The fol­low­ing re­port com­pares five ma­jor can­cer in­sur­ance poli­cies on pa­ram­e­ters that are rel­e­vant to con­sumers.

Subas Ti­wari & Gopal Ravi Ku­mar

Why buy a can­cer in­sur­ance pol­icy in the first place? The fol­low­ing fac­tors may have a role: a) The ex­ist­ing in­sur­ance cover by way of a crit­i­cal ill­ness plan does not fully cover the costs of can­cer treat­ment (which may stretch for a longer time). b) Once a per­son is di­ag­nosed with can­cer, there are in­sur­ance poli­cies that cover treat­ment only in ad­vanced stages of the ail­ment. c) The ad­di­tional fi­nan­cial bur­den that can­cer brings may be more than what the pa­tient/ pa­tient’s fam­ily is able to bear, even af­ter tak­ing their ex­ist­ing in­sur­ance poli­cies into ac­count. As of now, only five life in­sur­ance com­pa­nies of­fer can­cer plans. Al­most all of them of­fer non-linked (not linked to mar­ket for growth as in­di­cated in units) and non-par­tic­i­pat­ing (no bonus or any other ben­e­fit) in­sur­ance plans. The pa­ram­e­ters on which we com­pared these plans as well as some stan­dard fea­tures are dis­cussed here.

When buy­ing a pol­icy, the in­sured sum and the pre­mium to be paid are de­ci­sive fac­tors. At the same time, a host of other fac­tors also come into play, such as the type of plan cho­sen; the age of the in­di­vid­ual buy­ing the same; and one’s ex­pec­ta­tions from the plan.

Salient Fea­tures of Can­cer In­sur­ance Plans

a) All poli­cies of­fer lump-sum pay­outs once the pol­i­cy­holder is af­flicted with the dis­ease.

b) Lump-sum pay­outs are given at early stage (also called mi­nor/mild stage), ma­jor stage (also called mod­er­ate stage), and se­vere stage (also called crit­i­cal stage) of can­cer.

c) While some plans of­fer waiver of fu­ture pay­outs of pre­mium (also called waiver), some of­fer death ben­e­fit to the nom­i­nee.

d) While most of the com­pa­nies also of­fer sur­ren­der ben­e­fit (af­ter a spe­cific lock-in pe­riod), some of­fer a loan on as­sign­ment ba­sis to meet the in­sured in­di­vid­ual’s need (for which they could be sur­ren­der­ing the pol­icy). e) Once a lump-sum pay­ment has been made for treat­ment (for any stage of can­cer), the pol­icy gets ex­tin­guished.

f) Some com­pa­nies of­fer a com­bi­na­tion of heart dis­eases cover and can­cer cover, with the op­tion to re­ceive monthly in­come for pro­longed treat­ment for both ail­ments. g) No claim is en­ter­tained within 180 days of the pol­icy date – this is called the wait­ing pe­riod and it starts im­me­di­ately af­ter the pol­icy has been bought. h) The max­i­mum en­try age un­der this plan is 65 years.

Ex­clu­sions

a) Sex­u­ally trans­mit­ted dis­eases (STD), AIDS or HIV

b) Any pre­ex­ist­ing con­di­tion

c) Any con­gen­i­tal con­di­tion

d) Any crit­i­cal ill­ness or its signs or symp­toms hav­ing oc­curred within the wait­ing pe­riod of 180 days from pol­icy com­mence­ment

e) Com­pli­ca­tions aris­ing due to the in­flu­ence of nar­cotic drugs, al­co­hol or other such psy­chotropic sub­stance not pre­scribed by the treat­ing doc­tor

f) Treat­ment for in­jury or ill­ness caused by ac­tiv­i­ties wherein chances of get­ting in­jury are high. For ex­am­ple, in­juries caused dur­ing ac­tiv­i­ties like hunt­ing, moun­taineer­ing, rac­ing, scuba div­ing, and aerial sports like hang-glid­ing and bal­loon­ing are not in­cluded un­der the cover

g) Un­rea­son­able fail­ure to seek or fol­low med­i­cal ad­vice, or de­layed med­i­cal treat­ment in or­der to cir­cum­vent the wait­ing pe­riod or other con­di­tions

Some Ifs

a) The lump-sum pay­out at any stage will be re­duced to the ex­tent of any pay­outs at an ear­lier stage. For ex­am­ple, if 25 per cent has been paid in the early stage, the same will de­ducted and only 75 per cent of the sum in­sured will be get paid at another stage. b) There is an ini­tial wait­ing pe­riod of 180 days from the date of com­mence­ment of the pol­icy or from the date of re­in­state­ment of the pol­icy, for the di­ag­no­sis and valid claim to be ad­mis­si­ble un­der this pol­icy. c) There is no death ben­e­fit. If a pa­tient dies within the wait­ing pe­riod, 100 per cent of the pre­mium is re­funded to the fam­ily. d) In some plans there is a manda­tory seven-day sur­vival pe­riod, ac­cord­ing to which a can­cer pa­tient has to sur­vive for seven days from the date of di­ag­no­sis to make an in­sur­ance claim.

Tax Ben­e­fits

Un­der Sec­tion 80D of In­come tax Act, a de­duc­tion of Rs 25,000 per as­sess­ment year is avail­able to an as­sessee for pre­mium paid for med­i­cal in­sur­ance. For se­nior cit­i­zens, the de­duc­tion is Rs 30,000. For pre­mium paid to­wards med­i­cal in­sur­ance of de­pen­dent par­ents, spouse and chil­dren, the de­duc­tion al­lowed is Rs 30,000 per as­sess­ment year.

As per the Stages of Can­cer

Typ­i­cally, there are four stages of can­cer: car­ci­noma in situ (CIS), early stage, ma­jor stage and crit­i­cal stage. As far as pay­outs are con­cerned, in­sur­ers nor­mally treat the first two stages in the same way and the last two sim­i­larly. Car­ci­noma in situ (CIS): In the first-ever di­ag­no­sis of a his­to­log­i­cally proven stage, the can­cer cells have not yet pen­e­trated the base­ment mem­brane or in­vaded the sur­round­ing tis­sues. Early stage: In this stage, there is pres­ence of any of the spec­i­fied ma­lig­nant con­di­tions that can in­vade and de­stroy nearby tis­sue. (Pay­ment of lump sum rang­ing from 20 per cent to 25 per cent of sum in­sured is made at this stage.) Ma­jor stage: This stage is char­ac­terised by the first-ever ma­lig­nant tu­mour with un­con­trolled growth and spread of ma­lig­nant cells, with in­va­sion and de­struc­tion of nor­mal tis­sues. (Lump-sum pay­ment of up to 100 per cent of sum in­sured is paid at this stage.) Crit­i­cal stage: Any can­cer that meets the def­i­ni­tion of ‘ma­jor stage’ and where the in­sured in­di­vid­ual’s on­col­o­gist has de­ter­mined that the can­cer has pro­gressed to Stage IV is the crit­i­cal stage. (Pay­ment of lump-sum amount rang­ing up to 150 per cent of sum in­sured is pos­si­ble at this stage.)

Take­aways for Con­sumers

a) Go for a plan that of­fers a com­bi­na­tion of death/nom­i­nee ben­e­fit with max­i­mum ben­e­fit dur­ing the

three stages of the dis­ease (such as gold/plat­inum plans). b) Go for max­i­mum sum as­sured with min­i­mum ex­clu­sions and max­i­mum in­clu­sions.

We com­pared the five can­cer in­sur­ance plans on pa­ram­e­ters such as max­i­mum and min­i­mum pol­icy term, max­i­mum sum as­sured, pre­mium pay­ment op­tion, max­i­mum ma­tu­rity age, death/nom­i­nee ben­e­fit, sur­ren­der ben­e­fit, as­sign­ment ben­e­fit and min­i­mum en­try age. We gave the high­est weigh­tage (15 points) to con­sumer feed­back, based on which the most im­por­tant and ben­e­fi­cial vari­ables were short­listed.

CAN­CER IN­SUR­ANCE PLANS: Notes: a) In­for­ma­tion given here has been sourced from com­pany web­sites and brochures. b) Pre­mium as ap­pli­ca­ble to base plan, age 30 years, term 10 years, sum as­sured 10 lakh ru­pees (pol­i­cy­bazaarr.com) c) Please as­cer­tain pay­ment of ser­vice tax which may be in­cluded/not in­cluded in pre­mium cal­cu­la­tion.

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