Coverage Of Cancer Insurance Scheme And Exclusions Of Claim

Coverage Of Cancer Insurance Scheme And Exclusions Of Claim


Cancer is a devastating disease that affects millions of people worldwide. The financial burden associated with cancer treatment can be overwhelming for patients and their families. To alleviate some of this burden, various insurance companies and governments have introduced Cancer Insurance Schemes to provide coverage for cancer-related expenses. These schemes aim to offer financial support, ensuring access to quality treatment and care during the challenging journey of battling cancer.

In this document, we will explore the coverage provided by a typical Cancer Insurance Scheme and the exclusions that may apply to claims. It is important to note that specific details may vary based on the insurance provider and policy terms. However, we will present a general overview of the common features and limitations found in many Cancer Insurance Schemes.

Types of cancer insurance :

There are different types of cancer insurance policies available, including:

Basic Cancer Insurance: Provides coverage for cancer-related medical expenses, such as diagnostic tests, treatments, and hospitalization.

Comprehensive Cancer Insurance: Offers broader coverage, including pre- and post-diagnosis expenses, second opinion consultations, and additional benefits like palliative care.

Critical Illness Insurance with Cancer Coverage: Covers various critical illnesses, including cancer, offering a lump sum payment upon diagnosis.

Supplemental Cancer Insurance: Works alongside primary health insurance, providing additional financial support specifically for cancer-related costs.

Cancer Income Protection Insurance: Provides a steady income stream during cancer treatment and recovery periods.

Group Cancer Insurance: Offered by employers to employees, covering cancer-related expenses for a group of individuals.

Cancer-Specific Insurance Riders: Add-ons to existing life or health insurance policies, enhancing coverage for cancer treatment.

Family Cancer Insurance: Extends coverage to multiple family members under a single policy, protecting against cancer-related expenses for the entire family.

Coverage of Cancer Insurance Scheme :

Diagnostic Tests: Cancer Insurance Schemes generally cover the cost of diagnostic tests such as biopsies, imaging scans, blood tests, and other investigations to confirm the presence of cancer.

Medical Consultations: The scheme typically provides coverage for consultations with oncologists, surgeons, and other specialists involved in the cancer treatment process.

Treatment Expenses: Cancer treatment can be expensive. The insurance scheme often covers various treatment modalities, including surgery, chemotherapy, radiation therapy, targeted therapy, immunotherapy, and hormonal therapy.

Hospitalization: Inpatient hospitalization costs, including room charges, nursing care, and medicines, are usually covered under the Cancer Insurance Scheme.

Daycare Procedures: Some schemes may cover certain daycare procedures that do not require overnight hospitalization, such as chemotherapy sessions.

Post-Treatment Care: Cancer survivors may require ongoing follow-up care and medications. The insurance scheme may cover post-treatment expenses to ensure continued monitoring and management of the disease.

Ambulance Services: Many schemes provide coverage for emergency ambulance services required during cancer treatment.

Second Opinion: Some schemes offer coverage for seeking a second opinion from renowned cancer specialists to explore different treatment options.

Preventive Screenings: A few insurance schemes may cover preventive screenings for early detection of cancer in high-risk individuals.

Palliative Care: Palliative care, aimed at improving the quality of life for terminally ill patients, may also be covered by certain Cancer Insurance Schemes.


Coverage Of Cancer Insurance Scheme And Exclusions Of Claim


Coverage Of Cancer Insurance Scheme And Exclusions Of Claim


Exclusions of Claim:

While Cancer Insurance Schemes are designed to provide comprehensive coverage, they also have certain limitations and exclusions. These exclusions vary depending on the policy, and it is crucial for policyholders to be aware of them to avoid misunderstandings during the claims process. Some common exclusions include:

Pre-Existing Conditions: Cancer Insurance Schemes typically exclude coverage for pre-existing cancerous conditions at the time of purchasing the policy.

Waiting Period: There might be a waiting period after purchasing the policy during which claims related to cancer treatment may not be accepted.

Specific Cancer Types: Certain rare or experimental cancer treatments may not be covered by the scheme. Moreover, some policies may exclude coverage for specific types of cancer that are considered high-risk or pre-existing.

Alternative Therapies: Some alternative or complementary cancer therapies may not be covered under the insurance scheme.

Stage of Cancer: The insurance coverage might vary depending on the stage of cancer at the time of diagnosis.

Non-Cancerous Tumors: Some schemes may not cover non-cancerous tumors, even though they require medical treatment.

Intentional Self-Inflicted Injury: Claims arising from self-inflicted injuries or suicide attempts are generally excluded.

Unapproved Providers: If a patient seeks treatment from a healthcare provider not recognized by the insurance company, the claim might be denied.

Non-Disclosed Information: If the policyholder fails to disclose relevant medical information or provides false details during the application process, it may lead to claim rejection.

Cosmetic Procedures: Procedures primarily aimed at improving aesthetics rather than treating cancer-related issues are usually excluded.

Companies that offer Cancer Insurance Plans in India :

Some of the companies that offer Cancer Insurance Plans in India include:

ICICI Lombard General Insurance
HDFC ERGO General Insurance
Max Life Insurance
Apollo Munich Health Insurance (now HDFC ERGO Health Insurance)
Bajaj Allianz General Insurance
Religare Health Insurance (now Care Health Insurance)
Star Health and Allied Insurance
SBI Life Insurance
Aditya Birla Sun Life Insurance
Reliance Nippon Life Insurance
Please note that the availability of specific insurance plans and providers may have changed since my last update, so it is advisable to check with these companies or conduct further research to find the most up-to-date information.

Coverage Of Cancer Insurance Scheme And Exclusions Of Claim


Benefits of Cancer Insurance Plan :

The benefits of a Cancer Insurance Plan include:

Financial Protection: Cancer treatments can be costly. A cancer insurance plan provides financial support, covering medical expenses like surgery, chemotherapy, and radiation.

Lump Sum Payout: Upon diagnosis, the plan often provides a lump sum payment, allowing policyholders to use the funds as needed, including for non-medical expenses.

Coverage for Various Stages: Some plans cover early-stage cancer, offering benefits even before the disease reaches an advanced stage.

Additional Support: Cancer-specific policies may include benefits for second opinions, post-treatment care, and palliative care.

No Impact on Regular Health Insurance: Claims under cancer insurance do not affect regular health insurance coverage, providing comprehensive protection.


Cancer Insurance Schemes play a crucial role in providing financial support to individuals facing the challenges of cancer treatment. However, it is essential for potential policyholders to thoroughly understand the coverage offered and the exclusions that apply to avoid any surprises during the claims process. Reading and comparing policy documents, seeking clarification from the insurance provider, and making informed decisions can help individuals secure the right coverage for their specific needs.

Coverage Of Cancer Insurance Scheme And Exclusions Of Claim


Q1.  Does a cancer plan provide survival and maturity benefits?
No. No. It is pure health coverage and does not include the benefits of a life insurance plan.

Q2. Can it be a family plan floater?
It will always be an individual plan.

Q3. Is there a waiting period before you can get the benefits of the plan?
It is usually available for 180 days. However, this can vary depending on the company.

Q4.  How much does cancer insurance cost?

The cost of a policyholder’s cancer insurance coverage or premium depends largely on their age, medical history, and the amount they have insured.

Q5. . Do I need to pay tax on the money I receive from a cancer insurance policy?


Q6.Can I purchase a cancer insurance policy if I already have a health insurance plan?

You can purchase a cancer plan regardless of whether you have health insurance. The benefits of each plan serve different purposes.

Q7.  Does an insurance policy for cancer cover pre-existing conditions?

No. No. The cancer insurance plan does NOT cover pre-existing conditions. The policy covers only cancer treatment after the waiting period has expired.

Q8. Am I eligible for a cancer insurance plan if I smoke?

You can purchase this plan even if you smoke, but the premium you pay will be higher than for non-smokers.

Q9.  Can someone buy a cancer plan after being diagnosed?

If you have already been diagnosed with cancer, the plan will not allow you to buy it.

Q10.  Does a policy for critical illness cover cancer?

Yes. Most insurance companies cover cancer as part of their critical illness plans.