LEAD STORY. When your health policy falls short

When 45-year-old Shyam Sunder (name changed) was diagnosed with an early stage of lung cancer, he was advised that a surgery and chemotherapy would see him through the illness.

But the rude shock was his medical bill, which burnt a hole in his pocket despite the health insurance cover provided by his office. People end up paying from their pocket as many are not covered by insurance today, says senior oncologist SH Advani. And those who do have health insurance are not adequately covered as expenses are mainly reimbursed after hospitalisation, he adds.

In fact, the Indian insurance regulator says that less than 0.3 per cent of individuals have health insurance and most of them are under-insured. And this shows up when people have critical or chronic illnesses.

Insurance companies have tailored health products for specific illnesses. But do people understand these different products and more importantly, do these health covers come in helpful when most required?

Suresh Sugathan of Bajaj Allianz agrees that awareness on these plans is still low and restricted to those with a family history of the illness.

A cancer-specific insurance product offers more benefits than a standard health policy, as cancer involves prolonged treatment.

But it differs from a critical illness health plan, which can be bought additionally or separately and provides an up-front one-time amount to the policyholder. The patient can use this money to pay for expensive treatments, recuperation aids, make up for loss of income due or pay off debt, say insurers.

The drawback here is that a critical illness plan does not cover early stages of cancer and gives a payment only when cancer has progressed to the advanced Stage3.

Nevertheless, cancer claims have been on the rise. ICICI Lombard’s data reveals that cancer-related claims rose 12 per cent over three years, with the maximum number of claims in the 46-55 years age group.

S Prakash of Star Health and Allied Health insurance says the company has witnessed a 30 per cent increase in the claim value last year.

Max Bupa has seen a staggering 38 per cent increase in cancer claims from women last year, with more than half of that coming from the 41-60 years segment.

Cancer specific health plans cover costs associated with cancer diagnosis and treatment, including hospitalisation, radiation, chemotherapy and surgery.

HDFC Life’s cancer care plan sold more than 50,000 policies in less than 100 working days as it had cancer survivor Lisa Ray tell her story, says Sanjay Tripathy, a senior executive. People have since opened up to discussing the financial implication of cancer, he adds.

Dhruv Sarin from Policybazaar observes that cancer care plans are useful against that specific illness and are reasonably priced.

But the disadvantage is that a cancer patient cannot buy a new insurance plan if it is a pre-existing condition, say insurers.

Even those diagnosed with cancer after they have taken a policy are unlikely to be able to renew it or will be able to do so only on payment of high premiums.

Sarin agrees that insurers need to be more sympathetic to policyholders, as cancer is financially and emotionally tough on patients and their families.

Oncologist Advani points out that cancer patients are made to wait for long or run around before they are paid their insurance claims.

Clearly, insurers need to do more to ensure that patients find their health policies truly useful, especially when they need it the most.

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