Health Insurance: Are Experimental Treatments Covered Under Cancer Insurance Policies?

For anyone diagnosed with cancer, one of the biggest worries, apart from mental and emotional turmoil would be whether their treatments and therapies will be covered under any health insurance plan they have. As medical inflation continues to rise, cancer treatment costs will also skyrocket, putting families under financial stress.

This is where cancer-specific insurance policies come in handy, offering tailored coverage and a financial cushion in difficult times. However, one question looms above all - do these plans cover ‘experimental treatments’ like immunotherapy? Let’s understand.

But first, let’s discuss who should consider buying a cancer insurance plan. While health insurance is a must for everyone, according to Priya Deshmukh, Head of Health Products, Operations & Services at ICICI Lombard, “For further fortified financial protection, one can consider Cancer Insurance plans given the high-value expenditure required for the treatment.”

A dedicated cancer insurance plan would be needed by patients diagnosed with the same, offering additional financial protection to meet the high costs of cancer treatment.

How does a cancer-specific insurance policy differ from a critical illness plan?

Says Deshmukh, “It depends upon the design of such product.” She informs that there are cancer-specific benefit policies that offer lump sum benefits on the occurrence of Cancers of ‘specified severity’. Generally, the Critical illness policies offer lump sum benefits for listed major illnesses including Cancers.

The benefit structure depends on the policy design, some offer fixed payouts upon diagnosis, while others cover expenses incurred for treatment.

Do Cancer Insurance Plans Cover Experimental Treatments Like Immunotherapy?

A short answer would be: It depends. On what? Let’s understand.

According to Deshmukh, “Most of the cancer-specific plans are driven on fixed benefit chassis”. Here, a lump sum benefit is paid on detection of the disease which can be utilised by the policyholders as per his/her needs.

However, for indemnity products, immunotherapy is covered wherever it is not classified as an experimental treatment for a standard line of treatment.

“Experimental treatment across the industry is not covered in most of the offered comprehensive products,” Deshmukh notes.

How Much Does a Cancer Insurance Policy Cost?

The cost of a cancer insurance policy varies depending on age, sum insured, product type, and pre-existing conditions. Cancer-specific policies can have higher premiums, which raises an important question: should one opt for a critical illness rider on a standard health plan instead?

Deshmukh suggests that the best approach is to buy a comprehensive health insurance policy first. To expand coverage, individuals can consider a super top-up policy or a critical illness rider, which may offer better financial flexibility.

Policy Terms & Coverage Gaps: What to Watch Out For

Cancer insurance policies, while beneficial, come with certain limitations. Some of the key exclusions buyers should be aware of include:

Sub-limits and co-pays: Some policies impose caps on coverage amounts.

Experimental treatments: These are standard exclusions across most health insurance policies.

Waiting periods: Some policies require a survival period before claims can be processed.

Cancer insurance can be your financial shield but understanding the coverage scope and limit is a key to making the right choice. While immunotherapy may be covered under your standard treatment protocols, some experimental therapies generally aren’t.

For those looking for maximum coverage, carefully assess and opt for a comprehensive health insurance plan, possibly with a critical illness rider or super top-up policy for umbrella coverage. However, remember to read the fine print before signing on the dotted line.