Summary of this article
Health insurance covers cervical cancer treatment but excludes preventive screening
OPD tests and HPV vaccines usually remain out-of-pocket expenses
Preventive care gaps arise from sub-limits, room caps, and waiting periods
Coverage focuses on hospitalization, not early detection or wellness
Regular health insurance in India can only provide support when you are admitted to a hospital because of cervical cancer. Coverage for surgery, chemotherapy, radiotherapy, and other hospital-based treatments will be available from the policy as long as the treatment is within the limits specified. After diagnosis, treatment for the condition can typically be covered by the policy unless the insurer’s terms allow no further claims.
Treatment Covered, Screening Not
Standard health insurance policies will not always cover screening or other diagnostic tests done on an outpatient basis or as part of a health check-up for preventative measures against cervical cancer, but some plans provide O.P.D. benefits or your choice of health checks with a rider. “Unfortunately, many insurance companies do not cover routine or preventive screening tests for cervical cancer; therefore, there are several alternatives available through insurers to help offset the financial burden of a critical illness,” says Dinesh Mosamkar, senior vice president, TATA AIG General Insurance.
“Unless the policy includes OPD benefits or preventive care add-ons, screening and early diagnostic tests, such as Pap smears, HPV tests, colposcopies, or biopsies performed on an OPD basis, are often outside the core coverage,” says Sarita Joshi, head of health and life insurance, Probus.
The majority of the time, HPV vaccines and regular screening for cervical cancer are still paid entirely out of pocket. Although many people are now more aware of being screened for cervical cancer than they were 20 years ago, across-the-board coverage for preventative services continues to lag behind the overall trend in the marketplace for preventative service coverage.
Vaccines are typically categorized as preventative wellness expenses, not treatment-related expenses. “Therefore, the vaccine will not be reimbursed by standard (indemnity-based) health insurance. Also, screening tests will not be reimbursed unless they are included in a bundled payment associated with the provider's outpatient department (OPD) or wellness benefits,” says Mosamkar.
Says Narendra Bharindwal, president, Insurance Brokers Association of India (IBAI): “In India, standard health insurance has traditionally been designed around hospitalisation-led care, and that remains largely true even for cervical cancer. Once the disease is diagnosed and treatment requires hospitalisation, such as surgery, chemotherapy, or radiotherapy, most comprehensive health insurance policies do provide coverage, subject to waiting periods and policy terms.”
“However, screening and early diagnostic interventions like Pap smears, HPV tests, or colposcopy are not uniformly covered under standard indemnity policies. Some newer products and wellness-linked covers do include limited preventive screening benefits, but these are still exceptions rather than the norm. As a result, insurance meaningfully supports treatment after diagnosis, but falls short at the prevention and early detection stage, where outcomes and costs can be dramatically improved,” adds Bharindwal.
Hidden Factors Create Coverage Gap
It’s a combination of one or more factors that lead to coverage gaps. Most people are not aware of the exact coverage under their policy. “There are room rent capping either in the form of a percentage of the sum insured or a type of room (single, shared, Ac, Non- Ac). There are also procedure-related sub-limits in various polices. Most people know that there are exclusions in the policy, but their exact applicability may be tricky to understand and difficult to interpret. Waiting periods are mostly well understood across policyholders,” says Joshi.
“Even if hospitalisation is covered by the policy limits or exclusions, they can severely restrict the financial protection available to patients receiving prolonged or advanced-stage treatment,” says Mosamkar.
