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Care For A Cover?

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Care For A Cover?
Nirmala Konjengbam - 01 March 2021

For S Vijaya, a single mother from Hyderabad, 2018 was a year of memories – good and bitter.  While she was happily watching over her daughter join college and son prepare for 10th-grade board exams, the wrath of fate brought everything crashing down, when she was suddenly detected with breast cancer. The next two and half years were exhausting. Vijaya underwent several sessions of chemotherapy followed by surgery. Apart from the emotional scar, cancer left her financially crippled and indebted, fighting even for the basic needs.

Diseases like cancer and diabetes are silent killers that destroy millions of families every year in India. In fact, after cardiovascular diseases, cancer takes the maximum number of lives in India. A report by the World Health Organisation (WHO) says that one person among every 15 Indians will die of cancer. According to the report, in India, the six most common cancer types are breast cancer (162,500 cases), oral cancer (120,000 cases), cervical cancer (97,000 cases), lung cancer (68,000 cases), stomach cancer (57,000 cases), and colorectal cancer (57,000).

A latest report from the National Cancer Registry Programme (NCRP) shows India’s cancer burden could shoot up from 1.39 million in 2020 to 1.57 million in 2025. According to the report, tobacco-related cancer is likely to account for 27.2 per cent of all cases, followed by gastrointestinal tract cancer at 19.8 per cent.

Between 2016 and 2018, cancer cases were highest in Uttar Pradesh (270053) followed by Bihar (145051), Maharashtra (144032), West Bengal (117220), Madhya Pradesh (98403), Tamil Nadu (86180) and Gujarat (80820).

The report also shows that Uttar Pradesh has the highest mortality (136579), followed by Bihar (73361), Maharashtra (727620), West Bengal (59154), Madhya Pradesh (49713) and Tamil Nadu (43422). The data shows where we stand.

Diabetes is not far behind. According to International Diabetes Federation (IDF), India has over 77 million cases of diabetes, as of March 2020, which is close to 9 per cent. It is expected to rise to 101 million in 2030 and 134 million in 2045.

People suffering from diabetes lose their ability to produce new insulin hormone that regulates the amount of glucose (sugar) in the blood for the normal function of the body. Even as most health policies cover major critical illnesses, the coverage is not sufficient.

There are specific health insurance plans for diabetes and cancer. While a normal mediclaim policy would help in meeting the initial hospitalisation costs, it does not cover the entire cost of treatment. Moreover, it could be difficult to renew the policy in the future. Specific plans, on the other hand, cover the entire cost of treatment.  A lump sum amount is paid when diagnosed with the disease. It could also act as a saviour during a loss of income due to illness.

As Bhabtosh Mishra, Director Underwriting for Products and Claims at Max Bupa Health Insurance, suggests,  “Everyone should purchase a comprehensive health insurance plan. They may seek additional complementary or supplementary cover through different products or riders for the existing health condition(s) they may have.”  Such products and riders offer disease-specific coverage features or benefits, in addition to base health insurance plans, he adds.

If you have a family history of any such disease, it is worth having a specific health insurance policy.

Diabetes-Specific Plan

This plan provides cover against treatment and expenses for both Type-1 and Type-2 diabetes with no waiting period. A normal mediclaim policy has a waiting period of four years for diabetes. Policies with a shorter waiting period come at a very high premium.

“Diabetes plans have no waiting period and cover both diabetes and hypertension from the very first day. A regular health plan normally covers Type-2 diabetes. These plans usually consider diabetes as pre-existing disease, covered after a waiting period of 48 months,” informs S Prakash, Managing Director, Star Health and Allied Insurance.

One very crucial feature is that this plan provides cover against all other illnesses and renewability would ideally not be an issue, while pre-check up is not required.

“It (pre-check up) is not mandatory. The need for pre-check up depends on the options one chooses. A diabetic person can purchase this plan either as an individual or with a spouse, irrespective of the blood sugar level and the number of years one is diabetic. It is a special plan,” says Prakash.

Ideal Sum Insured

A minimum of Rs 5 lakh sum insured is advised keeping the rising medical cost in mind. Diabetes expenses increase with age.

As Prakash advises, “Given the trend of increasing medical costs, the minimum sum insured one should consider right now is Rs 5 lakh or above, particularly for people who are 50 years and above.”

Cancer-Specific Plan

A dedicated cancer insurance plan is usually a benefit-based policy that pays for medical expenses and is a replacement for the monthly income loss.

As Mayank Bathwal, CEO, Aditya Birla Health Insurance explains, “Cancer is a very taxing disease – physically, emotionally, and financially. Cancer treatment involves massive costs that keep increasing as the disease progresses. The last thing, a person suffering from cancer needs, is the burden of hefty treatment costs. A dedicated cancer cover combined with a regular health insurance plan will serve as a much-needed source of relief in such stressful times.”

One can also opt for a critical illness plan for cancer expenses. However, many only assist in the advanced stages of cancer. In a cancer-specific plan, there is no such restriction.

Unlike a diabetes plan, cancer medical cover would not protect against other illnesses. However, there are benefits like waiver of premium upon detection of disease and lump sum payouts that are not available with regular health insurance policies.

A pre-check up for such a plan is at the discretion of the insurance company, based on the terms and conditions.

“Anyone can opt for these (cancer-specific) plans. They are ideal for individuals who identify the risks posed by cancer and understand the financial drain associated with it. It is crucial to buy a cancer-specific cover in addition to a basic indemnity health insurance policy for enhanced protection,” adds Bathwal.

It is important to note that skin cancer is usually not included in cancer-specific plans along with any pre-existing disease.

Ideal Sum Insured

Cancer treatments costs could run in lakhs and it is strongly advisable to take maximum possible cover that suits your lifestyle.

Consider Before Buying

While diabetes special plans cover for other illnesses, cancer plans do not and hence it is crucial to add a mediclaim policy for enhanced protection and coverage.

While choosing a cancer plan, you need to check whether the plan supports treatment costs after the first diagnosis and covers the financial demands of each stage of cancer.  Does the plan provide a premium waiver, and if so, at what stage? Does the plan come with a regular income benefit? Also, a cancer plan may have a waiting period.

For a diabetes-specific plan, it is important to check what other illnesses are covered under the policy. More specifically, check the sub-limits available for various treatments covered, whether they are deductible or co-payment conditions.

Compare features, benefits and prices of different plans before purchasing.

***

Cancer Cover

Buy If

  • Family has a history of cancer
  • Greater risk due to environment, lifestyle
  • Regular health policy doesn’t pay
  • Insufficient savings
  • Sole breadwinner

How To Choose

  • Opt for higher sum assured
  • Cover extended period and all stages of cancer
  • Select premium waiver and income benefit
  • Take note of survival benefits and waiting period
  • Check family history and weigh risk factors

Mapping Challenges

  • Cases likely to touch 15.7 lakh by 2025
  • Current cases estimated at 13.9 lakh
  • Tobacco-related cancer: 27.1%
  • Breast cancer:  14.8%
  • Cervix cancer: 5.4%
  • Gastrointestinal tract cancer: 19.7%
  • Lung, mouth, stomach and oesophagus cancer common among men
  • Breast, cervix and uterine cancer most common in women
  • Significant rise in breast cancer observed
  • Rising trend of lung, head & neck cancer in both men and women

Source: ICMR & NCDIR

***

Diabetes Insurance

Who Should Buy

  • Individuals between 20 and 60
  • Affects more men than women
  • Family has a history of diabetes
  • Family’s sole bread earner

Why Buy

  • Treatment is expensive
  • Family’s finances could be hit

Premium Factors

  • Gender, age and location
  • People between 36 and 60 file most claims
  • Renewal premium rises with age and claims
  • More claims from major cities

***

Alarming Growth

  • 1 in 6 adults with diabetes is an Indian
  • 77 million Indians are estimated to have diabetes
  • Predicted to touch 101 million by 2030
  • 1 in 2 people with diabetes remain undiagnosed
  • 43 million people have undiagnosed diabetes

Source: International Diabetes Federation


nirmala@outlookindia.com

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