Modern health treatments and policy coverage
₹5 lakh for modern treatments, while offering a sum insured of ₹20 lakh is counter-productive. A few insurers have made it a standard policy to cap 50% of the sum insured for modern treatment. This obviously helps them get more customers by offering lower price, but creates negative feedback loop for the category.
Unsuspecting policyholders do not understand the implications of such capping at the proposal stage. Worse, they sign-up being unaware. Besides the capping, some insurers are being creative with the interpretation of these exclusions.
One insurer rejects oral chemotherapy claim if the treatment is not administered without being hospitalized. This is outrageous. Why should one need to get hospitalized for oral medication! Advancement of medical care has led hundreds of surgeries to be converted into day care procedures or ambulatory care.
The basic rule of 24-hour hospitalization, for standard health insurance, does not apply for day care treatments. The same principle should apply for oral chemotherapy, more so because the regulatory intent was to cover all kinds of treatment process whether “as in-patient or as part of domiciliary hospitalization or as day care treatment in a hospital." The insurer’s interpretation would not stand in the court of law. The question is: how many people would survive cancer and have the energy left to fight the insurer? Should the insurer be allowed to continue to benefit from this situation? The world of cancer treatment saw a breakthrough when the Indian drug regulator approved immunotherapy using ‘CAR T-cell’ therapy in October 2023.
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