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Cancer Health Insurance Claim Process - Things you should know about
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Steps to claim Cancer Health Insurance Policy in India

The modern lifestyle has witnessed the rise in diseases like cancer, which has become a common anomaly. For the year 2020, the projected incidence of patients with cancer in India among males was 679,421 (94.1 per 100,000) and among females 712,758 (103.6 per 100,000) for the year 2020. The study also forecasts that 1 in 68 males will develop lung cancer and 1 in 29 females will develop breast cancer in their lifetime. It is projected that 1 in 9 Indians will develop cancer during their lifetime of 0 – 74 years of age.

The reason behind ever-increasing cases of cancer in India

According to ICMR – the Indian Council of Medical Research, there will be an estimated 12% rise in Cancer cases in India in the next five years. The rise in life expectancy is one of the causes as the proportion of the elderly population has gone up, and cancer is more common in the advanced years.

Smoking and tobacco consumption are the main culprits behind oral and lung cancer, predominantly affecting the male population.

Apart from tobacco, alcohol, obesity, and sedentary lifestyle environmental factors also contribute to the increasing incidence of cancers. A sedentary lifestyle and access to a high-calorie diet have led to increasing obesity. About six types of cancers are linked to obesity and are on the rise among the population which is under 50. These are cancers of the colon or rectal, pancreas, gallbladder, uterine, and endometrial cancer. 

Why do we need Cancer Health Insurance? 

With the rising cases of cancer, it has become prudent to invest in a cancer health insurance policy. Cancer is a disease with an astronomical cost of treatment and recovery period as well. In addition, the financial strain of this disease can easily lead a common person to bankruptcy. Therefore, to battle the uncertainties of life and availing facilities that other traditional health plans may not provide, it’s essential to invest in a cancer-specific health insurance Plan.

Steps of claim process of Cancer Health Insurance

In the event a medical emergency arises, one needs to follow the following steps to claim the sum insured from the Insurance Company in a hassle-free way.

  • Inform the Insurance Company promptly: In case of any medical emergency requiring immediate hospitalization, a trusted friend or relative can immediately inform the Insurer about the hospital admission and expected expenses. One can contact the company directly or through TPA.
  • Submission of Documents required: Once the Insurance Company receives intimation about hospital admission, it will hand out a Claim Form. This Claim Form needs to be duly filled, signed, and submitted to the company, along with other relevant documents for verification purposes and evaluation of the amount that needs to be reimbursed. Therefore, you need to ensure that all documents are signed and stamped by the relevant authorities.
  • Bill Submission: The hospital bills need to be submitted to the Insurer along with other documents. The bills would include doctor’s fees, pharmacy bills, hospital bills, etc.
  • Claim Scrutiny: Upon submission of the Claim form and other bills, the Insurance company will check the authenticity and genuineness of the case in question.
  • Approval of Claim or Rejection of Claim: Based on the documents provided and findings, the company decides whether to approve the claim or reject it. More documents may need to be furnished to process the claim amount in certain cases.


Documents Required for Cancer Health Insurance Claim 

Several documents need to be furnished; however, the following list can provide basic guidelines to the claimant.

  • Correctly filled and signed claim form. 
  • Prescriptions of the treating doctors 
  • Medical Certificates
  • Reports of Medical investigations 
  • Reports of radiation therapy, chemotherapy, etc.


Common Inclusions in Cancer Insurance Plan 

  • Provides cover for the entire treatment: Several Insurers provide cover from day one of diagnosis till the full tenure of treatment is completed.
  • Tax Benefits: Premiums paid towards a Cancer Plan are usually eligible for Tax Benefits under the provisions of section 80D


 Common Exclusions in case of Cancer Health Insurance Policy

Even though your Cancer Health Insurance covers major types of cancer, the following exclusions must be kept in mind.

  1. Your Insurer will not cover major cancers, carcinoma-in-situ, or early stages of cancer if it results directly or indirectly from sexually transmitted diseases like HIV or AIDS.
  2. Congenital conditions, which can later develop into cancer, will not be provided coverage by the company.
  3. Cancers that might develop as a result of alcohol abuse or other addictive drugs, not prescribed by a Medical Practitioner.
  4. Cancers are resultant of contamination due to Nuclear, Chemical, or biological sources. 


Policyholders need to research and review the cancer Plan they are purchasing and must be aware of the list of exclusions. Exclusion to a policy means that the Plan does not cover those types of health conditions. The individual might end up paying the Medical expenses from his pocket, thus, defeating the entire purpose of buying the cancer Plan in the first place.

Certain health insurance cancer plans provide the policyholders with a “Free Look Cancellation” period of 15 days or 30 days, providing the policyholder crucial time to review the policy’s terms and conditions and exclusions and inclusions. In addition, the return of policy papers during this window period enables a refund of the premium paid.

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