Why Specialised Health Insurance is Important

35-year-old Gaurav had a well-paying job and a bright future. But he received a rude shock when he was diagnosed with lung cancer. It was not just his life that suddenly became unpredictable; his finances were in pieces too.

Now, Gaurav had a mediclaim policy that his employer provided, which he thought would be sufficient if he ever faced a medical crisis. Unfortunately, he found out the hard way that this was not the case. He soon learned that the cover offered would not be enough to meet the expenses of his cancer treatment. He also found that the hospital where he wanted to get treated was not in the list of his insurer’s network hospitals and hence he wouldn’t be able to avail cashless hospitalization.

Is a mediclaim enough to protect you from critical illnesses like cancer?

Cancer is not a rare occurrence in a country like India. An estimated 71% of cancer-related demises have been in the age group of 30-69¹. What is even more worrying is the cost of treating cancer, which has increased three to four-fold since 2000². From approximately Rs. 1.5 lakh, the basic cost to treat five of the most common cancers – lung, oral, breast, cervix and colorectal – increased to about Rs. 6- 7 lakhs in 2015^1_3. This cost is expected to have further increased due to inflation.

In a scenario like this, it may not be adequate to rely only on a mediclaim policy to take care of all your medical needs, especially critical ones like cancer and heart ailments, where the complete cost of treatment is around 20 lakh⁴. New targeted health plans like Heart/Cancer Protect ensure that you are adequately protected at an affordable price. Let’s look at the advantages of it through the following questions.

Why should I choose a specific heart & cancer plan over & along with a Mediclaim policy?

Although cancer and heart illness can be a really unfortunate thing to happen, the relief lies in the fact that most of the cancers are now fully treatable when diagnosed early and with proper treatment and care at proficient medical institutions. Many a times, what stands in the way of a successful treatment is the lack of funds. A reimbursement policy could be inadequate to cover the cost of treatment which can run into lakhs⁵. A targeted health plan like Heart/Cancer Protect can provide a cover of upto Rs. 50 lakhs for cancer treatment which can make the best treatment possible and dramatically increase the odds of a full recovery when inflicted with cancer.

Will a heart/ cancer plan give me sufficient financial assistance in case of a health emergency?

Yes, it will. In fact, claims are one of the biggest differentiators when it comes to these two policies. For instance, if you use a mediclaim policy when claiming expenses for your treatment, you might either have to get treated at a network hospital to avail cashless hospitalization or reimburse your spends after having paid out of pocket. It also would not help cover the non-medical expenses during that time, which can be quite huge at the time of distress.

However, a plan like ICICI Pru’s Heart and Cancer Protect, gives you a lump sum payout as soon as the condition has been diagnosed ^. The amount can be used for hospitalisation and treatment costs, or any other expenses that may be related to your medical condition.

Which policy will give me a higher coverage amount – Mediclaim or Heart/ Cancer Protect?

Average sum assured for mediclaim has been about 2 lakhs⁶ or so, even when larger covers are available under a mediclaim. This could be because of premiums being on the higher side and not necessarily signal a lack of need for a higher cover. For example, a 50 lakh mediclaim for a 30 year old starts from about Rs.11,000⁷ and the premiums will only increase from there on, with age.

Whereas, in the case of Heart/Cancer Protect, the premiums for a 50 lakh cover for a 30-year-old would be only Rs.3535 (For a 5 year period, since the min, policy term for the policy is 5 years). By availing a higher cover through these targeted plans for specific diseases, one can reduce the mediclaim expenses by taking up a smaller cover and still being adequately protected.

Can I choose which hospital I want to be treated in with mediclaim?

Unfortunately, no. A mediclaim policy offers cashless hospitalization only if you get treatment in a hospital that is part of its specified network⁸. If you get treated elsewhere, you have to go through the process of reimbursing money after paying out of your pocket.

A targeted health plan like Heart/Cancer Protect can be immensely helpful in such a scenario. Once a doctor’s certificate of diagnosis is provided, the claim is paid out, which can then be used in any hospital of your choice to get treatment. You can choose to be admitted to a non-network hospital, or even travel abroad for treatment if you want to, where significantly better medical facilities may be available.

Will Mediclaim give me a payout as soon as I file for a claim?

Obtaining a payout through a mediclaim will require submitting bills when treatment is availed at a non-network hospital. Only once these are approved by the insurer, will you be reimbursed for the treatment amount. However, a specialised plan like Heart/Cancer Protect has an easier and quicker process. You are paid the sum assured as soon as you are diagnosed with a specified condition, provided that a valid diagnosis report is present.

The last word

A mediclaim policy can only go that far for you. However, ICICI Prudential’s Heart/ Cancer Protect offers health cover that gives protection against diseases that are expensive to treat like Cancer at an affordable cost, providing you far robust financial cover and peace of mind. So, don’t be ill-informed like Gaurav and settle for a limited cover. Instead, opt for a plan that will give you financial assistance and peace of mind during a critical medical emergency.

Check Health Insurance Premium

Know more about ICICI Pru Heart/Cancer Protect
Claim payout on detection – Only diagnosis report needed
Premium discount for covering your spouse^* and for existing customers^#
Waiver of premium on minor/major diagnosis^~
Added benefits for hospitalization^** and cover enhancement^~~
Affordable cover – 20 Lakh Cover @ ₹ 235 p.m.^##

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Disclaimers

^{^} A lump sum is paid out on diagnosis of any of the listed conditions. This payout is based on the level of the condition. Medical records of diagnosis/doctor’s certificate of diagnosis has to be submitted.

^* A discount of 5% on the first year’s premium will be offered on purchase of ICICI Pru Heart / Cancer Protect when life assured and his/ her spouse is covered under the same policy. The policy benefits of both the Lives Assured shall be independent of each other. The Sums Assured of both the lives could be different. A claim made by one Life Assured under the policy does not affect benefits of other Life Assured. This Family benefit has to be chosen at the inception of the policy only, spouse cannot be added once the policy is issued. This discount is not applicable on Single Pay Policy. With one policy, you can avail either Family Benefit or Loyalty Benefit.

^# Existing customer discount of 5% on the first years premium is available only for policies with Regular Premium Payment Option, it is not applicable for Single pay policies. With one policy, you can avail either Family Benefit or Loyalty Benefit.

^~ The Company shall waive all future premiums on a claim of Minor condition under the chosen cover; or on the diagnosis of Permanent Disability (PD)of the Life Assured due to an Accident. If both Cancer cover and Heart cover are chosen such waiver is allowed on a minor/major condition claim under either Cancer cover or Heart cover; or on the diagnosis of PD. This benefit is available only if the Policy is in force as on the date of diagnosis of the condition/at the time of accident.

^** Under this cover, you will receive Rs. 5,000 as daily cash benefit in case you are hospitalised due to a covered ailment. The daily cash is given irrespective of actual hospitalisation costs to help you manage daily expenses. This benefit will be payable subject to a maximum limit of ten days per policy year and thirty days over the policy term for hospitalization of min 24 hours. The yearly limit of number of days of hospitalization cannot be carried forward to next year.

^~~ With Increasing Cover Benefit, the Sum Assured chosen at inception increases by 10% simple interest on each policy anniversary, for every claim free year. The maximum Sum Assured under the cover will be capped at 200% of the Sum Assured chosen at inception. This increase in Sum Assured will stop on occurrence of first claim under the cover. Where Cancer cover and Heart cover are chosen together, the Sums Assured for both the covers increase by 10% simple interest on each policy anniversary, for every claim free year. The maximum sum assured will be capped at 200% of the Sum Assured chosen at inception for each type of cover. In case of occurrence of first claim under any one type of cover, the increase in Sum Assured will stop for that cover type and Increasing Cover Benefit will continue for the other type of cover, for which no claim has occurred.

^## The premium has been calculated for a non smoker 30 year old male for a Cancer Cover of Rs.10 lakhs and Heart Cover of Rs.10 lakhs for a policy term of 20 years and is inclusive of all taxes, under ICICI Pru Heart/Cancer Protect.

1- https://economictimes.indiatimes.com/wealth/insure/can-you-bear-the-cost-of-cancer-treatment-find-out-how-to-buy-the-best-cover/articleshow/47744432.cms

2- http://www.business-standard.com/article/pf/don-t-depend-on-health-cover-by-your-employer-113070201069_1.html

3- https://iib.gov.in/IIB/healthpub/Health%20Insurance%20(Non-Life)%20Data%20Analysis%20Report%202011-12.pdf

4-http://www.livemint.com/Object/1XhvIv1t7ce1r1WiQ4BoyJ/mediclaimrating-2017.html

5-https://www.hdfcergo.com/blogs/health-insurance/short-term-vs-long-term-health-insurance.html

6- http://www.medimanage.com/my-health-insurance/articles/what-is-cashless-hospitalization.aspx

ICICI Pru Heart/Cancer Protect . UIN: 105N154V03

ADVT - W/II/1940/2017-18