Cancer Policy (CPAA)
We have seen that cancer is not covered under mediclaim policies.
However, members of the Cancer Patients Aid Association (CPAA) can take up a policy to cover cancer.
Let us see the details relating to the cancer policies.
The insured, by virtue of being a member of the CPAA, has to submit a proposal form with a declaration that he is in good health and is not suffering from cancer.
He has to undergo a medical check up. A certification to that effect has to be made by CPAA in the proposal form.
The proposal form and the certification form part of the contract of the insurance.
Premium will be paid by the insured to CPAA as part of the membership fee. This also applies as a condition precedent to the renewal of the policy.
|Note: Group policies are also available with a discount on the premium.|
If the insured suffers from cancer, the policy will pay to the insured medical/surgical/hospitalisation/diagnostic expenses actually and necessarily incurred but not exceeding the sum insured. Only allopathic mode of treatment is covered.
Sum insured is increased by 5% in respect of each completed year during which the policy shall have been in force prior to the claim. But the maximum increase is restricted to 50% of the sum insured. This cumulative bonus is lost if the policy is not renewed within 30 days after its expiry.
No claim is payable:
- If the insured contracts cancer within a period of 30 days from the date of becoming a member of the CPAA
- Unless the diagnostic investigation reveals positive presence of cancer
- By reason of the contact of the insured with radiation or radioactivity from any source other than diagnostic or therapeutic source
- If the insured ceases to be a member of the CPAA
Notice of claim shall be served upon the insurers within 30 days of the happening of any event, which gives rise to a claim.
The claim shall be substantiated with supporting documents within a reasonable period, duly certified by the CPAA.
Claim for reimbursement of medical expenses may be submitted on quarterly basis.
Difference as to the claim or quantum thereof is to be referred to the committee set up by CPAA and the company.
If the company disclaims liability or there is a dispute as to the quantum payable and if such questions are not referred to the committee within three months thereafter, the claim is deemed to have been abandoned.
|Note: A similar scheme with some variations is also available to members of the Indian Cancer Society.|