Group Health Insurance 127 views July 31, 2021

Chola Group Cancer Care Insurance Policy provides financial protection to the employees of an organization/company in respect of diagnosis/treatment of Cancer. This policy is available to persons aged between 3 months to 65 years. The coverage under this policy is available for primary members of the group (employees) and their spouses and children. The primary member’s age should be a minimum of 18 years on the date of commencement of the policy. Read this page further to learn more about the Chola Group Cancer Care Insurance Policy coverage.

Chola Group Cancer Care Insurance Policy Coverage

The insurer shall pay the lump sum benefit to the insured on diagnosis/treatment of Cancer as shown below, provided the policy is in force.

Benefit 1. Cancer Diagnosis Benefit

The insurer shall pay a lump sum amount in case of diagnosis of the following:

Carcinoma in situ or Early Stage Cancer

A lump sum amount of 20% of the Sum Insured is payable if the insured is diagnosed with Carcinoma in situ or Malignant cancer (early-stage cancer) during the policy period. The diagnosis of the Carcinoma in situ should be supported by a histopathological report. Also, there should be a positive diagnosis of Carcinoma in situ based on a microscopic examination of the fixed tissue, supported by a biopsy result. A pap smear alone won’t be sufficient to have a payout for people affected with cervix uteri. They will also need to submit a cone biopsy or colposcopy with the cervical biopsy report, showing the presence of Carcinoma in situ, to get the payout. At the same time, the policy doesn’t cover the clinical diagnosis of Cervical Intraepithelial Neoplasia (CIN) classification.

A pathologist must confirm an early stage cancer diagnosis based on histopathological features The diagnosis with the presence of one of the following malignant conditions shall be covered under the policy:

  1. Tumor of the thyroid histologically classified as T1N0M0 according to the TNM classification
  2. Prostate tumor histologically described as TNM Classification T1a or T1b or T1c
  3. Chronic lymphocytic leukemia of RAI Stage I or II
  4. Basal cell and squamous skin cancer that has spread to distant organs beyond the skin,
  5. Hodgkin’s lymphoma Stage I
  6. All tumors of the urinary bladder that are histologically classified as T1N0M0 (TNM Classification)

This benefit isn’t payable twice for the same organ during the lifetime of the insured. The insured can avail of this benefit on the first occurrence of Carcinoma in situ and early-stage cancer, except skin and prostate cancer.

Major Stage Cancer: A lump sum benefit of 100% of the Sum Insured is payable if the insured is diagnosed with Major Stage Cancer during the policy period. This benefit is equal to the sum insured less any payment made under Carcinoma in situ or Early Stage Cancer Diagnosis Benefit. A pathologist must confirm a Major Stage Cancer based on histological evidence of malignancy.

Exclusions shall apply to the following –

  1. All tumors histologically described as carcinoma in situ, benign, pre-malignant borderline malignant, low malignant potential, neoplasm of unknown behaviors or non-invasive
  2. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes
  3. Malignant melanoma that doesn’t cause invasion beyond the epidermis
  4. All tumors of the prostate unless histologically classified as having a Gleason score > 6 or having progressed to at least clinical TNM classification T2NoMo
  5. All Thyroid cancers classified as T1N0M0 (TNM Classification) or below
  6. Chronic lymphocytic leukaemia < RAI stage 3
  7. Non-invasive papillary cancer of the bladder histologically described as TaN0M or of a lesser classification
  8. All Gastro-Intestinal Stromal Tumours classified as T1N0M0 (TNM Classification) or below and with mitotic count of <= 5/50 HPFs
  9. All tumors in the presence of HIV infection

The diagnosis benefit will terminate on payment of 100% of the sum insured. A survival period of 7 days shall apply from the date of diagnosis of a condition.

Note: The insurer will not be liable for payment of any claim in case the insured person dies within the survival period

Benefit 2. Cancer Treatment Benefit

The insurer shall pay a lump sum benefit of 10% of the sum insured for every surgery for Carcinoma in situ or Early Stage Cancer during the policy term, provided the medical practitioner advises the same. Cancer Treatment Benefit has a limit of 30% of the sum insured. This benefit isn’t payable twice for the same organ during the lifetime of the insured. The Surgery benefit will stand exhausted on payment of 30% of the sum insured.

Benefit 3. Cancer Therapy Benefit

The insured will get a lump sum benefit of 20% of the sum insured for Chemotherapy /Radiotherapy if it the medical practitioner advises the same as a part of treatment for the Cancer. You can claim this benefit after the first session of undergoing Chemotherapy /Radiotherapy. This benefit is payable only once during the lifetime of the insured.

Waiting Period

The insurer is not liable to pay in case signs and symptoms related to Cancer occur or are diagnosed within 180 days from the date of the commencement of the policy.

Chola Group Cancer Care Insurance Policy Termination

The policy for the insured member will terminate on occurrence of the following, whichever happens earlier:

  1. On reaching the expiry date as mentioned in the policy certificate
  2. In case of death of the insured
  3. On payment of claim up to 150% of the sum insured
  4. On cancellation of the policy either by the insured, policyholder or insurer

Free Look Period

You will get a free look period of 15 days from the date of receipt of the policy to review the terms and conditions, and if the same is not acceptable, return the policy stating the reason for it. On cancellation, the insurer will refund the paid premium after retaining stamp duty charges and pro-rata premium, provided no claim has been made during the free look period.

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