Does Health Insurance Cover Brain Tumour?

The brain is one of the most important organs in your body. It is responsible for your memory, intelligence, senses, behaviour and body movement. Even the slightest issue with the functioning of the brain can cause critical diseases, such as a brain tumour. In case you are worried if a brain tumour will be covered by your health insurance policy or not, read on to find out.

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      What is Brain Tumour?

      A brain tumour refers to the abnormal growth of cells or lumps in the brain. This group of cells has an uncontrollable growth pattern and can compress brain tissues & other structures in the skull. As a result, a brain tumour can be life-threatening. A brain tumour can be either malignant or benign.

      • Malignant brain tumours: These are cancerous and can spread to other body parts.
      • Benign brain tumours: These are non-cancerous and do not spread to other parts of the body.

      As per the International Association of Cancer Registers (IARC), about 28,000 brain tumour cases are registered in India every year; however, according to the Indian Council of Medical Research (ICMR) statistics, the total number of brain tumour cases in India can be around 40,000 if unreported cases are also taken into consideration. Out of total registrations, 24,000 people lose their lives due to the disease or its complications.

      If diagnosed at an early stage, brain tumours may be removed with surgery. However, the cost to remove a brain tumour is high. In India, a brain tumour surgery costs somewhere between Rs 2.5 lakh to Rs 8 lakh on average, depending on the type of surgery, hospital and stage of the tumour.

      The craniotomy brain tumour treatment cost in India is between ₹2 lakh and ₹ 5 lakh, while neuroendoscopy in India can range from ₹6 lakh to ₹8 lakh.

      However, the prices may also vary depending on the city and the type of hospital where the surgery is being conducted. For example, a brain tumour surgery in Delhi will be more expensive than the one done in Patna. Similarly, the cost of brain tumour surgery in a private hospital will be more than in a government hospital.

      Is Brain Tumour Covered by Health Insurance Plans in India?

      Yes, brain tumours are covered under health insurance plans in India. They provide coverage for the medical expenses incurred on brain tumour surgery. It also covers the cost of hospitalization, ICU charges, ambulance charges, pre-hospitalization, post-hospitalization, room rent, OT charges and other medical expenses incurred during the brain tumour surgery. The scope of coverage in health insurance for brain tumour may vary from one policy to another.

      In case you are suffering from a benign brain tumour, the surgery cost will be covered under a critical illness insurance policy. Under this type of policy, your insurance company will provide you with a lump sum amount equal to the sum insured upon diagnosis of the brain tumour. The amount can be used to pay the surgery cost, medical bills, medicine costs, etc.

      However, not all critical illness plans provide coverage for benign brain tumour costs. Therefore, you must read your policy documents carefully to know if it covers brain tumours or not.

      Waiting Period for Brain Tumour Under Health Insurance

      All health insurance plans will provide coverage for brain tumours once the waiting period is over. In case you raise a claim for brain tumour surgery during the waiting period, your insurance company will have the right to reject it. This is because you are allowed to raise a claim under the health policy only after the waiting period has ended.

      Usually, all regular health insurance plans come with an initial waiting period of 30 days. However, if you have a critical illness insurance policy, you can raise a claim for the medical expenses incurred on brain tumour surgery after a waiting period of 90 days.

      Moreover, critical illness insurance plans also come with a survival period of 30 days. If the insured patient dies within 30 days of raising the claim, then the insurance company will not be liable to pay the claim amount.

      Summing It Up

      A brain tumour is a critical illness that can lead to severe brain damage and can be fatal. However, early diagnosis of the disease is essential for timely brain tumour removal surgery. However, it is an expensive surgery and thus, having a critical illness insurance policy is advisable to cover the brain tumour surgery cost so that you can focus on treatment and recovery. Just make sure to go through the waiting period and policy details carefully before you raise any claim.

      FAQs

      • Q1. Can I claim benefits if I have a brain tumour?

        Ans: Yes. You can file a health insurance claim for a brain tumour as it is considered a life-threatening disease. Most medical insurance plans cover brain tumour treatment costs under indemnity-based health insurance or critical illness plans. However, the coverage and eligibility may differ from plan to plan.
      • Q2. How much does 3 months of chemo cost?

        Ans: The chemotherapy cost depends on various factors like the disease’s stage, drugs used, number of cycles, hospital type, location, and so on. Usually, a cycle lasts for 2-4 weeks (including the treatment phase and the rest phase). One chemo cycle usually costs from ₹15,000 to ₹1 lakh or more, depending on the above factors.
        Hence, if one cycle is of 2 weeks, implying there shall be 2 cycles in a month. The cost of chemotherapy for 3 months can range from ₹90,000 to ₹6 lakh or more.
      • Q3. Are brain tumours 100% fatal?

        Ans: No. Brain tumours are not 100% fatal if diagnosed and treated timely. However, the survival rate for a brain tumour patient depends on various factors like type and grade of the tumour, shape and size of the tumour, location in the brain, biomarkers, patient’s age, etc.
      • Q4. How much does it cost to have a brain tumour removed?

        Ans: The average brain tumour surgery cost in India is between ₹1,00,000 and ₹5,00,000, apart from the costs of the pre-procedure tests, follow-up consultations, medicines and post-operative care. A complex surgery (like advanced radiosurgery) can, however, range up to ₹8,50,000 or more.
      • Q5. Will brain tumour be covered if it is a pre-existing disease?

        Ans: If you are diagnosed with a brain tumour before buying a health insurance plan, it will be covered after a waiting period of 2-3 years under a standard health insurance plan. However, full disclosure is required at your end to avoid claim rejections.
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