88% of working women lack cervical cancer vaccination — Does health insurance provide safety net?

Deepthy Nandakumar, AVP – Health Claims at Digit General Insurance, sheds light on the role health insurance plays in the context of cervical cancer.

"Health insurance provides a sense of security, allowing individuals to seek treatment without financial worries. The coverage is designed to ensure access to preventive, diagnostic, and treatment services, alleviating the financial burden associated with cervical cancer," she told CNBC-TV18.com.

A health insurance plan typically covers most costs related to diagnosing and treatment of cervical cancer. However, the same may vary from policy to policy and insurer to insurer.

Hence, policyholders must read the insurance contract carefully before buying the plan.

If someone has certain symptoms like unusual bleeding, pain, or discharge from the cervix, and the doctor may want to perform a few tests like a pelvic exam or cervical cytology, the same is covered.

"If they recommend a biopsy and hospital stay, the same will typically be covered by the insurer. Chemotherapy or radiotherapy, if needed, is also covered under the policy. Screening, tests, medicines, and immunotherapy appointments pre- and post-hospitalization are covered as well," Nandakumar said.

This also includes surgery, radiation, chemo, and targeted therapy.

Additionally, prescription medications used in the treatment of cervical cancer, hospitalisation costs for intensive treatments, and follow-up care are also commonly covered under health insurance plans.

"This includes coverage for oral chemotherapy drugs, pain management medications, and supportive care drugs, as well as hospitalisation costs, such as room and boarding, medical supplies, and associated services, and follow-up care services such as doctor visits, lab tests, imaging studies, and other services for monitoring and managing side effects based on the insurance plan chosen by the individuals," Nandakumar said.

If the policy covers OPD expenses, it means that screening consultations, diagnostic tests like colposcopy, and oral medications can be covered.

If the policy only covers health checkup expenses, it means that screening diagnostic tests like the pap test, and visual inspection with acetic acid (VIA), as well as consultations, will be covered.

However, medicine, biopsies, treatment plans, chemotherapy, and radiotherapy won't be included because health checkups are for preventive measures.

Some insurance plans may not cover the costs of treatments that are considered experimental or investigational, meaning they have not been proven effective or approved by the insurance company.

"If the policy is an individual policy and not associated with the group there will be a waiting period and the duration of the disease's existence will decide the claim decision. If the ailment is pre-existing, the same will not get covered up till the PED waiting period is over," Nandakumar said.

If someone has a group policy from the employer and it covers pre-existing diseases without any waiting periods, then there will be no exclusions and the same will be covered as per hospitalisation coverage or OPD coverage or health checkup coverage criteria as per the policy terms.

It's also important to note that while insurance primarily covers medical expenses related to cervical cancer, non-medical expenses such as transportation, home care, and some of the alternative therapies may not be covered.

"Insurance typically does not cover cosmetic procedures, such as reconstructive surgery if not associated with the cancer and are not deemed medically necessary for the treatment of cervical cancer. Lastly, insurance may not cover services that are not deemed medically necessary or appropriate for the specific diagnosis and treatment plan established by healthcare providers," Nandakumar said.

Prevention of cervical cancer vaccine is typically not covered by most insurers as vaccination comes under the ambit of prevention.