Sunayana Basu Mallik Highlights Need for Greater Transparency and Standardisation in Cancer Insurance Coverage

In an article published by Moneycontrol examining the adequacy of health insurance coverage for cancer care, Sunayana Basu Mallik shared critical insights into how insurers currently manage cancer treatment costs. She explained that insurers often rely on contractual tools such as waiting periods, sub-limits on specific therapies, co-payment clauses, and exclusions for treatments categorised as “experimental” to control payouts.

Sunayana cautioned that these mechanisms frequently lead to deductions even when the treatment is medically necessary, particularly in cases involving newer oncology therapies. She noted that the Insurance Regulatory and Development Authority of India (IRDAI) could play a pivotal role in improving effective payout ratios for cancer care by ensuring that deductions are predictable, transparent, and applied in a non-arbitrary manner.

She further suggested that IRDAI could introduce standardised cancer care riders that define coverage based on treatment classes rather than individual drug names. According to her, such standardisation would help ensure that essential therapies are not excluded merely because they are new. She emphasised that these riders should clearly outline defined coverage limits, permissible co-payments, lifetime caps, and exclusions grounded in objective medical or regulatory criteria.

This approach, she noted, would provide policyholders with greater clarity at the time of purchasing insurance, reduce disputes during the claims process, and still allow insurers the flexibility to price risk appropriately, thereby strengthening trust and efficiency within the health insurance ecosystem.

Visit link to article: https://www.moneycontrol.com/news/business/personal-finance/1-out-of-5-cancer-patients-run-out-of-rs-5-lakh-insurance-cover-says-study-13733038.html