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Policy Limitations | Print |

Review and study your policy after you receive it. It is important for you to understand your coverages, rights, and obligations. Some common policy limitations are:

  • Covering Treatment Received Only in an Inpatient setting – Today, cancer treatment, including radiation, chemotherapy, and some surgery, is often rendered on an outpatient basis. Because the average stay in the hospital for a cancer patient is only 13 days, a policy that covers only inpatient treatment might not meet your needs.
  • Increasing benefits After 90 Consecutive Days of Inpatient Treatment – However, since the average stay in a hospital for a cancer patient is 13 days, large dollar amounts for extended benefits have very little value for most patients.
  • Fixed Dollar Limits on Policy Benefits – For example, a policy might pay only up to $1,500 for surgery costs or $1,000 for radiation therapy, or it may have fixed payments such as $50 or $100 for each day in the hospital. Others limit total benefits to a fixed amount such as $5,000 or $10,000.
  • Excluding Coverage for Pre-Existing Conditions – Always review the terms of the application and policy, and always answer all application questions completely and truthfully.
  • Excluding Coverage for Cancer-Related Illnesses – Cancer or its treatment may lead to other health problems, such as infection, diabetes or pneumonia. Some cancer policies might not cover these other conditions.
  • Policy Waiting Periods and/or Coverage Time Limits – Some policies require waiting periods of up to 30 days. If cancer is diagnosed during the waiting period, you may not be covered. Also, depending on contract provisions, benefits may cease after a period of time (such as two or three years).
  • Requiring Documentation of Diagnosis – Most insurance companies require a pathology report (usually obtained from a tissue sample or biopsy) to verify the diagnosis of cancer. If a biopsy cannot be performed due to medical reasons, a clinical diagnosis may be acceptable.
  • Renewability – Some cancer policies are guaranteed renewable and may not be canceled by the company. Others are renewable at the company's option.
 

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