Immunotherapy Coverage in Health Insurance

What is Immunotherapy?

Immunotherapy is a type of treatment that uses the body’s immune system to fight diseases such as cancer. Instead of directly killing cancer cells (as chemotherapy does), immunotherapy trains and empowers the immune system to recognise harmful cells and attack them more effectively.

It can be personalised based on the patient’s cancer type and immune profile, making it one of the most advanced cancer treatment approaches.

How Monoclonal Antibody Immunotherapy Works?

Monoclonal Antibody Immunotherapy (mAb) uses lab-made proteins that mimic the body's immune system to attack cancerous cells. These proteins identify cancer cells by binding to unique markers on their surface, much like putting a bright flag on them. This enhances the immune system’s ability to recognise and destroy cancer cells.

Some monoclonal antibodies can also block signals that promote cancer cells' growth, while others can deliver medicines directly to cancer cells, making treatment more targeted and effective.

How Much Does Immunotherapy Cost in India?

Immunotherapy costs in India vary based on the type of immunotherapy, the cancer type and stage, the hospital and city, and the treatment duration. The table below shows the cost of each kind of immunotherapy:

Does Health Insurance Cover Immunotherapy?

Yes, many health insurance plans cover immunotherapy for cancer. However, coverage varies by the type of immunotherapy and the policy's terms and conditions.

At Care Health Insurance, we offer coverage for Immunotherapy under the advanced category benefit. Immunotherapy administered as monoclonal antibody injections is covered up to the chosen sum insured for expenses incurred under inpatient or day care treatment, subject to policy guidelines.

Why Health Insurance is Important for Immunotherapy?

Here are the reasons why securing health insurance is necessary for immunotherapy:

Covers High Costs

Immunotherapy treatments are expensive due to extensive research, complex biotechnology manufacturing, and specialised hospital care. A health insurance policy helps reduce the financial burden and protects long-term savings.

Provides Comprehensive Care

Health insurance not only covers immunotherapy but also additional expenses such as pre- and post-hospitalisation, diagnostic tests, daycare procedures, ambulance cover etc.

Who Should Consider Immunotherapy Coverage?

Immunotherapy can be highly effective but also expensive, making coverage essential for individuals who fall into the following categories:

• Individuals at higher risk of cancer: Those with a family history of cancer, such as breast, lung, melanoma or colon cancer, might benefit from coverage that includes modern cancer treatments.
• Patients diagnosed with early-stage or advanced cancers: Immunotherapy is used to treat several cancers, especially when chemotherapy or radiation is ineffective.
• Individuals who might require long-term or multiple treatment cycles: Many immunotherapy drugs (such as monoclonal antibodies) are given in regular cycles and can be expensive without health insurance.
• Individuals seeking financial protection against high medical costs: A single immunotherapy session can cost lakhs of rupees. Purchasing health insurance can reduce out-of-pocket expenses and protect long-term savings.

How to Claim Insurance for Immunotherapy?

Immunotherapy treatment is eligible for both cashless and reimbursement claims. If you’ve taken the treatment at a network hospital, you can file a cashless claim. Whereas, for a non-network hospital, a reimbursement claim can be submitted. Below are the steps for each:

Cashless Claim Process

Step 1: Admit to a network hospital and inform us within the specified timeframe. Complete the pre-authorisation form at the insurance desk and submit it for approval.

Step 2: Our claim management team will review your pre-authorisation request and documents.

Step 3: After verification of the documents, they’ll send the approval letter.

Step 4: On approval, avail the cashless treatment. We’ll settle your medical bill directly with the hospital.

Reimbursement Claim Process

Step 1: Inform us about your hospitalisation at a non-network hospital.

Step 2: Pay the bills at discharge and collect the discharge summary, bills, and reports.

Step 3: Submit a reimbursement claim with the required documents.

Step 4: After verification, the approved amount is transferred to your bank account.

Documents Required for Filing a Claim for Immunotherapy

The standard documents required for most health insurance claims, including those for immunotherapy, are:

• Filled Claim Form
• Pre-authorisation Form
• ID proof
• Original hospital bills with a detailed breakup of the expenses
• Original discharge summary
• Pharmacy bills
• Current health insurance policy copy

Why Choose Care Health Insurance?

Here are the reasons for choosing Care Health Insurance as your insurer:

Access to Quality Healthcare

With a vast network of more than 21,700 cashless healthcare providers, our health insurance plan ensures you receive quality treatment whenever you need it. You don’t have to worry about paying bills upfront, thanks to the cashless treatment benefit.

Comprehensive Healthcare Coverage

We offer comprehensive coverage beyond immunotherapy, including additional expenses such as inpatient care, ambulance charges, and more.

Additional Benefits

You can make your health insurance plan more robust by adding benefits, such as an annual health checkup, unlimited e-consultations, wellness benefits, etc.

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.