Malignant Brain Tumor and Health Insurance Coverage


Malignant brain tumors, also described as gliomas, meningiomas, and schwannomas all have an overall incidence of 4.5 per 100,000 of the population. The disease may cause central nervous system changes by invading and destroying tissues as well as secondary effects which constitute mainly compression of the brain, cranial nerves, and cerebral vessels or increased intracranial pressure.

Tumors can occur at any age. In adults, incidence is highest between the ages of 40 and 60. The most common types of brain tumors are described as gliomas and meningiomas. These tumors usually occur above the covering of cerebellum tissue and are called supratentorial tumors. Most tumors in children occur before the tender age of 1 or between ages 2 through 12. The most common are astrocytomas, meduloblastomas, ependymomas, and brain stem gliomas. Brain tumors are one of the most common causes of cancer mortality or death in children.

In regards to a prospective health insurance applicant with a history of malignant brain tumors, insurers are hesitant about issuing a policy even after complete remission due to risk of possible life threatening complications arising from increased intracranial pressures, coma, respiratory, or cardiac arrest, and brain herniation.

This article was intended to assist applicants diagnosed with a malignant brain tumor in obtaining an approval for a health insurance policy in the individual private healthcare marketplace.

Most insurers will not consider issuing and placing a policy if a malignant tumor was diagnosed within a prior 10 year interval. Some carriers will consider the case contingent on answers received through screening and also if the respective tumor was benign having received medical clearance within the prior 2 years. The following are questions that are specifically asked upon submission of a health insurance application and useful tips to obtain an affirmative underwriting decision or at very least prepare a prospective applicant to apply for a plan which would be approved.

Health Insurance Underwriting Questions on Malignant Brain Tumors.

(1) When was the malignant brain tumor diagnosed?

Tip: Most major medical insurers scrutinize any cancer that was malignant and not benign within a scope of the last 10 years. Simplified issue plans would generally contest cases within the last 5 years. As a general rule, maximum comprehensive coverage in terms of benefit levels are categorized in descending order with major medical being the best, simplified issue being second best, and guaranteed issue plans being last. If a cancer case occurred more than 10 years ago and has been in complete remission for the duration with no utilization of antineoplastic medications than an applicant would be in his or her legal right not to disclose this upon application submission. There have been many cases were applicants get prematurely denied coverage unfairly just by casual mention of cancer when in fact they have surpassed reverent periods of medical clearance according to underwriting guidelines.

(2) Was the tumor primary or secondary to another cancer somewhere in the body?

Tip: If the malignant tumor was a primary lesion, then the best case scenario would be a possible consideration after 3 years. However, in the most favorable cases where it was a well differentiated tumor that was less than 5 cm in size there is a possibility it will be considered. If the malignant brain tumor was secondary or metastatic to a primary tumor from another organ, the minimal period where medical clearance would have to be obtained is 5 years determined from the date of service of last treatment. This assumes that the end of treatment produced a complete remission for both the primary and secondary tumors. As a final note, the time frames discussed above apply to simplified issue plans and not all major medical plans.

(3) What treatment did the client receive and when did it end?

Tip: Treatment for a malignant tumor is comprised of several methods including radiation therapy, chemotherapy, or surgery. A surgery with no radiation or chemotherapy will most likely result in a affirmative and positive underwriting decision. The combination of all three treatments will definitely constitute in a declination for major medical coverage and in this case a simplified issue plan would be more appropriate. If only one or at most two of the treatments were used in conjunction and there have been complications such as recurrence, incomplete removal, post surgery symptoms or neurological deficit, then terms will depend on the individual characteristics of the case.

(4) How long has the tumor been in remission?

Tip: As a general rule a grade 1 and grade 2 tumor with a medical clearance of 5 years will be considered for major medical coverage if only one of three treatments are used. A grade 3 or grade 4 tumor will always constitute a declination for major medical and in this case a simplified issue plan will be more appropriate. As a final note remission will be determined as the final date of service where treatment was procured as well as termination of anti-neoplastic medication consumption.

(5) Are there follow up studies to verify the remission?

Tip: Blood testing is commonly used during the follow up visits to detect the presence of any recurrence of a tumor. If no recurrence is evident it would be prudent to disclose medical documentation supporting this upon application submission.

Not every case of an applicant who had a malignant tumor is uninsurable, if you or someone you know has faced difficulty in obtaining health insurance coverage within the individual private healthcare market because of a cancer we can help. For assistance, please visit our website at and leave your contact information so one of our licensed agents can assist you.