For Unplanned Medical Expenses
Critical illness is a life changing event which hinders your dreams and wipes out savings. Compare and find the best critical illness cover at PolicyBazaar
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Critical Illness Insurance

Critical Illness Definition

Critical illness is a serious health condition that has a debilitating effect on an individual’s lifestyle and requires a considerable amount of money towards treatment. It may also lead to loss of income due to inability to work.

Know How Critical is Critical Illness

The count of serious illnesses is escalating every day. Acute illnesses also mean loss of income, change in lifestyle and permanent disability. The financial burden could be more severe than what an indemnity health insurance plan would cover. To combat this issue one needs to get a critical illness insurance which meets your large medical cost as well as provides a lump sum compensation for meeting your day to day expenses without making you run in a fanatical race for money arrangement.

Quickly Read Complete Guide on Critical Illness Insurance

 

critical illness health insurance

Critical Illness Health Insurance For Unplanned Medical Expenses

Critical illness is a life changing event which hinders your dreams and wipes out savings. Compare and find the best critical illness cover at PolicyBazaar.

  • Free Quotes from Leading Insurers
  • Lowest Premium on Critical Illness Plan
  • Instant Critical Illness Policy Online

Critical Illness Plan Vs Health Insurance

When Neeraj was diagnosed with brain tumor, he was completely shattered. Above all, he thought his health insurance policy of Rs 10 lakh would take care of the expensive treatment that he would require on a regular basis. However, he was devastated when his health insurance company informed him that his insurance would cover only hospitalization expenses. Due to the severity of illness, he found it tough to concentrate on his business and as a result, his financial health deteriorated. There are many people like Neeraj who fail to understand that health insurance is different from critical illness policy. To guide them, we have explicitly detailed their points of differences in a tabular form.

Parameters Critical Illness Plan Health Insurance
Meaning It is a policy to cover life threatening diseases like tumor, permanent paralysis, etc. It is a comprehensive cover that includes hospitalization expenses.
Benefits Hospitalization is not required because diagnosis is enough to get critical illness benefits. The insured receives the entire amount at once and can use it in a way he likes. The insured can reimburse hospitalization expenses by submitting bills. He can also opt for cashless facility at network hospitals.
Coverage It has restricted coverage because it covers only 6-12 diseases. It offers an extensive coverage, including hospitalization expenses.
Waiting Period There is a waiting period of 3 months. There is a waiting period of 30 days.
Tenure It is taken for a long duration, usually 15-20 years. It is an annual contract, wherein the policy must be renewed after 1 year.

Read More About Why You Should Buy Health And Critical Illness Insurance Separately

Who Should Buy Critical Illness Policy?

There is a good reason to buy critical illness insurance cover, especially for the earning members of the family. According to the data compiled by the National Crime Records Bureau, 26,426 people in the nation suffering from chronic ailments like AIDS, cancer and paralysis died in 2013. Also, the World Health Organization has predicted that by 2015 end, 7 lakh people will die due to cancer. With hospitals investing heavily in super specialty equipments, cost of treatment is only escalating. Once a person is hospitalized, incidental costs can go sky-high. Take cancer for instance. Herceptin (breast cancer drug) may cost anywhere between Rs 75000/vial and Rs 1 lakh/vial. A patient needs at least 16 vials. Similarly, an angioplasty can cost anywhere between Rs 1 and Rs 3.5 lakh. Getting a best critical illness plan is only seems to be a viable option.Compare cancer insurance plans & protect yourself from the expensive cost of cancer treatments.

Critical illness Insurance cover is a good option if-

  • You don’t have any savings to help you if you seriously fall ill.
  • You don’t have employee benefit packages to cover a period of time off work due to critical illness.

critical illness coverage

Inclusions in Critical Illness Cover

Critical illness rider broadly covers following diseases:

  • Cancer of Specified Severity
  • First heart attack of specified severity
  • Open chest CABG
  • Open heart replacement or repair of heart valves
  • Coma of specified severity
  • Kidney failure requiring regular dialysis
  • Stroke resulting in permanent symptoms
  • Major organ/bone marrow transplant
  • Permanent paralysis of limbs
  • Motor neuron disease with permanent symptoms
  • Multiple sclerosis persisting symptoms
  • Aplastic anemia
  • Bacterial meningitis
  • Loss of speech
  • End stage liver disease
  • Deafness
  • End-stage lung disease
  • Fulminant viral hepatitis
  • Major burns
  • Muscular dystrophy

This critical illness list is only indicative and not exhaustive in nature. Insurance companies cover a varying number of critical illnesses under different critical illness insurance policies. The list is also dependent on the critical illness insurance quote. One should carefully read the policy terms and conditions to see which all illnesses are covered under a particular policy.

exclusions critical illness policy

Exclusions in Critical Illness Policy

Your critical illness cover will not insure you against following diseases-

  • Critical illnesses diagnosed within first 90 days from the inception of policy
  • Death within 30 days of diagnosis of critical illness or surgery
  • Illness due to smoking, tobacco, alcohol or drug intake
  • Illness occurring due to internal or external congenital disorder
  • Critical conditions or consequences due to pregnancy or childbirth, including caesarean
  • HIV/AIDS infection
  • War, terrorism, civil war, navy or military operations
  • Any dental care or cosmetic surgery
  • Infertility treatment
  • Hormone replacement treatment
  • Treatment done outside India
  • Treatment to assist reproduction

critical illness benefits

Advantages of Critical Illness Insurance

What will happen to you and your family if due to any serious illness you would not be able to make your living? On top of that you will need to incur medical expenses also. Here comes the critical illness health insurance which will give you lump sum amount if you’re diagnosed with serious illnesses covered by insurance policy. Apart from this, other benefits offered by critical illness policy are-

  • Include cost of care and recuperation aid
  • Tax benefits under section 80 D
  • Free health checkups

The policy covers expenses like donor expenses in a transplant surgery which are not covered under normal health insurance policy.

Checklist For Choosing The Best Critical Illness Plan

While buying a critical illness cover, check for the below parameters.

Parameters Excellent Scenario
Sum Insured Coverage should be 4-5 times of the annual income.
Waiting Period Low
Premium Low
Number of Disease Covered Extensive
Maximum Renewability Age High

How to File a Claim for Critical Illness policy?

If there is a need to file a claim, contact your insurance company and register your claim. Usually, following documents are required to file a claim:

  • Duly filled claim form
  • Photocopy of ID card
  • Medical certificate obtained from a doctor which conforms the critical illness diagnose
  • Detailed discharge summary given to you

After receiving above documents, claim team would check them to ensure their authenticity. A written communication would be sent to the insured regarding approval/disapproval of a claim.

Note: Additional documents may be required depending upon the claim.

critical illness help

How Can We Help You?

If you can’t work due to serious ailment how would you meet your daily household expenses? A good critical illness cover is the need of today. At PolicyBazaar, we can help you in evaluating available insurance policies according to premium, cover and benefits. We offer valuable advice so that you get the right protection you need, without paying for what you don’t need. Compare and find the most suitable insurance quotes and prepare yourself and your loved ones against all contingencies.

  • The Need for a Critical Illness Policy

    The need for a critical illness policy is now more than ever. The 21st century sedentary lifestyle is giving rise to all kinds of illnesses, most of which are critical in nature. All studies indicate a steady rise in the instances of people falling prey to critical illnesses. While the number of cases of critical illnesses is increasing, the age of people developing such illnesses is consistently decreasing. This only goes on to show that one is now more vulnerable than what the earlier generation was in their working years.

    A critical illness policy offers peace of mind to the insured and his or her family by providing financial assistance on the diagnosis of a critical illness. The lump sum amount in a critical illness insurance plan can be used for the treatment of the medical problem or even paying off a mortgage, home modifications, etc.

  • Who All Can Benefit From Critical Illness Insurance

    Anyone and everyone stand to benefit from taking a critical illness policy. Modern-day hectic lifestyle is a harbinger of lifestyle illnesses, most of which are critical in nature, like cancer, heart attack, stroke, etc.

    Critical illnesses have become commonplace and today even young people are being diagnosed with these ailments. Medical treatment is available for such serious conditions and patients are able to survive and recover to lead a normal life in most cases. However, this is possible, only if one is able to afford expensive medical care and treatment costs to battle the illness.

    Complications increase when people are not treated on time or not treated at all. Critical illnesses in many cases reduce the ability to earn because the patient is often sick, and mostly home-bound. Because they significantly reduce the ability to work and in some cases one may not be able to work at all, they cause financial crises in families.

    To prevent such situations, if one can afford a critical illness policy, it is best to take it. The below mentioned cases and categories of people stand to benefit most from a critical illness insurance.

    Those with a History of Critical Illness in Their Family

    Many critical illnesses are hereditary in nature, i.e. they run in families. One is at a much higher risk of contracting a critical illness if there is a family history of the same. Those with a history of critical illness in their family should definitely take a critical illness insurance policy.

    Primary Breadwinners

    The role and importance of the main person earning in a family is paramount. If something happens to him or her, the family’s finances will be severely hit and the family may even have to face unpleasant financial situations. Primary breadwinners should not take any chances with certain health conditions, especially if they have a medical history. They are ideal candidates for a critical illness insurance policy.

    Those in High Pressure Jobs

    Critical illnesses have a high correlation with high pressure jobs. Most studies indicate that people in high pressure work environments are at increased risk of developing a critical illness. Individuals whose nature of job is such should definitely get a critical illness policy. They can easily get a critical illness insurance quote from our website and be on their way to secure themselves against any major illness.

    People Who Have Crossed the Age of 40 Years

    People over the age of 40 years are more susceptible to developing critical illnesses. It is advisable that one buys a critical illness insurance policy after crossing 40. Moreover, one is also likely to be in a financially better position to afford such a policy at that age.

    Tax Benefits under a Critical Illness Insurance Policy

    The Income Tax Act, 1961 provides tax benefits for a critical illness policy. Tax exemption of up to Rs. 15,000 is available under section 80D of the act. Senior citizens can avail tax benefit up to Rs. 20,000 under the same section.
  • Things to Keep in Mind While Taking a Critical Insurance Policy

    There are a considerable number of things to check when one is planning to buy a critical illness cover. However, to put it in specifics, every person must check a few things before they buy the cover. These include features such as the total amount of the insurance, the sub-limits (if any), the waiting period restrictions, tenure, premium, etc. Let us take a look at some of the factors that you should keep in mind.

    Amount of Cover:

    The amount of cover is essential to determine which policy works for you. For instance, some critical illness healthcare costs are comparatively lower than others. For instance, the cost associated with attending to stroke victim is lesser than the costs involved in the caring and treatment of cancer patients. Knowing how much cover you have will help you choose the right one for your needs. Get a critical illness insurance quote from our website to filter the critical illness insurance that works for your needs.

    Standalone Critical Illness Policy or Critical Illness Insurance Rider:

    As a rule of thumb, the coverage provided under a standalone policy is more in comparison to a rider. Though a rider may provide the insurance against the same set of critical illnesses, the amount of cover or the sum assured may be less. This is due to the fact the rider is actually dependent on the base policy with which it has been clubbed. For instance, if the healthcare policy or mediclaim with which the rider is taken is for say, Rs. 2 lakh, then the critical illness rider will not be more than Rs. 2 lakh. On the other hand, a standalone policy will allow the individual to choose the amount of cover they need, generally without any limits like a rider nromally has.

    Sub-Limits:

    Checking the sub-limits under a critical illness insurance policy is important as they have repercussions on the costs the insurer would bear. Sub-limits operate within the boundaries of the total sum assured under the critical illness insurance plan. For instance, a critical illness insurance policy of say Rs. 5 lakh, may have a sub-limit of Rs. 1.5 lakh for tests and Rs. 2 lakh for surgery. Some critical illness insurance policies offer a higher amount of cover for surgeries while others may have a higher cover for tests. It is important that the insured understands the limitations before signing up for a critical illness cover.

    Inclusions and Exclusions:

    Though we have mentioned the standard inclusions and exclusions that are a part of a critical illness policy, certain plans may have a different set of inclusions and exclusions. For instance, a critical illness policy that focuses on cardiovascular problems may have exclusions such as cataract or cancer. If you are looking for a specific set of illnesses to insure against, then please make sure you have checked the details in the critical illness insurance policy document to understand what is covered and what is not.

    Age of the Insured:

    The critical illness insurance policies that are meant for the elderly population have a wider coverage but on the other side, have higher premium amounts. This is because the elderly are at a higher risk from critical illnesses than say, someone in their twenties or thirties. Insurers counter the higher risk they face with the higher premium amounts but provide a more comprehensive coverage.

    Maximum Age for Renewal:

    Some critical illness insurance policies provide a cover up to a specified age while others provide lifelong cover. You ought to know the age up to which you are allowed to renew the policy. If you are renewing a policy that does not allow you to renew beyond, say 60 years and has a maximum maturity age as 65 years, then it may be better to go with a different policy from another insurance company.

    Waiting Period Restrictions:

    Most of the critical illness policies have a waiting period restriction. This means that they will not provide any insurance from certain critical illnesses unless a waiting period of 2-3 years has elapsed since the insured signed up for the cover. This clause may restrict the insured from getting the lumpsum payment in case he or she is diagnosed with a certain critical illness that was covered under the waiting period restrictions. It is better to go with insurance plans that do not have a long waiting period.

Insurer Plan Name No of Diseases Covered Key Features Exclusions
Religare Assure 20
  • Zero day survival period
  • Accidental Death Coverage
  • Tax Benefit
  • Any pre-existing illness.
  • AIDS treatment medical expenses
  • Congenital disease
  • Cosmetic & aesthetic and obesity related treatment
  • Infertility and in vitro fertilization related tests and treatment
  • War, riot, strike, nuclear weapons induced hospitalization.
Bharti AXA General Insurance Smart Health Critical Illness - Lump sum 20
  • No Claim Bonus of 5%
  • Family Option Available
  • Tax Benefit U/s 80 D
  • Disease contracted in initial 60 days
  • Treatment traceable to pregnancy
  • AIDS or HIV or ARCS-AIDS related Complex Syndrome
Max Bupa Health Insurance Health Assurance Critical Illness 20
  • No Claim Bonus of 5%
  • Riders Available
  • Tax Benefit U/s 80 D
  • Disease contracted in initial 90 days
  • AIDS, related syndromes & HIV
  • Failure to seek or follow Medical Advice
Reliance General Insurance Reliance Critical Illness 10
  • No Claim Bonus of 5%
  • Tax Benefit U/s 80 D
  • 1 yr and 3yr Payment Option
 
Total Health Plan 1 17
  • Hospitalization benefit
  • Medical reimbursement benefit
  • Tax Benefit U/s 80 D
  • Disease contracted in initial 90 day
  • Dental treatment or surgery
  • AIDS treatment medical expenses
Total Health Plan 2 17
  • Hospitalization benefit
  • Medical reimbursement benefit
  • Tax Benefit U/s 80 D
  • Disease contracted in initial 90 day
  • Dental treatment or surgery
  • AIDS treatment medical expenses
HDFC ERGO General Insurance Critical Illness Plan 8
  • Tax Benefit U/s80 D
  • Disease contracted in initial 90 days
  • War and terrorist attacks
  • STDs, AIDS, Venereal diseases
HDFC Life Cancer Care Silver 1
  • Lumpsum on detection of Cancer
  • Waiver of Premium for 3 years
  • Tax Benefit U/s 80 D
  • No benefit shall be payable under the policy in respect of any Major Cancer
  • Carcinoma-in-situ or Early Stage Cancer resulting directly or indirectly from or caused or contributed by (in whole or in part)
  • Sexually Transmitted Diseases AIDS or HIV
  • Any congenital conditions
  • Any pre-existing condition
  • Nuclear, biological or chemical contamination (NBC)
Cancer Care Gold 1
  • No Claim bonus upto 200% of SA
  • No medicals
  • High Sum Assured Rebate
  • No benefit shall be payable under the policy in respect of any Major Cancer
  • Carcinoma-in-situ or Early Stage Cancer resulting directly or indirectly from or caused or contributed by (in whole or in part)
  • Sexually Transmitted Diseases AIDS or HIV
  • Any congenital conditions
  • Any pre-existing condition
  • Nuclear, biological or chemical contamination (NBC)
Cancer Care Platinum 1
  • Income payout - 1% of SA per month
  • Least documentation
  • Cover upto 40 lacs & 20 years
  • No benefit shall be payable under the policy in respect of any Major Cancer
  • Carcinoma-in-situ or Early Stage Cancer resulting directly or indirectly from or caused or contributed by (in whole or in part)
  • Sexually Transmitted Diseases AIDS or HIV
  • Any congenital conditions
  • Any pre-existing condition
  • Nuclear, biological or chemical contamination (NBC)
Apollo Munich Health Insurance Optima Vital 37
  • Tax Benefit U/s80 D
  • 37 Critical Illnesses covered
 
CignaTTK Health Insurance Basic 15
  • Tax Benefit U/s80 D
 
Enhanced 30
  • Annual Health Check up
  • Organ Donor Cover
  • Converted to Comprehensive health plan after 4 years
 
Edelweiss Tokio ET Criticare+ 17
  • Upto 1 cr Lumpsum
  • 3 claims under Multiclaim
  • Tax Benefit U/s 80 D
 
PNB Metlife MetLife Major Illness Premium Back Cover 35
  • Return of premium
  • 5% online discount
  • Tax benefits under Section 80C, 80D & 10(10)D
 
AEGON Life iCancer 1
  • All types of cancer,except skin
  • Covers all stages of cancer
  • Tax Benefit U/s 80 D
 

Documents required?

Ans:

Generally documents required are age proof, address proof and identity proof. Specific documents may be required in case the person needs to undergo medical tests. This can be checked on the Price quotes page.

How much cover do I need?

Ans:

Your age, lifestyle pattern, city of residence and annual income are vital parameters that help to determine the appropriate coverage required for you.

What are its Key Features?

Ans:

Covers major illnesses which are usually excluded from a standard health insurance policy. Covers all expenses associated with a critical illness. Large sum insured. For most of the plans, no medical check up is required up to 45 years of age. Regular tax benefits and no claim benefits.

Why do we need Critical Illness Cover?

Ans:

More often than not, critical illness is considered as an exclusion in a standard health insurance policy. Even if covered, the lump sum paid out is simply not enough to suffice the whopping expenses involved in the treatment of such dreadful illnesses. So, getting a critical illness cover is imperative to protect yourself and your family from any possible financial calamities.

What is Critical Illness?

Ans:

Critical Illness cover comes as a rider or as a stand alone plan. It provides the insured a lump sum, in case he/she gets diagnosed with a critical illness such as cancer, sclerosis, coma, heart attack, paralysis, kidney failure, etc. The insured has to bear a 30 days waiting period before the first diagnosis can be made.

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