Critical Illness Insurance Policy - Definition, Policies, Coverage, Exclusions, Best Plans, Companies, Claims, Premiums, Benefits | Free Quote Online

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What is a Critical Illness Insurance Policy? - Definition

A Critical Illness Insurance Policy pays a lumpsum amount to the Insured on the diagnosis of one of the Covered Critical Illness like cancer, heart attacks, kidney failure, paralysis etc subject to the terms and conditions of the Policy. Critical Illness requires long term treatment and thus is very expensive. A Critical Illness Insurance Policy ensures that your financial savings are not exhausted if you suffer a serious illness that requires extensive medical care and an extended recovery period. A Critical Illness Insurance Policy is a benefit policy which does not require the Insured to incur expenses on medical treatment to avail a claim. The Policy pays the Lumpsum benefit to the Insured upon the diagnosis of Critical Illness. Critical Illness Cover is offered as an Add-On Cover by some Insurance Companies and as a separate Insurance Policy by other Insurance Companies.

Definition of Critical Illness Insurance Policy

Which Critical Illnesses are covered by a Critical Illness Insurance Policy?

Different Insurance Policies cover different Critical Illnesses. However, the major critical illnesses covered by a Critical Illness Insurance Policy are as follows:

  1. Heart Attack (Myocardial Infarction)
  2. Open Chest CABG (Coronary Artery Disease Requiring Surgery)
  3. Stroke
  4. Cancer
  5. Kidney Failure
  6. Major Organ Transplantation
  7. Multiple Sclerosis with Persisting Symptoms
  8. Surgery of Aorta
  9. Primary Pulmonary Arterial Hypertension
  10. Permanent Paralysis of Limbs
  11. Neuro Surgery
  12. Joint Replacement

Types of Illnesses covered in a Critical Illness Insurance Policy

What are the Benefits of a Critical Illness Insurance Plan?

  1. Critical Illness Cover: A Critical Illness Insurance Policy pays a lumpsum amount to the Policyholder upon the diagnosis of a Critical Illness, such as a Brain Tumor, Kidney Failure, Heart Attack or Paralysis. The Medical Expenses required for treatment of such critical illnesses are very high and the regular Health Insurance Cover may be inadequate in such a case. The lumpsum amount received from the Critical Illness Insurance Policy can be utilised for treatment of the disease, lifestyle changes, or even a planned treatment outside India etc.
  2. Support for Lost Income: If the breadwinner of the family suffers from a Critical Illness, then the family suffers from lost income. The Lumpsum amount received from a Critical Illness Insurance Policy can be used to replace the lost income.
  3. Tax Benefits: The Premiums paid toward a Critical Illness Insurance Policy are eligible deduction under Section 80D of the Income Tax Act 1961. The Tax Benefits of a Critical Illness Insurance Policy make it more affordable for the Insured.
  4. Affordable Premiums: Since a Critical Illness Insurance Policy covers only specified illnesses, the Premiums for a Critical Illness Insurance Plan are much lesser than a regular Health Insurance Policy. Thus, a Critical Illness Insurance Plan is much more affordable for the Insured and enables him to avail larger coverage for lesser premiums.
  5. Simple Claim Process: Critical Illness Insurance Policy is a benefit Policy. The Insured does not need to submit a lot of documents to avail Claim Settlement under the Policy. Most Critical Illness Insurance Policy pays a lumpsum amount to the Policyholder once the disease is diagnosed meeting specific criteria and the insured survives 30 days after the diagnosis.

How to choose a Critical Illness Insurance Policy?

The Insured should consider the following factors when selecting a Critical Illness Insurance Policy:

  1. Sum Insured: Today, the cost of Treating Critical Illness is extremely high. The Policyholder must ensure that he opts for an adequate Sum Insured which will take of treatment expenses today and the future as well.
  2. Critical Illnesses Covered: The Critical Illnesses covered by a Critical Illness Insurance Policy differ from one Insurance Company to another. The Policyholder should review the list of Critical Illnesses covered before finalising the Policy.
  3. Age: Buying a critical illness rider when you're young can provide you with lower premiums and a large, assured amount.
  4. Waiting Period: Most Critical Illness Insurance Policies have a Waiting period of 90 days. Any Critical Illness diagnosed within the first 90 days of the date of commencement of the first Policy is excluded. It is important to review the Waiting Period before finalising the Critical Illness Insurance Policy
  5. Survival Period: Survival Period is the period after the diagnosis of Critical Illness that the Insured Person has to survive before a claim becomes valid. Make sure to choose a Critical Illness Insurance Policy with a low survival period.
  6. Exclusions: The Insured should carefully go through the exclusions of the Critical Illness Insurance Policy to avoid nasty surprises later on.

Best Critical Illness Insurance Policies in India

The list below names the Top Critical Illness Insurance Plans and their features:

Critical Illness Insurance Plans No. of Critical Illnesses Covered Sum Insured Waiting Period Survival Period
Bajaj Allianz Critical Illness Insurance Policy 10 Critical Illnesses Covered Upto Rs50 Lakhs 90 Days 30 Days
HDFC Ergo Critical Illness Platinum Insurance Policy 15 Critical Illnesses Covered Upto Rs10 Lakhs 90 Days 15 Days/30 Days
SBI General Critical Illness Insurance Policy 13 Critical Illnesses Covered Upto Rs50 Lakhs 90 Days 28 Days
Star Critical Illness MultiPay Insurance Policy 37 Critical Illnesses Covered Upto Rs25 Lakhs 90 Days 15 Days
TATA AIG Criti Medicare Insurance Policy 100 Critical Illnesses Covered Upto Rs2 Crores 90 Days 0 Days/7 Days/15 Days
Future Generali Criticare Insurance Policy 12 Critical Illnesses Covered Upto Rs50 Lakhs 90 Days 28 Days
Iffco Tokio Critical Illness Benefit Policy 25 Critical Illnesses Covered Upto Rs1 Crore 30 Days 28 Days

Critical Illness Insurance Policy vs. Health Insurance Policy

Do I need a Critical Illness Insurance Policy when I already have a comprehensive Health Insurance Policy? This is a question that comes to the mind of many people when they consider purchasing a Critical Illness Insurance Policy. It is important to understand that these two plans offer distinct benefits. A Health Insurance Policy provides coverage for hospitalisation expenses incurred by the Insured while a Critical Illness Insurance Policy offers a lumpsum payout to cover expenses beyond hospitalisation. The payout received from a Critical Illness Insurance Policy can be used for lifestyle changes, donor expenses or a planned treatment outside India, paying off loans etc. The table below explains the difference between a Health Insurance Policy and a Critical Illness Insurance Policy:

Features Health Insurance Policy Critical Insurance Policy
Coverage It provides comprehensive coverage, for Hospitalisation Expenses, pre- and post-hospitalization costs, daycare procedures etc arising on account of illnesses or injuries It offers coverage only for covered critical illnesses.
Benefit It is an Indemnity Policy which covers hospitalisation expenses incurred by the Insured Critical Illness Insurance Policy is a benefit policy which pays a lumpsum amount on diagnosis of Critical Illness.
Waiting Period Health Insurance Policy usually has a first 30-days waiting period before commencement of the first policy for coverage to begin. Critical Illness Insurance Policy usually has a 90-day waiting period before commencement of the first Policy for diagnosis of critical Illness Insurance Policy.
Survival Period Health Insurance Policies do not have any survival period Critical Illness Insurance Policy has a Survival Period of 15 days or 30 days after diagnosis for the Policy to pay a benefit
Premium Premium for a Health Insurance Policy is higher than a Critical Illness Insurance Policy and depends on Sum Insured, Coverages, and Age of Policyholder Premium for a Critical Illness Insurance Policy is lower than a Health Insurance Policy and depends on Sum Insured, list of Critical Illnesses Covered, and Age of Policyholder.

What is the Claims Process for a Critical Illness Insurance Policy?

The Insured should follow the following steps in order to file a Claim under Critical Illness Insurance Policy:

  1. Review Coverage: The Policyholder should review the Policy Coverages and make sure that his Critical Illness is covered by the Critical Illness Insurance Policy
  2. Intimate Claim: The Insured should intimate the diagnosis of Critical Illness to the Insurance Company. The Company will provide a Claim Intimation Number
  3. Submit Documents: The Insured should submit documents like duly filled and signed Claim Form, Diagnostic Reports confirming diagnosis of Critical Illness, other reports like X-Rays, MRIs, CT-Scans etc. Additonally, submit the KYC Form as well as Bank Details
  4. Claims Processing: Upon Receipt of documents, the Insurance Company will examine the same and process the Claim if everything is found to be in order.

What are the exclusions in a Critical Illness Insurance Policy?

A Critical Illness Insurance Policy does not provide coverage for the following:

  1. Any Critical Illness diagnosed within the Waiting Period of 90 days after the commencement of the first policy
  2. If the Insured dies within the Survival Period after the first diagnosis of the Critical Illness, the Policy won’t pay the claim
  3. Any Critical Illness for which treatment was first recommended by a Physician before the start of the Policy Period, will not be covered
  4. Any Illness contracted as a consequence of use of drugs or alcohol is not covered

Buy Critical Illness Health Insurance Policy with Qian!

Qian is an experienced Insurance Broker for Health Insurance Policy. Our dedicated team will assist you in comparing quotes of multiple Critical Illness Insurance Policies and suggest you the best Pwolicy as per your budget and requirements. Our team will assist you in Claims Settlement as well. If you have any query about Critical Illness insurance Policy, call now for a Free Quote via email at insurance@qian.co.in or call us on 022-35134695. We promise to give you a quote in 15 minutes.

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Hemik of Qian is knowledgable, prompt and very professional - highly recommended. I had to claim for a critical illness under my health insurance policy and Qian’s assistance with the claims process and advice on how to deal with the insurer was invaluable.

Niyati Shah