Critical Illness Insurance

Critical illness insurance protects you & family in case of fatal medical emergencies. Exclusive critical illness health

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Critical illness insurance

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Health Insurance for Critical Illness

According to the Global Burden of Disease Study, critical illness is the reason for 60% of deaths in India. The treatment for such illness can be a lengthy and expensive procedure. For the average Indian family, critical illness treatment costs are mostly not affordable. However, having a critical illness coverage can save you from such problems. Keep reading this article to understand more about critical illness health insurance. But first, let us understand the fatality of critical illness in Raman's situation.

Raman is a 45-year-old man, who fainted while returning from office one day. He got admitted to the hospital and according to the doctors, he had a minor heart attack, and needed a stent in his heart for recovery!

After the procedure, while settling the final bill, Raman claimed the bill from his insurance company. But he got covered only for the hospital admission bill. The insurer told him that the bill for the stent had to be paid by Raman himself. They also told him, "Sir, if you had gotten critical illness coverage, only then the claim can be settled by the company fully."

Now, Raman was wondering "What is this critical illness coverage?" And I am sure you are also thinking the same.

Don't worry, here we'll tell you everything important about critical illness and why you need insurance specifically for it.

What is Critical Illness?

You might have heard about the diseases like paralysis, cancer, organ failure, stroke, sclerosis, and heart attack. These illnesses affect major organs of our body like the brain, heart, lungs, kidneys, and liver. Treating these illnesses might take some time. And we all know that the cost of medical treatment is very high nowadays. Moreover, if you keep yourself healthy then there is a lesser chance of problems. Still, it is suggested that one should have critical illness insurance for a safer side, especially for people living in tier 1 cities, where both living and medical costs are generally higher than other places.

Now, talking about Critical Illness Insurance!

Technically, if you understand the actual meaning of critical illness insurance, then you already know that it provides exclusive benefits related to critical illness. In most cases, health problems might strike unexpectedly. Thus, giving you the burden of paying for the overall treatment cost. To save yourself from this hassle, it is necessary to get critical illness medical insurance.

Critical illness health insurance provides coverage for diagnostics test expenses, chemotherapy, radiotherapy expenses, and other expenses related to any of such diseases. You can get individual as well as family floater policy with the general entry age criteria ranging between 18 to 65 years.

List Of Critical Illness Health Insurance Plans In India 2024

There are various plans available in the market for critical illness health insurance. We have created a list where you can check the number of plans and make the right decision.

Critical Illness Health Insurance Plans
Entry Age
Sum Insured
Best Features Plan in Details
Care Heart Plan Minimum- 18 Years
Maximum- No Limit
Upto INR 10 Lakh Covers major heart ailments
Care Freedom Plan Minimum- 90 Days
Maximum- No Limit
Upto INR 5 Lakh Covers diabetes and dialysis costs
Star Cardiac Care Plan Minimum- 10 Years
Maximum- 65 years
Upto INR 4 Lakh Covers major heart illness
Star Cancer Care Platinum Insurance Policy Minimum- 5 months
Maximum- 65 years
Upto INR 10 Lakh Covers all types of Cancer
Star Critical Illness Multipay Insurance Policy Minimum- 18 years
Maximum- 65 years
Upto INR 25 Lakh Covers Cancer-related treatments, heart-related conditions, brain and nervous system-related conditions, major organ and other conditions
Star Special Care Minimum- 3 years
Maximum- 25 years (who are diagnosed with autism)
Upto INR 3 Lakh Covers Autism
Niva Bupa CritiCare Minimum- 18 years
Maximum- 65 years
Upto INR 300 Lakh Covers up to 20 diseases
ManipalCigna ProHealth Prime Minimum- 91 days
Maximum- No Limit
Upto INR 1 Crore Covers all kinds of critical illnesses
Aditya Birla Activ Secure Critical Illness Minimum- 5 years
Maximum- 65 Years
Upto INR 1 Crore Covers cancer, kidney failure, and heart diseases
SBI Critical Illness Insurance Plan Minimum- 18 years
Maximum- 65 years
Upto INR 10 Lakh Covers 13 major critical illnesses
What is Entry age?

The age (last birthday) at which you buy an insurance policy is your entry age to that policy. Insurance policies usually come with a minimum and maximum age at entry which means that you must attain a specific age or should be less than the maximum age to buy a policy.

What is Sum insured?

Sum insured is the maximum monetary coverage that a health insurance policy provides you. You should decide your sum insured based on the cost of medical treatments, your health, income, and lifestyle habits.

Common Features of the Critical Illness Plans

  • Covers Critical Illnesses

    You will be covered under the policy, in case the diagnosis of any critical illness in any part of the country. From diagnosis to full treatment, you can claim against the treatment cost.
  • Easy Claim Process

    Critical illness claim process is easier than other health insurance. You can claim based on just diagnosis reports.
  • Tax Benefits

    The government of India exempts tax based on critical illness health insurance plans under section 80D of the Income Tax Act 1961.
  • Affordable Premiums

    No doubt, the cost of hospital bills can be very high. But, you can secure your finances by getting critical illness health insurance.
  • Option to Buy

    Some health insurers give you the option to buy the policy for 1 or 2 years only, with the option of easy renewals.
  • Sum Insured

    You will get the sum insured up to Rs.10 Lakh.

How Critical Illness Plans are Beneficial?

When investing in a critical illness health insurance plan you will get a certain set of benefits. Such as

  1. Protection for you and your family

    Having critical illness insurance is the surety for safety. You can cover your family too in a single premium against life-threatening diseases. If you have a family history of critical illnesses like cancer, heart ailments, or others, it is advised to invest in the best critical illness policy suitable to your needs and requirements.

  2. Guaranteed Payout Benefit

    Critical illness health insurance plans offer a guaranteed pay-out benefit to insured individuals. So, if you are diagnosed with any of the listed conditions under a critical illness insurance plan, you will be covered. The maximum amount of sum insured, you opted for can be utilized for your treatment or sustaining your family members.

  3. Protection Against Loss Of Income

    Many critical illness medical insurance policies offer the option to receive their selected amount of sum insured value as a monthly income as they are unable to continue with their profession. This helps the family members run the household smoothly and does not bring in the financial burden of critical illnesses.

  4. Avail Tax Benefits

    Investing in a critical illness health insurance plan ensures the best medical care for you and your family in case of diagnosis of a critical illness. Also, it provides you with tax benefits under section 80 D of the Income Tax Act, of 1961. Health insurance plans can work as your ticket to the best medical care but are also a guarantee to save tax helping you further plan your finances better.

  5. Value-Added Benefits

    Critical illness health insurance plans are guaranteed to get the best medical care for illnesses like cancer, heart ailments, brain stroke, kidney failures, or other such illnesses. Along with this, many critical illness health plans are designed to offer you value-added benefits like pain management programs, home care, follow-up with doctors, wellness points, online consultations, e-pharmacy, and more.

Health Insurer for Critical Illness Plan

Know What is Covered- Inclusion

Major critical illnesses

Under the critical illness cover you will be covered for all the major illnesses such as heart attacks, lungs, cancer of specified severity and different organs, kidney failure, Alzheimer's, and many others.

Optional Covers

Optional coverage options are provided to the individuals to enhance the overall protection like wellness coach, international e-opinion, OPD Care, Covid-19 Care, Home Care, Coverage for Non-payable items, and more.

Lifelong Renewability

With this feature, you will get infinite coverage and lifetime renewability. However, the terms and conditions depend on the specific insurance policy you are choosing.

In-patient hospitalization

This policy will cover all the expenses that might occur for the required treatments in the hospital for more than 24 hours.

Domiciliary Treatments

Sometimes doctors do not recommend staying in the hospital for longer treatments. Now technology has advanced and few medical procedures can be done at home, which is called domiciliary treatment. Such treatment procedures have increased medical costs, but having critical illness insurance can cover such expenses as well.

Daycare Treatment

Advancement in healthcare technologies allows shorter treatment time span for certain diseases and might take less than 24 hours. These treatments will also be covered under a critical illness health insurance cover policy.

Annual Health Check-Up

Undergoing treatment for any critical illness means you must track your health regularly. The annual health check-up feature provided by a critical illness insurance plan offers you the same, sometimes for completely free of cost!

What is not Covered?- Exclusions

In case the insured individual is diagnosed with a listed critical illness during the waiting period, it will not be covered or treated before the waiting period ends. However, insured individuals can avail of treatment once the waiting period ends.

Death of an insured individual due to any of the listed critical illnesses will not be covered if the survival period was not served.

If you develop a critical illness due to drug abuse, intoxication, and smoking it will not be covered.

HIV/AIDS.

Infertility treatments are not covered under critical illness health plan.

Any injuries or critical illnesses developed due to taking part in an act of war/terrorism are not covered under the critical illness health plan.

Difference Between Health Insurance and Critical Illness Insurance

Individuals may often get confused between health insurance and critical illness health insurance, which is not a bad thing at all!

We have listed down important differentiating factors below to help you understand the difference between the two in simpler terms:

Differentiating Features Health Insurance Critical Illness Health Insurance
Coverage A health insurance plan offers coverage for accidents, pre-existing diseases, emergencies, maternity-related expenses, and more. Critical Illness health plan offers coverage for listed critical ailments like cancer, heart attacks, brain strokes, renal failure, and more.
Survival Period There is no survival period under a health insurance plan A generic survival period of a minimum of 15 to 30 days is applicable depending on the insurer under a critical illness health insurance plan
Waiting Periods There will be a waiting period of a minimum of 30 days. The waiting period may vary as per the plans.
Benefit You can avail reimbursement claims or cashless claims which will be equal to the amount of expenses during the hospitalisation and treatment. Under a critical illness health plan, you can avail the lump sum amount on the diagnosis of the critical illness.
Duration Usually, you need to renew your health insurance insurance policy, after every two or three years. Generally, critical illness health insurance needs to be renewed every year, but it depends from policy to policy.
Claim Procedure You can apply for cashless claim settlement in case of hospitalisation for more than 24 hospitalisations. If you have critical illness health insurance, then you will be available to claim for hospitalisation, diagnostics, and other treatment procedure costs as well.
Types of Plan Health insurance is an indemnity insurance plan. Critical illness health insurance is a fixed benefit plan.
Premium Costs The premium cost of general health insurance is comparatively low as it gives lower coverage. The premium cost of critical illness health insurance is slightly higher as it covers major critical illnesses as well.

Who Should Buy a Critical Illness Health Insurance Plan?

You might be wondering who should invest in critical illness health insurance. According to our insurance advisors at PolicyX, it is suggested that people mentioned below should purchase this type of health insurance plan:

  1. People With a Family History of Critical Illnesses

    Many critical illnesses are a part of your genetic makeup. You need to understand your family history of critical illnesses. Many diseases develop due to genetics and family history even if you have had a healthy lifestyle such as certain types of cancers, heart ailments, diabetes, liver ailments, and more.

  2. Who Are The Only Earning Members of The Family

    If you are the only earning member of your family, you must invest in a critical illness health plan. The loss of the primary earning member or availing treatment without a dedicated critical illness health insurance plan will cause financial distress not only for you but the entire family!

  3. Individuals With High-Risk Jobs

    People like miners, train drivers, healthcare workers or other high-risk or high-pressure professionals should also buy this health insurance plan. Unhealthy lifestyles along with work stress lead to multiple critical ailments. It is necessary for individuals who have frequent field jobs or have a stressful job to invest in the best critical illness health plan.

  4. If You Are Above The Age Of 40 Years

    You may be the healthiest in your family but above 40 years of age group then you should get this plan. However, with growing age, there are increased chances of developing critical illnesses like heart ailments and cancers of specific kinds. Individuals over the age of 40 need to invest in good critical illness medical insurance that suits their needs and requirements.

  5. Individuals Who Have Undergone Cardiac Surgeries

    Critical Illness health plans offer coverage to individuals who have undergone cardiac ailment surgeries in the past. If you are one of them, you must invest in a critical illness health plan to avoid further financial distress and avail of the best medical care.

Things to Consider Before Buying Critical Illness Health Insurance

Just keep a few things in mind before purchasing critical illness health insurance. These are:

  • Diseases Covered in the Policy

    Before you sign the proposal form, you need to see how many diseases it covers. Also, you need to check whether it covers the treatment and surgeries.
  • Limitations of Every Coverage Aspect

    Your policy document should have all the details about the policy and its limitations. This explanation will give you an idea of the terms and conditions. You need to go through the documents and check out the limitations of the policy.
  • Waiting Period

    It refers to the period just after you purchase the plan and the waiting period is a common feature in every policy. But it depends from policy to policy. Check for the waiting period the company is imposing on every disease.
  • The Balance of Premiums

    Budget is one of the most important factors. Check for the premiums and see whether it is in your budget or not.
  • Claim Settlement

    One of the most important factors to consider before purchasing any health insurance plan. If the insurer does not provide a hassle-free claim settlement process in your tough times, it will cause major emotional distress which is not required at such urgent times. Not being able to receive a claim timely will cause financial hardship for further treatments.

Buying Process

To buy critical illness health insurance coverage, you can either visit the respective company's office/website or call our insurance experts at PolicyX for a more efficient process.

Buy from the Company

  • Visit the official website of the chosen company.
  • Click on the critical illness tab and check for the premiums.
  • Choose your policy.
  • Click on buy policy, add documents and wait for the approval.
  • Make the payment after approval and the policy is yours.

Buy from PolicyX

  • Visit the website, PolicyX.com and click on the health insurance tab.
  • Click on the critical illness insurance.
  • You will get the plan list and details of the plans.
  • Choose your plan, add documents, and make payment.
  • Here you get the policy along with dedicated end-to-end support from our insurance experts!

Health Insurer Network Hospitals

Critical Illness Health Insurance Claim Process

The critical illness health insurance plan claim settlement process is efficient and hassle-free. You can contact your insurer to help you with your critical illness claim settlement process. However, before filing the claim make sure you have the following documents to receive your claim amount without any problems.

  1. Pre-authorized claim form to be filled properly by the inured individual
  2. Identity proof
  3. Residential proof
  4. Medical insurance card
  5. Doctor prescriptions, test reports, and other medical documents

Once the insurer receives all the documents, the claim process is set into motion and further settled effectively.

Select The Best Critical Illness Health Plan With PolicyX

You can Get the Following Benefits with PolicyX.

  • Comparison of critical illness health insurance premiums, features, and more
  • Customized premium calculation.
  • Expert guidance
  • Detailed explanation of all critical illness plan features
  • Finding the best critical illness medical insurance at an affordable premium
  • Instant purchase of critical illness health insurance plans

Bottom Line

With the rising costs of medical care, it is necessary to invest in the best critical illness insurance plan available. It guarantees financial support during the diagnosis of any critical illness and offers value-added services that help you safeguard your hard-earned savings. PolicyX experts are with you at every stage of your purchase decision to guide you toward the best critical illness plans suitable for your individual and family needs.

Critical Illness Insurance :FAQs

1. Top 5 critical illness health insurance plans in India based on claim settlement ratio.

The following are the top 5 critical illness health insurance plans in India based on the latest claim settlement ratio (CSR) for the year 2021-22:

  • Care Heart Plan
  • Star Cardiac Care Insurance Policy
  • ManipalCigna ProHealth Prime Active Plan
  • Niva Bupa CritiCare Plan
  • Aditya Birla Activ Secure Critical Illness Plan

2. What is a critical illness in health insurance?

Critical illnesses are illnesses that directly affect the major body organs like the heart, brain, lungs, kidneys, and more.

3. Does critical illness insurance cover death?

Critical illness insurance does not provide death benefits. It will provide the payout if you get hospitalized or fall ill due to the illness.

4. What are the features of a critical illness health plan?

The key features of a critical illness health plan are the availability of a high sum insured for dealing with major illnesses and coverage for expensive treatments such as chemotherapy, radiotherapy, organ transplant surgeries, and more. It also provides income replacement in case the only earning member of the family is diagnosed with a critical illness and is unable to work.

5. What are the factors to consider before deciding the sum insured of a critical illness health plan?

Insurance holders often consider a variation of factors when suggesting an ideal sum insured for a critical illness health plan such as age, lifestyle, medical history, occupation, annual income, and more.

6. What are the documents required to file a claim for a critical illness insurance policy?

In general terms, insured individuals need to provide their policy card, medical documents such as doctor's prescriptions, tests and diagnostic reports, address proof, age proof, identity proof, and a duly filled pre-authorized form provided by the TPA.

7. Is there a tax benefit of having critical illness insurance?

Yes. As per section 80D of the Income Tax Act of 1961, one is allowed to have tax exemptions on premiums paid for critical illness health insurance plans.

8. Do Critical Illness Health Insurance policies offer a free look period?

Yes. As per IRDAI, all insurance plans along with critical illness insurance policies come with a free look period during which the insured can review the terms and conditions of the policy, and if dissatisfied he/she can cancel their policy.

9. How many illnesses are covered under the Critical Illness Health Insurance Policy?

The number of critical illnesses covered under a Critical Illness Plan varies from insurer to insurer. However, a few general illnesses such as Cancer, Heart attack, Open heart coronary artery bypass grafting, Open heart replacement or repair of heart valves, Coma of specified severity, and Kidney failure are covered under the Critical Illness Health Insurance Policy.

10. Why is critical illness insurance needed?

Critical illness insurance is different from your regular health policy. It covers life-threatening diseases which have higher medical costs and procedures.

11. How much critical illness insurance should I buy?

Typically, the best way is to estimate the cost of how much a critical illness medical expenses would cost. Now, add your household expenses for the next five years including the critical illness expenses, deduct the unavoidable expenses from this (like your loans and EMIs) and emergency corpus. The amount left with you is the estimate that you should consider.

12. Can I get a critical illness policy after getting diagnosed with a critical illness?

No, if you are already suffering from a critical disease you cannot buy a critical illness policy.

13. What documents are required to buy best critical illness insurance?

A claim form, medical history, existing medical ailment reports are some of the primary documents that you would need while buying a critical illness cover.

14. What is critical illness health insurance?

Critical illness health insurance is a medical insurance plan that offers coverage against major critical illnesses like cancer of specified severity, heart ailments, kidney failures, brain strokes, and more.

15. Why do you need critical illness health insurance?

You need critical illness health insurance to protect yourself and your loved ones from major diseases that can drain your whole budget quickly.

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Simran Saxena

Written By: Simran Saxena

An explorer and a curious person, Simran has worked in the field of insurance for more than 3 years. Traveling and writing is her only passion and hobby. Her main agenda is to transform insurance information into a piece that is easy to understand and solves the reader’s query seamlessly.