Critical Illness Insurance
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What Is Critical Illness Insurance?

Critical illness insurance is a type of health insurance, which provides a lump sum amount to the insured if he is diagnosed with critical illnesses like cancer, major burns, coma, among others (as listed under the chosen policy). Not only can the insured use the amount to pay for medical expenses, but also look to meet other financial obligations.

In our current lifestyle, where we constantly come face to face with junk food, stressful work conditions and family responsibilities, it's pretty easy to succumb to critical illnesses. And when that happens, having critical illness insurance in your back pocket can be a lifesaver.

Types of illnesses covered under Critical Illness Insurance

Here's a list of some common critical diseases against which a critical illness policy usually provides coverage:

  • Cancer (up to a specified stage)
  • Heart attack
  • Kidney failure
  • Coma
  • Stroke
  • Organ transplant
  • Bone marrow transplant
  • Loss of speech
  • Deafness
  • Paralysis
  • Major burns
  • Brain surgery
  • Blindness
  • Apallic syndrome
  • Goodpasture's syndrome
  • Open heart replacement or repair of heart valve
  • Benign brain tumour
  • Open chest CABG
  • Alzheimer's disease
  • Primary Parkinson's disease

Who Should Take Critical Illness Insurance?

Given the busy modern-day lifestyle, nobody is safe from critical illnesses like cancer, stroke, etc. Therefore, most of us should go for a critical illness plan. However, to be precise, we've listed below certain categories who can majorly benefit from this insurance. Let's learn about them.

  1. Family History Of Critical Illnesses

    Generally, critical illnesses are genetic. This means that the people who have a history of critical illness in their family are at a higher risk of suffering from it. For example, if your mother suffers from Alzheimer's disease, there are higher chances of you catching the same. And if that happens, coverage from critical illness insurance can come handy, don't you think?

  2. Sole Earner Of The Family

    Being the only earning member in your family, what happens if you are diagnosed with paralysis? Who will pay your monthly expenses? With critical illness insurance in your pocket, you don't have to worry about it.

  3. High-pressure Jobs

    It has been observed that people who work in high pressure and stressful job environments have higher chances of developing some sort of a critical illness. So, if you can relate with this statement, a critical illness plan is a necessity.

How's Critical Illness Insurance Different From Standard Health Insurance?

People often think that critical illness insurance and health insurance are the same. However, this is not true. Critical illness insurance plans and standard health insurance plans are different. The table given below highlights the major differences between a critical illness and a standard health insurance policy.

Parameters Critical Illness Insurance Standard Health Insurance
Expenses coveredIt offers a lump sum amount to help the insured in making-up with all the expenses incurred while treating any critical disease such as heart attack, cancer, etc.It covers actual medical and surgical expenses incurred by the insured during hospitalization.
Benefits offeredThe claim benefits from a critical illness plan can be used to pay the hospitalization bills as well as cover any financial loss that arises due to critical diseases.The claim benefits of this policy are used to pay the actual treatment and hospitalization expenses only.
Survival periodIt requires the insured person to survive for a period (let's say 30 days) after the first diagnosis of illness to enjoy the coverage claim. The timeframe may vary from one insurer to another.There is no survival period for the claim to be received.
Waiting periodThe waiting period varies as per the insurance provider. For example, HDFC critical illness plan comes with a 90-day waiting period. Post that, all claims will be entertained.Apart from the case of an accident, standard health insurance plans have a waiting period, starting from 30 days.
CostCost for critical illness plans are very low as they cover only named diseasesSince a normal health plan covers all types of hospitalization, the costs are usually higher

I have a health insurance plan. Do I still need critical illness insurance?

Critical Illness Disease Treatment

*Sources for the data are taken from-

By looking at this graph, you can notice that treating critical illnesses such as cancer, kidney transplant, brain tumour and heart attack is a very costly affair in India. It can put a huge financial burden, something which not everyone can afford. Although a standard health insurance plan will provide coverage, it won't be enough to pay all the bills. That's why you need a critical illness policy, which comes with a big sum insured at a reasonable cost.

Benefits Of Critical Illness Insurance

Critical illness health insurance provides a variety of benefits to the insured. Some of these are discussed below:

Lower Premiums

Lower Premiums

The critical illness insurance plans provide coverage against some specific life-threatening diseases. Due to this reason, the premium of such plans is significantly lower in comparison to the regular health plans. For example, you can buy Care critical illness policy for Rs.1667/year (SI Rs.10 Lakhs) as compared to its Care comprehensive policy for Rs.9546/year (SI Rs.10 Lakhs).

Income Replacement

Income Replacement

The policyholder of a critical illness plan has a free hand to use the coverage amount in whatever way he likes. This serves as a big advantage here as the insurance amount can be used as an income replacement option and help the insured to cover his financial burdens.

Tax Benefits

Tax Benefits

Thanks to Section 80D under Income Tax Act, 1961, the owner of a critical illness policy can enjoy tax benefits up to Rs.25,000 on paying regular premiums. If you are a senior citizen, you can get up to Rs.50,000 as tax deductions. If your parents are senior citizens, you can grab tax deductions up to Rs.50,000 for premiums paid for them.

What's Not Included In Critical Illness Insurance?

There are a few situations, where critical illness insurance doesn't provide any support. Let's learn about them.

1

Any dental care or cosmetic surgery.

2

Any disease or medical condition not specified in the policy documents.

3

Expenses related to hormone replacement treatment.

4

Infertility treatment or treatment to assist reproduction.

5

Sexually transmitted diseases.

6

Critical illness developed by consumption of intoxicants such as tobacco, smoking, drug intake, or alcohol, etc.

7

Illnesses caused due to terrorism, civil war, navy or military reasons.

8

Any critical illness diagnosed within the waiting period.

9

Any critical illness arising due to internal or external congenital disorder.

How To Determine The Right Coverage Amount In Critical Illness Insurance?

There are some vital parameters, which determine the right coverage amount for a person applying for critical illness insurance. These include-

Location- The hospitalization expenses of any critical illness often vary significantly upon location where the person is taking the treatment. For example, if you reside in a relatively smaller city like Haridwar, then an insurance coverage of Rs.15-20 Lakhs would be enough to cover your medical expenses. But if you reside in a big city like Bangalore, you would need a coverage amount of more than Rs.30 Lakhs to cover your treatment and hospital bills. The cost of medical treatment varies by upto 100% in some cases from location to location. Accordingly, you should decide your coverage amount.

Age of the insured- Suffering from critical illness in the old age can make things worse. You are at a greater risk of catching more illnesses, along with the present illness. To tackle them effectively, you need the support of a higher coverage amount.

Lifestyle- The lifestyle of a person is also an important factor, which helps in determining the right coverage amount for a critical illness plan. People having unhealthy lifestyle practises like smoking or drinking are more likely to get diagnosed with critical illnesses like cancer or kidney failure. That is why such people should go for plans offering greater sum insured so when the illness arrives, you are financially prepared for it.

How To Choose The Best Critical Illness Insurance Policy?

Wait a minute, there is nothing called the 'Best critical illness insurance policy'. A person needs to go through all the policies available in the market and decide the best one for himself. To help with that, you can take a look at the below factors-

  1. Premium Amount

    Based on the plan you select, you will have to pay a premium amount to the insurer after specified intervals. The duration and benefits of the policy are directly linked with the premium payment. So, make sure to choose a policy whose premium you can afford to pay.

  2. Waiting Period

    It refers to a specific period after which the policy benefits are payable. Meaning, if your insurance plan has a waiting period of 4 months, then you can file your claim only after 4 months. The time frame can vary depending on the chosen insurance company. Therefore, it is advisable to go for a plan that offers a low waiting period.

  3. Diseases Covered

    Not all insurance companies provide coverage against the same type of critical illnesses in their plans. For example, ManipalCigna Health Insurance company provides coverage for permanent paralysis of limbs. Whereas Reliance General Health Insurance does not. So, choose a plan that covers the specific critical illness you expect yourself to get diagnosed with/are diagnosed with. Ideally, you should go with a plan that covers maximum diseases.

Best Critical Illness Insurance

Critical Illness Insurance Companies And Plans In India

Given the wide range of critical illness plans available in the insurance market nowadays, it is natural to feel confused about which one you should select. To make things a bit easy for you, we've first selected 15 top health insurance companies in the market and from them, we have listed 5 critical illness plans. Let's learn about them.

Please note- The premium amount mentioned in the table is for a sum assured amount of Rs 10 Lakhs.

Insurance Company Plan Name Annual Premium) Maximum Sum Insured
Care Health Insurance Company (formerly known as Religare Health Insurance Company Limited)Critical Health Insurance Plan11982 crore
SBI General Insurance CompanyCritical illness insurance policy168550 lakh
Max Bupa Health Insurance CompanyCriticare health insurance plan23682 crore
Manipal Cigna Health Insurance CompanyLifestyle protection- Critical care health plan291525 crore
Reliance General Insurance CompanyCritical illness plan323110 lakh

**Last Updated on 31-03-2021

  1. Care Health Insurance Critical Illness Plan

    The plan provides treatment cover for 20 critical illnesses that are pre-defined in the policy. There are a variety of features covered in the policy such as in-patient hospitalization cover, pre and post hospitalization, organ donor cover, annual health check-up and OPD Cover. This critical illness policy has an initial waiting period of 90 days.

    Here is a list of illnesses covered under the plan:

    • Cancer
    • End stage renal failure
    • Multiple Sclerosis
    • Benign Brain tumour
    • Total blindness
    • Motor neuron disorder
    • End stage lung disease
    • Major organ transplant
    • Heart valve replacement
    • Coronary artery bypass Graft
    • Stroke
    • Paralysis
    • myocardial infarction
    • Major burns
    • Coma
    • Parkinson's disease
    • Alzheimer's disease
    • End stage liver disease
    • Bacterial meningitis
    • Aplastic anaemia
  2. SBI General Insurance Critical Illness Plan

    This critical illness cover plan by SBI is available within two options- 1 year plan and 3 year plan. The plan covers 13 listed critical illnesses and has a maximum sum assured amount of Rs. 50 Lakhs. People below the age of 45 are not required to undergo any medical tests while taking this plan.

    The critical illnesses covered under this plan are-

    • Cancer of Specified Severity
    • Open Chest CABG
    • Aorta Graft Surgery
    • Open Heart Replacement or Repair of Heart Valves
    • Stroke Resulting in Permanent Symptoms
    • First Heart Attack of Specified Severity
    • Kidney Failure Requiring Regular Dialysis
    • Primary Pulmonary Arterial Hypertension
    • Major Organ/ Bone Marrow Transplant
    • Multiple Sclerosis with Persisting Symptoms
    • Coma of Specified Severity
    • Total Blindness
    • Permanent Paralysis of Limbs
  3. Max Bupa CritiCare Plan

    This critical illness plan is launched by Max Bupa and offers lifetime renewability and tax benefits to the policyholder. There is an initial waiting period of 90 days from the commencement of the policy. After which, the plan is liable to pay benefits.

    The plan provides coverage against these following 20 critical illnesses-

    • Cancer of specified severity
    • Open chest CABG
    • First Heart Attack
    • Open heart replacement/repair of heart valves
    • Stroke
    • Permanent paralysis of limbs
    • End stage liver disease
    • End stage lung disease
    • Comatose
    • Dialysis
    • Major Organ/Bone Marrow Transplant
    • Third degree burns
    • Loss of speech
    • Deafness
    • Aplastic Anemia
    • Bacterial meningitis
    • Fulminant Viral Hepatitis
    • Muscular dystrophy
    • Multiple sclerosis
    • Motor Neuron Disease
  4. ManipalCigna Critical Care Plan

    This critical illness plan by ManipalCigna comes within two variants. The base cover provides coverage for 15 critical illnesses and the enhanced cover provides coverage for 30 critical illnesses as listed in the policy. The initial waiting period of the plan is 90 days and in case you are diagnosed with a listed illness, you can grab the benefits via two means- lump sum or staggered payouts (25% as a lump sum and 75+10% in 60 equated monthly instalments).

    Here is a list of critical illnesses covered under the plan:

    Basic plan:

    • Cancer of Specified Severity
    • Myocardial Infarction (First Heart Attack - of Specific 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 with Persisting Symptoms
    • Primary (Idiopathic) Pulmonary Hypertension
    • Aorta Graft Surgery
    • Deafness
    • Loss of Sight

    Enhanced plan

    In addition to the 15 critical illness covered under the basic plan, it covers these other 15 critical illnesses:

    • Coronary Artery Disease
    • Aplastic Anaemia
    • End Stage Lung Failure
    • End Stage Liver Failure
    • Third Degree Burns
    • Fulminant Hepatitis
    • Alzheimer's Disease
    • Bacterial Meningitis
    • Benign Brain Tumor
    • Apallic Syndrome
    • Parkinson's Disease
    • Medullary Cystic Disease
    • Muscular Dystrophy
    • Loss of Speech
    • Systemic Lupus Erythematous
  5. Reliance General Insurance Critical Illness Plan

    This plan is available for two policy periods- 1 year and 3 years. It provides coverage against 10 critical illnesses and has a waiting period of 30 days after which the insurer can claim the insurance. The plan has three types of maximum sum assured options which vary according to the age of the policyholder. The maximum entry age to buy a 5-lakh sum insured policy is 65 years, for a 7 lakh sum assured policy is 60 years and for a 10 lakhs sum insured is 55 years.

    The critical illness covered under this plan are:

    • Cancer
    • Major Organ Transplant
    • Multiple Sclerosis
    • Third Degree Burns
    • Aorta Graft Surgery
    • Heart Valve Replacement or repair
    • Coma of Specified Severity
    • Coma Quadriplegia (persisting more than 90 days post-diagnosis without any significant recovery)
    • Total Blindness
    • End-Stage Renal Disease requiring regular dialysis.

Why Should You Buy Critical Illness Cover From PolicyX.com?

Critical illnesses often bring with them critical times. If you're diagnosed with a critical illness, your savings are most likely to be drained out quickly. If you want to protect them, it is important to have a backup plan against such uncertainties.

PolicyX.com helps you to find the suitable critical illness policy within few minutes. You can instantly compare different critical illness plans, evaluate their features according to your needs and find the best one for yourself. As a customer of PolicyX.com, you can enjoy the following benefits:

1

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2

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Calculate the premium amount of different critical illness policies.

3

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4

Complete Assistance

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What Is The Claim Process Of A Critical Illness Insurance?

The claim process of critical illness insurance is not so different from standard health insurance. For your convenience, we have briefly jotted down two ways of applying claim- cashless and reimbursement. Let's check them out.

Cashless Claim Process:

This is only applicable if you take treatment in a network hospital.

  • Inform the insurance company about the hospitalisation and submit your health card and photo id proof at the hospital insurance desk.
  • Fill-up the pre-authorization form and the hospital will share the same with the insurance company.
  • On approval from the company, you can avail of cashless treatment.

Reimbursement Claim Process

Here, the insured should meet all the treatment expenses himself and then apply for reimbursement (if a cashless request is rejected or hospitalization is at a non-network hospital).

  • Intimate the insurance provider.
  • Fill up the claim form and submit it along with the discharge certificate and other necessary documents to the insurance provider.
  • The insurer will verify the details of the claim and the claim amount will be transferred to the registered account as soon as everything is checked and sorted.

Note- The above-listed steps may vary depending on the chosen insurer.

Documents Required

Photocopy of the policy document

Discharge certificate

Hospitalisation and medicine bills

Treating doctor's report

Others requested by the company

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FAQ's

1. Do I get an option to cancel the critical illness policy?

Yes. Companies grant 15 days (generally speaking) to the policyholder to review the policy's TnCs and cancel it if not satisfied. The company will return the premium amount after deducting necessary charges.

2. How is the premium amount determined for critical care plans?

The premium amount for critical illness insurance is determined based on a variety of factors- age, the amount of sum insured, policy tenure, gender, medical history, among others.

3. Do critical illness plans offer a portability feature?

Yes. Many insurance providers allow individuals to port their policies. For more information, get in touch with your chosen insurer.

4. Do all insurance providers cover the same critical illnesses?

No, that's not the case. You may find some common illnesses covered by two/three providers, but it's hard to find all of them. Before you buy the policy, it's best to check the list of illnesses covered by a chosen plan.

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July 31, 2021

Pradeep Narayan Kushwaha

Other

We purchase a policy.Policy no.is P/161130/01/2022/053322.Our policy sell officer Miss Priya Pancholiya.she clear all policy doubt.She is a good advisor.

July 31, 2021

Rahul Yadav

Indore

Miss Priya Panchotiya (12807) is best employ of the Policyx.com. We are helpful to your organisation and specially sales team.

July 26, 2021

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Mumbai

It has been a great experience with sale as well aftermath personnels, of your organisation. They have define and help to core to add me as future loyal customer. Highly appreciate the efforts of Mr Dev k Singh and Rahul to close the deal very comfortably. Once again accept my best wishes to your company and especially the team as frontliner for tie up for our great future relationship and they do stand highest rank in professionalism.

July 22, 2021

Ajay Shah

Mumbai

We are thankful to your organization and specially to your sales team highlighted by Mr. Dev his efforts to explain the product in details was quite appropriate and it help us to get the closure. Once again thanks for gaining the confidence of the customer with genuinely.

July 11, 2021

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Hyderabad

Excellent service by policyx and particularly Ms Prashansha Yadav employee Id 12671. She was prompt on the answer and listen very patiently and the answer was very clear and understandable. really it was a pleasure to contact policyx.

Last updated on 16-04-2021

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