Critical Illness Insurance
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Critical Illness Insurance

Having a health insurance policy is very common in the present day. But there are few severe life-threatening diseases (cancer, heart attack, kidney failure, etc.) that do not get coverage under a basic health insurance policy. So, health insurance companies launched the Critical Illness Insurance Policy. It provides coverage for specific life-threatening diseases along with a lump sum amount for a higher sum insured option. The insured just needs to focus on his/her recovery. These critical illness health insurance policies help to fight financially with the situations when the insured is struggling between life and death.

Types Of Critical Illness Insurance Policy

There are two types of Critical Illness Policy and the same has been explained further:

1. Individual Critical Illness Insurance Plan

Here all the plan benefits will be only offered to an individual. The features and benefits of the plan will be limited to a single person.

2. Family Critical Illness Insurance Plan

This plan caters to the healthcare needs of an entire family. All members are covered in the plan and can apply for a claim as per the TnC's of the policy.

Best Critical Illness Insurance Plans

Below is the list of best critical illness insurance policies of 2019-2020 in the Indian market. The appreciable benefits, features, sum insured options and the coverage makes these plans stand out in a crowd:

  1. HDFC Ergo Health Optima Vital Plan (formerly known as Apollo Munich)
  2. Max Bupa CritiCare Plan
  3. HDFC ERGO Critical Illness Policy
  4. Edelweiss CritiCare+ Plan
  5. HDFC Life Cancer Care Plan
  6. ManipalCigna Lifestyle Protection Critical Care Plan
  7. Reliance Critical illness policy
  8. Aegon iCancer Plan
  9. Care Critical Illness Insurance Plan

Top Critical Illness Plans: Tabular Representation

The table mentioned below will make the plan comparison a super easy task for the policy buyers. The table contains data and facts as per 2019-2020.

Critical Illness Plan NameInsurance Company NameEntry AgeSum Insured OptionsPolicy TermWaiting Period
MinimumMaximumMinimumMaximum
Optima Vital PlanHDFC Ergo Health Insurance (formerly known as Apollo Munich)18 Years65 YearsRs. 1 LakhsRs. 50 lakhs1 Year2 YearsPre-Existing Disease: 4 Years (for cataract, joint replacement, hernia, surgery of hydrocele, etc.)
CritiCare PlanMax Bupa Health Insurance18 Years65 YearsRs. 3 LakhsRs. 2 Crores1 Year3 YearsPre-Existing Disease: 4 Years
Critical Illness PlanHDFC ERGO Insurance Company5 Years65 YearsSilver Plan - Rs.5 Lakhs, Rs.7.5 Lakhs, and Rs.10 Lakhs
Platinum Plan - Rs.2.5 Lakhs, Rs.5 Lakhs, Rs.7. 5 Lakhs, Rs.10 Lakhs
1 Year2 Years90 Days
CritiCare+ PlanEdelweiss Insurance Company18 Years65 YearsRs. 5 LakhsRs. 1 Crore5 Years30 YearsInitial Waiting Period - 90 Days
Survival Period - 28 Days
Waiting Period Between Claims - 365 Days
Life Cancer Care PlanHDFC Insurance Company5 Years65 YearsRs. 10 LakhsRs. 50 Lakhs3 Years(85 - Entry age) YearsWaiting Period - 180 Days
Survival Period - 7 Days
Lifestyle Protection Critical Care PlanManipalCigna Insurance Company18 Years65 YearsRs. 1 LakhRs. 1 Crore for Age <36 & Rs. 3 Crores for age>351 Year3 YearsInitial Waiting Period - 90 Days
Survival Period - 30 Days
Critical illness PlanReliance Health Insurance Company18 Years65 YearsRs.5 Lakhs, Rs.7 Lakhs, Rs.10 Lakhs1 Year3 Years--
iCancer PlanAegon Life Insurance companyEntry age18 YearsRs. 10 LakhsRs. 50 Lakhs5 Years70 Years minus entry ageInitial waiting Period: 180 days
Critical Illness Insurance PlanCare Health Insurance company5 Years50 YearsRs.10 LakhsRs.200 Lakhs1 Year3 YearsInitial Waiting Period - 90 days
Pre-Existing Disease - 4 Years

Table Data updated on 03-09-2020

A Brief Description Of The Above-Mentioned Plans

1. HDFC Ergo Health Optima Vital Plan (formerly known as Apollo Munich)

HDFC Ergo Health Insurance Company (formerly known as Apollo Munich) offers Optima Vital Plan. It is a critical illness insurance policy that pays the policyholder a lump-sum amount for the diagnosed critical illness. The amount is paid only after the confirmation of the critical illness or the date of undergoing specified surgery in respect of critical illness. The plan provides a wide range of coverage and benefits like second opinion option, portability facility, tax benefit, and sum insured enhancement, etc.

The plan offers coverage for 37 critical illnesses. The amount in a lump sum is paid if the insured gets diagnosed with the illness of defined severity or during the time of undergoing surgery for the covered Illness.

Mentioned below is the list of illnesses that are covered as follows:-

  • Cancer of specified severity
  • Multiple Sclerosis with persisting symptoms
  • End-stage Liver Disease with specified severity
  • Kidney Failure requiring regular Dialysis
  • Coma of specified severity
  • Bacterial Meningitis
  • First Heart Attack of specified severity
  • Major burns
  • Goodpasture's Syndrome
  • Apallic Syndrome
  • Aplastic Anaemia
  • Systemic Lupus Erythematosus
  • Multiple System Atrophy
  • Progressive Scleroderma
  • Open Chest CABG
  • Major organ or Bone Marrow Transplant
  • Aorta Graft Surgery
  • Primary Parkinson's Disease
  • Alzheimer's Disease
  • Stroke resulting in permanent symptoms
  • Permanent Paralysis of limbs
  • Benign Brain Tumour resulting in permanent neurological symptoms
  • Cardiomyopathy
  • Open Heart Replacement or repair of heart valve
  • Pneumonectomy
  • Pulmonary Artery Graft Surgery
  • Motor neuron disease with permanent symptoms
  • Primary Pulmonary Arterial Hypertension
  • End-stage Lung Disease
  • Creutzfeldt-Jakob Disease (CJD)
  • Major Head Trauma
  • Encephalitis
  • Brain Surgery
  • Progressive Supranuclear Palsy
  • Blindness'
  • Deafness
  • Total loss of speech

2. Max Bupa CritiCare Plan

CritiCare Plan launched by Max Bupa Insurance Company is one of the best critical disease insurance plans available in the insurance sector. Under the plan benefits, the insured gets sum insured as a lump sum amount. The plan offers lifelong renewability and tax benefit.

The plan provides coverage only for a list of critical illnesses mentioned below:

  • Cancer
  • First Heart Attack
  • Open Chest Coronary Artery Bypass Surgery
  • Open Heart Valve Replacement or Repair
  • Coma
  • Kidney failure
  • Stroke
  • Major Organ Transplant
  • Paralysis
  • Motor Neurone Disease
  • Multiple Sclerosis
  • Aplastic Anaemia
  • Bacterial Meningitis
  • Loss of Speech
  • End-Stage Liver Disease
  • Deafness
  • End-stage Lung Disease
  • Fulminant Viral Hepatitis
  • Major Burns
  • Muscular Dystrophy

3. HDFC ERGO Critical Illness Policy

The Critical Illness Plan offered by the HDFC ERGO insurance company safeguards the finances of the insured in all possible ways in case of critical illness. It ensures quality medical treatment to the policyholders. All the policy buyers who are less than 45 years of age do not require to undergo pre-insurance medical screening. The plan can be renewed for a lifetime and provides tax benefits under section 80D of Income Tax Act, 1961.

The plan provides coverage only for critical illnesses mentioned below:

  • Heart Attack (Myocardial Infarction)
  • Coronary Artery Bypass surgery
  • Kidney Failure
  • Major Organ/Bone Marrow Transplant
  • Multiple Sclerosis
  • Stroke
  • Cancer
  • Primary Pulmonary Arterial Hypertension
  • Paralysis
  • Aorta Graft Surgery
  • Heart Valve Replacement
  • Benign Brain Tumor
  • Parkinson's Disease
  • Alzheimer's Disease
  • End-Stage Liver Disease

4. Edelweiss CritiCare+ Plan

CritiCare+ is a critical illness insurance plan being offered by Edelweiss Tokio Life Insurance company. The plan covers 17 different critical illnesses. The insured is provided with a lump sum benefit so that he can bear the medical expenses incurred in the treatment of the critical illness. Other than this, the insured gets multiple claim option, tax benefit, and waiver of premium.

The plan provides coverage for a few selective critical illnesses mentioned below.

  • Open chest CABG
  • First heart attack of specified severity
  • Open heart replacement or repair of heart valves
  • Kidney failure requiring regular dialysis
  • Major organ transplant (Heart & Kidney)
  • Stroke resulting in permanent symptoms
  • Aorta surgery
  • Permanent paralysis of limbs
  • Major burns
  • Coma of specified severity
  • Aplastic anemia
  • Total blindness
  • Cancer of specified severity
  • Benign brain tumor
  • Major organ transplant (bone marrow, liver, lung, pancreas)
  • Motor neuron disease with permanent symptoms
  • Multiple sclerosis with persisting symptoms

5. HDFC Life Cancer Care Plan

HDFC Life Insurance Company is offering a Cancer Care policy. Life Cancer Care Insurance policy provides cover for both the early stage and major stage of cancer. It also provides the insured with coverage of Rs. 20 Lakhs at a premium of less than Rs.4/day. The insured can utilize the income benefits for the next 5 years under the platinum plan. Under this plan, any of the benefits and payouts are independent of any other health insurance plans. There are three variants of the plan among which only the silver and platinum plan cover critical illness.

Plan Variants:

  • Silver Plan
  • Gold Plan
  • Platinum Plan

The coverage details of the plan are:

  • Coverage for carcinoma-in-situ or malignant cancer
  • Early-stage cancer - 25% of the applicable sum insured.
  • Major stage cancer - 100 less Early-stage cancer or CIS claims if any.

6. ManipalCigna Lifestyle Protection Critical Care Plan

This Lifestyle Protection Critical Care policy offered by the ManipalCigna Health insurance company provides its insured with coverage against several critical illnesses mentioned in the policy. The insured gets full coverage and a lump-sum payout under the plan in case s/he is diagnosed with any kind of critical illness.

Other than the lump-sum payout, the insured can also get a staggered payout. In the case of staggered payout - 25% of the sum insured will be paid immediately on claim event and 75% + additional 10% of the sum insured will be paid in 60 equal monthly installments starting from the next month.

Plan Variants:

  • Base Cover: Provides coverage for 15 critical illnesses.
  • Enhanced Cover: Provides coverage for 30 critical illnesses.

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

  • Cancer of specific severity
  • First heart attack of specific severity
  • Open chest CABG
  • Open heart replacement or repair of heart valves
  • Coma of specified severity
  • Aorta graft surgery
  • 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 pulmonary hypertension
  • Loss of hearing
  • Coronary artery disease
  • Loss of sight
  • Aplastic anemia
  • Major burns
  • End of lung disease
  • End of liver disease
  • Fulminant hepatitis
  • Alzheimer's disease
  • Bacterial Meningitis
  • Apallic syndrome
  • benign brain tumor
  • Parkinson's disease
  • Medullary cystic disease
  • Muscular dystrophy
  • Loss of speech
  • Systemic lupus erythematosus

7. Reliance Critical illness policy

Reliance General Insurance company offers a critical illness policy that protects the insured's savings in hard times. A critical illness treatment bills can dent a hole in the savings and so this plan has come to policyholder's rescue.

Illnesses covered under this plan are:

Category I - Life-Threatening

  • Cancer
  • Major organ Transplant
  • Multiple sclerosis
  • Third-degree burns
  • Aorta graft surgery

Category II - Lifestyle Disabling

  • Heart Valve R
  • Replacement or repair
  • Coma of specified severity
  • Coma Quadriplegia
  • Total blindness
  • End-stage renal disease requiring regular dialysis

8. Aegon iCancer Plan

iCancer Insurance Plan is a non-linked & non-participating insurance plan being offered by Aegon Life insurance company. It provides comprehensive coverage with respect to all kinds of cancer illnesses.

When it comes to coverage, the plan has been particularly designed for cancer illness. It covers all types & stages of cancer.

9. Care Critical Illness Insurance Plan (formerly known as Religare Critical Illness Insurance Plan)

Care health insurance company offers affordable medical care for 32 major critical illnesses. The coverage provides financial support in the time of medical emergencies. It is one of the critical insurance policies one should opt these days. The insurance company chooses to pay a claim in lump-sum amount or payments in predefined structures for different medical procedures.

The plan provides coverage only for these critical illnesses:

  • Cancer
  • End-stage renal failure
  • Multiple sclerosis
  • Benign brain tumor
  • Parkinson's disease
  • Alzheimer's disease
  • End-stage liver disease
  • Motor neuron disorder
  • End-stage lung disease
  • Bacterial meningitis
  • Aplastic anemia
  • Pulmonary thromboembolism
  • Primary pulmonary hypertension
  • Infective endocarditis
  • Major organ transplant
  • Heart valve replacement/ repair
  • Surgery of aorta
  • Cardiomyopathy
  • Surgery of cardiac arrhythmia
  • Angioplasty
  • Balloon valvuloplasty
  • Carotid artery surgery
  • Coronary artery bypass graft
  • Pericardiectomy
  • Surgery to place ventricular assist devices or total artificial hearts
  • Stoke
  • Paralysis
  • Myocardial infarction
  • Implantation of the pacemaker of the heart
  • Implantable cardioverter-defibrillator
  • Major burns
  • Blindness

Common Critical Illness Exclusions

Here is a list of exclusions that are common to all the critical illness plans discussed previously.

  • Any illnesses or medical conditions not listed in the policy documents.
  • Any critical illnesses directly or indirectly associated with HIV/ AIDs.
  • Any treatment or surgery for change of sex.
  • Congenital anomalies.
  • Birth control procedures and hormone replacement.
  • Any treatment arising from or traceable to pregnancy.
  • Unreasonable failure to seek or follow medical advice.
  • Sexually transmitted diseases.
  • Nuclear, biological or chemical contamination
  • Intoxicant abuse related to drugs, alcohol, etc
  • Any medical condition arising from the donation of any of the policyholder's organs.
  • Any disease arising due to self-inflicted injury or suicidal attempt.

How To Choose The Best Critical Illness Policy?

Here is a list of facts that you should look for in the plans if you have made up your mind to buy a critical illness plan:

Finalize Sum Insured

The sum insured should be decided by the buyer after analyzing all the requirements. But in case of critical illness, it is a bit challenging. The occurrence of any of the critical illnesses in the family history makes one more prone to these life-threatening diseases. So, think and then finalize.

Compare Plans

Finalize a list of your demands & compare the plans with respect to benefits, features, hospitalization facilities, etc. Whichever strikes you the most should be your preference.

Check The List

Some of the critical illness plans have a list of coverage and they provide coverage only for those specific critical illnesses. Here the target should be to choose a plan covering more critical illnesses as one never knows about the uncertainties of life.

Affordable Premium

It is necessary to check whether the premiums fit into one's pocket. The policy will be only running till the time you are paying the premiums. So, go for a plan that you can afford.

Claim Ratio

The claim settlement ratio of the insurance company is the number of claims settled against the number of claims filed. So, it gives you an idea that to what extent the insurance company has been successful in satisfying the customers with its hassle-free claim settlement process. For the claim settlement ratio, you can visit the most trusted and authentic source of information- the IRDAI website.

How Can You Buy A Critical Illness Insurance Policy?

  • Step 1: Visit the 'free quote' section present at the top of this page.
  • Step 2: Fill some basic details & click on the tab 'Continue'.
  • Step 3: Compare quotes & choose a plan that suits your requirements.
  • Step 4: Fill the proposal form that requires some necessary information.
  • Step 5: Upload your documents online & make the payment via selected modes.

How To Go About The Claim Process?

A claim can be made in two ways- a cashless claim or reimbursement claim. The cashless claim facility can be availed only at the network hospitals of the third party administrator (TPA).

Cashless Claim:

  • In case of an emergency, intimate the TPA as soon as possible and do mention your health card membership number.
  • Fill in the cashless request form available at the hospital help desk and get it attested by your doctor.
  • Send the cashless request form along with the medical documents to the TPA.
  • The TPA will scrutinize the medical documents and will convey the decision to the hospital. The TPA will either sanction cashless requests or will call the policyholder for additional documents required.
  • After the approval from TPA, the medical bills will be directly settled.
  • In case the claim is not approved, the policyholder can make the payments and can apply for reimbursement. The policy claim will be processed as per the terms and conditions.

This is the way to make a claim in case of an emergency. Now, suppose the policyholder plans admission to the hospital to get treatment. In this situation, all that is required to be done is to inform the TPA a few days before, about the treatment/ surgery you are going to go through. The rest of the steps would remain the same for the application and function of the claim.

Reimbursement Claim:

If you decide to get your treatment done in a normal hospital, you can apply for reimbursement of the claim via the following process:-

  • ntimate the insurance company immediately after you get admitted to the hospital. The intimation should be made within 7 days after getting discharged. Do mention the policy number while informing the insurance company.
  • Download the claim form from the insurance company website and apply for reimbursement by submitting the necessary documents.
  • The insurer will verify the details of the claim. If everything is sorted, you will get the claim amount in no time.

Note: Keep all the bills & original medical documents with you. You never know what the insurer may ask for.

Which Documents Are Required To Purchase Critical Illness Plan?

A list of documents have been presented which can be required at the time of buying a critical illness policy:

  • Age proof.
  • Anyone of birth certificate, 10th or 12th mark sheet, driving license, passport, voter id, etc.
  • Identity proof.
  • Driving license, passport, voter id, pan card, aadhar card, which proves one's citizenship.
  • Address proof.
  • Electricity bill, telephone bill, ration card, driving license, passport, having the permanent address.
  • Passport size photos.

Family Health Insurance FAQs

1. Can I make multiple claims for the same illness or any other critical illnesses that are listed?

During the policy period, you are allowed to make only one claim on any of the listed critical illnesses mentioned in your policy document.

As soon as you make a claim, the lump sum amount shall be paid out for the particular critical illness. The policy would be automatically terminated and subsequent renewals would be allowed in the policy of the particular insured person. If at all the policy has been issued to more than one individual then the policy shall still remain active for the other policy members.

Certain insurance policies continue other benefits except for the one which you already made the claim.

If you are making a critical illness claim then the hospitalization expenses incurred will be paid under Health Insurance. The Lump sum benefit will be paid after the survival period under Critical Illness cover.

It is always better to speak to your insurance company about this clause as some insurers may allow you to make more than one claim.

2. I want to understand how is the premium determined for critical care plans?

Premiums for critical care insurance are determined on the sum insured stated in the policy document, the complete policy tenure, gender, and health status of the insured person.

The premiums vary from one individual to another depending on all these factors mentioned above.

3. Is it better to take critical illness cover or health insurance?

A critical illness cover offers you a lump sum amount in case of diagnosis of the critical illness that is mentioned in the policy document. However, health insurance reimburses the medical expenses borne by you. Hence, it is better that you buy a separate critical illness cover.

4. Can I change the sum assured during policy tenure?

No, you cannot change the sum assured during the policy tenure.

5. Do I get any tax benefits under this policy?

Yes, the premiums that you pay for your critical illness insurance cover qualifies for an income tax deduction under Section 80D of the Income Tax Act, 1961.

Find Out What PolicyX Customers Says

July 31, 2020

meenakshi singh
Delhi

Fantastic service providers, My details got changed within few days after the policy issuance. Efficient employees really.

July 16, 2020

Davuluri Venkata Sambasivarao
Vijayawada

Policyx is the best insurance web aggregator I have seen.Mrs Mayuri on behalf of policyx has helped me in choosing the best health plan and provided me fast and trustful service

July 16, 2020

Davuluri Venkata Sambasivarao
Vijayawada

Policyx has provided the best service as insurance web aggregator.It guided me in choosing the best health plan.

June 24, 2020

Ashok Talluri
Hyderabad

Thanks to Subham kumavat for helping me to choose the right plan and guiding right from beginning to the end

May 27, 2020

Monik Lakhani
Mumbai

Shubham has been prompt in providing information. He is a good salesman hope he provides good service too

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Last updated on 03-09-2020