Critical Illness Insurance

A critical illness insurance policy covers the insured against life-threatening critical illnesses such as cancer, heart attack, renal failure etc. This insurance policy provides coverage in the form of a lump sum at the time of diagnosis of a covered illness. The lump sum can be used for the treatment expenses.

Upon surviving a minimum number of days, the insured can avail the policy benefits as per the applicable terms and conditions.

Features of Critical Illness Insurance Plans

Here are the features of critical illness insurance plans:

• ■ Critical Illness Coverage- Coverage is provided for up to 36 major critical illnesses such as a tumour, cancer, kidney failure, heart ailments etc.
• ■ Lump-sum Payment- The insurer provides the lump sum payment for the treatment of covered illnesses.
• ■ Easy Claim Processing- The claim can be easily processed based on the diagnosis report(s).
• ■ Waiting Period- Usually, the coverage is provided after the end of the waiting period.
• ■ Loss of Income- A part of the lump sum can be used as an income replacement.

Advantages of Critical Illness Insurance

Have you ever wondered, what will happen to you and your family if you can′t earn as a result of a critical illness? On top of that, how will you take care of your incurred medical expenses?

We don′t want you to get scared, we want you to be aware of the severe situations that a critical illness can bring along.

Buying a critical illness health insurance policy is a foolproof way of securing your future against critical illnesses. It will provide you with a lump sum amount upon diagnosis of covered critical illnesses.

Tax Benefits under a Critical Illness Insurance Policy

The policyholder can avail tax benefits under the Income Tax Act, 1961. Tax exemption of up to Rs. 15,000 can be availed under Section 80D of the Income Tax Act, 1961. Senior citizens can avail tax benefit up to Rs. 20,000 under the same section.

How to Select an Ideal Critical Illness Insurance Plan?

The below parameters work like wonders when it comes to ensuring the right critical illness insurance plan:

Parameters	Details
Sum Insured	A lump sum amount equal to sum insured
Waiting Period	Initial 30 days from the policy start date
Survival Period	30-90 days
Number of Disease Covered	8-36 illnesses, depending on the provider
Renewability Age	Either maximum age or lifelong renewability

*The above information is subject to change as per the norms of insurance provider

Critical Illness Insurance Plan vs. Health Insurance Plan

When Neeraj was diagnosed with a brain tumour, he was completely shattered.

His health insurance policy having a sum assured of Rs. 10 Lakh took care of the incurred treatment expenses. Having said that, he was devastated when the revenues of his business started falling down. Due to the severity of his illness, he was unable to take care of his business. As a result, the financial health of business deteriorated (along with his health).

There are many people like Neeraj who don′t know that a health insurance policy is different from a critical illness insurance policy.

Here are the differences between a critical illness insurance plan and health insurance plan

Parameters	Critical Illness Insurance Plan	Health Insurance Plan
Meaning	It covers life-threatening diseases like tumour, permanent paralysis, etc.	It provides comprehensive health insurance coverage including hospitalization expenses.
Benefits	Hospitalization is not required to avail policy benefits. Diagnosis is enough to get lump-sum payment.	The insured can get the reimbursement of incurred hospitalization expenses by submitting bills. He can also avail cashless facility at network hospitals.
Coverage	It offers coverage for up to 36 critical illnesses.	It offers extensive coverage, including pre-hospitalization expenses and post-hospitalization expenses
Waiting Period	There is a waiting period that depends on the severity of illness.	There is a waiting period of 30 days.

Illnesses Covered in Critical Illness Insurance

Generally, critical illness insurance plans cover the following illnesses:

• ■ Cancer up to specified stage
• ■ Heart attack (first time)
• ■ Open heart coronary artery bypass grafting
• ■ Open heart replacement or repair of heart valves
• ■ Coma of specified severity
• ■ Kidney failure that requires regular dialysis
• ■ Stroke
• ■ Major organ transplant
• ■ Bone marrow transplant
• ■ Permanent paralysis of limbs
• ■ Motor neuron disease, also known as amyotrophic lateral sclerosis (ALS)
• ■ 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

Disclaimer- This list is only indicative and not exhaustive. Insurance companies cover various critical illnesses under different critical illness insurance policies.

Exclusions in Critical Illness Insurance Policy

Generally, critical illness plans don′t provide insurance coverage for the following:

• ■ Covered critical illness diagnosed within the waiting period
• ■ Death within 30 days of diagnosis of critical illness or surgery
• ■ Critical illness developed due to smoking, tobacco, alcohol or drug intake
• ■ Critical illness developed due to internal or external congenital disorder
• ■ Pregnancy or childbirth-related critical condition
• ■ HIV/AIDS
• ■ Illness caused/ developed due to war, terrorism, civil war, navy or military operations
• ■ Any dental care or cosmetic surgery
• ■ Infertility treatment/ treatment to assist reproduction
• ■ Hormone replacement treatment
• ■ Treatment underwent outside India

The Need for a Critical Illness Policy

Now, the need for a critical illness policy is more than ever. The sedentary lifestyle pf 21st-century is giving rise to all kinds of illnesses, most of which are critical in nature. Different studies indicate a steady rise in the number of people falling prey to critical illnesses. While the number of people developing/ contracting critical illness is increasing, the age at which people develop critical illnesses is consistently decreasing. This means that millennials are prone to developing critical illnesses as compared to the earlier generations.

Who Can Benefit From Critical Illness Insurance Plan?

Anyone and everyone stands to benefit from taking a critical illness policy. The modern-day hectic lifestyle is a harbinger of lifestyle-related illnesses including critical illnesses like cancer, heart attack, stroke, etc.

A critical illness can reduce the ability of patients to earn. It is because the patient is often sick and home-bound. The reduced ability to work in some cases leads to not being able to work at all. This triggers a financial crisis.

To prevent such situations, one can opt for a critical illness policy.

Who Should Buy Critical Illness Insurance Policy?

With hospitals spending heavily on super-speciality equipment, the treatment is getting better day-by-day. Due to this and medical inflation, the cost of treatment is increasing. When a person is hospitalized, incurred medical costs can go sky-high.

For women having breast cancer, Herceptin (breast cancer drug) can cost a bomb. While undergoing the treatment, the patient needs at least 16 vials. You can imagine how much a patient needs to spend during the treatment.

Keeping in mind the treatment expenses for critical illness, opting for the best critical illness plan seems to be a viable option.

Here is who all can get benefitted from a critical illness policy:

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 developing a critical illness if there is a family history of the same. Those with a history of critical illness in their family should definitely opt for a critical illness insurance policy.

Primary Breadwinners

The role and importance of the primary breadwinner of a family are paramount. If something happens to them, the family′s financial future will be severely affected. The family may even have to face unpleasant financial situations.

That′s why earning members of a family must buy critical illness insurance cover, especially if they have a medical history.

Those Having High-Pressure Jobs

Critical illnesses have a high correlation with high-pressure jobs. Various studies indicate that people working in high-pressure work environments are at increased risk of developing a critical illness. Employees having a job that puts high-pressure on them such should definitely opt for a critical illness policy.

People Over the Age of 40 Years

People over the age of 40 years are more susceptible to developing critical illnesses. It is advised that they buy a critical illness insurance policy in their late thirties. Moreover, they are likely to be in a better financial position and can pay policy premium easily.

Factors to Keep in Mind While Opting for a Critical Insurance Policy

Here are various factors to check before opting for a critical illness insurance plan:

• ■ Sum Assured

The amount of cover is essential to determine which policy works for you. Treatment for some critical illnesses costs comparatively lower than the others. Knowing how much coverage you want will help you choose the right plan for your needs. Get a critical illness insurance quote from our website to come across the critical illness insurance that works for your needs.

• ■ Standalone Critical Illness Insurance Policy or Critical Illness Insurance Rider

Since a standalone policy attracts a higher insurance premium as compared to a rider, it offers comprehensive coverage. The scope of coverage offered by a standalone critical illness insurance plan is higher as compared 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 will be way lesser.

This is due to the fact the rider is actually dependent on the base policy. For instance, if the healthcare policy or mediclaim is for Rs. 2 lakh, then the critical illness rider will provide insurance coverage only for Rs. 2 Lakh.

To enjoy a comprehensive insurance coverage, insurance experts recommend opting to opt for a standalone plan.

• ■ Sub-Limits

Checking the sub-limits under a critical illness insurance policy is important as they have repercussions on the costs you would have to bear. Sub-limits are applicable to the total sum assured under a critical illness insurance plan.

For instance, if a critical illness insurance policy having Rs. 5 Lakh sum assured comes with a sub-limit of Rs. 1.5 Lakh for tests and Rs. 2 Lakh for surgery, will cover up to 3 Lakh. Depending on the incurred expenses, you will have to pay up to 2 Lakh from your own pockets.

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 you have fair information about the limitations before opting for a critical illness insurance plan

• ■ Inclusions and Exclusions

Though the general inclusions and exclusions of a critical illness insurance policy are mentioned above, you should check the exact inclusions and exclusions in the policy brochure. It will help you get a better understanding of the plan.

For instance, a critical illness insurance policy focusing more on cardiovascular diseases may have exclusions such as cataract or cancer. If you are looking for a specific set of illnesses to insure against, please make sure you check the details beforehand.

• ■ Age

The critical illness insurance policies catering to senior citizens offer wider coverage and attract a higher insurance premium. This is because senior citizens are at a higher risk of developing critical illnesses as compared to young adults.

The insurance experts recommend opting for a critical illness insurance plan as per your age group.

• ■ Maximum Renewal Age

Some critical illness insurance policies provide coverage up to a specified age while others provide lifelong coverage. You ought to know the exact age up to which you, as an insured, can renew the plan. For some plans, you can′t renew beyond, say 60 years.

The insurance experts recommend opting for a critical illness insurance plan with a maximum renewal age.

• ■ Waiting Period

Generally, critical illness insurance policies come with a waiting period. This means that the policyholder can avail insurance coverage for covered critical illnesses after the end of the waiting period.

The insurance experts recommend opting for a critical illness insurance plan with a low waiting period.

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, the following documents are required to file a claim:

• ■ Duly filled claim form
• ■ Photocopy of ID card
• ■ Medical certificate obtained from a doctor confirming the dia gnose of critical illness
• ■ Detailed discharge summary

After receiving the above documents, the claim team would verify the details. Based on the verification, your claim will be approved or disapproved. Whatever the case may be, it will be intimated to you.

Note: The insured may have to provide additional documents depending upon the claim.