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- Critical Illness Insurance
- What is its Cover
- What are its Features
- Advantages of Cover?
- Tax Benefits of a Critical Illness Insurance Cover
- How to Select an Ideal Cover
- Critical Illness Insurance Plan vs. Health Insurance Plan
- Illnesses covered
- Illnesses Not Covered
- Factors To Consider Before Buying Critical Illness Insurance
- Who Can Buy Critical Illness Insurance Cover?
- Steps to Buy Coverage
- How to File a Claim
- Documents Required to File Claim
- Need for Cover
- Buying a Critical Illness Cover Even If You Have a Mediclaim Plan
- Factors to be Kept in Mind While Buying a Critical Insurance Policy
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Critical Illness Insurance
Critical illness insurance provides additional financial security in the event of serious medical emergencies, such as cancer, heart disease, stroke, or organ transplant, allowing policyholders to concentrate on getting well rather than worrying about how they will pay for treatment. ...Read More
Explore the range Health Plans by HDFC Life to cover your medical expenses
With Health plans from HDFC Life you can opt for medical insurance at affordable rates
Francis Rodrigues
Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.
Written By:
Vishal Subharwal
Vishal Subharwal heads the Strategy, Marketing, E-Commerce, Digital Business & Sustainability initiatives at HDFC Life. He is responsible for crafting and ensuring successful implementation of the overall organisation strategy.
Reviewed By:
What is Critical Illness Insurance Cover?
Critical illness insurance financially covers cancer, stroke, renal failure, and a host of other serious illnesses and lifestyle-related conditions. Since critical diseases require extensive care, they may affect your finances. Critical illness coverage is available as an add-on rider with term insurance plans.
Because severe diseases affect the central nervous system, respiratory system, heart, and other essential organs, critical illness insurance is essential. Negligence and a lack of preventative health screenings lead to the accumulation of illnesses that need extensive treatment. With a critical illness policy, you won't have to worry about how you'll pay for treatment.
What are the Features of Critical Illness Insurance Plans?
So, what features of Critical Illness Insurance Plans are vital? The features of critical illness policy include:
Critical Illness Coverage
Major operations, cancer, heart attacks, strokes, organ failure, and a host of other serious medical issues are usually covered by critical illness policy. These plans provide coverage for the expenses of diagnosis, treatment, and recovery from various serious diseases, offering financial security.
...Read More
Lump-sum Payment
The insurance company pays out a lump amount to policyholders when they are diagnosed with a covered critical disease. Critical illness cover, in contrast to other forms of insurance, pays out a fixed amount regardless of how much it really costs to treat the insured. Policyholders are given the freedom to utilise this lump amount as they see fit, whether it's to pay for medical expenditures, pay for alternative therapies, handle home expenses, or save up for lifestyle changes while they're recovering.
...Read More
Affordable Premiums
By keeping premiums low, critical illness insurance plans aim to cover a large population. Critical illness insurance usually has a lower price tag than other forms of insurance, including disability or comprehensive health. Because of its affordability, people may acquire the protection they need from the financially devastating costs of serious diseases without breaking the bank.
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Easy Claim Process
Insurance companies work hard to simplify the critical illness coverage claim procedure so that customers have as little paperwork and administrative burden as possible during this difficult time. Policyholders may get the financial help they need to deal with the difficulties of a critical disease diagnosis quickly thanks to an easier and faster claims procedure. The submission of documents must adhere to certain rules, claims must be processed efficiently, and customer assistance must be prompt in order to answer any questions or issues that may arise.
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Waiting Period
Generally, there is a waiting period for critical illness insurance plans. During this period, you cannot make a claim. It is recommended that you choose a plan with a shorter waiting period.
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Loss of Income
When you are diagnosed with a terminal illness, the critical care insurance will provide a lump sum depending on the sum assured. If you cannot work due to this illness, you can utilise a part of the amount towards the treatment, and the rest will be used to replace the loss of income during recovery.
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What are the Advantages of Critical Care Illness Insurance Cover?
To know more about what advantages of critical illness insurance are important, check the list below:
Provides Coverage for life-Threatening Illnesses
Critical illness insurance provides full coverage for a set of medical disorders that are considered life-threatening. Serious diseases and conditions, including cancer, cardiovascular disease, stroke, and organ transplants, may have a devastating effect on a person's well-being and standard of living. Critical illness cover helps policyholders pay for the expensive medical treatment, rehabilitation, and continuing care of these disorders by giving a lump sum payment.
...Read More
Offers Tax Advantages
You may be able to claim a tax deduction or other financial incentive for paying for critical health insurance. Because of this tax benefit, people are encouraged to have critical illness coverage in their entire financial plans. Decreasing the tax burden connected with insurance payments can maximise coverage value while potentially enjoying savings on yearly tax responsibilities.
...Read More
Provides a Lump Sum for Treatment
A lump sum payout upon diagnosis of a covered illness is one of the main benefits of critical health insurance. The policyholder receives a one-time payment that they may utilise for anything relating to their medical care and rehabilitation. The convenience of a one-time payment allows for managing healthcare costs by personal priorities and requirements, whether they pertain to hospital bills, expert consultations, prescription drugs, or home healthcare services.
...Read More
Provides Shorter Waiting Periods
A critical illness insurance policy often has a shorter waiting time before coverage starts for certain diseases, unlike regular term insurance policies. Therefore, policyholders may get their hands on medical care and financial assistance more quickly following a covered critical illness diagnosis rather than waiting for a long time. Critical illness coverage is more useful in delivering timely help when it's most required when waiting times are shorter.
...Read More
Provides Accidental Death Benefits
Some critical illness insurance plans go above and above by also covering accidental death payouts in case the insured passes away unexpectedly. If the insured dies due to an accident or injury, these benefits will financially protect their beneficiaries. Accidental death benefits provide additional peace of mind by expanding coverage to unexpected events that may cause loss of life. However, the main purpose of critical illness insurance is to assist with severe sickness.
...Read More
Additional Support on Top of Term Insurance
When standard term insurance policies don't cover the full cost of a serious illness, critical illness insurance may help offset the financial burden. In contrast to standard term insurance, critical illness insurance pays out a flat amount to cover medical bills. This might help fill in coverage gaps or enhance current insurance. No matter the restrictions of a policyholder's main term insurance, this supplemental coverage guarantees access to full financial protection in the event of a major sickness.
...Read More
Funding for Expensive Treatments
Critical illness insurance's lump sum payment might be a lifesaver when paying for pricey medical procedures that regular term insurance policies might not cover in full. Some life-threatening diseases may need unconventional approaches to therapy, such as cutting-edge therapies, experimental treatments, specialist pharmaceuticals, or even alternative medicine. Policyholders may get the care they need to achieve the greatest potential health results without financial obstacles with critical illness insurance, which provides the financial means to seek the most suitable and sophisticated therapies.
...Read More
Protection Against Disability
Insurance for critical illnesses not only helps pay for medical care but also protects against things like lost wages and higher healthcare costs if you become disabled due to a covered critical disease.
Critical illness coverage may assist in paying for living expenses, continuing medical bills, and other financial responsibilities if a policyholder becomes incapacitated due to a covered condition and cannot work or perform everyday activities. Offering peace of mind and security to policyholders and their loved ones, this disability insurance guarantees that policyholders may preserve financial stability and quality of life even in serious health issues.
...Read More
Tax Benefits of a Critical Illness Insurance Cover
The Age of the Assessee |
Beneficiaries of Critical Illness Cover |
Maximum Permissible Tax Deduction |
Below 60 years |
Self, Spouse, Dependent Children, and Parents |
₹25,000 for the premium paid for the self, spouse, and dependent children And ₹25,000 for the premium paid for parents under the age of 60 years and ₹50,000 for the premium paid for parents over the age of 60 years
|
Above 60 years |
Self, Spouse, Dependent Children, and Parents |
₹50,000 for the premium paid for the self, spouse, and dependent children And ₹50,000 for the premium paid for parents over the age of 60 years |
How to Select an Ideal Critical Illness Insurance Cover?
The contents in the table below will give you insight into how to select an ideal critical illness insurance cover:
Parameters |
Details |
Sum Insured |
The sum insured should be equivalent to the sum insured in the basic plan. |
Waiting period |
Opt for a plan with a waiting period as low as 30 days from the policy purchase date. |
Survival Period |
The policyholder has to survive for a minimum period after being diagnosed with a critical illness. Normally, it is between 30 to 90 days |
Number of Diseases Covered |
Check for the number of diseases covered and go for a plan with coverage for maximum diseases. Generally, it is 8 to 36 diseases |
Renewability age |
This is very important. Choose plans with lifetime renewability without age restrictions. |
Inclusions and exclusions |
Review the terms and conditions to understand what is covered under the plan and what is not covered under the plan. Pay more attention to waiting periods, pre-existing specifications, and specific diseases not covered by the plan. |
Critical Illness Insurance Plan vs. Health Insurance Plan
A health insurance plan which provides extensive coverage for a wide range of illnesses and medical emergencies. Yet you may face a financial crisis if you are diagnosed with critical illnesses like cancer, heart and kidney issues, stroke, etc., as the basic health insurance plan does not cover the treatment costs of these illnesses. Critical illness insurance as an add-on to the basic plan will serve the purpose. For higher coverage, you can also opt for a standalone critical illness plan.
Here is a glimpse of the differences between critical illness plans Vs health insurance plans for more clarity:
Parameters |
Critical Illness Insurance |
Health Insurance Plans |
Meaning |
Critical illness insurance provides a lump sum amount to meet treatment costs of illnesses like heart and kidney diseases, cancer, stroke, and many others permitted under the plan. |
Health insurance plans cover a gamut of illnesses and medical emergencies. It provides for pre/post-hospitalisation expenses, doctor’s fees, nursing care and surgery charges, prescription medicines, etc. |
Benefits |
The lump sum amount is released upon diagnosis of any critical illnesses permitted under the plan. Hospitalisation is not mandatory. |
The claim is admitted only when producing the hospital bills of the beneficiaries under the plan. Also, you can choose cashless hospitalisation across network hospitals or claim reimbursement. |
Coverage |
The treatment cost of life-threatening diseases such as paralytic stroke, cardiac and kidney issues, and other illnesses is included in the plan. The number of illnesses covered ranges from 8 to 36. |
Provides coverage for a range of health conditions and medical emergencies. It reimburses the pre/post-hospitalisation expenses, diagnostic tests, nursing and surgery costs, prescription medicines, ambulance services, etc. |
Waiting Period |
The duration of the waiting period depends on how severe is the illness diagnosed. |
The waiting period under the health insurance plan is generally 30 days. |
What illnesses are covered by critical illness insurance?
Typically, critical illness insurance will pay for a set of serious medical issues that are either life-threatening or significantly detrimental to a person's health and well-being. Critical illness insurance often pays for the following frequent illnesses:
- Cancer
- Acute coronary syndrome
- Systemic illness (such as renal failure)
- Cardiovascular revascularization
- Transplantation of an organ
These are just a few of the many instances; the diseases covered could differ from one insurance company to another and from one policy to another.
What Illnesses are Not Covered in Critical Illness Insurance?
A variety of significant medical diseases are covered by critical illness insurance. However, specific illnesses and scenarios are usually not covered. Among them could be:
- Coverage may not extend to illnesses or medical problems that existed before the purchase of the insurance policy.
- Critical illness insurance is usually designed to cover diseases that are considered serious. Critical illness coverage could not pay for common or minor medical issues.
- Coverage may not apply to injuries or diseases that are the direct consequence of reckless or purposeful self-harm.
- Some critical illness insurance plans may not cover certain cancers, especially those with poor prognosis or a modest growth rate.
- Coverage may not apply to illnesses or injuries sustained in hazardous activities or jobs.
Factors To Consider Before Buying Critical Illness Insurance
Before you include critical health insurance in your basic health insurance plan, you should consider the following factors:
No People Dependent On You
The number of family members, dependents among them, and your age play a critical role in your decision to purchase a critical illness plan. With senior citizens in the family, the need for medical emergencies is presumed to be high, and you will need better coverage for life-threatening illnesses like cancer, heart attacks, renal issues, stroke, etc. To be clear about the need for this plan ponder what advantage of critical illness has to be considered. The best advantage is providing a financial safety net when you or your family members are diagnosed with a critical illness.
...Read More
Your Current Health Situation
Your health conditions depend on your lifestyle, family history, etc. If you are a heavy smoker or there is a history of critical illness in your family, you are more susceptible to critical illnesses. It is better to opt for critical health insurance early in life to avoid obstacles like the age barrier to get the cover later in life. You can be worry-free about funding any critical illness treatment in the future if you have a critical care plan in place.
...Read More
Choosing Your Sum Insured Responsibly
Buying a critical insurance plan is the right way to allocate funds to take care of medical emergencies in the future. To decide on the sum insured, you should consider the rising cost of health care, especially for critical illness treatments. These illnesses need prolonged treatments and therapies that can be exorbitant. Determine the sum insured considering these factors so that you and your family are adequately covered when a situation arises in the future.
...Read More
Wider Coverage For Illnesses
Critical illness insurance need not be a standalone policy. It can be an add-on to your basic health insurance plan. In both cases, you should be aware of the critical illnesses covered under the policy before investing in one. Also, you should read the policy terms for exclusions to avoid surprises when raising a claim.
...Read More
Adds Advantage to Your Health Insurance Policy
While deciding on a critical illness cover as an add-on to your basic health insurance plan, you should ensure that all aspects of healthcare are covered so that you have no worries about your healthcare. Also, ensure that you get maximum coverage at an affordable price.
...Read More
Who Can Buy Critical Illness Insurance Cover?
A critical illness policy offers a financial safety net if you or your family members are diagnosed with any critical illnesses in the future. Who all can buy critical insurance coverage should also be looked into.
Individuals with a Family History of Critical Illness
A family history of critical illnesses like heart and kidney issues, cancer, stroke, etc., implies that you are more prone to these illnesses. Making provisions for the treatment of these issues is smart financial planning. Investing in critical insurance coverage is a wise decision.
...Read More
Primary Earners
If you are the sole or main breadwinner of the family, you shoulder all the financial responsibilities of the family. Buying a critical insurance plan can avoid a financial crisis in the future if you or your family members are diagnosed with a critical illness.
...Read More
Individuals with Demanding Jobs
It is observed that stress can trigger critical illnesses like heart attacks, cancer, etc. If you are in a demanding or stressful job, invest in a critical care plan to avoid financial stress in the future.
...Read More
Individuals Aged 40 and Above
You are prone to several health issues, including critical illnesses, after you cross 40 years. In anticipation, it is better to invest in a health care plan with critical illness coverage early in life, i.e., when you are in your 30s, it is highly recommended. At this age, your finances are good and you can pay the premiums easily.
...Read More
Steps to Buy Critical Illness Coverage
Follow the steps below to buy illness coverage in the following ways:
- Obtaining critical illness coverage begins with determining the premium for a life insurance policy based on your desired amount assured and policy duration using the online calculator.
- After selecting the basic policy, choose the Critical Illness and Disability rider to add additional critical illness coverage. This rider's critical illness coverage can help you financially in case you are disabled or have a serious illness diagnosis. You can avail of these additional coverage benefits by paying a little more.
- Once you've chosen a plan that includes critical illness coverage, add your personal details and make the premium payment.
- An extended version of your application form, the critical illness cover proposal form, asks for your medical history, smoking habits, and other lifestyle factors.
- A medical evaluation, taking into account the individual's life risks, may be recommended prior to providing critical illness coverage. Once the proposal form and supporting documents have been submitted, a medical examination will be carried out.
How to File a Claim for a Critical Illness Insurance Policy?
So, how to file a claim for a critical illness policy? A diagnostic report is all needed to process a claim for critical illness. It is necessary to get in touch with your insurance company and initiate the claim process in order to submit a critical illness policy claim. Here are the items you'll need to submit a claim with your critical illness insurance policy:
- Fill your critical illness insurance claim form.
- A photocopy of your government-issued photo ID together with your NEFT information or a copy of a voided bank check
- Every document collected before and after a patient's hospital stay
- The present diagnosis's associated consultation records
- Every diagnostic test and medical record that backs up the diagnosis
Under the terms and conditions of the critical illness policy, you will get the claim payout after the insurance company has confirmed the facts.
Documents Required to File Critical Illness Insurance Claim
Here are the necessary documents to submit a claim for critical illness insurance:
- Reimbursement Request Form
- Completed and signed claim paperwork
- Medical Documentation
- Proof of a critical illness diagnosis in the form of a medical certificate
- Official Document from Doctor
- The results of any diagnostic tests that back up the patient's critical disease diagnosis; A letter outlining the first consultation and any necessary medications;
- Identity Verification Paperwork
Need for Critical Illness Cover?
If you think that you have sufficient health insurance coverage and the need for critical insurance cover does not arise, then you are mistaken. Health insurance plans and critical insurance plans are different in many ways. Health insurance plans cover an array of medical issues but critical illness covers the cost of treatment of specific life-threatening diseases included in the plan.
Critical insurance coverage provides a lump sum amount based on being diagnosed with a critical illness. You can use the amount to meet household expenses or other financial needs. You can also use a part or entire lump sum for the treatment of the illness if the sum insured in your healthcare plan is exhausted or if it does not cover certain treatments. It provides for the cost of treatment, caretaking, and loss of income and helps maintain the lifestyle despite the adversities.
Why Should You Buy a Critical Illness Cover Even If You Already Have a Mediclaim Plan?
Many individuals mistakenly believe that health insurance covers their medical needs. Most people think that critical illness coverage and Mediclaim are interchangeable terms. Nevertheless, this is not based on reality.
A critical illness policy provides a one-time payout as an alternative to insurance. This means it can only be used in the most dire circumstances, when the expense of therapy would be prohibitive. When your health insurance won't cover a serious sickness, and you'll need to pay a large amount quickly, critical illness coverage is a good choice.
Unless specifically excluded, a Mediclaim policy will pay for a patient's pre- and post-hospitalization expenses, regardless of how serious their condition is. On the other hand, critical sickness insurance is better suited if the policyholder has a severe illness requiring a lengthy hospital stay. Expenses related to treatment and follow-up care, as well as income loss and lifestyle adjustments, are covered in one lump payment.
Factors to be Kept in Mind While Buying a Critical Insurance Policy
The factors you need to keep in mind before buying a critical illness insurance plan are:
Sum Assured
The sum assured plays a pivotal role in critical health insurance plans. If you are diagnosed with any of the critical illnesses approved under the plan, you get a lump sum payment, irrespective of the medical cost, which can be used for the treatment. The payout depends on the predetermined amount while buying the policy. So, deciding the right amount while purchasing the plan is very important.
...Read More
Standalone Critical Illness Policy or Critical Illness Insurance Rider
Choosing between the two options, i.e., standalone critical illness policy or critical illness insurance rider, depends on the extent of coverage you require. For comprehensive coverage, the standalone critical illness policy is better. You get better coverage under the standalone plan for a higher premium. On the contrary, the coverage in a critical illness insurance plan depends on the sum assured in the base plan.
For example - If your base plan is for Rs. 10 lakhs, the coverage under the rider is restricted to Rs. 10 lakhs. It is recommended to go for a standalone plan to derive the comprehensive insurance benefit.
...Read More
Sub-limits
The critical illness insurance policies set a sub-limit for tests and surgery depending on the illness, which impacts the medical cost you have to bear. Irrespective of the sum assured, the coverage is limited to the extent of sub-limits fixed under the plan, and you may have to bear the rest of the cost. So, understanding this aspect before investing in the plan is crucial to avoid surprises during the claim,
...Read More
Inclusions and Exclusions
Focus on the inclusions and exclusions under the critical health insurance plan before purchasing. If you opt for insurance for a particular illness, it is imperative to check if it is covered under the plan.
...Read More
Age
Age plays an important role in the extent of coverage available under critical illness cover. Older adults are more vulnerable to critical illnesses like heart disease, kidney issues, etc. They get wider coverage for a higher premium compared to younger adults. So, opt for a plan depending on your age group.
...Read More
Maximum Renewal Age
While purchasing health insurance plans, it is important to consider the maximum renewal age, especially for your critical illness cover. Some policies provide coverage only up to a certain age, while others provide lifelong renewal. Opt for a plan with the maximum renewal age.
...Read More
Waiting Period
Critical illness insurance plans have a waiting period depending on the severity of the condition. During this period, you cannot make a claim. Choose a plan with a minimum waiting period for optimum benefit.
...Read More
FAQs on Critical Illness Insurance
1 What does the critical illness insurance cover?
Major surgeries, cancer, heart attacks, strokes, organ failure, and a long list of other serious medical issues are all covered by critical illness insurance. After a covered critical disease is diagnosed, it pays out in a lump amount.
2 What is the critical illness benefit of term insurance?
You may be covered under the critical illness benefit for some severe conditions specified in your term insurance policy. This benefit provides a lump sum payout to aid policyholders in handling medical bills and other financial responsibilities while they are getting well.
3 Is it worth getting critical illness insurance?
If you are worried about how a severe sickness could affect your finances, critical illness insurance is something you should look into. In times of financial hardship, it helps keep you afloat by providing protection against potentially catastrophic medical expenses.
4 What are the key features of critical illness insurance?
Some of the key elements of critical illness insurance are coverage for certain severe diseases, a lump sum payout upon diagnosis, low premiums, an uncomplicated claim procedure, and extra benefits like tax breaks and accidental death benefits.
5 How much critical illness coverage do I need?
Personal health risk factors, medical history, financial responsibilities, and expected medical costs are some of the variables that determine the appropriate level of critical illness coverage. Consult an insurance expert to determine your individual requirements.
6 What are the documents required for critical illness insurance?
The papers needed for critical illness insurance usually include evidence of identity, medical records, test results, and any other pertinent medical paperwork that the insurance company specifies.
7 Can I get critical illness coverage after cancer?
The insurance company's underwriting standards, the kind and stage of the disease, the results of the therapy, and other variables determine whether critical illness coverage is available after cancer. Nevertheless, prices and coverage conditions could differ.
8 Is Critical Illness Insurance Cover Expensive?
Age, health condition, coverage quantity, insurance provider, and other variables all play a role in determining the cost of critical illness insurance. Critical illness coverage provides financial protection that may be worth the higher rates compared to other kinds of insurance.
9 Are Medical Tests Important to Get Critical Illness Cover?
Underwriting for critical illness insurance may include medical testing, particularly for older applicants or those seeking larger coverage levels. The results of these exams provide the insurance company with a better idea of the applicant's health and risk.
10 What are the Eligibility Criteria for Purchasing Critical Illness Insurance?
To get critical illness insurance, you need to be between the ages of 18 and 65, in excellent health, and follow the underwriting rules set forth by the insurance company. The conditions of coverage could change depending on the specifics of each case, and applicants might be subject to medical underwriting.
Related Articles to Critical Illness Insurance
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1. Annual Premium amount ₹ 1869 for Male aged 35 years, Base Benefit, 10 years term, Regular Pay option, Sum Assured=10 lakhs, excluding Taxes & levies as applicable.
ARN- ED/07/24/13725