What is a Critical Illness Insurance Policy?

A Critical Illness Insurance policy covers the insured against life-threatening critical diseases, such as cancer, heart attack, renal failure, stroke, etc. This critical illness policy provides a lump sum coverage amount to the insured on the first diagnosis of a listed critical illness that can be used to cover exorbitant treatment expenses. However, all critical illness insurance plans come with a waiting period of 90 days.

Features of Critical Illness Insurance Plans

Here are the features of critical illness insurance plans:

Coverage for 100 Critical Illnesses – These health insurance plans provide coverage for up to 100 critical illnesses and procedures, such as cancer, kidney failure, heart ailments, brain surgery, stroke, etc. However, the number of diseases covered may vary from one insurer to another.
Lump Sum Payment - The insurer provides a lump sum payment for the treatment of covered critical illnesses upon their first diagnosis.

Easy Claim Processing – Critical illness insurance claims can be easily processed based on the required medical documents and diagnosis report(s).
Waiting Period - Usually, the critical illness coverage is provided after the end of a waiting period of 90 days.
Replacement of Income - A part of the lump sum can be used as an income replacement in case patients lose their jobs.
Survival Period – Most critical illness plans come with a survival period of up to 30 days, after which the insurer pays the claim amount.

₹1000 Cr worth of claims assisted in 2022-2023

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Benefits of Buying a Critical Illness Insurance Plan

Take a look at some of the key benefits of buying a critical illness insurance plan:

Coverage Beyond Hospitalization

Regular mediclaim insurance plans cover critical diseases to the extent of hospitalization expenses only. They reimburse the expenses incurred on treating a critical illness during hospitalization. However, critical illness insurance plans provide a lump sum amount upon diagnosis of covered critical illnesses that can be used to pay for healthcare expenses with or without hospitalization.

Secures Financial Future

Patients diagnosed with a critical illness cannot earn as they used to due to the physical limitations of going to work every day. On top of that, there will be a huge burden of medical expenses incurred on the treatment of the disease. Buying a critical illness insurance policy is a foolproof way of securing the entire family’s future against critical illnesses, as the lump sum claim amount can be used not only to pay medical bills and day-to-day home expenses.

Rising Medical Inflation

With hospitals spending heavily on super-speciality equipment, the treatment is getting better day-by-day. Combined with medical inflation, it increases the cost of medical treatment, especially during hospitalization.

For example, women with breast cancer require Herceptin (breast cancer drug), which can cost anywhere between ₹15,000 to ₹54,000 per vial. While undergoing the treatment, the patient needs at least 16 vials. As a result, patients can end up spending ₹2.5 lakh to ₹8.6 lakh on medication during the treatment.

Considering these high treatment expenses, opting for a good critical illness insurance plan seems to be a viable option.

Aditya Birla Critical Illness Plans

Bajaj Allianz Critical Illness Policy

Bharti AXA Critical Illness Insurance Plan

Care Critical Illness Insurance Plans

Cholamandalam Critical Illness Policy

New India Assurance Critical Illness Policy

Reliance Critical Illness Policy

Royal Sundaram Critical Illness Policy

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Need of the Hour

The need for a critical illness policy nowadays is more than ever. The sedentary lifestyle of the 21st century is giving rise to all kinds of illnesses, most of which are critical in nature. 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. By buying a critical illness policy at an early age, young adults can safeguard themselves against the financial implications of these diseases while affording the best available treatment.

Tax Benefits

The policyholder can avail tax benefits of up to ₹25,000 on critical illness insurance premiums under Section 80D of the Income Tax Act, 1961. Senior citizens can avail tax benefits of up to ₹50,000 under the same section.

*Tax benefits are subject to changes in tax laws.

Who Should Buy a Critical Illness Insurance Policy?

Everyone can benefit from a critical illness policy. However, the following people must buy a critical illness insurance policy:

People with a History of Critical Illness in Their Family

Many critical illnesses are hereditary in nature, i.e., they run in families. A person is at a much higher risk of developing a critical illness if there is a family history of the same. Therefore, people 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 a critical illness insurance cover, especially if they have a medical history.

People with High-Pressure Jobs

Critical illnesses are highly correlated with high-pressure jobs. Various studies indicate that people working in high-pressure work environments are at increased risk of developing a critical illness due to high stress levels. Therefore, employees who have a job that puts high pressure on them 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 than those younger than them. Thus, it is advised that they buy a critical illness insurance policy in their 30s, if not early. Moreover, they are likely to be in a better financial position and can pay policy premium easily at that age.

List of Critical Illness Insurance Plans in India

Check out the list of all critical illness insurance plans in India:

Critical Illness Insurance Plans	Entry Age	Sum Insured (₹)	Critical Illness Waiting Period	Survival Period
Aditya Birla Activ Secure – Critical Illness Plan	Min: 5 years (18 years for Plan 3) Max: 65 years	1 lakh - 1 crore	90 days, 180 days	15 days
Bajaj Allianz Criti Care Plan	Min: 90 days Max: 65 years	1 lakh - 50 lakh	120 days, 180 days	7 days, 15 days
Care Assure Policy	Min: 18 years Max: 65 years	1 lakh - 3 crore	90 days	-
Cholamandalam Critical Healthline Insurance Plan	Min: 5 years Max: 65 years	1 lakh - 10 lakh	90 days	30 days
Digit Total Protect Plan	Min: 91 days Max: 85 years	5,000 - 3.5 crore	30 days, 60 days, 90 days	30 days
Future Generali Criticare Plan	Min: 6 years Max: 65 years	1 lakh - 50 lakh	90 days	28 days
HDFC ERGO Critical Illness Insurance Plan	Min: 5 years Max: 65 years	1 lakh – 50 lakh	90 days	15 days, 30 days
ICICI Lombard Criti Shield Plus Plan	Min: 91 days Max: 65 years	1 lakh – 1 crore	90 days	No survival period
IFFCO Tokio Critical Illness Benefit Policy	Min: 3 years Max: 65 years	1 lakh – 1 crore	30 days	28 days
Liberty Critical Connect Plan	Min: 5 years Max: 65 years	1 lakh - 1 crore	90 days	30 days
Magma HDI OneHealth Insurance Plan	Min: 91 days Max: No age limit	2 lakh – 3 crore	90 days	30 days
ManipalCigna Lifestyle Protection - Critical Care Plan	Min: 18 years Max: 65 years	1 lakh - 25 crore	90 days	30 days
National Critical Illness Policy	Min: 5 years Max: 65 years	1 lakh - 75 lakh	90 days	30 days, 90 days
New India Assurance Criti Protect Plan	Min: 18 years Max: 65 years	5 lakh – 50 lakh	90 days	No survival period
Niva Bupa Health Assurance Plan	Min: 18 years Max: 65 years	3 Lakh - 3 crore	90 days	30 days
Oriental Critical Illness Plan	Min: 18 years Max: 65 years	2 lakh - 50 lakh	90 days	30 days
Raheja QBE Cancer Insurance Plan	Min: 1 day Max: 70 years	1 lakh - 10 lakh	30 days	-
Reliance Critical Illness Plan	Min: 18 years Max: 65 years	5 lakh, 7 lakh & 10 lakh	90 days	60 days
Royal Sundaram Critical Illness Lumpsum Plan	Min: 91 days Max: 65 years	25,000 - 25 lakh	90 days	30 days
SBI Critical Illness Insurance Policy	Min: 18 years Max: 65 years	2 lakh - 50 Lakh	90 days	28 days
Star Critical Illness Multipay Insurance Plan	Min: 18 years Max: 65 years	5 lakh – 25 lakh	90 days	15 days
Tata AIG Criti Medicare Plan	Min: 18 years Max: 65 years	5 lakh – 2 crore	90 days	7 days, 15 days
United India UNI CritiCare Plan	Min: 21 years Max: 65 years	1 lakh, 3 lakh, 5 lakh & 10 lakh	90 days	30 days
Universal Sompo Critical Illness Insurance Plan	Min: 5 years Max: 65 years	2.5 lakh – 20 lakh	90 days	30 days
Zuno Critical Health Insurance Policy	Min: 18 years Max: 65 years	10,000 – 20 crore	90 days	-
Zurich Kotak Secure Shield Plan	Min: 18 years Max: 65 years	10,000 – 20 crore	90 days	-

See More Plans

*Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. This list of plans listed here comprise of insurance products offered by all the insurance partners of Policybazaar. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in.

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Illnesses Covered by Critical Illness Insurance Plans

Generally, critical illness insurance plans cover the following illnesses:

Cancer up to the 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. Different insurance companies cover various critical illnesses under their critical illness insurance policies.

Exclusions of Critical Illness Insurance Plans

Generally, critical illness plans exclude insurance coverage for the following:

Covered critical illness diagnosed within the waiting period
Death before the survival period is over
Critical illnesses developed due to smoking, tobacco, alcohol or drug intake
Critical illnesses developed due to 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 taken outside India

Who Can Benefit from a 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. Not only do these diseases take a lot of time to treat, but they are also expensive.

Moreover, getting diagnosed with a critical illness can reduce the ability of patients to earn. This is because the patient is often sick and home-bound. The reduced ability to work may lead to not being able to work at all, triggering a financial crisis.

Opting for a critical illness policy can help patients afford the best available treatment without exhausting their funds and offer a replacement for loss of income.

Critical Illness Insurance Plans vs Health Insurance Plans

When Neeraj was diagnosed with a brain tumour, he was completely shattered. His health insurance policy with a sum insured of ₹10 lakh took care of the incurred treatment expenses. However, the revenues of his business started falling down as he was unable to take care of his business due to the severity of his illness. As a result, the financial health of the business deteriorated (along with his health). If only he had a critical illness policy, he would have taken care of his treatment expenses as well as his family's future after the fall of his business.

Many people like Neeraj do not know that a health insurance policy is different from a critical illness insurance policy. To get a better understanding, check out the key differences between a critical illness insurance plan and a health insurance plan:

Parameters	Critical Illness Insurance Plan	Health Insurance Plan
Meaning	It covers life-threatening diseases like tumours, permanent paralysis, cancer, heart attack, etc.	It provides comprehensive health insurance coverage, including hospitalization expenses.
Benefits	Hospitalization is not required to avail policy benefits. Diagnosis is enough to get a lump sum payment.	The insured can get the reimbursement of incurred hospitalization expenses by submitting medical bills. He can also avail cashless facility at network hospitals.
Coverage	It offers coverage for up to 100 critical illnesses. Some plans also provide coverage for second medical opinions under these plans.	It offers extensive coverage, including pre-hospitalization expenses, post-hospitalization expenses, OPD treatments, day care procedures, modern treatments and ambulance charges.
Waiting Period	A waiting period of 90 days applies to most critical illness insurance plans.	An initial waiting period of 30 days applies to all regular health insurance plans.

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

Here are various factors to keep in mind before opting for a critical illness insurance plan:

Sum Insured

The sum insured amount is essential to determine which policy works for you. Treatment for some critical illnesses costs comparatively less than others. Knowing how much coverage you want will help you choose the right plan for your needs. Compare different critical illness insurance plans to find the plan with a sum insured that works for your needs.

Critical Illness Covered

Before buying a critical illness plan, it is essential to check the list of critical illnesses covered. Different plans provide coverage for a different number of critical illnesses. Make sure to opt for a plan that covers most of the common critical ailments for an affordable premium.
Waiting Period

All 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. Although most plans come with a waiting period of 90 days, some plans may ask you to wait for a shorter time. Therefore, insurance experts recommend opting for a critical illness insurance plan with a low waiting period.
Standalone Critical Illness Insurance Policy or Critical Illness Insurance Rider

A standalone policy attracts a higher insurance premium as compared to a rider, offering comprehensive coverage. The scope of coverage offered by a standalone critical illness insurance plan is higher as compared to a rider. Although a rider may provide coverage for the same set of critical illnesses, the sum insured will be way less. This is because the rider is dependent on the base policy. For instance, if a mediclaim policy is for ₹2 lakh, then the critical illness rider will provide insurance coverage for ₹2 lakh only.

To enjoy comprehensive insurance coverage, insurance experts recommend opting for a standalone critical illness plan.
Survival Period

Most critical illness insurance plans come with a survival period of up to 30 days. It is a period that the insured needs to survive to get a claim from the insurance company. If the insured dies during the survival period, then no claim amount is paid by the insurer.
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. It indicates the limit to which the insurer will cover a critical illness. Sub-limits are applicable to the total sum insured under a critical illness plan.

For instance, a critical illness insurance policy may cover Illness 1 for up to 100% of the sum insured and Illness 2 for up to 50% of the sum insured or ₹10 lakh. Thus, if you are diagnosed with Illness 2, you will have to pay for any expenses incurred above ₹10 lakh from your own pockets.
Inclusions and Exclusions

Before purchasing a critical illness insurance policy, you should check the exact inclusions and exclusions in the policy document. It will help you get a better understanding of the plan, as coverage may vary from plan to plan.

For instance, a critical illness insurance policy focusing more on cardiovascular diseases may have cataract surgery as an exclusion. Moreover, if you are looking for a specific set of illnesses to get insured against, make sure you check the details beforehand.
Premiums

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. Therefore, buying a critical illness plan at an early age is recommended to keep your premiums low.
Age Limit

Most critical illness insurance policies provide coverage to people between the ages of 18 and 65 years. However, some plans may provide coverage to children as well as senior citizens above 65 years. Therefore, you must check the exact entry age to know if you are eligible to buy the plan.

How to File a Claim for a Critical Illness Policy?

Follow the steps given below to file a critical illness insurance claim:

Step 1: Contact your insurance company as soon as you are diagnosed with a critical illness and register your claim.

Step 2: Submit the following documents to get your claim approved:

Duly filled claim form
Photocopy of ID card
Medical certificate obtained from a doctor confirming the diagnosis of critical illness
Detailed discharge summary
Any other document requested by the insurer

Step 3: After receiving the documents, the claims team of the insurer will verify the details.

Step 4: Based on the verification, your claim will be approved or disapproved. Whatever the case may be, you will be intimated of it.

Step 5: Once your claim is approved, the insurer will transfer the claim amount to you.

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

How Can Policybazaar Help You?

Treatment for a critical illness can wipe out your savings in a single go. Instead, you can opt for a critical illness plan and secure your financial future. You can compare and find your ideal critical illness insurance plan in a matter of a few clicks at Policybazaar.com.

We at Policybazaar can help you evaluate different critical illness insurance policies according to your needs. We can help you find the plan that offers a wide range of insurance benefits at an affordable premium. Our trained customer care executives will guide you so that you can get the right protection in your time of need.

At PolicyBazaar, you can avail the following benefits:

Get free quotes from leading health insurers
Buy critical illness plans at the lowest premium
Instant issuance of critical illness policy online

Q1. What is critical illness insurance?

Ans: Critical Illness Insurance cover comes as a rider as well as a standalone plan. It provides the insured with a lump sum amount in case they get diagnosed with critical illnesses, such as cancer, multiple sclerosis, heart attack, paralysis, kidney failure, etc. The insured has to bear 90 days waiting period before the first diagnosis can be claimed.
Q2. What does critical illness insurance cover?

Ans: A critical illness policy provides coverage for listed critical illnesses, including stroke, cancer, permanent paralysis, heart attack, kidney failure, etc. It pays a lump sum amount on the first diagnosis of a listed critical disease.
Q3: Why do we need a critical illness insurance cover?

Ans: More often than not, critical illness is considered an exclusion in a standard health insurance policy. Most standard plans cover critical illness to the extent of hospitalization expenses only. It does not cover medical expenses without hospitalization and is not enough for income replacement. Getting a critical illness insurance plan is imperative to ensure comprehensive medical coverage and your financial security.
Q4: What are the key features of critical illness insurance?

Ans: Critical illness insurance covers major illnesses, which are usually excluded from a standard health insurance policy. It provides a lump sum amount to the insured upon the diagnosis of the covered illness. While the plan has a waiting period of 90 days, it also comes with a survival period of up to 30 days under most plans. Moreover, for most critical illness insurance plans, no medical check-up is required up to 45 years of age. Also, just like regular health plans, critical illness plans provide tax benefits on the paid premium.
Q5: How much critical illness cover do I need?

Ans: Your age, lifestyle pattern, city of residence, and annual income are vital parameters that help to determine the appropriate coverage amount for your critical illness insurance plans.
Q6: Which documents are required to buy critical illness insurance?

Ans: Generally, no documents are required to buy a critical illness plan. However, some insurers may ask for your age proof, address proof and identity proof at the time of policy purchase. Additionally, specific documents may be required in case you need to undergo some medical tests.
Q7: Can I get critical illness cover after cancer?

Ans: Most insurers provide critical illness insurance to people prior to the diagnosis of a major illness. However, there are some plans that may offer coverage after your cancer diagnosis. It is best to check with the insurance company to know if the coverage is available or not.
Q8. Where can I check the cost of a critical illness insurance plan?

Ans: You can use a critical illness insurance premium calculator to determine the estimated price of buying a plan.
Q9. Is it worth getting critical illness cover?

Ans: Yes. Buying a critical illness insurance policy is totally worth it as it not only covers the treatment cost of a critical illness but also provides a replacement of income in case the insured ends up losing the job.
Q10. Where can I find the covered critical illness list for my plan?

Ans: You can go through the policy documents issued by your insurer to check the list of critical illnesses covered by your health insurance plan.

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Disclaimer: The list mentioned is according to the alphabetical order of the insurance companies. Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by any insurer. For complete list of insurers in India refer to the Insurance Regulatory and Development Authority of India website www.irdai.gov.in

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