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Critical Illness Health Insurance

Critical illness policy is designed to provide comprehensive coverage for life-threatening health conditions like cancer. It can be taken additional to your regular health insurance policy to seek financial protection in case of an unexpected, serious, and extended illness.

With medical inflation on the rise, having a critical illness insurance policy is necessary to safeguard against inflated hospitalisation charges. While taking care of your finances during health emergencies, the policy also offers tax benefits.

Bajaj Finance offers a comprehensive and cost-effective critical illness insurance plan that can be very helpful in case of an unlikely health emergency.

Key Features and Benefits

Here are the key features and benefits offered under critical illness insurance:

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    High coverage amount

    Critical illness policies offer coverage up to Rs. 50 lakh to help you to seek quality treatment. However, the coverage amount will depend on the policy you choose.

  • Comprehensive usage

    Use the policy cover for extensive medical treatment, expert medical advice, or to pay for the medicines.

  • lap documents required

    Covers major illnesses

    Critical illness health insurance mainly covers up to 50 major critical illnesses. Some of these are coronary artery bypass surgery, stroke, kidney failure, major organ transplant, etc.

  • Tax rebate

    The premium paid for this insurance is tax-deductible under Section 80D of the Income Tax Act, 1961. If a policyholder is below 60 years old, he/she can save up to Rs. 25,000 in taxes. Senior citizens over the age of 60 years can save up to Rs. 50,000 in taxes.

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    Hassle-Free Claim

    Settle your claims in a hassle-free manner without involving any third party.

  • Tailor-made policy

    This policy covers expenses which are not usually covered under regular health insurance policy.

What is Critical Illness Policy

A critical illness insurance policy offers coverage against life-threatening critical diseases like renal failure, heart attack, cancer, organ transplants, etc. Such policies offer one-time lump-sum coverage against the exorbitant cost associated with treating these diseases.

Since medical treatment costs are rising with each passing year, access to a comprehensive insurance policy is vital to meet medical and non-medical expenses.

Tax benefits under a Critical Illness Insurance Policy

A notable advantage of a critical illness policy is the availability of income tax benefits. Under the norms of the Income Tax Act, 1961, you can claim an income tax deduction as per prevailing tax laws of Section 80D ( for individuals below the age of 60 can avail the benefit up to Rs. 25,000 on insurance premium paid for self, spouse, and children.). Additionally, senior citizens can claim a deduction of up to Rs. 50,000 as income tax deductions for individuals more than the age of 60 years.

*Tax benefit is subject to changes in tax laws

How to select an ideal Critical Illness Insurance Plan

Parameters Details
Sum Insured Minimum Coverage up to Rs. 50 lakh or above
Waiting Period Minimum of 30 days from policy start date or a maximum of 2 years
Survival Period As specified in the policy documents
Number of Diseases Covered Up to 50 or more notable critical illness depending on the policy
Age of Renewability Usually, the maximum age or lifetime renewability

Critical Illness Insurance Plan vs. Health Insurance Plan

Here are the notable differences between critical illness cover and health insurance plan –
Parameters Critical illness insurance plan Health insurance plan
Meaning It offers coverage against life-threatening diseases. It offers comprehensive health insurance coverage that includes hospitalisation expenses.
Benefits Hospitalisation is not imperative to receive policy coverage, diagnosis is enough. The policy coverage is only available after submitting hospitalisation bills. One can also get cashless benefits at network hospitals.
Coverage It provides coverage against up to 50 diseases. It offers comprehensive coverage, including pre and post hospitalisation expenses.
Waiting period The waiting period depends on the severity of an illness. It comes with a standard waiting period of 30 days.

Comparison of Critical Illness Insurance Policies

Following is a table of comparison between different critical illness plans –

Insurance plan Age Sum Insured Policy term
ManipalCigna ProHealth Insurance Policy - (Super Top Up Scheme) 18 – 56 + years Rs. 15 lakh, Rs. 21 and Rs. 30 lakh 1 year
Niva Bupa Health Companion 18 - 60 years Rs. 5 lakh 1 year
ManipalCigna Super Top Up 18 - 91 years Rs. 3 lakh to 30 lakh 1/2/3 years

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

Who should buy a Critical Illness insurance policy

Broadly, anyone can buy a critical illness plan as any critical illness can knock on your door anytime without warnings. Nonetheless, here are those who can benefit the most from this insurance policy –
  • With a history of critical illness in the family
    Several critical illnesses are hereditary, and those in scenarios like this should look for an insurance plan of this kind. Hence, one is at a higher risk of developing this illness if it runs in their family.
  • Primary earner
    Individuals who are the primary breadwinners of their families should look for this insurance plan to mitigate the financial implications of a critical illness. The coverage offered by such insurance policies can safeguard the financial interest of their family.
  • Individuals over the age of 40
    Individuals over the age of 40 are more susceptible to developing such illnesses than others. They can opt for a critical illness policy to protect their financial interests. Also, they will be in a better position financially to manage this additional expense.
  • Those involved in a highly competitive job environment
    Individuals involved in high-pressure jobs can look for such critical illness covers. Stress and erratic routines can lead to carelessness towards health. Studies also indicate that individuals in fast-paced, high-pressure work environments must opt for such insurance plans.

Things to keep in mind while opting for a Critical Insurance Policy

Following are some pointers that one must keep in mind before applying for critical illness plans –
  • Sum assured
    One must keep an eye on the sum assured while looking at various policies. Since every critical illness has a different cost structure, it is imperative to check the coverage amount before applying.
  • Sub-limits
    Sub-limits of critical illness insurance can impact the total cost of a policy. This limit applies to the total sum assured as well. For instance, a critical insurance plan comes with a sum assured of Rs. 5 lakh. Also, it has sub-limits of Rs. 2 lakh for tests, and your final bill is Rs. 3 lakh for tests. In that case, you need to pay Rs.1 lakh from your pocket.
  • Inclusions and exclusions
    One must check the inclusions and exclusions of a critical illness insurance policy beforehand. Some policies might not cover the illnesses you consider as critical under critical diseases. It will help applicants understand the scope of their expenses that can be covered and those which are not.
  • Maximum renewal age
    The age to renew such insurance policies varies from one provider to another. Some insurance companies offer coverage up to 60 years of age, whereas others can be renewed the whole lifetime. Thus, it is essential to check this pointer.
  • Waiting period
    Typically, insurance policies like these come with a waiting period. It means policyholders can only receive these benefits after a stipulated time.
  • Claim settlement ratio
    Last but not least, checking the claim settlement ratio is another important point here. It can provide an overview of the efficiency of a particular policy provider.

How to file a claim for Critical Illness Policy?

Cashless claim
Cashless treatment is only available at a network hospital registered with Bajaj Allianz. To avail of the cashless treatment, the following procedure must be followed:  

  • Approach the network hospital with your policy details.

  • The hospital will verify your details and send a pre-authorization form to the insurer.

  • The insurer will verify the pre-authorization request and convey the policy coverage and other details to the hospital.

Planned hospitalisation

  • Insured members should intimate about admission at least 72 hours before.
  • Emergency hospitalisation - Insured member or his representative should intimate such admission within 24 hours.
  • The insurer will send you or the network hospital a pre-authorisation letter. The pre-authorisation letter, ID card issued to you along with this policy and any other information or documentation that the insurer has specified must be produced to the network hospital identified in the pre-authorisation letter at the time of your admission to the same.
  • If the procedure above is followed, you will not be required to directly pay for the medical expenses above the aggregate deductible in the network hospital.
  • Original bills and evidence of treatment in respect of the same shall be left with the network hospital.

Reimbursement claim
If the insurer denies pre-authorisation under the cashless claim procedure mentioned above in a critical illness insurance policy. Or if the treatment taken is in a hospital other than a network hospital or if you do not wish to avail of the cashless facility, then the following procedure must be followed:

  • You or someone claiming on your behalf must inform the insurer in writing immediately within 48 hours of hospitalization and gather all the documents from the hospital as well.

  • In the event of the insured person’s death, someone claiming on his behalf must inform the insurer(in writing) immediately and send a copy of the post mortem report (if any) within 30 days.

  • The insurer shall not indemnify you for any period of hospitalisation of fewer than 24 hours, except for daycare procedures.

  • The insurer can make claim payment in Indian rupees only.

Inclusions of Critical Illness Insurance Policy

Here are the standard inclusions under critical illness policy:
  • Critical illness health insurance mainly covers max upto 50 major critical illnesses. Some of these are coronary artery bypass surgery, stroke, kidney failure, major organ transplant, etc.
  • The critical illness cover amount varies depending upon the insurance provider.
  • You can benefit from critical illness insurance within 30 days of diagnosis or as mentioned in the terms and conditions of the critical illness insurance policy.
  • The insured gets the lump-sum amount as mentioned in the critical illness policy.
  • The critical illness insurance policy also covers annual health check-ups.

Exclusions of Critical Illness Insurance Policy

Here are the standard inclusions under critical illness policy:
  • No compensation if a person dies within 30 days of diagnosis of critical illness or surgery.
  • Any critical illness developed due to smoking, tobacco, alcohol, or drug intake is not included in a critical illness insurance policy.
  • The critical illness developed due to internal or external congenital disorder is not included in critical illness insurance.
  • Pregnancy or childbirth-related critical conditions are not covered under critical illness insurance.
  • Adventure sports injuries, self-harm, and war injuries are not included in the critical illness policy.

Importance of Critical Illness Insurance in India

Here’s why critical illness insurance is important in India:

Enhanced coverage

The extensive coverage offered by critical illness insurance is one of the reasons why it is so important. It encompasses a wide variety of serious illnesses with varying degrees of severity. In addition, the sum insured under this policy can help you to manage the healthcare expenses other than the hospital bills.

Benefits of lump-sum

Critical illness insurance provides a lump-sum payment, which increases its value in managing healthcare costs. The lump-sum payment is made regardless of the hospitalization bills. This money can be used for post-hospitalization medication, transportation, lodging, at-home therapy, and other costs.

Access to quality healthcare

Critical illness insurance plans are crucial in the fight against critical illnesses. Due to lack of funding, many people suffering from a serious illness are unable to receive care. The policy enables access to quality healthcare. Hence, patients can get the correct treatment with critical illness insurance coverage, increasing their chances of survival.

Why there is a need to buy a Critical Illness Insurance Plan

While your primary health insurance will take care of the routine illness and standard hospital procedures, the critical illness plan will cover any unforeseen critical illness or medical complications. Here are a few reasons for the need for a critical illness insurance plan.

  • Added coverage for expensive treatments
  • Additional financial security
  • Stress-free hospitalisation
  • Savings are not disturbed
  • Substantial coverage at low premiums
  • Provide benefits not covered in the primary health insurance plan.

Frequently Asked Questions (FAQs) for Critical Illness Insurance

1. What is critical illness insurance?

A critical illness policy is a type of health insurance plan that covers your medical expenses if any critical illness mentioned in the policy is detected. It acts as an add-on policy to the regular Health Insurance.

2. Why is a critical illness cover necessary?

If you or your family member are diagnosed with a severe illness, critical illness cover offers you financial security. The coverage includes a lump-sum payment that can be utilized for treatment and healthcare costs, recuperation aids, etc. Therefore, a critical illness insurance policy is necessary as an add-on to your primary Health Insurance to provide additional and extensive coverage.

3. Is it worth getting critical illness insurance?

Not only your health but even your finances suffer grievously during a critical illness. It can put you in a financial crisis. Therefore, it is crucial to invest in a good critical illness insurance policy. It covers diseases that may or may not be covered under other health insurances and the most worthwhile point is that the insured has full liberty to decide how to use critical illness cover.

4. Do I need critical illness insurance if I have health insurance?

Yes, critical illness insurance can be beneficial in covering the medical expenses incurred for the treatment of major diseases like cancer, heart diseases, among others. It covers the additional costs incurred for any critical illness treatment, which may or may not be included in your regular health insurance policy.

5. What illnesses are covered under critical illness insurance?

Here’s the list of some of the critical illnesses that are commonly covered under the policy:

· Cancer
· Heart attack
· 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 (ALS)
· Multiple sclerosis
· Aplastic anaemia
· Bacterial meningitis
· Loss of speech
· End-stage liver disease
· Deafness
· Major burns
· Muscular dystrophy

6. Are there any eligibility criteria for purchasing this policy?

People between the age group of 5 years to 65 years can apply for a critical illness insurance policy. A pre-policy medical check-up is required for individuals after the age of 45 years.

7. Does critical illness cover pay off your mortgage?

Yes, a critical illness can pay off your health mortgage if the policy coverage includes this facility.

8. How long does it take to get a critical illness pay-out?

Typically, critical illness health insurance providers complete the pay-out within 30 days of filing a claim. However, this timeline can vary from one insurance provider to the other.

9. How much does critical illness insurance pay-out?

The pay-out amount or percentage of a critical illness insurance plan will alter as per each policy.

10. How much critical illness coverage should I get

Their is no exact amount for the coverage you should avail. Various factors like lifestyle, age, city of residence, income, etc., are considered.

11. What illnesses are covered by critical illness cover?

A critical illness insurance policy provides financial coverage against acute diseases such as organ transplants, heart attack, renal failure, cancer, etc. This policy extends lumpsum coverage against substantial costs associated while treating these illnesses, and the policy is over and above the basic health insurance plan.
A critical illness policy could cover diseases like:

  • Cancer
  • Total blindness
  • Kidney failure
  • Heart valve surgery
  • Coronary artery surgery (Bypass surgery)
  • Stroke
  • Heart attack (Myocardial Infarction)
  • Major organ transplantation
  • Aorta graft surgery
  • Multiple sclerosis
  • Coma
  • Paralysis
*Each critical illness policy covers a different set of illnesses. The ones stated above are some of the common inclusions. It is advisable to carefully go through the policy wordings to determine which ones are included in your policy.

12. What is not covered by critical illness insurance?

In the critical illness policy, any illnesses developed due to smoking, drug intake, alcohol, tobacco etc., will not be included. Besides, the policy does not include illnesses due to external or internal congenital disorders. Moreover, this policy does not cover pregnancy and child-birth-associated critical conditions.
In the critical health insurance policy, self-harm, adventure sports or war injuries are not included. Also, there will be no compensation if a person dies within 30 days of treatment.

13. What are the 36 critical illnesses?

Here is the list of 36 most common critical illnesses/health conditions usually covered under critical illness plans:
1. Kidney failure
2. Cancer
3. Heart attack
4. Stroke
5. Multiple sclerosis
6. Parkinson’s disease
7. Terminal illness
8. Coma
9. Encephalitis
10. Full-blown AIDS
11. Chronic lung disease
12. Poliomyelitis
13. Motor-neuron disease
14. Muscle dystrophy
15. Benign brain tumour
16. Chronic liver disease
17. Alzheimer’s disease
18. Aorta surgery with the help of laparotomy or thoracotomy
19. A major head trauma
20. Apallic syndrome
21. Bacterial meningitis
22. Permanent loss of speech
23. Paraplegia
24. Craniotomy or brain surgery
25. If the victim has contracted AIDS due to the blood transfusion when receiving infected blood
26. Chronic persistent bone marrow failure which leads to anaemia
27. Third-degree burns or major burns on the body covering at least 20% surface of the body
28. Permanent or total deafness
29. Major transplantation of an organ such as heart, kidney, lungs, liver or bone marrow
30. Heart valve replacement because of abnormalities or defects in the body
31. Permanent or total blindness
32. AIDS contracted by medical staff, where it is caused due to an injury or an exposure to the contaminated blood
33. Fulminant viral hepatitis is massive necrosis of the liver caused by a virus that may lead to a liver failure
34. Various other serious coronary heart diseases are caused due to the narrowing of the lumen of the three major arteries - the Circumflex, RCA, LAD
35. Primary pulmonary arterial hypertension
36. Medullary cystic disease

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