Critical Illness 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:

• 

  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.

• 

  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.

• 

  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.

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.

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

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

• 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.

• 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.

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.

• 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.

• 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.

• 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.

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.

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.