Critical Illness Insurance Policy

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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.

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  Comprehensive usage

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

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  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.

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  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, they 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.

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  Tailor-made policy

  This policy covers expenses which are not usually covered under a 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 a one-time lumpsum 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 Income Tax Act, 1961, you can claim an income tax deduction per prevailing tax laws of Section 80D (individuals below the age of 60 can avail of 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

Many people mistakenly believe that critical illness policy and health insurance are identical. Both plans provide financial coverage per the specific requirements of the policyholder. In actuality, the coverage and benefits these plans provide are unique and cannot be interchanged. Furthermore, it is inaccurate to assume that getting any one of these two insurances is enough.

Health insurance cover is imperative to address medical contingencies. Critical illness insurance extensively covers a specified list of illnesses that are often life-threatening and not covered by regular health insurance. Investing in comprehensive health insurance supplemented with a critical illness policy is advisable to maximise financial security and ensure complete coverage.

When investing your hard-earned money to safeguard your future well-being and peace of mind, it is vital to have complete clarity. This is only possible through informed decision-making. The table below outlines some key differences between a critical illness policy and health insurance.

Recently, life-threatening illnesses like cancer, heart disease, stroke, kidney failure, etc. have increased. Also, many people require critical procedures like coronary artery bypass surgery, heart valve surgery, etc. Often, basic health insurance coverage proves inadequate as they don't cover these critical illnesses or procedures. Supplementing your health insurance plan with a critical illness cover to secure your finances and your and your family's health thus becomes essential.

Critical illness cover, purchased on its own or as a rider to your health insurance, safeguards policyholders from specific illnesses otherwise excluded under comprehensive health insurance plans.

When choosing the best critical illness cover, make an informed decision by comparing the various features of available plans and picking the one that best suits your needs. Also ensure you consider important factors such as income, age, and personal liabilities when choosing.

The table below compares different critical illness plans to provide a basic overview.

• With a history of critical illness in the family

  
  Several critical illnesses are hereditary, and one is at a higher risk of developing such illnesses if it runs in the family. Individuals in such situations should look for an insurance plan of this kind.

• 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 recommend that individuals in fast-paced, high-pressure work environments should 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, checking the coverage amount before applying is imperative.

• 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 throughout one’s lifetime. Thus, it is essential to check this point.

• 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.

• Choose between standalone critical illness insurance or critical illness health insurance rider.

  
  Each has its advantages and disadvantages. While a rider attracts a lower premium, a standalone policy offers a greater scope of coverage and sum assured.

• Select the policy term and sum assured.

  
  Treatment costs for critical illnesses vary greatly. Knowing how much coverage you want is essential to choosing a plan that suits your needs. Use an online insurance calculator to ascertain the premium payable for the desired policy term and sum assured of an insurance product of your choosing.

• Pay the premium.

  
  After selecting your plan, provide the necessary personal information and pay the premium

• Fill in the proposal form.

  
  The proposal form for critical illness insurance requires information about your lifestyle habits (such as drinking and smoking) and medical history, among others. 

• Medical tests.

  
  The insurer may request a medical test before offering you critical illness health insurance coverage once you successfully complete the proposal form and submit the required documents.

Here are the complete process for the Claim Process for Critical Illness Insurance 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-authorisation form to the insurer.


• The insurer will verify the pre-authorisation 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.
• In the case of emergency hospitalisation, the insured member or his representative should intimate such admission within 24 hours./li>
• 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

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


• In the event of the insured person’s death, someone claiming on their 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 day-care procedures.


• The insurer can make claim payments 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.

• There is 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.

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 manage the healthcare expenses other than the hospital bills.

Benefits of lumpsum

Critical illness insurance provides a lumpsum payment, which increases its value in managing healthcare costs. The lumpsum payment is made regardless of the hospitalisation bills. This money can be used for post-hospitalisation 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 a lack of funding, many people suffering from a serious illnesses cannot 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.

• 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.