Which Critical Illness is Covered Under the Critical Illness Policy?

Features of Critical Illness Insurance Plans

From the name itself, it is understood that critical illness insurance is unique. Most Critical Illness Insurance Plans in India are fixed benefit health insurance plans which pay out a defined sum insured amount on diagnosis of any of the listed critical ailments.

Some of the unique features of critical illness insurance include:

• Comprehensive coverage: This sort of health plan allows comprehensive detection of any of the critical ailments listed by the chosen insurance provider.
• Lumpsum payout: Critical Illness cover allows for lumpsum payout once the beneficiary is diagnosed with any of the listed critical ailments as this is a fixed benefit plan.
• No necessity of medical bills: You need not have to produce any medical bills to ensure claim settlement. Presenting the document that confirms the presence of any of the listed critical illnesses is enough for claim settlement.
• Waiting period: Most critical illness plans come with a standard waiting period of 90 days. This also ensures that PEDs aren't covered immediately, allowing you to buy the cover while being healthy.
• Survival period: To ensure the prevention of fraudulent claims, the beneficiary needs to stay alive for a specified period post-diagnosis of the critical illness. This period may vary from one insurer to another and according to the nature of the ailment.
• Premiums and renewability: Critical illness covers are easily renewable, ensuring coverage until advanced age. Depending on the plan, the premium may either remain fixed or increase with age.
• Riders: To expand the coverage span, rider options are also available with critical illness policies.

Benefits of critical illness insurance

Critical illness insurance comes with certain unique benefits, some of which may differ from standard health plans. Some of these benefits include:
• Finance management: These health plans have been uniquely designed to ensure effective and efficient finance management during medical contingencies during severe ailments like cancer, kidney failure, stroke, heart attack, etc.
• Instant financial assistance: Unlike standard health plans, critical care health plans offer lumpsum financial support immediately on the detection of any of the listed critical ailments.
• Backup with regular cover: You must note that critical health plans are not absolute. You must maintain it as an additional backup along with a standard health plan to ensure optimum coverage.
• Flexibility: On the detection of any critical illness comes a host of several types of expenses apart from the treatment costs. The lumpsum payout available from critical illness insurance can be utilised in any manner considering the current financial scenario. There is no rule that you have to spend it for treatment purposes only.
• Unlimited healthcare choices: With a critical illness care plan, you can enjoy unlimited healthcare options at standard hospitals and other competent medical facilities considering your unique requirements.
• Relief from financial stress: Having a critical illness plan significantly relieves you from tremendous financial pressure that inevitably arises in the detection of any serious health issue.

Ailments covered under critical illness policy

The types of critical illnesses covered by a critical illness plan may vary from one insurer to another. However, there are certain standard inclusions. Some of the common critical health issues that are usually covered by critical illness insurance include:

HEALTH ISSUE	COVERAGE DETAILS
Cancer	Allows coverage for several cancer variants, including offering assistance for expensive treatment methods, including surgery.
Heart attack	Offers financial support for treatment and recovery during any incident of heart attack of the beneficiary.
Stroke	Allows medical bill coverage, rehabilitation expenses, and lifestyle adjustment costs after stroke.
Renal or kidney failure	A single-time lump sum payout is offered to cover transplantation, dialysis, and other follow-up costs in the case of kidney failure.
Organ transplant	Effectively eases the tremendous financial burden that comes with major transplantation costs like kidney, heart, liver, lungs, etc.
Multiple sclerosis	Allows financial support for the treatment and recovery of multiple sclerosis.
Paralysis	Lumpsum payout for treatment, therapies, and lifestyle changes necessary after paralysis.
Major organ failure	Covers treatment costs for major organ failures like liver or kidney.
Coma	Allows medical treatment cost coverage if the concerned beneficiary gets affected by a coma.
Coronary artery bypass surgery	Allows medical cost coverage for this severe heart issue.

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Exclusions in critical health plans

No health plan offers 100% coverage under any circumstances, and critical health plans are also no exception. Although the pattern and type of exclusions may vary from one plan and insurer to another. However, some standard exclusions include:
• Any associated health issue arising within the waiting period, which usually spans 90 days.
• Any fatality of the beneficiary occurring within the survival period.
• No coverage for critical ailments caused due to overuse of drugs, alcohol, or smoking.
• No coverage for congenital critical ailments.
• Any complications arising due to pregnancy and childbirth are also not covered.
• Issues like AIDS or HIV get no coverage.
• Any critical health issue arising due to direct or indirect involvement in activities like terrorism or war.
• No coverage for cosmetic treatments or dental care.
• Infertility treatments or other reproduction-assisting treatments get no critical illness insurance coverage.
• Any sort of hormone treatment is also excluded.
• If you avail of any treatment outside the geographical boundaries of India, you can not enjoy critical illness plan coverage,
• provided your chosen critical illness plan offers no such option.

Conclusion

From the above discussion, it is clear that critical illness insurance offers several benefits, provided you are affected by any of the critical health issues listed by your insurer. You must carefully read the policy papers to know and understand all the related terms and conditions, rules and regulations of your chosen plan before purchasing to avoid any misunderstanding during claim settlement.