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You might debate that as you are covered in a comprehensive health insurance plan and also under group medical policy offered by your employer, you do not require any additional coverage. Well, yes, but any critical illness calls for specialized treatment & care and as your comprehensive health plan has limitations on hospitalization, doctors' fees, etc. it will not cover the entire medical expense towards treatment.
In simpler terms, there is a limit on certain expenses like prosthetic, intensive care or even medicines and your spending on such ailments is always more than what your health insurer will pay. In such cases, you'll have no option but you'll end up paying from your own pocket.
Examples of Critical Illnesses:
Note: You can claim only once on your Critical Illness insurance policy and then it stands terminated.
Any major sickness or illness can have a debilitating effect on the patient’s life. It leads to huge medical treatment costs and the same time leaves the family members shattered both emotionally as well as financially. At such circumstances, a Critical Illness Insurance comes as a real saviour, guaranteeing financial protection whenever there is shortage of funds for getting the patient treated. Here, the insurance company offers an amount in lump sum in case the insured gets diagnosed with any of the critical illnesses mentioned in the policy document. Covering the medical costs of the patient as well as the day-to-day expenses of the family members would be taken care by the Critical Illness Insurance Plan.
Critical Illness Insurance Plans from Top Insurers
Bharti AXA Smart Health Critical illness plan offers coverage to an individual post first diagnosis of critical illness. Mentioned below are the features, benefits and coverages of this critical illness cover: Plan Variants:
Bharti AXA SmartHealth Critical Illness Insurance Policy offers two variants. They are
Features and Benefits:
Offers daily cash benefit for claims under Section I of the policy. With this benefit the insured is eligible for daily cash as follows:
Dreaded disease recuperation cover- In case you are diagnosed with any critical illness that is listed under this policy (list mentioned below), a daily cash of INR 500 per day up to a maximum of 45 days would be provided. Hospital Daily cash allowance- This insurance plan offers hospital daily cash allowance benefit that enables you with an allowance of INR 750 per day for a maximum of 30 days, in case the hospitalization exceeds 3 days.
Survival period: 30 daysWaiting Period:
Critical illness insurance cover offered under Religare Care Insurance Policy along with an array of benefits ismentioned below. Let’s have a look at them: Features & Benefits
Religare Care Plan does not offer any treatments due to the below mentioned conditions:
Apollo Health Insurance offers you a critical illness cover names Apollo Optima Vital Health Insurance with a higher coverage and at a lower premium. Let’s have a look at the features and the scope of cover that this plan offers: Features & Benefits:
The plan offers coverage for 37 Critical Illnesses. The amount in lump sum is paid if the insured gets diagnosed with the illness of defined severity or during the time of undergoing surgery for the covered Illness. Mentioned below is the list of illnesses that are covered as follows:
Max Bupa CRITICARE is a Critical Illness insurance cover offers a host of benefits. Let’s have a look at them:
Benefit Option 1: Sum insured payable as lump sum Benefit Option 2: Sum insured payable as lump sum plus additional 10% of the sum insured payable each year for subsequent 5 years. Features and Benefits:
The below mentioned illnesses are covered by Max Bupa Critical Illness:
Silver and Platinum Features & Benefits:
The List of Ailment Covered Under Critical Illness Plan Are:
Silver - Entry Age - 5 to 65 years.
Sum Insured Options – Rs. 5 Lakh, Rs. 7.5 Lakh and Rs. 10 Lakh
Platinum - Entry Age - 5 to 65 years.
Sum Insured Options – Rs. 2.5 Lakh, Rs. 5 Lakh, Rs. 7.5 Lakh and Rs. 10 LakhGold - NA (this plan is discontinued and there is no information available on the eligibility criteria).
A waiting period of 90 days will apply to all claims unless the Insured Person has been insured under this policy continuously and without any break in the previous Policy Year.
Mentioned below are the factors that you need to keep in mind to select the best critical illness insurance:
Coverage: It makes sense to opt for a product that provides maximum coverage. Here, it is important that you figure out the number of critical illnesses that are covered under the plan. The more coverage for illnesses, the better the insurance policy.
Total Ailments Covered: One of the first few things you need to consider before freezing on any Critical Illness insurance is to check the total critical ailments covered by the policy. While some plans like HDFC Ergo Critical Illness Insurance covers 8 critical ailments, Religare Assure plan covers as many as 20 major illnesses. Hence, it’s imperative to properly research the plans before finalizing on one.
Built-in Coverage: While the critical Illness plan is aimed to provide financial armor against the detection of any major life threatening disease, some insurance companies offer several built in coverages. Personal Accident Cover, Child Education Benefit, Hospital Cash, Complementary Health Checkup, etc. are some of them so that your loved ones are least affected in situations you are incapable of supporting them financially, as the illness strikes.
Pre-existing Disease: While some plans will cover any pre-existing diseases after a waiting period of 48 months, plans like Religare Assure does not cover them at all. Hence, one need to do a careful assessment on what’s covered in pre-existing clause.
Free-look: Mostly, all insurance companies offer a free-look period of 15 days to review your decision. During this period, if you find the plan unsuitable to your needs, you can request for cancellation and subsequent refund.
Tax Benefit: As per the prevailing rates of the Income Tax Act, 1961 (u/s 80D), you can avail the tax benefit on the premium you pay towards the premium.
Survival & Waiting Period: Usually critical illness policies have a survival clause of 30 days from the date of diagnosis for the person who is insured. A waiting period of 90 days too should be adhered from the beginning of the insurance policy. Also, there is a waiting period for the pre-existing diseases which is around 3 to 4 years. Opt for the critical illness cover that has a limited waiting and survival period.
Sum Assured: Opt for a critical illness cover that offers a cover of that sum assured you wish to opt for in case of an emergency.
Incurred Claim Ratio: Insurer’s keeping up their promises to settle your claim on-time and hassle-free is what you should be looking for. Incurred Claim Ratio is what you should look out for while opting for a good critical illness health insurance.
The above chart demonstrates an alarming growth in cost of treatments over years. With this upsurge, it is practical to choose a sum insured basis a systematic research involving the cost of treatments, ensuing recuperative aids, potential financial liabilities in case of income loss, etc. Most insurance companies offer vast range of sum insured ranging from Rs.5 Lac to as high as Rs.1 Crore.
Million Dollar Question: Standalone or as a part of health plan? You are blessed with a choice there. You can either opt for a standalone policy or can combine it to form a part of your base health plan. There are no major changes in the policy terms and conditions in both the options. The choice between a standalone policy or as an add-on feature purely depends on your individual needs.
By and large, a standalone policy provides more flexibility in the sum insured and extensive cover in comparison to an add-on. The cap on sum insured for an add-on is mostly the same as the base plan. Hence, if you have invested in a health plan of Rs.3 lakh and opt for a critical illness add-on with it, it is very unlikely that the insurance company will offer you a sum insured in excess of Rs.3 lakh for the add-on cover.
Every insurance policy has its own terms and conditions and similarly, Critical Illness Insurance Plan comes with its own restraints. Some of the conditions mentioned below are not covered under the plan:
For details on what's excluded in the coverage of critical Illness Plan, kindly refer to the policy wordings.
|Critical Illness Insurance||Cancer Insurance|
|Critical illness insurance provides lump sum benefit post diagnosis of a terminal illness. The lump sum amount can be used for treatment or recuperation expenses||It covers all expenses related to cancer. The benefit amount can be utilised to pay for your medical expenses or as a replacement of your monthly income|
|Covers a specific list of critical illness as mentioned in the policy document||Provides comprehensive coverage against all stages of cancer (pre-stage, early stage and major stage)|
|This plan is ideal for policyholders who have a higher probability of contracting a critical illness and can identify the risk associated with such illnesses||This plan is ideal for policyholders who understand the risk associated with cancer|
|Can be added as a rider to the base health plan||Can be added as a rider to the base health plan|
|Available for long term (20 years)||Available for long term (20 years)|
The Below Documents Would Be Required For Applying For A Critical Illness insurance Plan:
To Initiate The Claim, The Insured Should Offer The Below Documents For The Initial Assessment Of The Claim:
Who Should Buy Critical Illness Policy?
Given the rising cost of medical treatment and inflation, it is advisable to purchase a comprehensive health insurance policy with a critical illness rider plan. Many critical illnesses are hereditary and run in families. Individuals who have a history of critical illness should definitely opt for a critical illness plan.
Primary breadwinners along with individuals with high-stress level jobs are at an increased risk of developing critical illness plans.
How to File a Claim for Critical Illness Plan?
In case of an emergency, the first thing to do is contact your insurer immediately. You will be required to submit the following documents:
Post submission, the insurer will verify the documents and the claim will be approved or disapproved accordingly.
Frequently Asked Questions
Q. Is Critical Illness Rider Available On Edowment Plans And Money Back Policies?
Ans: Riders may be attached to your insurance plans such as term plan, endowment plan, money back plan. The critical illness rider helps customize your life insurance policy.
This rider covers 4 critical illness conditions: cancer, first heart attack, stroke, and open chest CABG. If you are diagnosed with any of these 4 critical illnesses, future premiums payable under the plan and riders (if any) are waived off while your life cover as well as other rider covers continue.
Q. Why Should I Buy Critical Illness Insurance? Is It Important?
Ans: Life can throw bouncers at you when you’re least expecting them. You should buy a critical illness plan for yourself and your family members to battle financial challenges if diagnosed with a critical illness. With a critical illness plan you can receive a lump sum amount that:
Q. Can I Make Multiple Claims For The Same Illness Or Any Other Critical Illnesses That Are Listed?
Ans: During the policy period, you are allowed to make only one claim on any of the listed critical illnesses mentioned in your policy document.
As soon as you make a claim, the lump sum amount shall be paid out for the particular critical illness. The policy would be automatically terminated and subsequent renewals would be allowed in the policy of the particular insured person. If at all the policy has been issued to more than one individual then the policy shall still remain active for the other policy members.
Certain insurance policies continue other benefits except for the one which you already made the claim.
If you are making a critical illness claim then the hospitalization expenses incurred will be paid under Health Insurance. The Lump sum benefit will be paid after the survival period under Critical Illness cover. It is always better to speak to your insurance company about this clause as some insurers may allow you to make more than one claim.
Q. I Wanted To Understand How Is The Pemium Determined For Critical Care plans?
Ans: Premiums for critical care insurance are determined on the sum insured stated in the policy document, the complete policy tenure, gender and health status of the insured person. The premiums vary from one individual to another depending on all these factors mentioned above.
Q. Is it better to take critical illness cover or health insurance?
Ans: A critical illness cover offers you a lump sum amount in case of diagnosis of the critical illness that is mentioned in the policy document. However, a health insurance reimburses the medical expenses borne by you. Hence, it is better that you buy a separate critical illness cover.
Q. Can I purchase a critical illness insurance policy online?
Ans: Yes, you can purchase a critical illness insurance policy online. You can go on the particular insurer’s website to get the needful done.
Q. Who Should Buy Critical Illness Plan?
Ans: Critical Illness Insurance Plan is intended to shield you with a strong financial backup in case you’re diagnosed with any of the major illnesses. The money you claim on your policy can be used to pay off mortgage, children’s education, home improvement, medical treatment, etc. – just the way you want. Opting for a critical Illness cover will be an ideal choice for you, if –