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5 Things To Know About Critical Illness Covers In India

Team AckoJan 17, 2024

Suffering from a  critical illness may be the toughest time of a person’s life. Right coverage and smart selection of a health insurance plan is the key to availing seamless medical treatments.

In this article, we will discuss 5 main things that you need to know about selecting a critical illness cover in India.




5 Things to know about Critical Illness Covers

#1 Survival period in critical illness

The survival period is defined as the survival period is the length of time you, the insured, must survive after you have been diagnosed with a covered critical illness. Once you have passed the survival period, the health insurance benefits will be paid. It is similar to the waiting period in health insurance. However, unlike waiting period survival period is usually much shorter.

If the insured meets an unfortunate end during the survival period, the benefits of the Critical Illness cover will not be given to the nominees. This is because the critical illness cover is not a death benefit like life or term insurance, this is a policy that will help the insured financially in order to avail the best possible medical treatment and recover. Thus, any type of claim will get rejected whether it is cashless mediclaim or reimbursement claim. As mentioned earlier, the survival period of a critical illness cover is short. Usually, a person needs to let 14 to 30 days pass before filing a claim for the treatment of a critical illness after being diagnosed.

#2 Coverages of a critical illness cover

A critical illness cover will pay a sum insured in case the policyholder is diagnosed with any of the listed illnesses under the terms of the policy. Each insurance company has its own consolidated list of illnesses that they cover. Some may allow cashless mediclaim as well.

Remember that you should go through the list of illnesses before buying the critical illness cover. Also, consider your family history when consulting the list of ailments covered. Here are the common ones that are a part of most of the critical illness covers:

  • Cancer

  • First heart attack

  • Open heart replacement or repair of heart valves

  • Coma up to a certain severity

  • Major organ/bone marrow transplant

  • Motor neuron disease with permanent symptoms

  • Kidney failure

  • Stroke resulting in permanent symptoms

  • Permanent paralysis of limbs

  • Multiple sclerosis

  • Major burns

  • Loss of speech

  • End-stage liver disease

  • Deafness

  • End-stage lung disease

#3 Common exclusions

Every insurance policy has its own terms and conditions and similarly, Critical Illness Insurance Plan comes with its own restraints. Some conditions mentioned below are not covered under the plan:

A critical illness cover has its own set of exclusions. Go through the policy document thoroughly to know the exact conditions that your health insurance company will not accept a claim for. Here are the common ones:

  • Self-inflicted injury resulting in a critical illness

  • Critical illnesses as a result of the use/misuse/abuse of intoxicating substances

  • Contracting Human Immune-deficiency Virus (HIV) infection

  • Critical Illness caused due to any cosmetic & aesthetic and obesity-related treatment

  • Critical illnesses attributed to congenital diseases

Also, read: Critical Illness Insurance Cover for the Self Employed

#4 Type of cover – standalone or as a part of health insurance benefits?

If you already have purchased health insurance benefits, you might be wondering whether you should buy a critical illness cover as an add-on or buy a standalone or separate plan altogether. While this decision completely lies upon you, it is normally advised that one should go for a separate plan. Buying a standalone critical illness cover enables you to receive a dedicated sum insured if you are unfortunately diagnosed with an illness. It also provides more flexibility and extensive cover in comparison to an add-on.

#5 Choosing the best plan

Choose the most suitable plan by selecting adequate coverage. You may want to gather information on the diseases that your family members suffered. If a disease is suffered by at least two members of your family on any side – maternal or father’s, consider including the disease in your list.

Select a plan with the least duration of both – survival and waiting period. This will enable you to file a claim in case of diagnosis at the earliest.

Choose the adequate amount of sum assured. A little research will help you understand the approximate cost of treatment for a particular disease. Make sure that you have enough sum insured to avail of the necessary treatment.

The Bottom Line

One may not predict how one’s health will be in the future. This is exactly, why it is important to be prepared for the worst and try to cope with it. Remember that the chances of surviving a critical illness increases when proper medical treatment is availed.

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Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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