Critical illness insurance pays a lump sum amount when serious illnesses like cancer, heart attack, or stroke are diagnosed. The money can fund medical treatments, everyday living expenses, or other necessities during a difficult period.
Zero
Waiting period
10,500+
Cashless hospitals
100%
Bills covered
In contrast to conventional health insurance, which usually covers hospitalisation and treatment expenses, critical illness insurance provides a single lump sum cash payment when a covered condition is diagnosed. The payment gives policyholders the option to use their money as they see fit in response to their specific situation, whether paying for out-of-pocket treatments not included in regular insurance, paying for household expenses while recovering, or adjusting living situations to meet new healthcare requirements.
Here is a table that says what critical illness insurance covers:
| Feature | Details |
| Comprehensive Coverage | Critical illness insurance covers specific conditions such as cancers, heart attacks, strokes, and organ transplants, providing support during tough times. |
| Lump Sum Payout | Upon diagnosis of a covered illness, a lump sum is paid, reducing the financial burden of medical bills, rehabilitation, and lifestyle changes. |
| No Medical Bills Required | The plan does not require medical bill reimbursement, as the payment is made in a lump sum, easing the claims process. |
| Waiting Period | A typical waiting period of 90 days is required before coverage begins, ensuring pre-existing conditions are not covered immediately. |
| Survival Period | A survival period is mandated after diagnosis, ensuring the policyholder survives for a set time before the benefit is paid out, preventing fraudulent claims. |
| Renewability and Premiums | Policies are generally renewable, allowing continued coverage in old age, though premiums may increase with age. Fixed premiums are available with some plans. |
| Rider Options | Additional riders can enhance coverage, including a waiver of premium rider, which waives premiums if the insured is diagnosed with a critical illness. |
Here are the reasons why Critical Illness insurance is important.
Medical bills in India can be very high. Extensive and costly treatment is needed for critical illnesses such as cancer, heart attack, or organ failure. Critical Illness Insurance provides a lump sum payment that helps people survive financially when faced with this situation even though regular health insurance may have covered some expenses. Medical bills are not the only covered expense though, as this includes transportation, housing, as well as loss of income that occurs during the treatment period.
Despite the fact that hospitalisation costs are usually covered by ordinary health insurance, these insurances usually don’t cater to very extensive and prolonged treatments necessitated by critical illnesses. Critical Illness is supplementary health insurance designed to pay out in particular circumstances.
Quality healthcare in India may not be equal across all communities. With Critical Illness Insurance, individuals would access the best medical care and attention, may it be in a metro city clinic or in a specialised institution. This guarantees that the insured gets the latest and best health care services.
Critical illness should not only be seen as affecting the patient, it affects the family. The emotional stress and financial strain can be overwhelming. Knowing that your family is well insured with Critical Illness Insurance gives you an added peace of mind. As a result, all attention can be shifted towards recovery.
Here's how it works:
You need to first buy a Critical Illness Policy from an insurance company. The coverage amount is determined by requirements and financial capabilities.
Critical Illness Policies generally provide coverage for certain severe diseases. These may include cancer, heart attack, stroke, renal failure or major organ transplantation. Review and choose one of the listed policies that cover the illnesses you are most worried about.
Before making a claim for a critical illness, there is always a cooling off or a waiting period after buying the policy. However, during this period, no claim will be allowed. It is necessary to know about this waiting time.
If you are diagnosed with a covered critical illness while within the defined waiting period you may claim. Since the insurance company will need medical records to ascertain the correctness of the diagnosis. After the approval, you shall be paid in full.
The payouts from the insurance cover are generally meant for costs related to the patient’s disease. These can include medical treatment, hospital bills, rehab, and even daily living costs in case you cannot work.
You must ensure that you make timely payments for premiums lest the policy becomes dormant. Failure to make payment by a stipulated period may lead to the policy lapsing and you may lose your coverage.
Such policies normally operate on a short-term basis and can be renewed when their validity period expires. Other policies may even need a health review after some time, enabling one to upgrade to new coverage in case of changes in health status.
Insurers are expanding the list of critical conditions covered to include more cancers, heart conditions, stroke, paralysis, major organ failures, etc. This provides wider protection.
As more data becomes available on critical illness claims and survival rates, premiums are expected to reduce over time. Insurers can more accurately gauge risks and pricing.
Currently, most policies cover between Rs. 5 and 50 lakhs. However, with rising medical costs, the sum insured is likely to increase substantially in future.
Instead of standard policy wordings, insurers may allow more flexibility and customisation regarding illnesses covered, payout percentages, premiums paid, etc., based on customer needs.
The claim settlement process for critical illness is expected to become smoother, leveraging technology and data analytics to verify diagnoses faster.
There is currently low awareness among the masses about critical illness policies. Promotions around the early detection and treatment of critical illnesses will improve penetration.
Here are the benefits of critical illness insurance:
Imagine having a financial ally when faced with the daunting challenges of severe illnesses like cancer, heart attacks, or strokes. Critical illness insurance steps in as your safeguard, preventing the depletion of your savings during the costly treatment of these ailments.
In contrast to standard healthcare policies, Critical Illness Insurance offers a unique benefit – a lump sum payout upon the diagnosis of a covered disease. This financial boost can cover everything from medical fees to rehabilitation costs and even essential needs during your treatment journey.
Consider it as a backup to your primary healthcare insurance. While regular health insurance handles hospital bills, critical illness insurance steps up to address the specific financial challenges that come with life-threatening illnesses.
The beauty of this insurance lies in your hands. You have the freedom to decide how to use the payout – whether it's for medical expenses, alternative treatments, or covering household bills. Your priorities, your call.
With Critical Illness Insurance, you're not confined to a select group of network hospitals. You have the liberty to choose the facility and healthcare providers that perfectly align with your unique needs, offering a range of options beyond specialised treatments.
Facing a critical illness is not just emotionally challenging; it takes a toll on your family's finances too. Critical Illness Insurance provides peace of mind to your loved ones, offering support when they need it the most.
Let's break down the tax benefits under a critical illness insurance policy in the realm of health insurance:
| Benefits | Details |
| Premium Payments | Premiums paid towards critical illness policies are free from taxes subject to certain limits . |
| Family Coverage | Family floater plan deductions available. Rs. 25,000 limit if all family members are below 60 years; Rs. 50,000 limit if family members are senior citizens. |
| Critical Illness Rider | Covers specific essential illnesses. Premiums attract tax deduction under Section 80D. |
| Preventive Health Check-up | Deduct expenses related to preventive health screenings. Vital for detecting critical illnesses not explicitly insured against. Indirect costs, including check-up expenses, can be deducted. |
Here are the common illnesses covered under a Critical Illness Insurance plan:
| Illness | Coverage Details |
| Cancer | Covers various types of cancer. Assists with high treatment costs, including surgery. |
| Heart Attack | Financial support for medical bills and recovery expenses in the event of a heart attack. |
| Stroke | Rehabilitation, medical bill coverage, and assistance with lifestyle adjustments post-stroke. |
| Kidney Failure | One-time settlement for costs related to dialysis, transplantation, and follow-ups in case of kidney failure. |
| Organ Transplant | Coverage for major organ transplants such as heart, lung, liver, and kidneys. Eases financial burden associated with transplantation costs. |
| Multiple Sclerosis | Financial support for treatment and care of illnesses like Multiple Sclerosis. |
| Paralysis | Lump sum payout for medical costs, rehabilitation, and modifications to living areas in case of paralysis. |
| Major Organ Failure | Covers treatment costs for organ failures like liver or lung failure. |
| Coma | Pays for medical treatment expenses if the insured person falls into a coma. |
| Coronary Artery Bypass Surgery | Coverage for costs incurred during coronary artery bypass surgery, a treatment for severe heart conditions. |
Below are some of the common exclusions of a Critical Illness Insurance policy. Nevertheless, go through the policy document to find out the exact exclusions.
Here is a table that lists the differences between a Critical illness and a Health Insurance Plan:
| Aspect | Critical Illness Insurance Plan | Health Insurance Plan |
| Purpose | Covers specific, major illnesses like cancer, heart attack, etc. | Provides coverage for a broader range of medical expenses, including hospitalisation, surgeries, etc. |
| Payout Structure | Lump sum payment upon diagnosis of a critical illness | Reimbursement or direct payment for medical expenses as per the policy coverage |
| Coverage | Limited to predefined critical illnesses specified in the policy | Comprehensive coverage for hospitalisation, doctor visits, medicines, and other medical expenses |
| Survival Period | Typically, a survival period is required after diagnosis (e.g., 30 days) | No specific survival period required for most medical expenses |
| Renewability | Generally renewable, but premiums may increase with age | Renewable throughout life, with premiums often increasing with age or as per policy terms |
| Use of Funds | Can be used for any purpose, not limited to medical expenses | Primarily intended for covering medical expenses related to illness or injury |
| Preventive Care | Does not cover routine check-ups or preventive care | May cover preventive care, vaccinations, and wellness check-ups depending on the policy |
| Waiting Period | Typically has a waiting period for pre-existing conditions | May have a waiting period for certain conditions as per policy terms |
| Cost | Premiums may be higher compared to health insurance due to specialised coverage | Premiums may be comparatively lower, but depend on factors like age, health condition, and coverage |
| Recommended Scenario | Ideal for individuals concerned about major illnesses and seeking financial support for treatment | Suitable for overall health coverage, including regular medical expenses and unforeseen emergencies |
Here are the steps to buy a Critical Illness plan online.
Start by researching different insurance companies that provide Critical Illness Insurance Plans in India. Use search engines and visit insurers' websites, or reach out to them via email. Get a plan that is not only affordable but also offers better coverage..
Go through the terms and conditions of the Critical illness plan before coming to a decision. Ensure that you note the diseases covered, waiting periods and exclusions. By doing so, you will be able to make an informed decision and avoid any unexpected issues in the future.
Use online insurance aggregators for the comparison of several plans at the same point. These make it easier for you to find a suitable Critical Illness Plan as they provide a direct comparison of different Critical Illness Plans side by side.
There are web-based online calculators available on most insurance websites to assist you in arriving at the premium cost for preferred Critical Illness Plan. Kindly enter your age, sum assured (if applicable) and any other rider(s) you wish for an accurate premium quote.
Choose a plan and move to your insurer’s website where you will fill in an online application form. Make sure you have correct and credible information as it may be of vital importance at the latter stages of your claim process. Ensure that you will also have the necessary documents ready for upload.
Depending on your age or health some insurers may request a medical examination. The insurer will lead you through the procedure. Some insurance companies also provide policies where medical examination is not required hence enhancing convenience and speed of access.
Ensure you understand all the information provided by the insurer before making payment. Be sure to pay attention to the terms and make a payment only when you are content with the offerings of the plan.
Use any of the online payment options available and complete your payment for the Critical Illness Plan. Most insurance companies will accept payment by credit/debit cards, net banking, and digital wallets.
The following are some tips for choosing the best Critical Illness Insurance cover:
| Factors to Consider | Details |
| Understand Your Needs | Consider the family’s medical history, lifestyle, and general health to select the best policy. |
| Comprehensive Coverage | It is safe to consider standard diseases, including cancer, heart ailments, and kidney diseases, to avail of a financial shield. |
| Sufficient Sum Insured | Select the right sum insured about potential future medical expenses; it is noted that medical expenses differ by region. |
| Shorter Waiting Period | It is better to choose the one with a short waiting period if you have health issues included in the pre-existing category. |
| Survival Period | Choose a short time from the date of diagnosis since this will increase your chances of receiving your money. |
| Renewal Age | Select policies with higher renewal age so that you have long-term coverage. |
| Claim Process | Ensure that the provider has an easy and short cycle for making claims to avoid complications when claiming during the recovery period. |
| Premiums | Choose your policy right; do not be blinded by cheap policies with minimal coverage. |
| Riders and Add-ons | One can also include the most common or custom riders, like Critical illness riders. |
| Read Reviews and Seek Advice | Take a look at the customers’ feedback and check the reliability and overall quality of the service from other sources. Evaluate family medical history, lifestyle, and current health to choose a suitable policy. |
Buying a Critical Illness plan will be beneficial for the following people:
| Group | Reason for Purchase |
| Breadwinners | Safeguard the financial needs of a family for treatment in the event of severe ailment within a family to avoid disruption of the recovery process by financial problems. |
| Self-Employed Individuals | Protect business and own money during a disease treatment process. |
| Young Professionals | Preventive for any health worries or sickness which may occur at any age. |
| Individuals with Family History | This cover is, therefore, essential because children with such genetic disorders get exposed to an even higher risk of being born with similar diseases. |
| Retirees | Shield cash in retirement plans from the unpredictability of medical emergencies. |
| Parents with Dependent Children | To make sure the children are financially provided for during sickness and dropped off to school |
Follow the below steps to raise a Critical Illness Insurance claim. Also, note that the process may differ from insurer to insurer:
Once you are diagnosed with a critical illness that is covered under your policy, inform your insurer and register a claim.
Submit the necessary documents to file a claim.
Based on the terms of the policy and the submitted details, the insurer will either accept or decline your claim.
The following table lists the documents you might need to raise a claim:
| Document Type | Details |
| Claim Form | Complete the claim form issued by the insurance company with accurate information. |
| Medical Certificate | Obtain a medical certificate from the attending doctor, specifying diagnosis, seriousness, and prescribed medication. |
| Discharge Summary (if applicable) | Include the hospital discharge summary detailing the duration of hospitalisation, treatment, and any operations performed. |
| Investigation Reports | Attach medical investigation reports such as blood tests, scans, and relevant documents supporting the critical illness diagnosis. |
| Prescriptions and Bills | Keep original receipts for medicines, consultations, and bills related to critical illness medical expenses. |
| Photo ID and Address Proof | Provide photocopies of identity proof (e.g., Aadhar card, passport, or driving licence) and address proof (e.g., utility bills or Aadhar card) for authentication. |
| Policy Document | Submit a copy of your Critical Illness Insurance policy for verification and review of provisions. |
| Hospital Registration (if applicable) | Submit admission and discharge documents specifying dates and details of hospitalisation. |
| Test Reports for Diagnosis | Include test results confirming the critical disease for validation of the medical situation. |
| Claimant's Bank Details | Provide bank account information, including the bank name, account number, and IFSC code, for claim payment. |
| Death Certificate (if applicable) | If the critical illness results in demise, include the death certificate as part of the claim documentation. |
Here are some essential factors to keep in mind when opting for a critical insurance policy:
Ensure that there is coverage against major illnesses such as cancer, heart attack, stroke, and kidney failure which are rampant in India. Make sure the policy covers major health issues sufficiently.
Look at the renewal age of this policy. Select a plan that permits you to renew coverage during old age. To ensure that you are still able to receive the benefits in later life, opt for a policy which has a higher renewal age.
Ensure you get a list of network hospitals affiliated with the health insurance company. The availability of a broader network means you can get cashless treatment in hospitals across the region, which alleviates financial issues during an emergency.
Check the premium rates between various insurers. Remember though, while affordability is important, the coverage and benefits are also equally important. Finding the most appropriate policy includes striking that all-important balance between cost and cover.
Carefully review the policy exclusions. Knowledge of what is excluded will assist in managing expectations and ensure that there are no surprises when a claim is raised.
Search for more options than what is included in your policy. Waiver of premium and income benefit riders, for example, can help add on some money during tough times.
Choose a policy with a higher deductible amount - this is the threshold limit up to which you bear the expenses if you make a claim. Higher deductibles reduce the premium outgo.
Carefully assess how much coverage you need rather than opting for a random high figure. Higher cover equals higher premiums. Buy adequate protection.
Do not zero-in on the first policy you come across. Shop around and compare quotes online from multiple insurers to find the best premium rate.
Insurers offer discounts if you can showcase habits like regular medical check-ups, healthy diet, fitness levels, etc. Small lifestyle changes can mean lower premiums.
Multi-year premium payment terms like 3-year or 5-year premium commitments attract sizable discounts compared to annual payments.
Enroll in preventive care programs offered by insurers to manage lifestyle diseases, addiction, etc. It makes you less risky to cover.
Follow these tips during your critical illness policy purchase to optimise premium payouts and get adequate coverage. Evaluate trade-offs between price and coverage carefully.
A critical illness insurance policy provides immediate financial security in any difficult situation so that both You & Your Family are financially secure during critical life conditions. Fast processing of claims and wide-ranging coverage combined with affordable and versatile premiums make ACKO Health’s plans ideal for protecting your future healthcare needs. Are you sitting comfortably? If not, you are wrong – for an opportunity to strengthen your position today.
Don’t wait. Sign up for ACKO Health’s critical illness insurance plan now and be prepared for the future!
The following are frequently asked questions regarding a Critical Illness Insurance.
Disclaimer: It is important to note that all the plans, services, features, processes, etc stated on this page are likely to vary. Kindly refer to the relevant policy wordings before making any insurance related decisions do so. You can forward your questions to us at [email protected].
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