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What Is Covered By Critical Illness Insurance?
Mar 5, 2021

What Is Critical Illness Insurance & What’s Covered?

Most of us already have health insurance plans so the question that hits every mind is what is critical illness insurance, what is covered by critical illness insurance, who needs it, and when do I need to take critical illness insurance, and isn’t my existing health insurance plan enough to cover everything? Well here is all you need to know about critical illness insurance.

What is critical illness insurance?

Critical illness insurance, also known as catastrophic illness insurance, is insurance that pays you a lump sum amount on being diagnosed with a disease that could prove fatal. A list of such diseases covered for the purpose of critical illness insurance is provided in the policy. Generally, it covers cancer of certain stages and types, Alzheimer’s disease, Parkinson’s disease, major head trauma, and other severe illnesses.

Why do you need critical illness insurance?

The need for critical illness insurance arose mainly because we all know that life expectancy has increased with the passage of time. But something that also rose with life expectancy is the cases of such severe life-threatening diseases that too among the middle-aged population and the medical expenses are shooting up. A cover for such exorbitant expenses could give a sense of relief.

Isn’t my current health insurance plan enough?

The health insurance plans cover general diseases as well as such severe diseases. The cost of critical illnesses is also high. A normal health insurance plan might not suffice. An additional cover will assist financially.

What does critical illness insurance cover?

Though the coverage of diseases may differ from one insurance company to another, it generally covers the following list of diseases
  • Permanent paralysis
  • Last stage lung disease
  • Cancer beyond a certain stage
  • Kidney failure requiring regular dialysis
  • Alzheimer’s disease
  • Parkinson’s disease

Exclusions from critical illness insurance

What is covered by critical illness insurance is stated in the policy and everything else is excluded. Though, certain general exclusions should be taken care of which are as follows:
  • Cosmetic surgery
  • Illness caused due to tobacco, smoking, alcohol, or drugs intake
  • Infertility treatment
  • Hormone replacement
  • Illness caused due to terrorism, military or navy operations, or civil war

What matters should be considered before taking critical illness insurance?

Sum insured: The total sum insured is the maximum amount that will be paid by the insurance company in case of a claim made for any critical illness. This amount is usually 10-15 lakhs. Waiting period: The waiting period is the time the policyholder has to hold on before he can make a claim under critical illness insurance. Survival period: This is the period the claimant has to survive after being diagnosed with the disease. Number of diseases covered: The larger the coverage, the better it is for policyholders. But the premium amount also varies based on coverage of diseases. The higher the number of diseases covered, the higher the premium will be. Renewability age: There are some companies that have a bar over the age of policyholder for this specific insurance like critical illness insurance might not be available beyond the age of 60 years. Choose a critical illness policy or rider: Rider means the critical illness insurance is dependent on the base policy. Like if the health insurance or mediclaim is for Rs. 50000 then the critical illness rider shall also be for Rs. 50000 only. On the other side, the policy can have wider coverage. Sub-limits Limits might be decided within the insurance cover for different expenses such as tests, treatment expenses, post-treatment expenses, etc. Inclusion/ Exclusion What does the critical illness insurance cover and what is excluded should be studied beforehand.

Who needs critical illness insurance?

Needless to say, insurance is something everyone should buy. It’s a cover against potential risk and when we are talking about something that is life-threatening, it’s something that shouldn’t be ignored. We can say the following people are advised to definitely take up this insurance:
  • Having a family history of any such disease
  • Sole financial supporters of the family
  • Involved in high-pressure jobs
  • Anyone above the age of 40 years of age

What all kind of receipts can be expected under critical illness insurance

Payment related to diagnostic reports, services taken concerning treatment, and post-treatment expenses are covered here. Moreover, it also covers loss of income due to his inability to attend the workplace. FAQs:

Miss Asma posted a question “Can I claim the sum insured under both, Critical illness insurance and health insurance for the same illness and same hospitalization?”

Yes, you can claim for both critical illness insurance and health insurance. Under health insurance, you can get a claim amount for hospitalization and other costs while under critical illness insurance, you get a lump sum amount if you survive through the survival period provided.

If I have floater critical illness insurance and I have claimed the amount for a particular disease, then can my spouse claim for the same disease under the same policy?

Yes, you can if the total amount falls within the limits of the sum insured.

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