Critical Illness Insurance | Indian Insurance

What is Critical Illness Insurance Policy?

Critical Illness Insurance pays a lump-sum benefit upon diagnosis of an illness or condition specified in your plan. The benefit you receive can be spent however you wish - there are no restrictions or requirements.

Difference between health insurance and critical illness policy ?

A mediclaim policy is a reimbursement of actual medical expense whereas critical illness insurance is a benefit policy.

Health insurance Critical illness policy

Basic feature Reimbursement of actual medical expense or provision of cashless facility It gives you a lump sum on diagnosis of any of the pre-specified critical illnesses

Coverage Covers hospitalisaion expense, pre and post hospitalisation expense, accident and the entire gamut of ailments Covers specific critical illness like cancer, stroke, kidney failure, heart attack etc.

Purpose To defray hospitalization expenses It compensate the financial loss or hardships that arise from your serious or critical illness.

Sum assured Maximum is usually capped Rs 5 lakh-10 lakh Maximum coverage ranging from Rs 5 lakh to Rs 50 lakh.

Policy term Policy continues even after the claim is made Policy ceases once the benefit is paid

Key Benefits
Coverage
Exclusions
Claims
Salient Features

What are the benefits covered under the policies?

Sum insured: Lumpsum benefit on diagnosis upto Rs. 25,00,000 is provided, if suffering from a Critical Illness
Renewal Bonus: For every No claim bonus (NCB) insurance company entitles you to increase the sum insured by 5%, up to a maximum accumulation for 10 claim-free years.
Medical test: Does not require the medical test upto the certain age limit.
Policy term: Policy is issued for term of one year. Some companies offer it for period of 2-5 years and 10-30 years.
Waiting period:Waiting period is a period of time immediately following your effective date that begins once a policy is effective and can last up to 90 days from that date.
Domiciliary hospitalisation: The patient are covered for treatment in home.

How does one ensure that they continue to enjoy the standard of living that they enjoyed before a critical illness?

A thought of critical illness is undesirable. It effects an individual mentally, physically and financially. Before attaining a retirement age the chances of getting ill are more high than to die. It is therefore very important to prepare yourself to deal with this unfortunate situation. The cost of these illness are reaching the heights and to cover these you need critical insurance.

What are the illness covered under the Critical Illness Policy?

Cancer
Kidney failure
Organ transplant
Multiple sclerosis
Major burns
Coronary artery surgery
Coma
Arota graft surgery
First heart attack
Heart attack
Coronary artery bypass surgery
Paralysis
Primary pulmonary arterial hypertension
Stroke

Critical Care Insurance also provides cover against accidental death and permanent total disablement (PTD).

90 days exclusion
Any illness within 90 days from start date of policy will not be covered.

Permanent Exclusion

Death occurs within 30 days of diagnosis of the critical illness.
Expense arising from HIV or AIDS related diseases, drugs or misuse of liquor.
Any congenital Illness or condition
Absence of Doctor's medical certificate confirming the diagnosis of illness, injury or undergoing a surgical procedure.
Treatment of pregnancy or childbirth, including caesarean.
Any iternal illness present from birth
Surgery for change of sex or any cosmetic surgery or any treatment not scientifically recognized.
Hypertension arising due to any consequential like loss of business interruption.
War,Accidents arising out of terrorist activities, strike etc.
Illness arising due to intentional self-injury, suicide or attempted suicide

Claim are basically of two types:

Reimbursement Claims
Cashless claims.

Claim Procedure

Inform TPA in case of planned or unplanned hospitalization. Avail cashless facility by admiting into a network hospitalization.

Make the notice in writing to the company and get the claim form.

Documents required to reimburse the claim:

Insured person's name, name of sickness, date of occurrence, policy number and membership ID number, Place & contact details of the Insured Person
Doctor's signature and medical details of the illness/surgery.
Certificate confirming the name of diagnosis or performance of surgery.
Confirmation that the Insured Event does not relate to any Pre- Existing Illness or disease.
Duly completed claim forms .
Bills, receipts, cash memo from hospital and all documents related to illness.
Certificate/card from hospital.

Submit all necessary bills, documents, reports and proofs along with claim form to settle the claim.

How does Return On Premium(ROP) work?
On death of policy holder or at time when policy comes to an end company return 100% of premium paid minus any claim paid by company, to the policy owner or to the beneficiary.The critical illness insurance premium to be returned will be calculated after all pending claims have been settled and the premium is interest free.

What should I buy the critical illness rider from life insurance policy or the separate non-life critical illness policy?
Non-life critical illness policies are year-on-year contracts - which means that the insurance comapny might refuse to renew your policy as you grow old. The critical illness rider on a life insurance policy, on the other hand, is good for the entire tenure of the life cover specified in the policy. Under non-life critical illness policy benefit is reduced by 50% after the age of 65 years

Does a critical illness plan ceases on making a claim?
Yes, critical illness plan stops once the claim is made, but there are some insurance companies which still cover the insured even after the claim. For lower Sum assured or high premium

What features should you compare before puchasing critical illness insurance product?

Survival Period
Waiting Period
Number and Types of Covered Illnesses
Ailment suffered during waiting Period:(30days,1st year,2nd year)
Amount Paid for Each Covered Illness
Conditions for Payment
Death Benefit
Benefit Reduction Age and Amount
Guaranteed Renewable "To Age"
Return of Premium
Minimum and Maximum Benefit Amounts Offered
Discount for Multiple Policie