CRITICAL ILLNESS INSURANCE PLANS

What is Critical Illness Insurance Plan ?

CRITICAL ILLNESS INSURANCE : The Issuer of the policy generally pays a lumpsum amount on diagnosis of predefined critical illnesses and medical procedures. The illnesses are specified in the policy . By nature, critical illnesses are high severity and low frequency and cost of treatment is higher compared to regular medical problems like heart attack, stroke , kidney failure , cancer etc .

​There are critical illness policies which only reimburse the actual expenses only for the treatment of specified critical illness and they do not pay out any lump-sum amount .
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Critical illness like cancer , kidney failure , liver failure , Heart diseases etc may require prolonged hospitalization or multiple admissions to hospitals . The treatment costs are much more higher than the usual illness . Patient may need consultations with multiple doctors and treatments in multiple hospitals . Just ordinary health policy may not suffice , if one is the victim of such conditions . Such conditions may also hinder the income capacity of the patient and require extra funding . To meet such catastrophic exigencies , critical illness insurance plans are designed . Once the patient is diagnosed for the illness , the insurer will pay the insured full amount of the policy irrespective of actual expenditure . Patients can use the cover for any of his / her requirements . ​

Normally the premium to be paid for Critical Illness plan are lower than the general health insurance plans as the coverage is limited to specific diseases only . Check up with insurance company for getting a quote .

Note that unless the disease reaches certain predefined severity , insurance company may not pay out the covered amount .

WHAT ARE CRITICAL ILLNESS / DISEASES ?

Normally following listed medical conditions / diseases are considered Critical illness . But the list is not exhaustive or complete . All the conditions below may not be considered by insurance companies as critical illness and they may have their own list to consider the illness as critical for the purpose of the insurance policy :
​1. Cancer
2. Heart Attack
3. Coronary Artery By-pass Surgery / Heart Valve Surgery
4. Stroke
5. Kidney Failure
6 .Coma
7. Paralysis
8 .Blindness /Deafness / Loss of Speech
9 .Multiple Sclerosis
10 . Hepatitis
11. Bone Marrow Transplantation
12 .Major Burns
13 . HIV Due to Blood Transfusion and Occupationally Acquired HIV
14 . Liver Failure
15. Meningitis
16 . Brain Tumour

IRDAI REDIFINES SOME CRITICAL ILLNESSES :

​Dated 31.05.2022 : In July 2020 Insurance Regulatory and Development Authority of India ( IRDAI ) had issued a master circular with regard to standardization of health policies and had defined various critical illnesses . Now it has now redefined the three critical illnesses Cancer , Multiple Sclerosis and loss of speech to be covered as critical illness in a health policy and elaborated the conditions in which are to be treated as critical illness . The new definitions are as follows :

CANCER OF SPECIFIED SEVERITY

I. A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term cancer includes leukemia, lymphoma and sarcoma.

II. The following are excluded –

1. All tumors which are histologically described as carcinoma in situ, benign, pre-malignant, borderline malignant, low malignant potential, neoplasm of unknown behavior, or non-invasive, including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN - 2 and CIN-3.

   1. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;

   2. Malignant melanoma that has not caused invasion beyond the epidermis;

   3. All tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0

   4. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;

   5. Chronic lymphocytic leukaemia less than RAI stage 3

      1. Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,

      2. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs

MULTIPLE SCLEROSIS WITH PERSISTING SYMPTOMS

The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the following:

1. investigations including typical MRI findings which unequivocally confirm the diagnosis to be multiple sclerosis and

2. there must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months.

1. Neurological damage due to SLE is excluded.

LOSS OF SPEECH

1. Total and irrecoverable loss of the ability to speak as a result of injury or disease to the vocal cords. The inability to speak must be established for a continuous period of 12 months. This diagnosis must be supported by medical evidence furnished by an Ear, Nose, Throat (ENT) specialist.

The above definitions are to be adopted by all health insurance companies for the purpose of any health policy issued by them covering critical illnesses .

To read IRDAI press release , CLICK HERE

SOME SELECT CRITICAL ILLNESS PLANS

Below are the some of the critical illness insurance plans available in India . You will be taken to the prospectus of the plan with eligibility requirement on clicking on it :

1. ADITYA BIRLA CRITICAL ILLNESS HEALTH INSURANCE POLICY
2. HDFC ERGO CRITICAL ILLNESS INSURANCE
​ 3. ICICI PRU TERM INSURANCE PLAN
4. MAX BUPA CRITICARE
5. IFFCO TOKIO CRITICAL ILLNESS INSURANCE
6. RELIGARE CRITICAL ILLNESS INSURANCE

BASIC FEATURES OF CRITICAL ILLNESS INSURANCE PLANS .:

The policy pays a lump-sum amount in case a person is diagnosed with a critical illness covered by the policy . Certain illness / disease is considered critical only on reaching certain predefined severity by IRDA . Further the patient has to survive for a pre-determined period after the first diagnosis before making claim .

EXCLUSIONS :
Normally the policy excludes the following :

1 . Medical treatment pertaining to pre-existing diseases.
2. Medical treatment for a disease that occurs during the first 60 to 120 days of commencement of critical care insurance cover.
3. AIDS
4. Ailments arising out of drug addiction or alcoholism.
5 . Self-harm or suicide.
6 . Person who is under or above specified age in the policy .
7. Venereal diseases.
8 . Any critical Illness which is caused directly or indirectly or contributed to by or arises from the following external threats:
​Ionizing Radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel or nuclear weapon materials.
9. War, Invasion, Act of foreign enemy, Hostilities, Civil war, Rebellion, Revolution, Insurrection, Mutiny, Military or usurped Power, Seizure, Capture, Arrest, Restraints, and Detainments of all kinds, Princes of whatever nation conditions or quality so ever.

LIMITATIONS :

1. Only one critical illness can be covered during the entire term of the policy . Insured will receive the claim amount after being diagnosed with a critical illness. Insurer will l make payment to Insured Person only once in respect of the treatment of any particular critical illness or injury.

2. Waiting Period : For critical illness insurance plan it is usually 90 days after the policy has been purchased and 30 consecutive days of survival before the sum assured is paid out.

3. Survival Period : Insured person can make a claim only if he/she survives for a pre-decided number of days, also known as the survival period starting from the day when the illness was first diagnosed.

4 . ​Stage or Specified Severity of Disease :

Diseases such as a case of heart attack, cancer, angioplasty or arthritis need to reach a certain level of criticality such that it qualifies to be considered as critical. There is always a level which the disease has to reach in order to be considered as critical. As per IRDA, there are certain stages which are explained in medical terminology which states that the diseases are critical enough to be covered under the online critical illness policy.


PLEASE GO THROUGH FINE PRINTS IN THE POLICY DOCUMENT FOR COMPLETE OF EXCLUSION / INELIGIBILITY BEFORE BUYING A POLICY

SELECT CRITICAL ILLNESS POLICIES THAT MAY SUIT YOU

RELIGARE CRITICAL ILLNESS PLAN :

1. COVERAGE : Covers 32 Critical Illness : Insured Amount from Rs 10 lakh to Rs 2 crore
2. Entry Age : 5 years to 50 years
3. Pre Medical test : Not Required
4. Initial waiting period 90 days : Pre Existing : 48 months
5. BENEFITS : Hospitalization , Day care , OPD cover , Chemotherapy & Radiotherapy Cover , Dialysis , Alternate treatments etc
6. Claim : To be claimed with bills , proof of hospitalization etc Check with the company

​ For complete details , terms & conditions & premium payable visit Insurance company website

HDFC ERGO Critical Illness :

1. COVERAGE : Silver Plan :
Heart Attack (Myocardial Infarction) , 2. Coronary Artery Bypass Surgery ,3. Stroke ,4. Cancer
5. Kidney Failure , 6. Major Organ Transplantation , 7. Multiple Sclerosis ,8. Paralysis

Platinum plan : Heart Attack (Myocardial Infarction) , 2. Coronary Artery Bypass Surgery ,3. Stroke ,4. Cancer
5. Kidney Failure , 6. Major Organ Transplantation , 7. Multiple Sclerosis ,8. Paralysis 9. Aorta Graft Surgery 10. Primary Pulmonary Arterial Hypertension 11. Heart Valve Replacement 12. Parkinson's Disease 13. Alzheimer's Disease 14. End Stage Liver Disease
15. Benign Brain Tumour

​2. Entry Age : 5 years to 45 years
3. Pre Medical test : Not Required
4. Initial waiting period : 90 days
5. BENEFITS : Lumpsum payment of Insured amount
6 . Exclusions : Any pre existing disease , Drugs and alcohol related complications ,Venereal disease, AIDS (Acquired Immune Deficiency Syndrome) and/or infection with HIV ,Any treatment arising from pregnancy (including voluntary termination), miscarriage, maternity or birth (including caesarean section), congenital internal and external diseases, defects or anomalies
For complete list please refer the policy wording.

7. CLAIM PROCEDURE :
1. Duly Completed Claim Form
2. Original Discharge Summary.
3. Consultation Note/ Relevant treatment papers.
4. All relevant medical reports along with supporting invoices and doctors requisition advising the same.
5. Original and Final hospitalization bills with detailed breakup.
6. Pharmacy Bills along with prescriptions.
7. Any other documents as may be required by the Company.

For complete details , terms & conditions & premium payable visit Insurance company website

MAX BUPA CRITICARE POLICY :

1. COVERAGE : 1. Cancer of specified severity 2. •Open chest CABG 3. First heart attack of specified severity
4. Open heart replacement or repair of heart valves 5. Stroke resulting in permanent symptoms
6.Permanent paralysis of limbs 7. Coma of specified severity 8. Kidney failure requiring regular dialysis
9. Major organ/bone marrow transplant 10 . Motor neurone disease with permanent symptoms
11. Multiple sclerosis with persisting symptoms 12 End stage liver disease 13 . End-stage lung disease 14 . Major burns
15 . Loss of speech 16 . Deafness 17 . Aplastic anaemia 18 . Bacterial meningitis 19 . Fulminant viral hepatitis
20 . Muscular dystrophy
​ Insured Amount from Rs 3 lakh to Rs 2 crore

​2. Entry Age : 18 years to 65 years
3. Pre Medical test : Recommended
4. Initial waiting period : 90 days
5. BENEFITS : Lumpsum payment of Insured amount
6 . Exclusions : a. Acquired Immune Deficiency Syndrome (AIDS), AIDS-related complex or infection by Human
Immunodeficiency Virus (HIV)
b. The Insured Person's attempted suicide or self-inflicted injuries while sane or insane;
c. Narcotics used by the Insured Person unless taken as prescribed by a Medical Practitioner, or the
Insured Person's abuse of drugs and/or consumption of alcohol;
d. Taking part in any naval, military or air force operation during peace time;
e. Participation in aviation/marine including crew other than as a passenger in an aircraft/water craft
f. Including but not limited to engaging in or taking part in professional/adventure sports or any
hazardous pursuits, such as speed contest or racing of any kind (other than on foot), bungee
jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock
climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard
helmet and breathing apparatus, polo, snow and ice sports, hunting etc; or
g. Participation by the Insured Person in a criminal or a breach of law with criminal intent;
For complete list please refer the policy wording.

7. CLAIM PROCEDURE :
a. Duly filled and signed claim form and KYC documents
b. Final Hospital Discharge Summary in original / self attested copies if the originals are submitted with another insurer, if applicable c. Final Hospital Bill in original / self attested copies if the originals are submitted with another insurer, if applicable
d. Consultation notes and / or investigation reports from outside the hospital prior to hospitalization
e. Copy of First Information Report (FIR) (if CritiCare being claimed for is admissible in event of an Accident)
​ f. Copy of Medico Legal Certificate duly attested by the concerned hospital (if CritiCare being claimed for is admissible in event of an Accident) if applicable

For complete details , terms & conditions & premium payable visit Insurance company website

ADITYA BIRLA CRITICAL ILLNESS HEALTH INSURANCE POLICY :

There are 3 plans under the policy .

PLAN 1 : COVERAGE : 20 Critical Illness
PLAN 2 : COVERAGE : 50 Critical Illness
PLAN 3 : COVERAGE : 64 Critical Illness
​​ Insured Amount : 12 times annual gross income .

​2. Minimum Entry Age : 5 years for PLAN 1 & 2 and 18 years for Plan 3
3. Pre Medical test : Recommended
4. Initial waiting period : 90 days
5. BENEFITS : Lumpsum payment of Insured amount
6 . Exclusions : Any pre existing disease , Drugs and alcohol related complications ,Venereal disease, AIDS (Acquired Immune Deficiency Syndrome) and/or infection with HIV ,Any treatment arising from pregnancy (including voluntary termination), miscarriage, maternity or birth (including caesarean section), congenital internal and external diseases, defects or anomalies
For complete list please refer the policy wording.

7. CLAIM PROCEDURE :
1. Inform the insurance company within 7 days of Diagnosis
2. Submit your claim within 30 days along with medical records :
1. Duly Completed Claim Form
2. Medical certificate confirming the disease .
3. Certificate that the case is not related to any pre-existing disease .
4. FIR copy in case of accident
5. Any other documents as may be required by the Company.

For complete details , terms & conditions & premium payable visit Insurance company website