Critical Illness Insurance is a Health Insurance which covers your medical and hospitalization expenses to be incurred by providing a lumpsum amount in case of detection of any critical illness (covered in the insurance) based on the Illness and Insurance coverage. The Insurance Company examines the medical documents and history of an individual and after ascertaining the expenses related to the treatment provides a lumpsum to the individual to the extent of sum assured. These Insurance policies are offered mainly by Private Sector Companies.
The terms and conditions of the policies varies from company to company and atleast 10-20 illness/disease are covered under the policy. Individuals have to be very careful while choosing a Critical Illness Insurance as they should be aware of terms and conditions and also the illness covered under the policy.
The Critical Illness Insurance is offered by non Life Insurance Companies which is regulated by norms set by Insurance Regulatory Authority of India (IRDA). Insurance Companies have tie ups with certain Hospitals and Nursing Homes for providing Health Check and illness/disease assessment.
The Insurance coverage offered by most Insurers are in the range of Rs 1,00,000- Rs 50,00,000/-. However some Insurers do provide higher insurance cover at a higher premium. The entry age for Critical Illness Insurance is 18 years and Maximum age limit is 65 years generally while some Insurance companies have not fixed any upper age limit. Companies do offer renewal up to the age of 80 years or more upon satisfying their terms and condition. . Under Family Floater option, family members under 18 years but above 3 months can also covered under Critical Illness.
Employers also provide Critical Insurance cover to the Employees under the Group Insurance Scheme. Critical Insurance Policies are also available for Retired Pensioners.
Critical Illness Insurance Premium is calculated in terms of Age of the Individual and past medical record. The premium is expectedly higher for elderly persons.
Some of the major illnesses covered in most of the plans are mentioned below. However, One should check the term policy and coverage before purchasing.
- First heart attack
- Kidney failure
- Major organ /bone marrow transplant
- Stroke resulting in permanent symptoms
- Permanent paralysis of limbs
- Open heart replacement or repair of heart valves
- Multiple sclerosis with persisting symptoms
- Primary Pulmonary Arterial Hypertension
The policy will cease to exists upon the payment of sum insured or in case of group insurance the concerned individual will be excluded from the cover.
Provision for periodic Health Check up is also available as per the terms and conditions laid out in the policy by the Insurers. Normally it is available once during the tenure of policy.
Personal Accidental and Disablement Cover up to the sum assured is also provided by some of the Insurers which do make the policy a very attractive buy.
Even Child Education expenses are covered up by some of the policies. So these are pretty sensible covers for young Individuals with young family.
Some Insurers also provide Add On cover for some of the excluded illness and disease upon payment of additional premium according to terms and conditions laid out in the policy.
PAYMENT OF PREMIUM
Insurance in most cases needs to be renewed annually or as the terms and conditions of the policy. The premium for the policy should be paid on or before the due date. However a grace period of 15-30 days is provided after the due date for the renewal of the policy without the loss of continuity benefits. Insurance coverage is not available for the period for which no premium is received. Amount of premium depends on age and other factors. The premium rates for these policies are pretty reasonable too.
Since the inception of a new policy, generally, there will be a 90 days waiting period starting from the policy inception date, during which period any hospitalization charges will not be payable by the insurance companies. However, this is not applicable to any emergency hospitalization occurring due to an accident. This waiting period will not be applicable for subsequent policies on renewal.
FREE LOOK IN PERIOD
Insured person/family is allowed a period of 15(approximately) days from the date of receipt of policy to review the terms and conditions of the policy. The policy can returned during that period and refund of the premium may be claimed.
Transfer from one Insurance Company to another is also possible, the insured person must apply with details of policy and claims to the insurer as to where and whom the policy needs to be ported.
The following exclusions shall apply to the benefits admissible under this policy and No benefit shall be paid for the following circumstances and for the following conditions/ tests/ treatments:
- Pre- Existing disease, related condition(s) & complications.
- Waiting period of 90 days from the date of issuance of the policy.
- Any congenital Illness/Conditions.
- Attempted suicide (whether sane or insane) or intentionally self inflicted Injury or Illness.
- Sexually transmitted conditions, mental or nervous disorder, Acquired Immune Deficiency Syndrome (AIDS), Human Immune deficiency Virus (HIV) infection.
- Being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Medical Practitioner and taken as prescribed.
- War, invasion, act of foreign enemy, terrorism, hostilities (whether war be declared or not), civil war, rebellion, revolution.
- Any Illness or Injury directly or indirectly resulting or arising from or occurring during commission of any breach of any law by the Insured Person with any criminal intent.
List is not exhaustive and may cover some more grounds for exclusion depending on the terms of policy.
In case of any event as covered under the Policy occurs, the Policyholder or Insured (Person or Nominee) as the case may be shall notify the claim to the
Company within thirty (30) days from the date of its occurrence either through mail or fax or any other medium prescribed by the company.
All the documents related to the treatment and details of the policy should be provided within the stipulated time frame for the processing of the claim.
SETTLEMENT OF CLAIMS
On receiving the final documents or report, the claim shall be settled within a period of 30 days.
If company fails to do so, it has to pay interest above the prevalent bank rate on the outstanding amount till it is cleared.
COMPANIES PROVIDING CRITICAL ILLNESS INSURANCE
Some of the private sector companies providing Critical Illness Insurance is provided below:-
Religare Health Insurance
SBI General Insurance
There are many other companies too providing the same.
Tax Deduction is available on the premium pay for Health Insurance U/S 80D up to Rs 25,000/- for Individuals. Senior Citizen can avail deductions up to Rs 30,000/- on the premium paid.
If you have any grievance against the Insurer or any policy you can get in touch with the IRDAI on the Toll Free Number 155255 or you can also email them at email@example.com
Also Read About Mediclaim (Cashless) Insurance and Health Insurance in the links provided below:-
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