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Critical Illness Insurance

Critical illness insurance provides additional financial security in the event of serious medical emergencies, such as cancer, heart disease, stroke, or organ transplant, allowing policyholders to concentrate on getting well rather than worrying about how they will pay for treatment. ...Read More

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Critical Illness Insurance
Francis Rodrigues Francis Rodrigues

Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.

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Vishal Subharwal Vishal Subharwal

Vishal Subharwal heads the Strategy, Marketing, E-Commerce, Digital Business & Sustainability initiatives at HDFC Life. He is responsible for crafting and ensuring successful implementation of the overall organisation strategy.

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What is Critical Illness Insurance Cover?

image-star image-star image-star image-star image-star image-star image-cloud image-cloud image-cloud moon Critical Illness Insurance Cover?

Critical illness insurance financially covers cancer, stroke, renal failure, and a host of other serious illnesses and lifestyle-related conditions. Since critical diseases require extensive care, they may affect your finances. Critical illness coverage is available as an add-on rider with term insurance plans.

Because severe diseases affect the central nervous system, respiratory system, heart, and other essential organs, critical illness insurance is essential. Negligence and a lack of preventative health screenings lead to the accumulation of illnesses that need extensive treatment. With a critical illness policy, you won't have to worry about how you'll pay for treatment.

Who Can Buy Critical Illness Insurance Cover?

So, who all buy critical illness insurance coverage? This critical insurance requires a minimum entrance age of 18 years. When buying a basic life insurance policy, male and female policyholders have equal access to the critical illness coverage option. Furthermore, the following groups of persons would benefit greatly from Critical Illness Insurance:


Individuals with a Family History of Critical Illness

There is no way to prevent being sick. However, a diagnosis is more likely when serious diseases run in the family. As a result, when you get basic insurance coverage, think about your family's medical background. It is strongly advised that you get critical illness insurance if you become aware of any such critical sickness case. This guarantees you are fully protected financially and medically if the need ever comes.


Main Earners

Your family expects you to shoulder more than health expenses if you're the main earner. Your future is jam-packed with costs. Spending all your money on top-notch medical care in the event of a serious sickness is the last thing you need. So, to get the most out of your term insurance coverage, critical illness insurance is a must.


Individuals with Demanding Jobs

Although few people understand it, stress is a major contributor to a wide range of health problems. Stress may cause or worsen heart problems. Critical sickness insurance is a good investment, so consider getting it if your job is stressful and high-pressure.


Individuals Aged 40 and Above

Some health problems become more common as people age. If you are over 40 and in good health, you should still consider getting a critical illness insurance rider just in case.

What are the Features of Critical Illness Insurance Plans?

So, what features of Critical Illness Insurance Plans are vital? The features of critical illness policy include: 


Critical Illness Coverage

Major operations, cancer, heart attacks, strokes, organ failure, and a host of other serious medical issues are usually covered by critical illness policy. These plans provide coverage for the expenses of diagnosis, treatment, and recovery from various serious diseases, offering financial security.


Lump-sum Payment

The insurance company pays out a lump amount to policyholders when they are diagnosed with a covered critical disease. Critical illness cover, in contrast to other forms of insurance, pays out a fixed amount regardless of how much it really costs to treat the insured. Policyholders are given the freedom to utilise this lump amount as they see fit, whether it's to pay for medical expenditures, pay for alternative therapies, handle home expenses, or save up for lifestyle changes while they're recovering.


Affordable Premiums

By keeping premiums low, critical illness insurance plans aim to cover a large population. Critical illness insurance usually has a lower price tag than other forms of insurance, including disability or comprehensive health. Because of its affordability, people may acquire the protection they need from the financially devastating costs of serious diseases without breaking the bank.


Easy Claim Process

Insurance companies work hard to simplify the critical illness coverage claim procedure so that customers have as little paperwork and administrative burden as possible during this difficult time. Policyholders may get the financial help they need to deal with the difficulties of a critical disease diagnosis quickly thanks to an easier and faster claims procedure. The submission of documents must adhere to certain rules, claims must be processed efficiently, and customer assistance must be prompt in order to answer any questions or issues that may arise.

What are the Advantages of Critical Illness Insurance Cover?

To know more about what advantages of critical illness insurance are important, check the list below:


Provides Coverage for life-Threatening Illnesses

Critical illness insurance provides full coverage for a set of medical disorders that are considered life-threatening. Serious diseases and conditions, including cancer, cardiovascular disease, stroke, and organ transplants, may have a devastating effect on a person's well-being and standard of living. Critical illness cover helps policyholders pay for the expensive medical treatment, rehabilitation, and continuing care of these disorders by giving a lump sum payment.


Offers Tax Advantages

You may be able to claim a tax deduction or other financial incentive for paying for critical health insurance. Because of this tax benefit, people are encouraged to have critical illness coverage in their entire financial plans. Decreasing the tax burden connected with insurance payments can maximise coverage value while potentially enjoying savings on yearly tax responsibilities.


Provides a Lump Sum for Treatment

A lump sum payout upon diagnosis of a covered illness is one of the main benefits of critical health insurance. The policyholder receives a one-time payment that they may utilise for anything relating to their medical care and rehabilitation. The convenience of a one-time payment allows for managing healthcare costs by personal priorities and requirements, whether they pertain to hospital bills, expert consultations, prescription drugs, or home healthcare services.


Provides Shorter Waiting Periods

A critical illness insurance policy often has a shorter waiting time before coverage starts for certain diseases, unlike regular term insurance policies. Therefore, policyholders may get their hands on medical care and financial assistance more quickly following a covered critical illness diagnosis rather than waiting for a long time. Critical illness coverage is more useful in delivering timely help when it's most required when waiting times are shorter.


Provides Accidental Death Benefits

Some critical illness insurance plans go above and above by also covering accidental death payouts in case the insured passes away unexpectedly. If the insured dies due to an accident or injury, these benefits will financially protect their beneficiaries. Accidental death benefits provide additional peace of mind by expanding coverage to unexpected events that may cause loss of life. However, the main purpose of critical illness insurance is to assist with severe sickness.


Additional Support on Top of Term Insurance

When standard term insurance policies don't cover the full cost of a serious illness, critical illness insurance may help offset the financial burden. In contrast to standard term insurance, critical illness insurance pays out a flat amount to cover medical bills. This might help fill in coverage gaps or enhance current insurance. No matter the restrictions of a policyholder's main term insurance, this supplemental coverage guarantees access to full financial protection in the event of a major sickness.


Funding for Expensive Treatments

Critical illness insurance's lump sum payment might be a lifesaver when paying for pricey medical procedures that regular term insurance policies might not cover in full. Some life-threatening diseases may need unconventional approaches to therapy, such as cutting-edge therapies, experimental treatments, specialist pharmaceuticals, or even alternative medicine. Policyholders may get the care they need to achieve the greatest potential health results without financial obstacles with critical illness insurance, which provides the financial means to seek the most suitable and sophisticated therapies.


Protection Against Disability

Insurance for critical illnesses not only helps pay for medical care but also protects against things like lost wages and higher healthcare costs if you become disabled due to a covered critical disease. 
Critical illness coverage may assist in paying for living expenses, continuing medical bills, and other financial responsibilities if a policyholder becomes incapacitated due to a covered condition and cannot work or perform everyday activities. Offering peace of mind and security to policyholders and their loved ones, this disability insurance guarantees that policyholders may preserve financial stability and quality of life even in serious health issues.

Advantages of Critical illness insurance Advantages of Critical illness insurance

How to Select an Ideal Critical Illness Insurance Cover?



Sum Insured

 A lump sum amount equal to the sum insured

Waiting Period

 Initial 30 days from the policy start date

Survival Period

The period a policyholder must survive after the diagnosis of a critical illness to be eligible for the claim. Generally, it ranges from 30 to 90 days.

Number of Disease Covered

 8-36 illnesses, depending on the provider

Renewability Age

 Either maximum age or lifelong renewability

Inclusions and Exclusions

 Understand what the policy covers (inclusions) and what is not covered (exclusions). Pay attention to pre-existing conditions, waiting periods, and specific illnesses excluded from coverage.

Critical Illness Insurance Plan vs. Health Insurance Plan


Critical Illness Insurance Plan

Health Insurance Plans


Offers a one-time payment in the event of a covered serious disease diagnosis. Critical illness treatment is eligible for the financial aid that is provided.

Hospitalisation, operations, prescription drugs, and preventative care are all covered. Its stated goal is to address a wider range of healthcare requirements.


Hospitalisation is not necessary to benefit from the coverage. Simply providing a diagnosis will get you a lump sum amount.

Insured patients may receive their money back when they submit their hospital bills. They may also use the cashless option at hospitals in the network.


Pays out in the event of a covered catastrophic sickness, such as cancer, heart disease, stroke, etc. Up to 36 serious diseases may be covered.

It provides extensive protection for a variety of medical costs, including inpatient stays, outpatient procedures, prescription drugs, doctor visits, and diagnostic testing. Both life-threatening and less serious medical issues are covered.

Waiting Period

How long you have to wait to get treatment is proportional to how severe your sickness is.

Thirty days is the waiting time in health insurance plans.

What illnesses are covered by critical illness insurance?

Typically, critical illness insurance will pay for a set of serious medical issues that are either life-threatening or significantly detrimental to a person's health and well-being. Critical illness insurance often pays for the following frequent illnesses:

  • Cancer
  • Acute coronary syndrome 
  • Systemic illness (such as renal failure)
  • Cardiovascular revascularization
  • Transplantation of an organ

These are just a few of the many instances; the diseases covered could differ from one insurance company to another and from one policy to another.

What Illnesses are Not Covered in Critical Illness Insurance?

A variety of significant medical diseases are covered by critical illness insurance. However, specific illnesses and scenarios are usually not covered. Among them could be:

  • Coverage may not extend to illnesses or medical problems that existed before the purchase of the insurance policy.
  • Critical illness insurance is usually designed to cover diseases that are considered serious. Critical illness coverage could not pay for common or minor medical issues.
  • Coverage may not apply to injuries or diseases that are the direct consequence of reckless or purposeful self-harm.
  • Some critical illness insurance plans may not cover certain cancers, especially those with poor prognosis or a modest growth rate.
  • Coverage may not apply to illnesses or injuries sustained in hazardous activities or jobs.

Steps to Buy Critical Illness Coverage

Follow the steps below to buy illness coverage in the following ways:

  • Obtaining critical illness coverage begins with determining the premium for a life insurance policy based on your desired amount assured and policy duration using the online calculator.
  • After selecting the basic policy, choose the Critical Illness and Disability rider to add additional critical illness coverage. This rider's critical illness coverage can help you financially in case you are disabled or have a serious illness diagnosis. You can avail of these additional coverage benefits by paying a little more.
  • Once you've chosen a plan that includes critical illness coverage, add your personal details and make the premium payment.
  • An extended version of your application form, the critical illness cover proposal form, asks for your medical history, smoking habits, and other lifestyle factors.
  • A medical evaluation, taking into account the individual's life risks, may be recommended prior to providing critical illness coverage. Once the proposal form and supporting documents have been submitted, a medical examination will be carried out.

How to File a Claim for a Critical Illness Insurance Policy?

So, how to file a claim for a critical illness policy? A diagnostic report is all needed to process a claim for critical illness. It is necessary to get in touch with your insurance company and initiate the claim process in order to submit a critical illness policy claim. Here are the items you'll need to submit a claim with your critical illness insurance policy:

  • Fill your critical illness insurance claim form.
  • A photocopy of your government-issued photo ID together with your NEFT information or a copy of a voided bank check
  • Every document collected before and after a patient's hospital stay
  • The present diagnosis's associated consultation records
  • Every diagnostic test and medical record that backs up the diagnosis

Under the terms and conditions of the critical illness policy, you will get the claim payout after the insurance company has confirmed the facts.

Documents Required to File Critical Illness Insurance Claim

Here are the necessary documents to submit a claim for critical illness insurance

  • Reimbursement Request Form
  • Completed and signed claim paperwork
  • Medical Documentation
  • Proof of a critical illness diagnosis in the form of a medical certificate
  • Official Document from Doctor
  • The results of any diagnostic tests that back up the patient's critical disease diagnosis; A letter outlining the first consultation and any necessary medications;
  • Identity Verification Paperwork

Need for Critical Illness Cover

The importance of critical illness insurance has grown in today's unpredictable and fast-paced society. Sudden onset of life-threatening diseases, including cancer, cardiovascular disease, cerebrovascular accident, or organ failure, may devastate a person's physical and financial well-being. Critical diseases, in contrast to less serious conditions that may be covered by regular term insurance, sometimes need protracted hospital stays, rehabilitation, and other costly medical procedures, which may swiftly drain funds and burden finances.

Critical illness insurance mitigates this substantial financial risk by paying out a large amount to policyholders in the event of a covered critical disease diagnosis. This one-time payment provides much-needed financial support at a critical juncture, letting recipients concentrate on getting well rather than stressing how they will pay for treatment. You will be able to stay self-sufficient and flexible in case you need extensive healthcare, including specialist treatments, experimental therapies, prescriptions, or modifying your housing to live with a disability.

Furthermore, critical illness insurance defends people and their family members against huge financial losses due to long-term illness or inability to work. It gives policyholders the opportunity to concentrate on their health by eliminating financial pressures, permitting them to receive outstanding medical care and rehabilitation resources. 

Also, getting enough insurance is necessary because of the growing healthcare expenditures and the increasing regularity of serious diseases. Through critical illness insurance, people can sleep well, get stronger, and face life's uncertainties with confidence, knowing that they can handle any unprecedented health issues that may arise without experiencing financial or mental stress. 

Why Should You Buy a Critical Illness Cover Even If You Already Have a Mediclaim Plan?

Many individuals mistakenly believe that health insurance covers their medical needs. Most people think that critical illness coverage and Mediclaim are interchangeable terms. Nevertheless, this is not based on reality.

A critical illness policy provides a one-time payout as an alternative to insurance. This means it can only be used in the most dire circumstances, when the expense of therapy would be prohibitive. When your health insurance won't cover a serious sickness, and you'll need to pay a large amount quickly, critical illness coverage is a good choice.

Unless specifically excluded, a Mediclaim policy will pay for a patient's pre- and post-hospitalization expenses, regardless of how serious their condition is. On the other hand, critical sickness insurance is better suited if the policyholder has a severe illness requiring a lengthy hospital stay. Expenses related to treatment and follow-up care, as well as income loss and lifestyle adjustments, are covered in one lump payment.

FAQs on Critical Illness Insurance

1 What does the critical illness insurance cover?

Major surgeries, cancer, heart attacks, strokes, organ failure, and a long list of other serious medical issues are all covered by critical illness insurance. After a covered critical disease is diagnosed, it pays out in a lump amount.

2 What is the critical illness benefit of term insurance?

You may be covered under the critical illness benefit for some severe conditions specified in your term insurance policy. This benefit provides a lump sum payout to aid policyholders in handling medical bills and other financial responsibilities while they are getting well.

3 Is it worth getting critical illness insurance?

If you are worried about how a severe sickness could affect your finances, critical illness insurance is something you should look into. In times of financial hardship, it helps keep you afloat by providing protection against potentially catastrophic medical expenses.

4 What are the key features of critical illness insurance?

Some of the key elements of critical illness insurance are coverage for certain severe diseases, a lump sum payout upon diagnosis, low premiums, an uncomplicated claim procedure, and extra benefits like tax breaks and accidental death benefits.

5 How much critical illness coverage do I need?

Personal health risk factors, medical history, financial responsibilities, and expected medical costs are some of the variables that determine the appropriate level of critical illness coverage. Consult an insurance expert to determine your individual requirements.

6 What are the documents required for critical illness insurance?

The papers needed for critical illness insurance usually include evidence of identity, medical records, test results, and any other pertinent medical paperwork that the insurance company specifies.

7 Can I get critical illness coverage after cancer?

The insurance company's underwriting standards, the kind and stage of the disease, the results of the therapy, and other variables determine whether critical illness coverage is available after cancer. Nevertheless, prices and coverage conditions could differ.

8 Is Critical Illness Insurance Cover Expensive?

Age, health condition, coverage quantity, insurance provider, and other variables all play a role in determining the cost of critical illness insurance. Critical illness coverage provides financial protection that may be worth the higher rates compared to other kinds of insurance.

9 Are Medical Tests Important to Get Critical Illness Cover?

Underwriting for critical illness insurance may include medical testing, particularly for older applicants or those seeking larger coverage levels. The results of these exams provide the insurance company with a better idea of the applicant's health and risk.

10 What are the Eligibility Criteria for Purchasing Critical Illness Insurance?

To get critical illness insurance, you need to be between the ages of 18 and 65, in excellent health, and follow the underwriting rules set forth by the insurance company. The conditions of coverage could change depending on the specifics of each case, and applicants might be subject to medical underwriting.

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