Discovering Critical Illness Insurance Cover – An A to Z Guide

No matter how young or old you are, how rich or poor you are, how healthy or unfit you are, illnesses don’t discriminate. If you want proof of this, simply think of that famous actor whose young son was diagnosed of cancer, or that online page you saw where a young mother was trying to raise funds for her teenaged daughter’s treatment. When such an illness strikes it brings with it a world and worries, while depleting your savings at the same time. In health insurance, we call these critical illnesses and to help you face the costs associated with such illnesses, we offer a critical illness policy. Let’s find out what critical illness policy is and why you need it.

what is Critical Illness Cover?

A medical condition that typically translates to a longer-term treatment course, which can be life-threatening or fatal, is defined as a critical illness. The road to recovery from such an illness can often be long, hard, and riddled with high costs and uncertainties. Plus, you may be required to undergo surgery, or other forms of treatment for an unknown period of time. Cancer, for instance, is considered a critical illness since a patient diagnosed of cancer may need surgery, chemotherapy and radiation.

What is a Critical Illness Cover?

With its extensive treatment period, the diagnosis of a critical illness like cancer, can be physically and mental draining for the patient, emotionally draining for their loved ones, and financially draining for the family member funding the treatment costs. However, your health insurance provider allows you to eliminate this last aspect of the equation by offering a critical illness cover.

A critical illness cover or policy essentially enables you to manage the costs of treating a critical illness. Under this policy, the insurer provides the financial compensation, typically a lumpsum amount, that you can use to fund the treatment costs. Insurers may offer critical illness cover as an additional rider to an existing health insurance policy, or as a standalone policy.

How does a Critical Illness Policy work?

Let’s assume your relative has been diagnosed of a critical illness, say cancer. Their doctor has recommended surgery, followed by six rounds of chemotherapy, and possibly, radiation treatment. The patient must start the first round of chemotherapy 21 days after the surgery and maintain a gap of 21 days between each chemo session. As such, the treatment period is inconclusive.

To enable the patient to concentrate on their treatment, the insurer typically provides the sum insured as a lump sum, or as a staggered payout to the policyholder. In case of the latter, the insurer pays a fixed percentage of the sum insured as a lumpsum (generally 25%), and the remaining amounts in EMIs spread across a specific duration.

So, if your relative has a critical illness policy worth ₹20 lakhs, the insurer pays the sum insured amount, depending on their chosen payout model. However, the policyholder can file a claim only after riding out a waiting period, and an initial survival period after being diagnosed of a critical illness. The policyholder can use the insurance payout to pay for the treatment costs, as and when they come up.

Why is Critical Illness Insurance important?

Investing in critical illness insurance proves to be a wide, prudent decision for many reasons:

• A critical illness policy helps covers the costs of a wide range of illnesses which are designated as critical by the IRDAI.
• Such a policy helps you bear the high costs associated with treating long-term illnesses, which could otherwise burn a huge hole in your pockets.
• The sums insured under these policies are usually high, and you can choose to get a lump-sum payout, so you don’t have to keep filing claims at regular intervals.
• Since a critical illness diagnosis can impact your ability to work and provide for your dependents, you can use the sum insured amount to cope with your everyday expenses.
• The high sums insured under a critical illness cover empower you to afford the best medical treatment, without having to compromise.
• Ther premiums charged against critical illness insurance policies are usually low, especially if your purchase the policy when you are young, fit, and healthy.
• You can save money further since any investment in health insurance plans makes you eligible for tax deductions under section 80D of the Income Tax Act.

List of Diseases Covered Under a Critical Illness Policy

The best critical illness insurance plans typically cover you against up to 30 ailments and resulting medical conditions classified as critical by the IRDAI. The commonly covered illnesses include:

Remember to check the list of diseases covered under your health insurance with critical illness cover before purchasing the policy to ensure you are eligible for coverage against the maximum illnesses.

How to Choose the Best Critical Illness Insurance Cover?

If you wish to buy the best critical illness insurance plan with the best coverage options, you should consider these factors listed below.

• Check the Sum Insured

Since critical illnesses result in long-term, expensive treatment, you must ensure you purchase a policy with a high sum insured. You can find policies with sums insured ranging from ₹1 lakh to ₹25 Crore.

• Assess the Coverage Terms

You can never really predict which illness you may be diagnosed of in the future. As such, the wise thing to do is to select a policy that covers the maximum number of critical illnesses.

• Evaluate the Inclusions and Exclusions

Every insurance policy has a list of ailments, treatments, and costs, which the insurer covers or excludes from coverage. It is thus vital to evaluate the inclusion and exclusion under your chosen plan.

• Review The Survival Period

To file a critical illness insurance claim, you first need to survive an initial period to receive the claim amount. It thus makes sense to choose a policy with a considerably lower survival period.

• Verify the Exit Age

Most critical illness plans come with an exit age (usually 50 years), after which your coverage ceases. So, it is best to choose one with a high exit age or opt for a policy with lifelong renewability benefits.

Critical Illness Insurance: The Ideal Customers

As they say, illnesses see no caste, gender, or age. Therefore, anyone who can afford it, should buy a critical illness policy. However, if you identify with any of these below mentioned scenarios, you should most definitely invest in medical insurance with critical illness cover.

• If you have family history of critical illnesses

If your parents/their siblings have had any critical illnesses, you must invest in a critical illness plan as these illnesses usually have genetic components, enhancing your chances of being diagnosed of them.

• If your lifestyle habits are not ideal

Studies have shown that critical illnesses are common among people who work, eat, and sleep at odd hours. If this is what your daily life looks like, you must certainly invest in critical health insurance plans.

• If you work a high pressured-job

Does you often work erratic hours or have a job that requires you to meet unattainable targets or stringent deadlines? If yes, you could be susceptible to critical illnesses, and so you must get insurance.

How to Buy a Critical Illness Plan Online?

Today, you can buy critical illness insurance plans online. The steps to do so are incredibly simple, as mentioned below.

1. Research different insurers and choose the one offering the best critical illness cover.
2. Shortlist your preferred plan, submit scanned copies of the requested KYC documents, and make the payment through the insurer’s online portal.
3. Fill out the proposal form sent by the insurer and provide truthful, accurate details about your lifestyle habits (smoking, drinking), medical history, etc.
4. If requested by the insurer, be prepared to undergo a medical check-up or certain tests scheduled by them.
5. The insurer will assess whether you are eligible for critical illness insurance coverage and communicate the decision to you.

If you are deemed eligible, the insurer will send the policy documents on your e-mail and/or registered home address. If not, they will refund the premium paid by you during the purchase process.

You can also buy health insurance with critical illness cover Aoffline by visiting your chosen insurance provider’s office or nearest branch or through an insurance agent. The steps are more or less the same as the online process, except agents may charge a non-refundable fee/commission for their services.

Filing a Critical Illness Insurance Claim – The Steps To Follow

In the unfortunate event that you are diagnosed of a critical illness, your first reaction may be to panic or grief-stricken. However, if you have medical insurance with critical illness cover, you can at least stop worrying about the expenses and follow these steps to file a claim.

1. Check if the critical illness you are diagnosed of is covered under your critical illness policy.
2. Inform your insurer about your need to file a claim, along with other necessary details such as the illness diagnosed, the date of diagnosis, etc.
3. Fill out the claim form and submit the requested documents, including those proving that you have ridden out the survival period of the diagnosed illness.
4. Wait for the insurer to verify the legitimacy of your claim. It typically takes insurers anywhere from 30 days to 8 weeks to release the claim amount.
5. The insurer approves or rejects your claim based on the evidence presented, after which you will receive the claim amount in your bank account, per the details provided in the claim form.

The claim amount you shall receive will depend on whether you are eligible for a lump sum payment or a staggering payout plan.

Exclusions Under Critical Illness Insurance Policy

Although your critical illness policy; offers extensive coverage against various life-threatening illnesses, claim filed under the following circumstances are outside the scope of coverage:

• Illnesses resulting from lifestyle habits like smoking, drug abuse, alcohol consumption, etc.
• Illnesses caused as a result of congenital disorders.
• Critical illnesses diagnosed before the policyholder rides out the waiting period.
• Claims filed before riding out the survival period after a critical illness is diagnosed.
• Illnesses/medical conditions resulting from incidents of human strife like war, terrorism, etc.
• Reproduction-related assistance, fertility and hormone replacement treatments.
• Cosmetic enhancement surgeries not deemed medically necessary.
• Treatments for critical illnesses obtained outside Indian borders

Prepare For the Unexpected – Invest in Critical Illness Plans with Manipal Cigna Health Insurance

The odd thing about critical illnesses is that we often know someone suffering from a critical disease but seldom expect ourselves to be in their situation. But there’s no telling when such an illness can creep up on you. So, it is always best to prepare in advance and invest in a good critical illness policy. At Manipal Cigna, we offer some of the best critical illness insurance plans with sums insured ranging from ₹1 lakh to ₹25 Crores. What’s more, we provide online services – from buying policies to filing claims. You can visit our website and choose from a range of critical and general health insurance plans.

Safeguard your finances and your health with Manipal Cigna Critical Illness Insurance Plans.