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Critical Illness Insurance Plan

What is Critical Illness Insurance Plan

Life is full of uncertainties. Apart from the risk of death, there is a risk of illness too. There are certain illnesses like cancer, stroke, lung disease which are life threatening and may result in loss of income due to disability or severity of the disease. Treatment for such critical illnesses require a lot of money, which can cause imbalance in your savings and financial setup. Critical Illness Insurance plans provide a lumpsum fixed benefits in the event the person is diagnosed with any of the critical illnesses listed in the critical illness insurance policy. It is a fixed benefit health plan which pays out a lumpsum amount.

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Why should I Buy Critical Illness Insurance Plan?

There are various factors listed below which will illustrate the need to buy a Critical Illness Health Plan:

Shield for Huge Treatment Cost

A Critical illness insurance plan can safeguard you from an enormous and cumbersome treatment expense. Extracting such huge amounts from your regular financial kitty may storm your financial stability. It pays fixed amount opted under a plan which will help you in getting the treatment done without any worries.

Ensure Financial Back Up

A critical illness plan acts as a backup financial cover in case of adversities arising out of critical illness. The severity of critical illness is so much that it may result in loss of income due to poor health conditions and treatment costs which will make a huge hole in your pocket. With Critical Illness insurance, you may not have to pull money from your savings or other investments which you have kept for other important purposes.

Ensure Peace of Mind

A Critical Illness Plan by your side will always keep you in solace. If you are being diagnosed with any of the listed critical illnesses under your plan, you know at the back of your mind that you will get fixed benefits from your policy without attaining any financial burden.

Save you from Other Borrowings or Debts

Some real life stories depict that critical illness patients have such deterrent impact that they almost lost all their savings, investment and assets like car, jewelry, house, etc. for getting the treatment done. Also, due to the severity of illness, there is a loss of income. Such scenarios disrupt the financial equilibrium and compel anyone to take loans or debts for maintaining the finances. Critical Illness Plan safeguards you from getting into loans or debts and provide you a fixed benefit for the treatment which you may use as per your priorities.

What kinds of Critical Illness Plans can I opt from?

Critical Plans can be opted as

1. Critical Illness Plan as a Stand Alone Plan

Critical Illness plan is available as a stand alone individual policy offering critical illness benefits as a fixed payout depending upon the chosen Sum Assured in the event of diagnosis of a critical illness. Stand alone plans cover a vast list of critical illnesses which may vary from insurer to insurer. For stand alone critical illness plan the sum assured can be taken as per your requirement and budget.

2. Critical Illness Plan as an Add-on or Rider

Protection against critical illness can also be taken as an add on cover or as a rider along with the basic health insurance plan. Critical Illness rider will have restricted sum assured subject to the maximum of the base health insurance policy sum assured and cannot exceed the same. Taken as an Add on with the standard health plan, the number of critical illnesses covered are limited and not exhaustive.

What are the Benefits of Buying a Critical Illness Insurance Plan?

The benefits under the Critical Illness health plan are as follows:

Critical Illness Fixed Benefit

In the event of the insured being diagnosed with the listed Critical Illness in the plan, he/she is entitled to get the full Sum Assured under the policy irrespective of weather being hospitalized or not. There may be a loss of income because of the illness, so the lump sum amount paid by the insurer can be used for numerous purposes by the insured, such as: primarily to get the treatment for the illness, for recuperation purposes like buying recuperation utilities, to pay off any loans or debts, to manage household expenses, etc.

Tax Benefit

The Premium paid for the critical illness plan is applicable for a tax benefit under section 80D of the Income Tax Act,1961. These benefits are subject to change in tax laws.

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How is my Critical Illness Insurance Plan Premium Calculated?

Following are the key determinants for computing the premium amount for your Critical Illness Insurance Plan.


As the age progresses, the risk of getting an illness also increases. To accommodate the high risk based on the age, the insurer charges a higher premium for higher ages to provide critical illness cover.

Sum Assured

The higher amount of critical illness cover or sum assured demands higher premium. For a critical illness cover of 15 lakh, the premiums will be more as compared to the critical illness cover of 5 lakh. Higher the Sum assured, higher will be your premium amount.

Past/Present Medical Condition

The past and present medical health condition will also affect the premium under your policy.

Term of the Policy

Critical Illness policy has a minimum term of one year and can be renewed yearly to get a continuous coverage. However, some plans come with 2 years or more as a tenure and many insurers offer discounts on choosing the term as more than 1 year.

List of Common Critical Illnesses Covered under the Critical Illness Plan

1. Cancer

2. First Heart Attack

3. Coronary Artery Disease

4. Coronary Artery bypass surgery

5. Heart valve surgery

6. Stroke

7. Kidney Failure

8. Aplastic Anemia

9. End Stage Lung Disease

10. End Stage Liver Failure

11. Coma

12. Major Burns

13. Major Organ/Bone Marrow Transplantation

14. Multiple Sclerosis

(Note: The list of critical illnesses covered may vary from insurer to insurer and plan to plan)

What are Some Smart Buying Tips?

Before buying a Critical Illness Plan, check on the following parameters to make a smart buy:

Buy Adequate Cover: It is most important to take the right amount of cover under the critical illness policy. The sum assured should be assessed keeping in view the current cost for treating the major critical illnesses plus the medical inflation. Inadequate sum assured will not subsist in the adverse scenario considering the cost and expense associated with the critical illness.

Check List of Illnesses Covered: The list of critical illnesses may vary from insurer to insurer and plan to plan. Opt for the plan offering exhaustive and vast coverage of critical illnesses to provide you a comprehensive protection against numerous illnesses.

Check on Survival & Waiting Period Clauses: Look for a critical illness plan offering least surviving period conditions and waiting period time frame. Some insurers even do not have the survival clause or waiting period clause and the claim is paid immediately post the critical illness diagnose. Look out for such plans.

  • (Survival Clause states that the insured has to survive the specified number of days post diagnosis of a critical illness to get the benefits under the critical illness insurance plan. It ranges from 30 days to 60 days as per the plan and insurer.
  • Waiting Period Clause states that the insured has to wait post taking the policy to get the benefits under his/her plan. Usually, the waiting period is for 90 days, but it varies from insurer to insurer.)

Check the Sub Limits: Sublimits put a restriction on the benefits or claim amount paid for certain critical illnesses listed in the plan. Check on the plan with zero sublimits or minimal sublimits.

Buy a plan with Lifetime Renewability: Lifetime renewability allows you to renew your critical illness plan lifelong without any age bar. Choose the critical illness plan offering a lifetime renewability option rather limited renewability option.

Scrutinize the Claim related Aspects: Getting your claim, when most needed is the purpose of taking any insurance plan. This holds true for critical illness claims as well. It is important to check the important details related to the claims like claim settlement ratio of the insurer, claims procedure is simple or complex, claims payment turn around time, claims history,etc.

Compare and Buy Online: Multiple critical illness plans are available in the market, which one is the best plan offering maximum benefits can be known by comparing the plans online. Buying online is cost effective in terms of premium rather than buying offline.

What is Not included in my Health Plan?

Following are the conditions/exclusions that are not included in your Critical Illness Health Plan.

• Any claim within waiting period is not covered

• Any pre-existing diseases

• Treatment received outside India

• Medical treatment expenses for insured involved in any criminal act

• Medical Expenses related to self-inflicted injury like attempted suicide

• Medical Expenses occurring medical treatments due to alcohol or drug use

• Medical expenses for the treatment of AIDS

• Expenses related to pregnancy and childbirth

• Congenital disease

(Exclusions may differ from one insurer to another and plan to plan.)

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