• Critical Illness Insurance faq

Critical Illness plan is a health insurance plan that pays a lump sum amount, equal to the sum insured, to the insured on acquiring a serious ailment such as cancer, Heart attack, stroke etc. A Crtical Illness cover provides a lump sum benefit which can pay for the cost of care and treatment, recuperation expense and even pay off any debt if taken. Regardless of your hospital expenses, the insurer pays the full sum insured. There are various pre specified plan which covers one illness and plans which covers more than one ( Kidney stone, Heart disease, Cancer etc. ). Critical Illness Insurance policies may also cover such conditions as Heart transplant, Coronary bypass surgery, Angioplasty, Kidney (Renal) failure, Major organ transplant, Paralysis etc.

Critical Illness Insurance provides you and your family, the additional financial security on diagnosis of a critical illness. The policy provides a lump sum amount which could be used for:

  • Costs of the care and treatment
  • Recuperation aids
  • Debts pay off
  • Any lost income due to a decreasing ability to earn
  • Fund for a change in lifestyle.

What is a benefit policy?

Under a benefit policy on happening of an insured event, the insurance company pays the policyholder a lump sum amount.

What are the benefits under Critical Illness Insurance?

Normally, the Insurance company will pay the Sum Insured as lump sum on first diagnosis of any one of the Critical Illness, provided that the Insured Person survives a period of 30 days from the date of the first diagnosis.

The following are normally covered Critical Illnesses with various Insurance Companies:-

  • Heart Attack (Myocardial Infarction)
  • Coronary Artery Bypass Surgery
  • Stroke
  • Cancer
  • Kidney Failure
  • Major Organ Transplantation
  • Multiple Sclerosis
  • Paralysis

However, the coverage may differ from policy to policy and hence it is important to compare the illnesses covered before buying the Critical Illness Insurance. Also, the survival period may vary from company to company.

Is there any tax benefit under Critical Illness Insurance?

Yes, you can avail uptoRs.15,000 as tax benefit under ‘Section 80D’. In case of senior citizens, you can avail uptoRs.20,000 as tax benefit under 'Section 80D'.

What does pre-existing disease mean?

Any condition, ailment or injury or related condition(s) for which insured person had signs or symptoms and/or was diagnosed and/or received medical advice/treatment within 48 months prior to your first policy with the Insurance Company.

What is meant by disease?

Disease means a pathological condition of a part, organ, or system resulting from various causes, such as infection, pathological process, or environmental stress, and characterized by an identifiable group of signs or symptoms.

What alldocuments are required at the time of the Claim?

The Insured shall arrange for submission of the following documents required for processing of claim within 45 days from the date of Intimation.

  • Duly Completed Claim Form
  • Original Discharge Summary.
  • Consultation Note/ Relevant treatment papers.
  • All relevant medical reports along with supporting invoices and doctors requisition advising the same.
  • Original and Final hospitalization bills with detailed breakup.
  • Pharmacy Bills along with prescriptions.
  • Any other documents as may be required by the Insurance Company.

On receipt of claim documents claim will be processed in accordance with the terms and conditions of the Policy.