Critical Illness Insurance Policy


Critical Illness Insurance Policy: In this plan, the insured receives a lump sum amount within a few days of diagnosing a critical illness, Once this lump sum is paid, the plan ceases to exist.

Some insurers insist on the insured surviving for a pre-defined period (typically 30 days) post-diagnosis before they honor the claim.


Some insurers offer critical illness plans with the alternative option of receiving claims payment in installments over a period of 5 years (the choice needs to be made at the time of making the claim). Such policies provide long term cover of 10 years to 30 years.


Typically, once a claim has been made no more premiums have to be paid and the plan ceases. However, some insurers provide the insured with a choice of continuing the plan for the remaining critical illnesses for a lower sum assured and revised premium rates.


Illnesses covered by Critical Illness plans


Typically, a critical illness plan would provide cover for the below mentioned illnesses:

Aorta graft surgery
Coronary artery bypass surgery
First heart attack
Kidney failure
Major organ transplant
Multiple sclerosis
Primary pulmonary arterial hypertension


When does the Critical Illness plan not cover the illnesses?

The critical illness plan will not offer coverage if the insured person has been suffering from the specified illnesses at the time of purchasing the insurance policy or if care, treatment, or advice was recommended.

Further, coverage is not offered if she/he is diagnosed with a specified critical illness within a period of 90 days to 120 days from the commencement of the policy.


A number of exclusions are applicable to the critical illness plan:

Death within 30 days following the diagnosis of a critical illness.
Absence of submission of a doctor’s medical certificate confirming the diagnosis of illness/injury or underwent medical/surgical procedure.
Any congenital illness or condition.
Any medical procedure or treatment not medically necessary, not performed by a doctor, treated by family member.
Self-medication or any treatment that is not scientifically recognized.
Treatment relating to birth defects and external congenital Illnesses.
Birth control procedures and hormone replacement therapy.
Any treatment/surgery for change of sex or any cosmetic surgery or treatment
Presence of HIV/AIDS infection.
Naval or military operations of the armed forces or air force requiring the use of arms
Consequential losses of any kind, be they by way of loss of profit, loss of opportunity, loss of gain, business interruption etc.


List of some Critical Illness Insurance Providers:

ICICI Lombard
Apollo DKV
National Insurance
Reliance Health Insurance
Tata Aig Health Insurance
Star Health Insurance
Oriental Health Insurance
New India Assurance


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