Critical Illness Insurance

There are many things in life you simply have minimal control over. Your health is one of them. In today’s world of climate and lifestyle changes, if it feels like “stressed out” is your new normal, you’re not alone.

Even if you choose a health insurance plan best suited to your requirements, you may end up facing a dearth of sufficient coverage should you get diagnosed with a critical illness. Ailments such as cancer, cardiac stroke, and paralysis, to name a few, are not encompassed by a basic health insurance policy.

In this article, we will learn how to maintain financial stability, even after suffering from a critical illness.

Let’s begin by understanding-

What is meant by a Critical Illness?

Any serious illness, sickness, disease or condition that affects the general well-being of a person, and needs treatment by a medical practitioner can be termed as a Critical Illness. In contrast to general health conditions, a critical illness often requires emergency treatment, and costs way more than the average cost of healthcare.

Here are some conditions that could be termed as critical illnesses-

Heart attack

Coma, stroke, paralysis

Organ transplants

Primary pulmonary/arterial hypertension


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What happens when you get diagnosed with a Critical Illness?

We have heard about hard-working, middle-aged people having to quit well-paying jobs - after suffering a stroke. A critical illness can occur to anyone, and can

impact their financial stability, drastically. Not only does it affect your earnings, but you will also see a rise in expenses - consultations, treatments, tests, checkups, lifestyle alterations (like the need for wheelchairs, ramp installations, automatic beds that help with movements, full-time nurses, etc.) - and many of these are not covered by a basic health insurance.

With the increase in breakthrough medical technologies, the cost of getting quality treatment is rising exponentially. In this age of medical inflation, suffering from a critical illness and getting treated for the same can really cause a huge financial distress.

So what is the solution?

A Critical Illness Policy

It pays your family a lump sum amount of money if you contract any of the serious diseases listed in the policy document. You can use this money to compensate for the loss in income during your illness and recovery. You can also fund the exorbitant medical expenses incurred during the treatment process.

What does a Critical Illness Policy cover?

It can help you cover expenses like doctor consultation fees, the cost of medicines and tests, among others. You can use the money from a critical illness policy to cover ambulance costs and room rent, along with pre and post-hospitalisation expenses. If your monthly income has been compromised due to any of the listed illnesses, the payout can also be used by your family as a substitute.

List of illnesses covered in Critical Illness Insurance Policy

Here are some major conditions that are covered across most plans-

To suit the needs of different people there are different types of health insurance plans available, such as:

  • Cancer (of specified severity based on the policy)
  • First heart attack (of specific severity based on the policy)
  • Stroke resulting in permanent symptoms
  • Open chest Coronary Artery Bypass Grafting (CABG)
  • Open heart replacement or repair of heart valves
  • Kidney failure requiring regular dialysis
  • Major organ transplant, like liver and heart valves
  • Bone marrow transplant
  • Permanent paralysis of limbs
  • Multiple Sclerosis with persisting symptoms

Let’s take an example to understand this policy better.

Suppose, Mohan is diagnosed with cancer. He has to undergo radiation therapy, bone marrow transplant, and medications. The cost of these treatments amount to Rs. 7.5 lakhs. Mohan had already bought a Critical Illness Cover for himself, with a sum assured of Rs. 7 lakhs. Hence, most of the expenses for his cancer treatment will be covered by the critical illness health insurance cover.

He just has to pay Rs. 50,000 from his pocket. If he had bought a policy with a higher sum assured, then the entire cost of healthcare would have been covered under the critical illness policy.

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What are the illnesses not covered under Critical Illness Policy?

Understanding the exclusions is as important as (if not more than) learning the list of diseases and treatments covered. Here are some examples of exclusions-

Illnesses as a result of self-injury or attempts of suicide.

Conditions caused by ionising radiation or contamination by radioactivity from nuclear fuel.

Congenital external diseases, defects, or anomalies.

Medical conditions developed as a result of substance abuse, use of illegal drugs, narcotics (unless prescribed by a medical practitioner), intoxicants, alcohol, hallucinogens, etc.

To get the detailed list of the exclusions particularly applicable to your policy, refer to your critical illness policy document.

For instance, you buy a critical illness policy and get diagnosed with hepatitis due to alcoholism. However, it is mentioned in your policy that if your illness is a result of alcohol abuse, the cover will not be valid. Hence, the costs incurred while treating hepatitis will not get paid for.

Medical bills are a common cause of bankruptcy in our country. Critical illness insurance can take away some of the financial stress, when you cannot work anymore due to a serious medical condition. It also provides flexibility, as the payout money can be used to cover a wide variety of potential needs. Take out some time to research, and choose the critical illness insurance plan that offers optimal protection, without putting a huge dent in your pocket.

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