Critical Illness Insurance Policy

Critical illness is a serious medical condition that affects an individual’s health, lifestyle and finances. Some examples are illnesses such as cancer, sclerosis, coma, heart attack, paralysis , kidney failure, lung failure, major burns etc which leave Permanent symptoms . This insurance gives the insured a lump sum amount in case one gets diagnosed with a critical illness whereas standard health insurance policy reimburses only hospital expenses that are incurred. The number of critical illnesses covered under critical illness policy depends on the policy chosen and the Insurer. This policy is ideal for those who have a family history of a critical illness, are primary Breadwinners in the family and/or individuals with high pressure jobs.

Scope of Cover

A critical illness policy when taken standalone proves to be more beneficial than taken as a rider with a health insurance policy. An independent critical illness policy provides better, comprehensive coverage for critical illnesses as compared to a critical illness rider. Usually a 30 day waiting period will be applicable after diagnosis (depending on Insurer).

Key Features

Most important benefit of a critical illness cover is the upfront sanction of lump sum amount. Once a diagnosis certificate is submitted, the insured gets the lump sum within the chosen period of wait time or Cost of care and hospitalization expenses.
Pre-medical check-ups required for people over a certain age limit (generally 45 years).
Day care Procedures can also be covered, wherein treatment such as dialysis that can be done within a few hours will be covered.
Pre-existing diseases are not covered under this Policy.
Critical illness insurance is meant for providing cover for specific ailments only, and claims pertaining to unrelated health expenses are not payable.
Tax benefits under Section 80(D) of the Income Tax Act.
Easy documentation for making claims.
Wide range of options for Sum assured, Premium, and policy tenure
Insurable age Group: 18 years to 60 years (Varies from Insurer to Insurer).Family members can also be covered under a single plan as per policy documents. If more than one person is covered under a single critical illness policy, each member stands to receive cover once during the policy tenure.
Health insurance should be bought when young and healthy, as this directly affects the Premium asked by the Insurer for issuing Critical Illness Policy.


No coverage for 60 days (30 in some cases) after the policy is purchased. However, policy renewals are exempt from this exclusion.
Overseas treatments.
Any kind of medical treatment pertaining to pre-existing diseases.
Any medical treatment for ailments arising out of drug addiction or alcoholism.
Any instances of self-harm or suicide.
Any person who is under 5 years or is aged 60 years or more
Any critical Illness which is caused directly or indirectly or contributed to or arises from Ionizing Radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from combustion of nuclear fuel or nuclear weapon materials.
War, Invasion, Act of foreign enemy, Hostilities, Civil war, Rebellion, Revolution, Insurrection, Mutiny, Military or usurped Power, Seizure, Capture, Arrest, Restraints and Detainments of all kinds, Princes of whatever nation conditions or quality so ever.