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What does Critical Illness Insurance Policy Cover?

What does Critical Illness Insurance Policy Cover

A critical illness insurance policy is a benefit that pays the insured a lump amount upon the diagnosis of a serious illness defined in the policy document. This lump-sum payment can be used to cover treatment costs, pay off debt, replace lost income, or make any required lifestyle modifications for recovery. You can be protected by a critical illness insurance policy that you purchase on your own or one that your employer provides as an optional benefit. You may also include it in your life insurance policy if you have one, which may save you money.

Critical illness insurance policies, as opposed to normal health insurance plans, cover serious and long-term diseases that necessitate costly medical care and hence come with large sum insured choices. These plans are specifically intended to compensate for income loss and treatment costs if the insured suffers from a severe illness.

Critical illness insurance policies cover certain conditions that differ by insurer. To make the greatest use of critical illness coverage in times of need, one must be well-versed in these disorders. Common critical illnesses that critical illness insurance policies usually cover are given below:

  • Alzheimer’s disease
  • Apallic syndrome
  • Benign brain tumor
  • Blindness
  • Brain surgery
  • Cancer
  • Coma
  • Goodpasture’s syndrome
  • Heart attack
  • Kidney failure
  • Major burns
  • Open chest CABG
  • Open heart replacement or repair of heart valve
  • Primary Parkinson’s disease
  • Stroke

Types of Critical Illness Health Insurance

Critical illness coverage is provided by both general insurance companies and health insurance companies in the following ways:

A standalone critical illness policy is a fixed benefit policy that provides the policyholder with full coverage. In terms of the sum insured, this is more adaptable. A medical test is necessary to be covered under this. Also, although a solo critical illness can be transferred to a similar insurance policy, a rider cannot.

A rider, also known as an add-on benefit, is an additional benefit that you may acquire voluntarily under a standard health insurance policy by paying an additional premium. The coverage in this case is determined by the base insurance from which you are purchasing a rider. However, in this scenario, the base policy’s coverage amount cannot be extended. One of the advantages of purchasing a rider is that no medical examination is required.

What does Critical Illness Insurance Cover?

Cancer, renal failure, organ transplant, multiple sclerosis, significant burns, coronary artery, coma, aorta graft surgery, coronary artery bypass surgery, paralysis, primary pulmonary arterial hypertension, and stroke are all covered under Critical Illness health Insurance. This is not a complete list, and the conditions covered vary according to the kind of critical illness health plan. Some critical illness insurance policies cover 12 illnesses, while others may cover 32 or more. A severe illness frequently develops as a result of or leads to organ failure. Failure of any vital organ necessitates a transplant. Organ transplantation is a complex surgical process in which a healthy organ is taken from one person and transplanted into the body of the person in need. It is a costly operation. As a result, be sure that your critical illness health insurance policy covers organ transplants. The best thing to do is to acquire a complete health insurance plan that includes critical illness coverage and the option of an organ transplant.

What is the difference between Critical Illness Insurance vs. Health Insurance Policy?

Regular health insurance pays for medical and out-of-pocket expenditures incurred during hospitalization. They may not cover all ailments and have long waiting times. Critical illness health insurance, on the other hand, cover life-threatening conditions like stroke and cancer and pay the insured a flat amount upon diagnosis. These plans have nothing to do with hospitalization. In addition, critical illness plans have shorter waiting periods and higher total covered amounts than standard health insurance policies.

Exclusions from Critical Illness Insurance

Exclusions vary across critical illness insurance policies. In general, these plans do not cover the following expenses:

  • Death within 30 days of diagnosis of critical illness or surgery
  • Pregnancy or childbirth-related critical illness
  • The critical illness developed by tobacco, smoking, drug intake, or alcohol, etc.
  • Illnesses caused due to terrorism, civil war, navy or military reasons
  • Any critical illness diagnosed within the waiting period
  • Any critical illness arising due to internal or external congenital disorder
  • Treatment has taken outside India
  • Any dental care or cosmetic surgery
  • Expenses related to hormone replacement treatment
  • Infertility treatment or treatment to assist reproduction
  • HIV/AIDS

This article is published in the public interest and is intended solely for informational reasons. Readers are cautioned not to depend on the article’s contents as conclusive and should do additional research or consult for purchasing health insurance.

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Written by Hardik Tokas

Hardik Tokas is a law graduate from GGSIPU, Delhi. He is an analytical thinker, an active team player who is proactive in legal research and writing, and has highly motivated enthusiasm for business, start-ups, and entrepreneurship. He has the vision to deliver excellent support to the visionary entrepreneurs and educate them in all legal compliances of applicable laws considering their business level and long term growth. He is a goal-oriented professional and a valuable member of the organization.

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