Critical Illness Insurance

You might debate that as you are covered in a comprehensive health insurance plan and also under a group medical policy offered by your employer, you do not require any additional coverage. Well, yes, but any critical illness calls for specialized treatment & care and as your comprehensive health plan has limitations on hospitalization, doctors' fees, etc. it will not cover the entire medical expense towards treatment.

According to the World Health Organization (WHO), Cardiovascular Diseases, Cancer, Stroke, and Chronic Obstructive Pulmonary Diseases are significant health ailments in India that require critical illness coverage.

The minimum entry age to purchase this critical illness and disability insurance rider is 18 years and max age is 65. Both male and female buyers can opt for the critical illness cover at the same premium rates while purchasing a base life insurance plan.

Any major sickness or illness can have a debilitating effect on the patient’s life. It leads to huge medical treatment costs and the same time leaves the family members shattered both emotionally as well as financially. At such circumstances, a Critical Illness Insurance comes as a real saviour, guaranteeing financial protection whenever there is shortage of funds for getting the patient treated. Here, the insurance company offers an amount in lump sum in case the insured gets diagnosed with any of the critical illnesses mentioned in the policy document. Covering the medical costs of the patient as well as the day-to-day expenses of the family members would be taken care by the Critical Illness Insurance Plan.

Mentioned below are the factors that you need to keep in mind to select the best critical illness insurance:

• Coverage: It makes sense to opt for a product that provides maximum coverage. Here, it is important that you figure out the number of critical illnesses that are covered under the plan. The more coverage for illnesses, the better the insurance policy.
• Total Ailments Covered: One of the first few things you need to consider before freezing on any Critical Illness insurance is to check the total critical ailments covered by the policy. While some plans like HDFC Ergo Critical Illness Insurance covers 8 critical ailments, Religare Assure plan covers as many as 20 major illnesses. Hence, it’s imperative to properly research the plans before finalizing on one.
• Built-in Coverage: While the critical Illness plan is aimed to provide financial armor against the detection of any major life threatening disease, some insurance companies offer several built in coverages. Personal Accident Cover, Child Education Benefit, Hospital Cash, Complementary Health Checkup, etc. are some of them so that your loved ones are least affected in situations you are incapable of supporting them financially, as the illness strikes.
• Pre-existing Disease: While some plans will cover any pre-existing diseases after a waiting period of 48 months, plans like Religare Assure does not cover them at all. Hence, one need to do a careful assessment on what’s covered in pre-existing clause.
• Free-look: Mostly, all insurance companies offer a free-look period of 15 days to review your decision. During this period, if you find the plan unsuitable to your needs, you can request for cancellation and subsequent refund.
• Tax Benefit: As per the prevailing rates of the Income Tax Act, 1961 (u/s 80D), you can avail the tax benefit on the premium you pay towards the premium.
• Survival & Waiting Period: Usually critical illness policies have a survival clause of 30 days from the date of diagnosis for the person who is insured. A waiting period of 90 days too should be adhered from the beginning of the insurance policy. Also, there is a waiting period for the pre-existing diseases which is around 3 to 4 years. Opt for the critical illness cover that has a limited waiting and survival period.
• Sum Assured: Opt for a critical illness cover that offers a cover of that sum assured you wish to opt for in case of an emergency.
• Incurred Claim Ratio: Insurer’s keeping up their promises to settle your claim on-time and hassle-free is what you should be looking for. Incurred Claim Ratio is what you should look out for while opting for a good critical illness health insurance.

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The Below Documents Would Be Required For Applying For A Critical Illness insurance Plan:

• Age Proof: The age proof can be any of these – Driving license, School/college certificate, Passport, PAN card, Birth Certificate.
• Identity Proof: Voter ID, driving license, PAN card or Aadhar card can be used an identity proof.
• Address Proof: Electricity bill, Bank account statement can be presented as the proof of address.
• Income Proof
• Duly Filled Proposal Form

Documents Requirement to Claim under Critical Illness Insurance Policy

To Initiate The Claim, The Insured Should Offer The Below Documents For The Initial Assessment Of The Claim:

• Duly filled and signed claim form
• Medical Certificate confirming the diagnosis of Critical Illness
• A medical certificate, investigation test report, etc. from an attending Medical Practitioner authorising that the claim does not relate to any Pre-existing conditions or any Illness or Injury which was diagnosed within the first 90days of the inception of the Policy.
• Discharge Card/ Death Summary from the hospital, if applicable
• First Consultation letter and subsequent prescriptions
• Specific documents listed under the respective critical illness
• Know your client doc (KYC)
• In the case critical illness arises due to an accident, FIR copy would be required.
• Other medical or Pharmacy Bills along with the required prescriptions