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What is Critical Illness Policy?

A critical illness policy is a type of health insurance plan that offers a lump sum payout to cover critical illness treatment. Read to know what a critical illness insurance policy and its benefits is.

  • Nov 17, 2018

Before understanding critical illness plans, it will be beneficial to know the meaning of critical illness. It is a severe health condition which has an incapacitating consequence on your health and lifestyle. Generally, you need to spend huge amounts on treating such critical illnesses. You may also be unable to work due to your severe health condition.

As modern living becomes stressful, coupled with unhealthy eating habits, there is a rise in the number of people being affected by such critical illnesses. You may also face financial difficulties due to loss of income and high treatment costs.

To protect yourself and your family from financial difficulties during an emotionally stressful situation, it is important to avail yourself of a critical illness policy. This kind of critical illness insurance plan offers a lump sum payout if you are diagnosed with any of the covered health conditions. The money may be used for your treatment or to meet the daily expenses of your household.

Difference between critical illness and health plans

Often, you may confuse between health insurance and critical illness insurance. However, the former is a comprehensive plan covering hospitalization expenses for any medical condition. On the other hand, the critical illness insurance plan cover is available in case you are diagnosed with severe sicknesses, such as permanent paralysis and tumour, among others. Another difference is that to avail of benefits under a health plan, you need to be hospitalized for treatment. You may either claim your expenses by providing the bills or seek treatment at a network medical facility. Under a critical illness plan, hospitalization is not mandatory. The plan will pay a lump sum amount when you are diagnosed with the medical condition, and the money may be used as desired.

Critical illness plan inclusions

Most of the types of critical illness plans cover the following medical conditions

  • Certain specified severity cancer
  • It is a type of cancer that is distinguished by uncontrolled cell multiplication and dissemination, as well as invasion and destruction of normal tissues. Based on histological evidence of malignancy, a pathologist must confirm the diagnosis

    • First cardiac arrest

    The first occurrence of a myocardial infarction, which is the death of a piece of the heart muscle due to insufficient blood supply to the affected area, is covered under critical illness.

    Coronary artery bypass grafting (CABG)

    The real procedure of undergoing open chest surgery to repair one or more constricted or blocked coronary arteries with a coronary artery bypass graft (CABG). The diagnosis must be substantiated by coronary angiography, and surgery must be performed by a skilled medical practitioner.

    • Heart valve repair or open heart replacement

    The actual procedure of undergoing open-heart valve surgery to repair one or more heart valves as a result of flaws, anomalies, or disease-affected cardiac valves (s). The diagnosis of a ventricular anomaly must be substantiated by echocardiography, and surgery must be approved by a competent medical practitioner.

    • Stroke causing permanent damage

    Any cerebrovascular episode that results in long-term neurological consequences. This involves brain tissue infarction, thrombosis in an intracranial vessel, haemorrhage, and extracranial embolisation. A specialist medical practitioner must confirm the diagnosis, which must be supported by usual clinical symptoms as well as typical findings in a CT scan or MRI of the brain.

    • Kidney failure requiring periodic dialysis

    End-stage disease is defined as the chronic irreversible inability of both kidneys to function, which necessitates either regular renal dialysis (hemodialysis or peritoneal dialysis) or renal transplantation. A specialist medical practitioner must confirm the diagnosis.

    • Bone marrow or major organ transplant

    The real procedure of enduring a transplant of:

    • One of the following human organs: heart, lung, liver, kidney, pancreas that occurred from an irreversible end-stage failure of the relevant organ.
    • Human bone marrow using haematopoietic stem cells
    • A transplant must be approved by a specialist medical practitioner.
    • Stroke:

    Any cerebrovascular episode that results in long-term neurological consequences. This involves brain tissue infarction, thrombosis in an intracranial vessel, haemorrhage, and extracranial embolisation. A specialist medical practitioner must confirm the diagnosis, which must be supported by usual clinical symptoms as well as typical findings in a CT scan or MRI of the brain.

    • Permanent limb paralysis

    Total and irreversible loss of function of two or more limbs as a result of brain or spinal cord injury or disease A specialist medical practitioner must be present for more than three months and believe that the paralysis is permanent with no possibility of recovery.

    Several other conditions may be covered by various insurance companies. It is important you read the policy document carefully to avoid any unpleasant surprises in the future.

    Critical illness plan exclusions

    Some of the conditions that are not covered under a critical illness insurance plan are listed below:

    • Benefits will not be available for any pre-existing or related condition(s), or any complications arising therefrom, for which the Insured has been diagnosed, received medical treatment, or had signs and/or symptoms prior to the inception of the Insured’s first Policy unless such a condition is stated in the Proposal form and specifically accepted by the Insurer and endorsed thereon.
    • During the Waiting Period, the Insurer shall not be obligated to make any payment under this Policy in connection with or in respect of any Insured Event.
    • Any diseases that kill the insured during the specified Survival Period assessed from the onset of the condition.
    • Any medical operation or treatment that is not medically necessary or is not administered by a Medical Practitioner.
    • Any congenital diseases or conditions.
    • Any Covered Critical illness resulting from birth control treatments and/or hormone replacement therapy, as well as any sequelae.
    • Any treatment/surgery for gender transition or aesthetic surgery, as well as any complications/illness resulting from such treatment/surgery.
    • Other Covered Critical Illness resulting from Treatment by a Family Member and Self-Medication or any treatment that is NOT scientifically recognised.
    • Any Covered Critical Illness resulting from Treatment with Alternative Medicines such as Ayurvedic, Homeopathy, Unani, acupuncture, acupressure, osteopathy, naturopathy, chiropractic, reflexology, aromatherapy, and the like, as well as any complications developing therefrom.
    • Suicide attempt (sane or mad) or intentionally self-inflicted injury or illness
    • Sexually transmitted diseases, mental or nervous disorders, Acquired Immune Deficiency Syndrome (AIDS), and HIV infection

    Benefits of a critical illness policy

    Have you considered the consequences on your family in case you are unable to earn an income due to a serious medical condition? Moreover, how will you meet the treatment costs? A critical illness insurance plan is beneficial to deal with this situation. In addition to receiving a lump sum payout under the policy, here are other benefits of such insurance plans:

    • You receive regular health check-ups
    • The plan covers recuperation and care costs
    • The premium paid on the plan is eligible for tax benefits under section 80D of the Income Tax Act

    Factors to consider while buying a critical illness plan

    • Critical illness cover sum assured amount must be four to five times of your yearly income
    • Choose the lowest waiting period to ensure coverage commences at the earliest
    • Ensure that the policy covers a higher number of severe medical conditions
    • Opt for a plan that offers the highest age for renewal
    • Without compromising on the benefits, find a plan with the lowest premium costs

    It is important to know what is critical illness before you choose the most appropriate policy for your needs. Critical illness coverage is vital today as the number of people affected by such conditions is increasing. Moreover, due to stress, many people in the young age group are being affected by critical illnesses. Therefore, such a policy is crucial to protect you and your family against financial difficulties in case of a critical illness.

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    - A Consumer Education Initiative series by Kotak Life

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