Analyse coverage, waiting period clause before choosing critical illness cover

Health Insurances

The importance of health insurance has gone up substantially now with the rampant rise in ailments and the expenditure to treat the same. An adequate health insurance plan not only offers you the cover for hospitalization expenses during the treatment of the ailment but also makes you mentally calm and secured.

You must get the cover for critical illnesses like cardiovascular disease or cancer, which are on a rampant rise in India due to the poor lifestyle exhibited by the people here. Health insurers do offer critical illness plans to the customers. But before choosing such plans, you must know their operational methodology, what's covered, how much is covered, waiting period clause and many more. We, in this article, will keep our eyes firmly on critical illness plans of the health insurance policy.

Critical Illness Cover

The operation of critical illness is different from that of a mediclaim policy. With critical illness cover, the insured gets the lump sum amount from the health insurer after he/she gets caught with a serious disease or condition. The lump sum can be utilized for making payment for the cost of care and treatment, as well as the expenses on recuperation. The insurer pays the entire sum assured amount to the insured irrespective of the hospitalization expenses.

Critical illness insurance is provided mainly for conditions like cancer, heart attack and stroke. The other ailments covered under critical illness plans include

  • Heart transplant
  • Kidney failure requiring frequent dialysis
  • Major organ transplantation
  • Permanent paralysis of limbs
  • Motor neuron disease
  • Speech loss
  • End stage liver & lung disease
  • Viral Hepatitis
  • Deafness
  • Major burns
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How Much Cover Amount You Should Look For?

The treatment cost of critical illnesses is generally over Rs 1 lac. In the absence of cover, you may have to borrow the money from your friends or relatives to get yourself treated. But since the amount is big, you may fall short of the requirements. So, you must have the critical illness cover in your health insurance policy. Ideally, you should choose the policy based on factors such as your age, profession, family's medical history, medical inflation, etc. One should always look for higher sum assured amount so that they can get the wider coverage. Something in the range of Rs 15-20 lacs would be good.

Be Mindful of Waiting Period Clause

As per the critical illness cover, the insured is required to survive for 30 successive days post the diagnosis of the critical illness so that he/she can make the claim. Also, one has to contend with the waiting period, which is generally 90 days from the start of the policy. If you are diagnosed with critical illness within the initial 90 days and succumb to death within 30 days post the diagnosis of the same, then you will not get the coverage.

How Can You Buy Critical Illness Plan?

You can purchase critical illness plan from a general insurance company or a pure health insurance provider or even from a life insurance firm. General insurance or standalone health insurance companies can allow you to add critical illness plan to the base mediclaim plan. These companies may also provide critical plans exclusively for women. While in life insurance companies, critical illness cover is available seprately. These companies can add the critical illness as a rider to the base plan. If that is the case, then you may see the emergence of two situations. First, the continuation of the base policy post the utilization of rider. Second, the end of the base policy if the CI rider is utilized anytime during the term of the policy.

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Advantages of Critical Illness Cover

  • Offers cover for the cost of care and recuperation
  • Tax benefits under section 80D of the Income Tax Act
  • Free health check ups

Shortcomings

  • The critical illness plan does not reimburse the expenses incurred on hospitalization. Therefore, you need to have a mediclaim policy that can pay for your hospital bills.
  • The terms and conditions of critical illness cover can be stringent. You can be made to get the diagnosis done from a particular physician or may have to undergo a specific test for the confirmation of the illness. It is only after you meet these requirements, the claim can be settled.

It is indeed necessary to have a proper critical illness insurance plan with higher sum assured amount to get enhanced coverage. Keep an eye on the policy details like what's covered and what's not to clear out the confusion that you may have with regards to the critical illness plan. If you can afford higher premium, then you can buy separate critical illness cover for you and your spouse.