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Critical Illness FAQ

Most frequently asked questions about critical illness insurance.

Do you need critical illness insurance coverage if you already have health insurance?

Each health insurance policy has different coverages, but certain treatments for serious illnesses may not be included. Critical illness insurance will provide you with a lump sum payment, which you can use at your discretion. You can use it to take care of yourself if you have to stop working and lose your income, or you can use it to cover the medical bills. Your loved ones will also inherit a lump sum payment amount from serious illness insurance in the event that you pass away.

Critical illness insurance covers specific illnesses, which varies between insurers. Accidents that aren’t covered by regular health insurance are covered by this form of insurance as well. Some of the most common illnesses covered by critical illness insurance are stroke, heart attack, and cancer.

Key points

  • Critical illness insurance covers you for the illness that standard health insurance don’t cover.
  • Critical illness insurance provides you with a lump sum payment if you’re diagnosed with a serious illness, which you can use at your discretion.
  • Many people assume that serious illness insurance should be obtained at a later age but it is often more economically efficient to obtain while you are young.

Is it possible to make multiple claims for the same disease under critical illness cover?

No, during the policy term you can only make one application for the same disease. Once a lump sum payment is made for a specific critical condition, the policy’s coverage will immediately stop. However, future renewals will be permitted for the specific insured individual. If a policy is issued for more than one individual the policy will remain in effect for the remaining members.

What conditions are protected by critical illness insurance?

The list of illnesses covered by critical illness insurance varies from policy to policy. Cancer of a specific severity, heart attack of a specific severity, stroke resulting in lifelong medical complications and major organ transplant or bone marrow transplant are among the major diseases protected by a critical illness program. Some insurance firms offer customised packages that cover more illnesses for a lower premium.

Premiums for Critical Illness Insurance are determined by many factors, including your gender, age, smoking status, medical background, height/weight, and the amount/type of coverage you choose.

What Are the Exclusions and Waiting Periods of Critical Illness Insurance?

A critical illness plan protects a person from a serious illness that has a devastating effect on their lifestyle, financial situation and requires a significant sum of money for the treatment. The illness may also result in a loss of income due to the inability to work or the need for a long leave following the treatment care. However, it is important to read the policy terms and conditions carefully before purchasing a critical illness package as there will be exclusions. Some of the most common exclusions are:

  • Intentionally self‑inflicted injuries.
  • Illness or injury that results from elective plastic or cosmetic surgery.
  • Any disease caused either due to prolonged usage of tobacco, drugs or alcohol
  • Any diseases caused by disability from birth

A critical illness plan protects a person from a serious illness that has a devastating effect on their lifestyle, financial situation and requires a significant sum of money for the treatment.

What Documents Are Needed When Filing a Claim?

For an initial assessment of the claim, the insured must have the following documents:

  • Completed and signed claim form.
  • A medical certificate verifying the serious disease diagnosis.
  • A certificate from an attending medical professional stating that the claim is unrelated to any preexisting illness or accident as well as any illness or injury diagnosed within the first 90 days of the policy’s start date.
  • The hospital’s discharge card/death summary (if necessary).
  • Test results confirming the condition as defined in the critical illness’s description.
  • Documents specific to each critical illness are identified under the respective critical illness.
  • If a critical illness occurs as a result of an accident, a copy of the FIR or a medico-legal certificate may be requested anywhere the investigation is performed.
  • Prescriptions with pharmacy bill.
  • Any other documents that the insurance provider can request

Keep in mind that all records must be original and they must be submitted with the claim form to the insurance provider. The claim will then be processed in compliance with the policy’s terms and conditions after receiving the paperwork.

What Are the Critical Illness Insurance Claim Options?

The majority of critical illness policies have a lump sum payout option. When an insured person is diagnosed with a significant illness, a lump-sum payout is made to them.

There are two compensation choices in some serious illness insurance policies:

Lump-Sum Payment
If the insured is diagnosed with any of the covered critical illnesses, they will receive a lump sum payment equal to the sum insured. Benefit payment would be made after a 30-day survival period from the date of diagnosis of a serious condition or treatment.

Staggered Payment
In the case of a serious illness 25% of the sum insured will be paid as a lump sum and the remaining 75% and 10% additional of the sum insured will be paid in 60 equally distributed monthly instalments.

Other Types of Critical Illness Insurance

Critical Illness Insurance Guides