Coverage, Eligibility Criteria & Documentation of Best Critical Illness Insurance

Critical illnesses take a toll on not only your body but your finances as well. The cost of treating such conditions can get overwhelming. Investing in the best critical illness policy helps you reduce your financial burden. It assists you in managing the exorbitant treatment expenses associated with a critical illness diagnosis. Whether it is the multiple doctor visits, diagnostic tests, or undergoing rounds of surgical procedures to treat a critical illness, you can count on the high sum insured offered in critical illness insurance plans to manage the costs and get the best treatment money can buy.

Besides the hospitalisation and treatment course, you can also use the lump sum amount provided under critical illness policies to manage your living expenses while you recover from the illness. A critical illness plan is either available as a standalone plan or included as a rider with your base health plan. You can select the category based on the coverage, value-added benefits, and your preferred sum insured amount. 

Coverage Offered Under the Best Critical Illness Insurance Plans

A critical illness cover helps you manage the treatment costs of various long-term illnesses, typically requiring extensive treatment. Whether you purchase it as stand-alone policy or an additional rider, you can seek treatment for the following health conditions under critical illness plans.

• Cancers of various kinds 
• Heart attack (first time)
• Kidney failure requiring regular dialysis 
• Heart valve replacement or repair due for fixing abnormalities
• Aorta surgery via laparotomy or thoracotomy
• Open heart coronary artery bypass surgery 
• Coma of specified severity 
• Last-stage liver disease 
• Last-stage lung disease 
• Total or permanent blindness 
• Total or permanent loss of hearing
• Total or permanent loss of speech 
• Major transplantation of organs like bone marrow, lungs, liver, or heart
• Parkinson’s disease
• Motor neuron disease with permanent symptoms
• Degenerative brain disorder or Alzheimer’s disease
• Paralysis or paraplegia resulting in permanent loss of limbs 
• Multiple sclerosis 
• Major burns
• Bacterial meningitis 
• Muscular dystrophy 
• Stroke 
• Fulminant viral hepatitis 
• Aplastic anaemia 

The above list includes all the major illnesses covered under the best critical illness cover plans. The coverage is subject to variation from insurer to insurer, and you can find details of the same in the inclusions section of your policy document. 

Eligibility Criteria to Buy Critical Illness Plans 

You must be aged between 18 years to 65 years to buy a critical illness plan. If you choose to purchase this policy in your 40s or beyond, insurers may ask you to undergo a medical test and submit a report of your health condition, based on which they determine the premium amount. Other parameters for buying the best critical illness policy include being an Indian resident and meeting the documentation requirements. As for the sum insured, the amount depends on the policy provider and coverage type you choose. The critical illness standalone plan has a higher sum insured than a critical illness rider. 

Documentation Involved in Buying Critical illness policy 

You must provide the following documents handy while purchasing the best critical illness insurance plans:

• Passport sized photographs
• Age and Identity proof (Aadhaar Card/Pan Card/ Driver’s License, Passport/Voter’s ID)
• Address proof (Utility Bills/ Driver’s License/Voter’s ID/Passport/Aadhaar Card)
• Medical test reports (upon request and if you are over 40 years old). 

Best Critical Illness Insurance Plans in India 

Some of the best critical illness plans in India are as follows: 

CritiCare by Niva Bupa Health Insurance 

Niva Bupa Health Insurance gives you complete control over the claim settlement process. It allows you to file claims easily through digital solutions without third-party involvement. If you meet the requirements, the insurer processes your claim within 30 minutes. If you want coverage for critical illnesses, you can opt for a rider with comprehensive Niva Bupa health plans like the Health Premia and Niva ReAssure plans. Alternatively, you can buy Criticare, which includes the following benefits:

• Coverage for 20 critical illnesses. 
• Discount on choosing a policy tenure of two to three years. 
• Lifetime renewability where only your age and resident city are considered for renewal. 
• A cumulative bonus of up to 20% for not filing insurance claims in the initial years.
• Coverage amount ranges between ₹3 lakhs to ₹2 crores. 
• Annual health check upon renewal at no extra cost.

Critical Illness Insurance by HDFC Ergo 

Quick customer support is at the heart of HDFC Ergo General Insurance Company’s services. Their one claim-per-minute settlement rate and their rapid claim approval processing within 20 minutes with a massive network of 13,000+ hospitals for cashless treatments, make HDFC Ergo one of the best critical illness insurance providers. Other benefits of investing in HDFC Ergo’s Critical Illness Policy include:

• Comprehensive plan options – Platinum and Silver plans help you meet your specific coverage needs.
• Flexibility to choose the policy tenure of one or two years.
• Hassle-free claim settlement of lump sum amount in a single transaction.
• Coverage for 15 critical illnesses.
• Lifetime renewability.
• No medical check-ups required upon buying policies until the age of 45 years.

Health Shield by ICICI Lombard 

ICICI Lombard Health Insurance Company lets you buy health plans with minimal formalities. It allows you to buy the policy through their IL Take Care App to make the process convenient. Through the app, you can raise claims on the go and initiate hassle-free claim settlements with a vast network of 6700+ healthcare providers. For the most comprehensive coverage, you can buy Health Shield by ICICI Lombard, which has the option to add critical illness coverage. The highlights of choosing this policy are:

• Flexibility to select a sum insured ranging from ₹3 lakhs to ₹50 lakhs. 
• Coverage for an extensive range of expenses like day-care treatments, AYUSH treatments, domiciliary hospitalisation, emergency healthcare assistance, etc.
• Coverage for most critical illnesses requiring long-term treatment including cancer, cardiovascular ailments, kidney failure and dialysis, permanent paralysis, end-stage liver diseases, major organ transplants, etc.
• Coverage up to the sum insured if the sum insured is ₹10 lakhs or below. You may also choose a plan with coverage of up to 50% if the basic sum insured is more than ₹10 lakhs. 
• Coverage for organ donor expenses to a predetermined limit of ₹10 lakhs. 

Care Insurance Critical Illness Plan

Care Insurance Company offers a wide range of health plans to meet your diverse healthcare needs. With a convenient claim filing process, a high claim settlement ratio of 92.2%, and claim processing within two hours, you can expect the best support in times of medical emergencies. For the treatment of critical illnesses, Care Insurance offers the best critical illness insurance plan, which entails the following:

• Coverage of over 30 critical illnesses and conditions. 
• Financial backup to manage the pre and post-hospitalisation costs. 
• Cashless hospitalisation facility to pay for over 15 day-care treatments.
• Coverage to handle organ donor expenses, dialysis, chemotherapy, radiation therapy, and other critical illness treatment expenses.
• Psychiatric counselling online with the doctor on call facility or Care Insurance digital health portal to help you cope with recovery. 
• No claim bonus with 100% enhancement of sum insured amount over the years.
• Coverage for OPD expenses, diagnostic examinations, and pharmacy bills. 
• Option to get a second opinion from an international medical practitioner upon request. 

Tata AIG Criti Medicare Insurance 

Tata AIG General Insurance Company built quite the reputation for itself over the years with its unparalleled operations, evident through their efficient customer support, self-service options, and vast network of 7200+ hospitals across India. If you want medical protection for critical illnesses, you can opt for an add-on with the Tata AIG Medicare health plan. Another option is getting comprehensive coverage with the Tata AIG Criti Medicare plan. The highlights of this best critical illness health insurance plan are as follows:

• Coverage for up to 100 critical illnesses. 
• Option to choose between three base covers – Critical Illness, Cancer 360 Degree, and Hospital Cash. The sum insured and coverage benefits depend on the base cover you select. 
• Facility to choose an optional cover that entails wellness benefits. 

Star Criticare Health Insurance Policy

With Star Health Insurance Company, you can get medical protection for yourself and your family at an affordable premium. With its network of 13,000+ hospitals and 89.9% claim settlement record within two hours, you can rely on this best critical illness cover provider. You can benefit from their excellent customer support network and much more with Star Criticare Plus Insurance Policy, which includes:

• Coverage for nine critical illnesses specified in the policy. 
• Lump sum payment settlement processed quickly and efficiently after diagnosis. 
• Lifelong renewability facility in case of false diagnosis of a critical illness.
• Cover for critical illnesses through non-allopathic treatment up to a specified limit. 
• Coverage for hospitalisation expenses. 
• Tele-medicine service – Talk to Star, assisting with online medical consultations. 

Activ Secure by Aditya Birla Health Insurance 

Complete health management remains at the core of Aditya Birla Health Insurance Company’s health insurance plans. Besides the regular coverage, you get a means to maintain a healthy lifestyle with value-added facilities like a health coach, a chronic health management program, and the HealthReturns programme offering discounted benefits. For covering treatment costs of critical illnesses, Aditya Birla Health Insurance offers Activ Secure, which is one of the best critical illness insurance as it involves benefits like:

• Coverage for 20 to 64 critical illnesses, depending on your chosen plan type. 
• Coverage amount up to ₹1 crore based on plan type for holistic protection. 
• 150% sum insured on the diagnosis of more than one critical illness. 
• A short survival period lasting only up to 15 days. 
• Minimum entry age ranging between five to 18 years, depending on the plan you select.

Lifestyle Protection by ManipalCigna 

ManipalCigna Health Insurance is a company that promises premium health care benefits at affordable prices. Over the years, the company has built a vast network of distributors across 600+ cities in India, making their services accessible to customers in every big and small corner of the country. You can rely on this robust service with ManipalCigna’s Lifestyle Protection Critical Care Health Plan, which entails the following benefits:

• A sum insured amount ranging between ₹1 lakh to ₹25 crores.
• Coverage for 15 critical illnesses under the base plan and 30 major illnesses under the enhanced plan. 
• Option to choose between a lump sum payment or staggered payment option. 
• An additional 10% sum insured for choosing the staggered payment option, the terms of which, are mentioned in the policy document. 
• 10% discount on purchasing insurance plans covering more than two family members. 
• Premium discounts of 7.5% and 10% upon selecting a policy period of two and three years, respectively. 
• Assistance from online wellness programs for maintaining your physical well-being. 

Exclusions to Check in a Critical Illness Plan 

While most insurers offering the best critical illness cover provide all-encompassing policies covering the treatment costs of various ailments, they do not consider your claims under the following conditions: 

• Dental treatment or cosmetic surgeries.
• Illness not specified in the insurers’ policy statement. 
• Expenses pertaining to hormone replacement, infertility, or reproductive treatments. 
• Critical illness developing from internal or external congenital conditions. 
• Illnesses resulting from the usage of tobacco, drugs, or alcohol.
• Treatment of sexually transmitted diseases like HIV and AIDS. 
• Injuries or conditions resulting from self-harm
• Illnesses developed due to engagement in civil riots, war, terrorism, military, or armed forces-related operations.
• Claims filed before riding out the survival period of 15 to 30 days, per policy terms.
• Critical illnesses treated beyond the domestic borders of India. 
• Conditions developed due to any complications during pregnancy or childbirth. 

The above-mentioned exclusions are generic in nature. Insurers may modify them from time to time. Remember to review the policy terms for further clarification before purchasing the best critical illness plan. 

Reasons to Invest in the Best Critical Illness Policy 

Investing in a critical illness health plan that meets your specific needs is important due to the following reasons.

• Increasing Lifestyle Risks

Critical illnesses have become more common due to unhealthy lifestyle conditions. Hence, you are not completely immune even if you do not have a family medical history of acute illnesses. You may contract conditions like cancer, heart problems, stroke, kidney failure, etc., at any stage of life, depending on your lifestyle habits. Having a critical illness plan lets you get through the cost of treating them even if they come unannounced. 

• Income Replacement

Critical illnesses are hard to deal with because they affect you financially and compromise your ability to earn. This jeopardises your family’s financial stability if you are the primary breadwinner. Hence, you can use the best critical illness cover to recover from the loss of income besides paying for the treatment costs. You can manage the living expenses and support your family with the sum insured based on your discretion while you undergo the treatment. 

• Coverage for Rising Healthcare Costs 

The treatment of critical illnesses goes on for an extended period of time. Depending on your condition, you may undergo multiple diagnostic tests to monitor your progress. Based on this information, the doctor may recommend alternative treatments, as treating critical illnesses is not a one-time activity. The best critical illness plan helps you get through the cost of such continuous monitoring and medical expenses incurred on the same. 

• Lump sum Pay-out 

Upon being diagnosed with a critical illnesses listed in your insurers’ policy statement and riding out the survival period, you can file your insurance claim. If the medical reports and other documents prove the diagnosis, your insurer settles your claim through a lump sum pay-out. You can use the sum insured to manage the treatment costs and other expenses. 

• Cost-effective Investment 

The premium you pay on a critical illness plan is relatively small compared to the expenses associated with treating acute, long-term illnesses. Against a few thousand rupees, you can get coverage worth lakhs, or even crores. Additionally, insurers provide you with two options to purchase the best critical illness cover – as standalone policies and additional riders. You can choose your preferred plan per your affordability. 

Difference Between Critical illness insurance and Standard Health Insurance 

Consider these factors to understand how critical illness coverage differs from a standard health insurance policy 

• Coverage 

A standard health insurance policy offers medical protection to deal with costs incurred for various health complications like diseases, accidents, injuries, etc. Contrarily, a critical illness cover is specifically meant for treating illnesses mentioned in the policy documents. The coverage amount is also usable for loss of income, unlike regular health insurance plans. 

• Purpose 

You can use health insurance to weather the medical costs incurred on various medical conditions throughout the policy period. The best critical illness policy is limited to dealing with the treatment cost and other expenses relating to recovering from a diagnosed critical health condition. 

• Waiting Period

When you buy a health insurance policy, you must ride out an initial waiting period of 90 days before filing claims. In the case of critical illnesses, the waiting period ranges between two to four years. Additionally, you have to ride out a survival period of 30 days, following the diagnosis. The insurer disburses the claim amount as soon as the survival period ends. 

• Claim Settlement 

When you file a claim in a standard medical policy, the insurer verifies the hospital bills and settles your claim through reimbursement or cashless claim settlement processes. In the case of critical illness coverage, the main requirement is proving diagnosis, which may or may not involve hospitalisation. After verifying the medical records for the same, the insurer settles your claim through a lump sum pay-out.

• Sum Insured

The sum insured depends on the type of health insurance plan you choose. The same goes for the critical illness cover. The only difference is that the best critical illness policy has a relatively higher sum insured than standard health insurance plans. The reason is the high treatment cost of critical illnesses. 

• Policy Validity 

Your health insurance policy remains active until you exhaust your sum insured. You can make multiple claims during the policy period for the same. However, a critical illness plan terminates after filing a claim as the insurance company pays the sum insured in a lump sum. As the policy is no longer valid, you cannot file any further claims.