Critical Illness Plan

Critical illnesses require immediate attention and specialist care.Illnesses like cancer, organ transplants, heart related treatments, etc. take a toll on a family’s emotional and financial health, apart from causing physiological and psychological distress.. Dealing with the related medical costs and expenses can be a nightmare. This is where the role of a critical illness plan comes into play.

Read on to find the details

What are critical illness plans?

Critical illness plans are health insurance plans designed to cover critical illnesses. A lump sum benefit, equal to the sum insured, is paid if the policyholder is diagnosed with covered critical illnesses.

What are critical illnesses?

Critical illnesses require complicated, extensive and expensive treatments. They are physiologically damaging and psychologically draining.

Features of critical illness insurance policy

Critical illness health plans have following distinctive features–

• Coverage offered

They cover specified critical illnesses. Benefit is paid only if the insured is diagnosed with a listed illness.

• Illnesses covered

A critical illness plan can cover a single illness or a combination of two or more ailments/illnesses. Some common illnesses covered by the plans include–

o Open chest Coronary Artery Bypass Graft (CABG) Surgery
o Cancer of specified severity
o First heart attack of specified severity
o A stroke causing permanent symptoms
o Multiple sclerosis causing permanent symptoms
o Major organ transplant
o Kidney failure for which regular dialysis is required
o Coma of specified severity
o Major burns
o Repair of heart valves
o Aorta surgery
o Bone marrow transplant
o Bacterial meningitis
o Muscular dystrophy
o Aplastic anaemia
o Motor neurone disease which causes permanent symptoms
o End stage liver disease

• Premiums

Since benefit is paid only in case of diagnosis of a critical illness, the premium amount is low. Claim

When the insured makes a claim for the sum insured on diagnosis of a critical illness, the plan is terminated.

• Benefit usage

Use claim amount from a critical illness insurance policy to

o Pay for advanced treatments
o repaying existing liabilities or other financial obligations
o replace loss of income when capacity to work is lost due to an illness.

• Basis of coverage

Critical illness insurance cover is offered on an individual coverage basis. Family floater plans are not available under this category. You can buy a plan to cover your family members. However, individual sum insured would be available for each member.

• Age eligibility

Adults between18 to 65 years of age can buy critical illness plans. For minor children, critical illness insurance policy is available at 5-6 years of age. Parents can buy plans for infants aged three months and above if either of the parents is already covered under the same plan.

• Sum insured

The sum insured under the critical illness insurance policy usually starts from Rs.2 lakhs or Rs.5 lakhs and goes up to Rs.10 lakhs. Most insurance companies do not offer high sum insurance.

Who offers critical illness plans?

Critical illness insurance cover is offered by both life and health insurance companies, albeit there some major differentiators. Here are some of the differences –

Critical Illness Plan Health Insurance Companies Life Insurance Companies
Term of the plan Offered for a term of one, two or three years. It is offered as an annual plan. Offered for a continuous period of 5 years or 10 years
Coverage Several critical illnesses are covered Limited critical illnesses are covered
Premiums Premiums are low Premiums might be a little higher


Critical illness vis-à-vis health insurance plans

Critical illness insurance cover is different from normal health insurance plans and given below are the major differences:

Here are some of the differences –

Features Critical Illness Insurance Cover Health Insurance Cover
Type of plan Fixed benefit plans Indemnity insurance plans
Insurance for Individuals only Self and family members
Incidence of claim Claim insurance on diagnosis of a covered critical illness Claim insurance for treatment or hospitalization of a covered illness
Sum Insured paid Lump sum amount paid on diagnosis of a covered illness Incurred medical costs up to the limit of the sum insured
Benefit Limits No usage limits – pay medical expenses or non-medical financial liabilities Pays for medical expenses supported by relevant bills
Coverage offered Provides cover against specified critical illnesses Wide coverage features including pre and post-hospitalization, ambulance costs, day care or AYUSH treatments, etc

Benefits of critical illness plans

A critical illness insurance cover provides the following benefits –

• It is a necessary cover to manage financial turmoil in case of a critical illness.

• The lump sum benefit supplements an existing health insurance cover. Avail specialised medical treatments not covered under a health insurance plan.

• Meet financial liabilities with lump sum benefit received. Create a fund for the family financial needs, education fund for a child, pay off debts, or replace lost income.

• Critical illness plan offer deduction under Section 80D up to Rs.25, 000 under the Income Tax Act. Limit increases to Rs.50, 000 for senior citizens. Also avail an additional deduction of Rs.50, 000 on buying plan for your senior citizen parents.