What is Covered on Critical Illness Insurance?

Critical illness insurance is designed to offer coverage for life-threatening illnesses, such as cancer or heart disease. Unlike regular health insurance, which reimburses hospital bills, a critical illness policy provides a lump-sum payout upon the diagnosis of a listed chronic condition.

Although a standard health insurance policy provides financial assistance for medical emergencies, it is not enough to treat chronic diseases. Mostly because critical illness often requires ongoing, expensive, and long-term care that standard policies rarely cover entirely.

Which Diseases are Covered Under a Critical Illness Insurance?

• Cancer: The coverage extends beyond multiple types of cancer to include a range of serious cancer-related conditions. For example, aplastic anaemia and bone marrow transplantation.


• Heart-related conditions: Heart ailments like Myocardial Infarction (heart attack), Primary Pulmonary Hypertension (High Blood pressure), along with heart transplantation and open heart replacement, are covered in this policy.

• Brain and Nervous System-Based Illness: Neurological disorders like stroke, brain tumour, Alzheimer's disease, and Encephalitis are included in a critical illness plan.

• Major Organ Transplants: These include transplants of major organs like the heart, liver or kidney.

• Other Critical Conditions: Serious medical conditions such as coma, paralysis, blindness, or deafness are covered under this policy.

Note: The list of critical illnesses can vary across different insurance providers. Thus, always read your policy documents carefully before purchasing.

What are the Features of Critical Illness Insurance?

• Entry Age: Individuals aged between 18 years and 65 years are eligible for this policy.

• Waiting Period: Upon the first diagnosis of any covered major disease, policyholders have to serve a waiting period of 90 days.

• Survival Period: To get the policy amount, an insured person must survive for 15 days after the diagnosis of the major disease.

• Claim Limit: Only one claim is admissible under each category. However, policyholders can get the benefit up to 400% of the chosen basic sum insured as a lump sum payout.

• Waiting Period Between Conditions: In multi-claim critical illness policies, a policyholder has to serve a 12-month waiting period between the occurrence of each covered condition.

• Policy Renewal: This policy is eligible for renewal as long as at least one category remains where no claim has been made.

• Claim Limit Per Year: One claim is payable in a policy year.

• Policy Term:This policy can be availed for 1 to 3 years.

What are the Benefits of a Critical Illness Policy?

1. Flexible Financial Support

The lump-sum payout of this policy can be used for any purpose. For instance, policyholders can use it to cover non-hospitalisation expenses, such as paying off debt if they are unable to work.

2. Short Waiting Period

Critical illness policies generally include a shorter and specific waiting period of 90 days. It is usually less than standard health insurance, covering pre-existing conditions, with a waiting period of up to 36 months.

3. Tax Benefit

Under Section 80D, premiums paid for a critical illness insurance policy are eligible for tax deductions. Therefore, by purchasing a critical illness plan, policyholders can reduce their overall tax burden.

Final Words

Individuals with a high-stress lifestyle and a family history of chronic medical conditions should not overlook critical illness coverage. By providing a lump sum, it ensures financial stability during serious health emergencies.

However, to ensure all-around security, always choose a policy which lists the maximum chronic illnesses.