What Is Critical Illness Cover?
Health Insurance

What Is Critical Illness Cover?

Life–threatening diseases, cancer for example, show up uninvited. You need to make multiple hospital visits and pay astronomical prices for the treatment of such a disease. Sometimes, you may even need a particular type of treatment over an extended period of time. Under such circumstances, relying solely on a health insurance policy is not a good idea. That’s where a critical illness insurance policy can be helpful.

If you have such a policy and you are diagnosed, unfortunately, with a critical illness, then you can raise a claim. Your insurer will pay you a lump sum amount. This amount is fixed at the time of obtaining the coverage.

With the appropriate critical illness coverage in your portfolio, you can confidently battle life–threatening diseases.

Read on to know more about what is critical illness cover and how beneficial it is for you and your loved ones.

What does critical illness insurance cover?

You may ask what does critical illness cover you for? Well, each insurer has a list of critical illnesses that are covered under such a policy. Here’s a list of critical ailments that most insurers cover

  • Heart attack

  • Stroke

  • Kidney failure

  • Most types of cancers

  • Organ transplant

  • Multiple sclerosis

  • Alzheimers/ Parkinsons/ other degenerative diseases

  • Third–degree burns

  • Coma

  • Chronic lung or liver disease

  • Major trauma to the head

  • AIDS

  • Motor neuron diseases

  • Muscular dystrophy

The insurer will provide a complete list of critical illnesses covered by your policy when you sign the documents.

What is critical illness cover?

While planning to purchase a critical illness coverage policy, you should ask yourself this question: what does critical illness cover mean?

In simple terms, the specific coverage provided when you are diagnosed with a critical illness is referred to as the critical illness insurance cover. Insurance plans for critical illness are designed to give you a lump sum amount if you are diagnosed with a critical ailment. It does not matter whether you are hospitalised or not. You will receive the payment if other policy conditions are met.

Contrast this with a regular health insurance policy where the benefit can be claimed only when you are hospitalised.

What does critical illness cover include?

The critical illness cover includes a lump sum pay–out equal to the sum insured under the policy. The coverage provided by such policies is usually INR 1 lakh and above.

You can use this amount to meet the various expenses incurred during the treatment of critical illness or for your daily costs, such as paying for boarding facilities, travel, post-treatment care, etc. You can even use it to pay off any debt that you may have incurred to bear the cost of treatment, or the lifestyle changes needed to recover from the illness.

Critical illness insurance: what does it cover that your regular health insurance doesn’t?

You may be wondering if you need a separate critical illness insurance plan if you have already purchased a health insurance policy.

A regular health insurance policy may or may not cover critical illnesses. On the other hand, critical health insurance is designed for covering critical illness. A special coverage meant for critical illnesses alone.

Moreover, a health insurance policy is meant to pay off hospitalisation cost, and the amount depends on the medical expenses incurred. You have to provide copies of your medical bills along with the claim form. The health insurance policy continues to be in force if you pay the required insurance premium every year.

When you buy a critical illness insurance cover, you get paid a lump sum amount on diagnosis of any of the covered illnesses listed. The amount is paid irrespective of the actual medical expenses incurred for the treatment. You don’t need to submit any bills to the insurance company to receive the insured amount. However, once the pay–out is made, the policy lapses.

Some insurance plans also put a condition that once diagnosed with a critical illness, you must survive for 30 successive days to raise a claim. It is also common for insurers to impose a waiting period of 90 days from the date of the policy. If you are diagnosed with a critical illness during the waiting period and don’t survive, no pay-outs will be made

You can make only one claim during the policy period, whereas you can raise multiple claims under a regular health insurance plan. You can make your claim under a critical illness policy, in addition to the claim under your health insurance or Mediclaim plan

Lastly, compared to health insurance policies, critical illness insurance plans work out cheaper as you get coverage for a wide range of fatal diseases for a significantly lower premium.

Given our current lifestyle and high-stress levels, the chances of developing a life-threatening disease are higher. Apart from damaging your physical and mental health, such diseases can also haemorrhage your financial health and leave you in the lurch.

A critical illness insurance plan gives you additional security to help you tide over the immediate medical crisis. Therefore, apart from getting a health insurance policy, also consider purchasing a critical illness policy.


The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.

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