What is critical Illness and the policy conditions you should be aware of

Critical illness means any kind of acute illness like heart attack or stroke, partial and total paralysis and organ transplants that not only demand immediate medical care but also prove to be a huge financial burden for the respective patient and his family. With the lifestyle changes in today’s world, these illnesses are not only limited to ageing people. People as young as 30 years are suffering from heart stroke and kidney failure.

These critical illnesses require a large amount as treatment and recuperation expenses. A normal health plan or a group health policy is insufficient in such a case. This is because these indemnity plans cover only the hospitalisation expenses and have a cap on the amount that can be given for one hospitalisation. Any loss of income and payment of debts, transportation expenses to carry the patient for the treatment of the critical illness is not covered under these health plans. If the patient is the sole breadwinner of the family, the problem further accelerates.

To provide some relief, there is a critical illness insurance policy to cover such expenses. This cover provides a lump sum amount or the sum assured if any critical illness is diagnosed. This amount can be availed irrespective of whether the patient has been hospitalised or not and whether the treatment expenses are close enough to the amount thus received. So, unlike a normal health plan, one doesn’t need to show any proofs to avail the benefits of a critical illness policy.

The policy is available both as a rider and a standalone policy. Generally, people opt for a rider plan as it is economical and easy to manage as well. However, a standalone policy, though expensive, has other benefits as it does not require one to constantly renew his basic health policy to keep alive the critical illness cover that comes along with it. It also gives one the option of availing a higher sum assured unlike in case of a rider plan in which the sum assured is limited within the whole policy limit.

Standalone or otherwise; every insurer offers different provisions in the critical illness insurance policy.

While choosing the best plan to suit one’s requirements, one needs to be aware of the various conditions governing the policy chosen. Let’s have a look at some of the important factors that one should be aware of before choosing a critical illness cover:

  1. Survival Clause:

Though this policy promises to offer a lump sum amount upon the diagnosis of the disease; irrespective of any proofs or hospitalisation; there may still be an obstacle to receive the sum assured immediately. Some insurers have a survival clause attached to the policy. This is generally of 30 days. It requires that the patient must survive for at least 30 days after the diagnosis of the disease in order to make a claim. If the patient is not able to survive during this period, the policy is lapsed and no benefit can be availed of it.

So, you need to be aware of such clause before you nod to a critical illness cover being offered.

  1. Scope of coverage:

A critical illness insurance policy is considered to be cost-effective as compared to a normal health plan. This is because a health insurance policy has a wider range of coverage in terms of the diseases that it covers. On the other hand, a critical illness insurance policy covers certain specific diseases that may vary from about 8 to 20 illnesses; depending on the insurer.

So, you need to decide on the best plan available by comparing the coverage offered by different insurers. You need to take into account your age, personal and family medical history and other such factors to make the right decision in such a case.

  1. Sub-limit on specific treatments:

Some critical illness insurance plans come with a sub-limit in the treatment expense of some illnesses. For example, in case of kidney transplant, if there is a sublimit and it is the main purpose for which the insured is availing the plan, it is best to choose one that has no sublimit for this particular treatment. In such a case, one must choose another plan to get the full sum assured.

Thus, a critical illness insurance plan is crucial to avail in today’s time but only after you have scanned and studied the conditions governing the policy you have chosen.
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