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Critical Illness Insurance

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Product Advantage

Comprehensive Cover
These insurances pay a fixed benefit if you get any of the specified critical illnesses. The payment is not linked to actual costs incurred by you. Increasingly, these plans cover a large number of diseases some of which may not be covered under a under a regular mediclaim.
Covers Out-of-pocket Expenses
Critical illnesses can result in high incidental costs such as loss of wages, home nurses, and medical equipment. These costs are not covered under a regular mediclaim insurance. The benefit of a critical illness plan is that these costs are compensated for by the fixed benefit.
Higher Sum Insured
Medical inflation is reported to be increasing by over 20 per cent each year. A high sum assured critical illness plan provides an excellent way of safeguarding yourself against future increases.
No Restrictions On Use Of Claim Benefit
When the claim is made, the lump sum amount is given to you for treatment, irrespective of what it is used for - specialist’s fees or medicines. This amount can also be used to pay off liability, support the dependents or any other financial purpose too.

Why Claims Get Rejected?

Non-Disclosure

Non-disclosure of important medical information may cause the Insurer to deny the claim. This can range from an inadvertent omission that was important to deliberate lapses to reduce your premium.

Filing A Fraudulent Claim

The insurer will thoroughly investigate your claim. If they find that it was fudged, not only will they reject it but will also blacklist you. This means that other insurers may also reject your application for health insurance.

Unavailability Of Medical Documents

Insurance companies will process the claims mostly based on the documents provided, although they may also opt to have independent tests done by their appointed physician to look into the diagnosis of the critical illness. If the person insured fails to provide these documents, his claim will be denied.

Claim Documentation

Duly filled and signed claim form, Photocopy of ID card, a medical certificate confirming the diagnosis of critical illness from a doctor not less qualified than MD/MS, Investigation reports/ other related documents reflecting the critical illness diagnosis, original detailed discharge summary / day care summary from the hospital.

Add-on Cover

Some add on to cover include: Child education benefit, liability benefit, accidental death and partial or total disability due to accidents.

Exclusions

Any pre-existing conditions/ diseases/ injuries at the inception of the policy cover, Treatment received overseas, Medical treatment required following any criminal act of the insured.

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Quick Turnaround

Cover notes are issued within hours of request. This ensures that your goods don’t sit idle at any stage.

Strong Claim Support

We manage all aspects of your claim - from survey appointment to documentation to insurer follow-up.

Value Added
Services

We will advice you on risk management best practices.

Policy Administration
System (PAM)

See all your contracts renewal information in one place. Place service requests on PAM.

PROPOSAL FORMS
CLAIM FORMS
POLICY WORDINGS
NETWORK HOSPITAL LIST

FAQs

Critical Illness Insurance can help safeguard your finances by providing you with a lump-sum payment when your family needs it most. The tax free payment you receive is yours to spend as you see fit and in addition to any other insurance you may have. It helps protect yourself, your family and your budget from the impact of a critical illness.

Each company differs in its exclusions for critical illness payouts. Some common exclusions are drug related claims, self-inflicted injuries and claims arisen from war. Some companies may exclude conditions from a policy if you have a pre-existing medical condition, for example it's unlikely that a company would cover you for cancer if you've had cancer before.

An Insured Person can choose to secure an expert opinion from Insurance Company’s network of Medical Practitioners, if he/she is diagnosed with a covered Critical Illness during the Policy Period. This benefit can be availed once, by each Insured person during the lifetime of a policy for a particular Critical Illness.

No, once a claim for a particular Critical Illness has been admitted and paid, the coverage under the Policy will automatically terminate for that Insured person. If the Policy is issued to more than one individual, it will continue to be in force for the remaining members.

A basic health insurance policy generally pays hospitalization bills. But a health insurance would not be enough if you are diagnosed of a critical illness. To help you tide over such medical exigencies, there are critical illness insurance plans that you should consider. Some health insurance plans come bundled with critical illness (as rider or add-on), but a standalone critical illness plan is more comprehensive both in terms of covered and the amount of cover it offers.

The critical illness policy provides a lump sum payment of amount equal to the Sum Insured in an event mentioned in policy, whereas existing care product only provides the payment equal to the Sum Insured or treatment cost, whichever is lower.

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