Critical Illness Insurance

Life is about surprise, along with usual, there are odds too. Now a day’s, number of cases like early age Heart Attack, Cancer, Paralysis, Disorders etc. have been increased drastically. Statistic says, for every 2 minutes, 4 people under 50 age group dies, more than 5.5 lakhs+ patient of cancer, 24 lakhs+ Cardiovascular Disease Patient and many more. This is happening due unhealthy lifestyle, Work Pressure / stress, excessive consumption of alcohol & tobacco, Unhealthy Food Habits, Lack of Exercise etc. At the same time cost of medical treatment and hospitalization expenses have increased tremendously in last 2 decades. The recurring costs of treatments for critical illnesses have crossed their limit. Critical ailments not only affect the person physically; it also has a major impact on the finances of the family. They have to use their savings & on top of it, they may need to go for loan. Minimum Treatment cost of some of the treatments are as follows:

Cardiovascular Diseases – Rs. 3.5 Lakhs

Lung Diseases – Rs 20 Lakhs

Cancer – Rs. 10 Lakhs

Liver Diseases – Rs. 18 Lakh

Kidney Diseases – Rs. 5 Lakh

There are many people, end up paying medical bills from their pocket in the absence of individual health insurance policies. Also, those who do have a health insurance are not adequately covered as the regular health insurance policy only takes care of hospitalization costs. What about household expenses, loan EMI, children school fees, which may also arise in case the patient takes a break from work?

Presently, there is only one solution available in the market and that is “Critical Illness Insurance”. Critical Illness Insurance, is an insurance product in which the insurer is contracted to typically make a lump sum cash payment if the policyholder is diagnosed with one of the specific illnesses on a predetermined list as part of an insurance policy. The lump sum amount can be used to meet household expenses and other expenditure on diagnostic test and treatment. The illnesses and treatments covered are Cancer, Heart attack, Angioplasty, Angiography, Blindness, Brain Tumor, Neuron disorder, Major Organ transplantation or replacement, Coronary Artery Bypass, Paralysis, Stroke, Alzheimer, Parkinson’s Disease,
End Stage Liver Disease, Multiple Sclerosis, etc.

 Features of Critical Illness Insurance:

  1. 20+ Critical Illnesses Covered
  2. Zero Day to 1 Month Survival Period. (As per Policy)
  3. Lump-sum 100% of Sum Assured on the basis of Diagnostic Reports
  4. Up-to 10% of Sum Assured child Education Cover. (As per Policy)
  5. Sum Assured available from Rs. 5 Lakhs onwards
  6. Inclusion of Personal Accidental Benefits. (As per Policy)
  7. Second Opinion
  8. Entry age is between 18 to 65. No age bar for Renewal.

How Critical Illness Policy differ from Medi-claim Policy?

The policy provides a lump sum payment of amount equal to the Sum Insured in an event mentioned in policy, whereas Medi-claim Policies only provides the payment equal to the Sum Insured or treatment cost, whichever is lower.

Exclusions in Critical Illness Insurance:

  1. Pre-existing Illness
  2. Expenses attributable to self-inflicted injury
  3. Diagnosis within 90days of Policy Period start Date
  4. Congenital Diseases
  1. Medical expenses incurred for treatment of AIDS
  2. Cosmetic & aesthetic and obesity related treatment
  3. Tests and treatment relating to infertility and in vitro fertilization.
  4. War, riot, strike, nuclear weapons induced hospitalization.
  5. Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
  6. Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)

Benefits of Critical Illness Insurance:

  1. It acts as an income replacement for family.
  2. It gives tax benefits under Section 80D of the Income Tax Act.
  3. It gives peace of mind as the lump-sum benefit will take care the expenses part.
  4. It covers treatment taking place in a foreign country, as Under a critical illness insurance plan, a fixed sum is paid on the diagnosis of a critical ailment, irrespective of whether the treatment takes place in India or abroad.

Blog by

Prof. Suyog Chachad
Indira School of Business Studies, Pune

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