Critical illnesses like stroke, cancer, or organ failure can lead to serious financial and emotional stress. Here comes the critical illness insurance coverage to the rescue, as it provides financial protection during medical emergencies.
In this blog, we will highlight what a critical illness health insurance policy covers and how to apply for it.
What does a Critical Illness Health Insurance Policy Cover?
The specific list of critical illnesses plan inclusions varies from one insurer to another. However, these are some common conditions:
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Cancer
Critical health insurance coverage provides a sum insured for various advanced or specified stages of malignant tumours. Some policies may exclude less invasive forms depending on the terms and conditions.
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Heart Attack
Most of the plans cover a myocardial infarction of a specified severity. You need to confirm with a cardiologist and medical evidence in case of severe procedures like coronary angiography to validate the claim.
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Stroke
The coverage typically applies to major strokes, which can cause brain damage or tissue death, such as ischemic or haemorrhagic strokes. Most policies require you to survive for a specific period, usually 14 to 30 days after the diagnosis, to enable the claim payout.
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Kidney Failure
Policies generally cover the cost associated with both regular dialysis and kidney transplant surgery. These include hospitalisation, post-operative care, and fees for surgeries. Some plans also cover the costs of necessary medications, such as immunosuppressants, after a transplant.
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Major Organ Transplant
Common organs that critical illness insurance coverage provides include the lungs, heart, kidneys, pancreas, and bone marrow. Some plans usually come with a waiting period of 60 to 90 days from the start date of the policy, which you need to complete before making a claim.
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Coronary Artery Bypass Surgery (CABG)
Most of the critical illness health insurance policies include specific open-chest CABG in the list of covered critical illnesses. Whereas many policies cover specific heart conditions, like a first heart attack and open-heart valve repair, with specific criteria for coverage.
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Paralysis
To get a coverage benefit under a critical illness health insurance plan, you need to follow the strict definitions of the policy. One of the most common criteria includes that the paralysis must be the result of an injury or a disease of the brain or the spinal cord. Additionally, there must be a complete and irreversible loss of muscle function in two or more limbs.
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Multiple Sclerosis
The clinical impairment of motor or sensory function must have been present for a continuous period, typically at least 6 months is mandatory to make a claim. Additionally, there must be a documented history of relapses and remissions, with at least two clinically documented episodes within one month apart.
What is Excluded Under Critical Illness Coverage Policies?
Here are some common aspects which are usually excluded from critical illness insurance coverage policies:
- Pre-existing Conditions: The Majority of these plans do not cover the Diagnosis or treatment of any condition before the policy start date.
- Self-Inflicted Injury: Any case of attempted suicide or other types of self-harm is typically excluded under critical illness health insurance policies.
- Substance Abuse: Policies do not provide coverage for extensive treatments related to alcohol, drugs, or tobacco abuse.
- Certain Illnesses: Some critical illness plans exclude specific diseases, such as sexually transmitted diseases, some types of cancer, and HIV/AIDS.
- Pregnancy and Childbirth: Most critical illness plans exclude treatment coverage for complications related to miscarriage or childbirth.
How does the Critical Illness Plan differ from a Standard Health Insurance Plan?
Let us explore how critical illness insurance coverage policies differ from standard medical insurance plans. These include:
| Feature | Critical Illness Plan | Standard Health Insurance |
| Type of Payout | It typically provides a lump-sum payout upon diagnosis and extensive treatment of a covered critical illness. | Mainly indemnity-based, as it covers specific medical expenses like hospital bills and doctor fees. |
| Purpose | Provides financial support for non-medical expenses, such as living costs, travel, and income replacement. | Covers the extensive costs of medical treatments and hospitalisation. |
| Claim Process | Payout is triggered upon diagnosis and a survival period, not by specific bills. | Reimbursement for actual medical bills incurred. |
| Coverage Period | Often becomes inactive after the payment of the coverage option. However, this can vary from policy to policy. | Remains active until the end of the policy term, and you can easily renew it. |
Final Words
Investing in a critical illness insurance coverage policy is a smart step to ensure financial security for you and your family during medical emergencies. Always carefully read the terms and conditions before choosing the best one. Additionally, seek advice from an expert to know the inclusions and exclusions properly as per your required health needs.
