Critical Illness Policy

When a serious illness occurs, it brings not only high medical costs but also significant financial stress on the family as they manage daily expenses while the patient recovers.
In such situations, a Critical Illness Insurance policy can provide financial relief by covering hospitalization expenses and offering a lump-sum compensation to help with daily costs, such as school fees, car and house EMIs, and credit card payments.

Key Benefits

  • Income Replacement: Critical illnesses not only impact health but also the family’s finances. This policy provides a lump-sum payout that can be used to cover both medical and household expenses.
  • Tax Benefits: Payouts from critical illness insurance are tax-free under Section 80D of the Income Tax Act.
  • Peace of Mind: The policy offers peace of mind, allowing you to focus on recovery without the added burden of arranging funds for medical and daily expenses.
  • International Coverage: This policy covers treatment both in India and abroad. Upon diagnosis of a critical illness, a fixed sum is paid, regardless of where the treatment is received, making it helpful if you need to seek treatment overseas.

Coverage

  • Critical Illnesses
  • Cancer
  • Brain Tumor
  • First Heart Attack
  • Coronary Artery Disease
  • Coronary Artery Bypass Surgery
  • Open Heart Surgery
  • Stroke
  • Kidney Failure
  • Aplastic Anemia
  • End-Stage Lung Disease
  • End-Stage Liver Failure
  • Coma
  • Major Burns
  • Major Organ or Bone Marrow Transplantation
  • Multiple Sclerosis
  • Fulminant Hepatitis
  • Motor Neuron Disease
  • Primary Pulmonary Hypertension
  • Bacterial Meningitis
  • Temporary Illnesses
  • In-Patient Hospitalization Coverage
  • Room Rent/ICU Charges
  • Nursing Services
  • Medical Drugs
  • Consumables
  • Medical Practitioner Fees: Includes charges for surgeons, anesthetists, consultants, etc.
  • Blood
  • Oxygen
  • Anesthesia
  • Diagnostic and Pathological Tests
  • Operation Theatre Charges
  • Chemotherapy Costs
  • Dialysis
  • Pacemaker
  • Artificial Limbs
  • Pre-Hospitalization Expenses: Medical expenses incurred prior to hospitalization, within the specified period before treatment.
  • Post-Hospitalization Expenses: Medical costs incurred after discharge from the hospital for continued care related to the diagnosed condition.
  • Domiciliary Treatment: Medical treatment provided at home for conditions that would typically require hospitalization, under the following circumstances
  • Organ Donor
  • Daily Allowance
  • Emergency Ambulance
  • Day Care Procedures: Coverage for medical procedures that don’t require overnight hospitalization.

Exclusions

  • Pre-existing Conditions: Any pre-existing medical conditions and complications arising from them.
  • Non-Critical Illnesses: Any illness, sickness, or disease not specified as a critical illness in the policy schedule.
  • Critical Illness Onset: Any critical illness where signs or symptoms first appeared prior to or within 90 days of the policy issue date or the last commencement date, whichever is later.
  • Undisclosed Conditions: Critical illness resulting from a physical or mental condition existing before the policy issue date or the last commencement date that was not disclosed.
  • Self-inflicted Injuries: Any intentionally self-inflicted injuries or illnesses, including sexually transmitted conditions, mental or nervous disorders, anxiety, stress, depression, AIDS, HIV infections, or suicide.
  • War and Related Events: Injuries or illnesses resulting from war, civil war, invasion, insurrection, revolution, acts of foreign enemy, hostilities (whether declared or not), rebellion, mutiny, or use of military power.
  • Radiation and Nuclear Risks: Ionizing radiation, contamination from nuclear fuel, nuclear waste, or any radioactive, toxic, or explosive materials related to nuclear equipment.
  • Congenital Conditions: Any congenital anomalies or complications arising from them.
  • Hazardous Activities: Injuries or illnesses caused by participating in hazardous activities such as winter sports, skydiving, hang gliding, scuba diving, mountain climbing, racing, hunting, horseback riding, skin diving, rafting, yachting outside coastal waters, professional sports, or any dangerous sport whether trained or untrained.
  • Pregnancy and Childbirth: Any loss directly or indirectly related to childbirth, pregnancy, or related complications.
  • Unverified Diagnosis: Critical illness based on a diagnosis made by the insured, their immediate family members, household members, or non-traditional healthcare providers such as herbalists or acupuncturists.
  • Cosmetic or Elective Procedures: Cosmetic surgery, plastic surgery, or any elective surgery or procedure aimed at improving physical appearance, including treatments for obesity and weight control programs.
  • Routine or Non-Essential Care: Special nursing care, routine health check-ups, convalescence, custodial care, general debility, lethargy, or rest cures.
  • Unrelated Treatments: Any investigations or treatments not directly related to a covered illness or injury or the conditions leading to hospitalization.

Claim Procedure

The process for filing a claim under the Critical Illness policy is straightforward and hassle-free. After being diagnosed with a critical illness, you should notify your insurance provider. The insurer may request additional proof, such as a diagnosis from a specialist or supporting test results.

Documents required for a Critical Illness claim:

  • Completed and signed claim form
  • Medical certificate confirming the diagnosis of the critical illness
  • Discharge summary or death summary from the hospital, if applicable
  • First consultation letter and any subsequent prescriptions
  • KYC documents
  • Any other documents that the insurance company may request