Overall Guide to Critical Illness Insurance and Health Cover

Overall Guide to Critical Illness Insurance and Health Cover

There has been a growing emphasis on maintaining a healthy lifestyle and prioritising one’s well-being. However, amid these discussions on staying fit and robust, an alarming trend has emerged – critical illnesses. Critical Illnesses are increasingly becoming a topic of concern in everyday conversations.

The impact of these illnesses extends far beyond physical health, as they create financial strain and significant mental stress. Thus, having critical healthcare insurance that can safeguard you from such problems. But what is a critical healthcare insurance plan? How does it work?

This article will talk about insurance for critical illness. So let’s get started.

What is a Critical Illness Healthcare Insurance?

Under a critical illness insurance policy, the insured is protected against severe, life-threatening diseases like cancer, heart attack, and renal failure, among others. This policy offers a lump sum coverage amount that effectively addresses massive medical expenses associated with the covered critical illnesses.

What are the Features of a Critical Illness Healthcare Insurance?

The features of insurance for critical illnesshealthcare policy typically include:

1. Tax Exemption

The policyholder can avail of tax deductions on the premium paid for critical illness coverage as per Section 80D of the Income Tax Act 1961.

2. High Coverage Amount

The critical illness policy offers coverage up to ₹50 lakhs, ensuring that the policyholder can access necessary medical treatment without financial concerns.

3. Easy Claim Processing

Based on the diagnosis report(s), the claim can be smoothly processed without any hassle. The insurer ensures a straightforward and efficient claim settlement process for the policyholders.

What are the Inclusion and Exclusion Under a Critical Illness Healthcare Insurance?

Inclusions and exclusions under healthcare insurance for critical illness policy:

Health insurance critical illness covers up to 50 major critical illnesses, such as coronary artery bypass surgery, stroke, kidney failure, major organ transplant, etc.No compensation is provided if a person dies within 30 days of being diagnosed with a critical illness or undergoing surgery.
The coverage amount for critical illnesses varies based on the insurance provider.Critical illnesses resulting from smoking or drug intake are not covered by the critical illness insurance policy.
Policyholders can benefit from critical illness insurance within 30 days of diagnosis or as specified in the policy’s terms and conditions.Critical illnesses developed due to internal or external congenital disorders are not included in the critical illness insurance coverage.
The insured receives a lump-sum amount, as mentioned in the critical illness policy, upon meeting the policy’s criteria.Injuries from adventure sports, self-harm incidents, and war injuries are not included in the critical illness policy’s coverage.

What are the Benefits of a Critical Illness Healthcare Insurance?

There are numerous advantages to having a healthcare insurance critical illness policy. Some of these benefits include:

1. Income Replacement

A critical illness plan provides a predetermined lump sum that can be utilised to cover both medical and household expenses, alleviating the financial strain on the family during challenging times.

2. Peace of Mind

With a critical illness policy, individuals can rest assured that the financial repercussions of the treatment or potential loss of workdays are taken care of, allowing them to concentrate solely on their health and well-being.

3. Covers a Range Of Expenses

In the event of a diagnosis of any covered ailment, the critical illness policy provides a lump sum payment to the policyholder. The individual has the liberty to determine the usage of the funds, be it for hospitalisation expenses, household needs or any other relevant expenses.

What is the Process to File a Claim Under Critical Illness Healthcare Insurance?

The following is the complete process for filing a claim under a critical illness healthcare insurance policy:

Cashless Claim

  1. Approach a network hospital registered with the healthcare insurance company and provide the policy details.
  2. The hospital will verify the policyholder’s details and submit a pre-authorisation form to the insurer.
  3. The insurer will review the pre-authorisation request and communicate the policy coverage and other relevant information to the hospital.
  4. For planned hospitalisation, inform about the admission at least 72 hours before. In case of emergency hospitalisation, notify within 24 hours.
  5. The insurer will issue a pre-authorization letter to the insurance holder or the network hospital. Present the letter, policy ID card and any other specified documentation at the network hospital during admission.
  6. By following this procedure, one can avoid direct medical expense payments above the network hospital’s aggregate deductible.

Reimbursement Claim

If the insurer denies pre-authorisation for the cashless claim or if the insurance holder seeks treatment at a non-network hospital or chooses not to use the cashless facility, this procedure should be followed:

  1. Collect all documents and inform the insurer in writing within 48 hours of hospitalisation.
  2. In case of the insured person’s demise, the representative must inform the insurer promptly in writing and send a copy of the post-mortem report (if any) within 30 days.
  3. The insurer will not provide indemnity for hospitalisation periods less than 24 hours, except for day-care procedures.


Thus, having healthcare insurance for critical illness is essential. Before buying healthcare insurance coverage, one must properly conduct research and understand your requirements. Moreover, one should compare the plan to find a suitable plan for themselves. Moreover, if you are someone who is looking for healthcare insurance, then consider Niva Bupa, the best health insurance company in India for comprehensive critical illness coverage and to secure your health and well-being. With its network of registered hospitals and efficient claim processing, Niva Bupa offers reliable support during challenging times.

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