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Critical Illness Health Insurance
Critical Illness Health Insurance
Happy Customer:
20.46Cr
Claims Handled:
24000Cr
Network Hospital:
16625+
What is Critical Illness Insurance?
Critical illness insurance is a type of health insurance that provides a fixed lump sum payout when the policyholder is diagnosed with a covered critical illness. Unlike standard health insurance, this policy focuses on high-cost illnesses and the associated long-term expenses for treatment for such illnesses.Features of Critical Illness Insurance Plans
- Lump Sum Payment:Ensures a fixed sum is provided upon diagnosis for treatment and recovery.
- Comprehensive Coverage: This covers illnesses like cancer, heart attack, organ transplant, and more.
- No Restrictions on Use: The payout can be used for treatment or any other financial needs, including repaying debts.
- Add-on Rider Option: Can be added to an existing health plan for enhanced protection.
Benefits of Critical Illness Insurance Plans
- Financial Security: This insurance will cover the high medical costs associated with the treatment of serious illness without impacting your savings.
- Flexible Coverage: Comprehensive plans allow you to customize your plan with add-on riders based on individual or family needs. You can even simply extend your health insurance coverage to include critical illness, which is a more economical option.
- Reduced Stress: Financial security provided by the critical health insurance allows you to focus on recovery without worrying about hospital bills.
- Tax Exemptions: Premiums paid for critical illness insurance policy are eligible for tax deductions under Section 80D. This feature reduces your overall tax burden.
Why Choose SBI General’s Critical Illness Policy
- Comprehensive Coverage: Covers 13 critical illnesses, including cancer, heart attack, stroke, and kidney failure, offering financial protection against major health crises.
- Flexible Tenure: Choose from 1-year or 3-year plans; 3-year plans lock in premiums, safeguarding against rate hikes.
- Affordable Premiums: Budget-friendly plans without compromising coverage.
- Simple Claims Process: Offers both cashless claims and reimbursement options.
- Reliable Brand: Trusted for its customer support and transparent policies.
Tax Benefits of Critical Illness Insurance
| Tax Benefit | Details |
|---|---|
| Applicable Section | Section 80D of the Income Tax Act, 1961 |
| Premium Deduction Limit |
Up to ₹25,000 for individuals and families (under 60 years old) Up to ₹50,000 for senior citizens (60 years and above) |
| Additional Deduction for Parents |
Additional ₹25,000 if parents are under 60 years Additional ₹50,000 if parents are senior citizens |
| Total Maximum Deduction | Up to ₹1 lakh (₹25,000 for self and family + ₹50,000 for senior parents) |
Critical Illness Insurance v/s Regular Health Insurance
| Feature | Regular Health Insurance | Critical Illness Cover |
|---|---|---|
| Coverage | Covers a wide range of medical expenses including hospitalization, doctor visits, and medications. | Provides coverage for a specific list of critical illnesses (e.g., cancer, heart attack). |
| Payout | Reimburses actual medical expenses incurred, with the sum insured adjusting accordingly. | Pays a lump sum upon diagnosis of a covered illness, after which the policy ceases. |
| Number of Claims | Allows multiple claims throughout the policy term. | Typically allows only one claim during the policy duration. |
| Policy Term | Usually has terms of 1 to 3 years, requiring renewal at the end of the term. | Generally an annual policy with options for lifetime renewal. | Cashless Claims | Offers cashless treatment at SBI General Insurance network hospital. | Not typically applicable; lump sum is paid directly upon diagnosis. |
| Premium Amount | Generally higher due to extensive coverage and benefits. | Lower premiums as coverage is limited to specific illnesses. |
| Waiting Period | Usually has a waiting period of 30 days for pre-existing conditions. | Waiting periods can vary; often around 90 days for critical illnesses. |
| Survival Period | Not applicable; claims can be made as soon as treatment is needed. | Requires the insured to survive a specified period (e.g., 14 to 30 days) after diagnosis. |
Understand What’s Covered by Our Critical Illness Insurance
The following illnesses are commonly included in most critical illness health insurance policies:
- Cancer: Coverage includes various types of cancer.
- Heart Attack: A heart attack of a specified severity is usually covered.
- Coronary Artery Bypass Surgery: This includes surgical procedures to improve blood flow to the heart.
- Stroke: Coverage for strokes resulting in permanent symptoms.
- Kidney Failure: Also includes treatment for end-stage renal disease requiring dialysis.
- Major Organ Transplant: Coverage for transplants such as heart, liver, or kidney.
- Permanent Paralysis of Limbs: Coverage for conditions that result in permanent loss of limb function.
- Multiple Sclerosis with Persisting Symptoms: Coverage for severe cases affecting daily living.
- Aorta Graft Surgery: Surgical procedures related to the aorta.
- Primary Pulmonary Arterial Hypertension: Severe high blood pressure in the lungs.
Check the specific list with your insurer to know the inclusions.
Understand What’s Not Covered by Our Critical Illness Insurance
While health insurance for critical illness provides valuable coverage, there are certain exclusions that policyholders should be aware of:
- Pre-existing Conditions: Illnesses diagnosed or treated before the policy start date are generally not covered.
- Minor or Non-Critical Illnesses: Conditions that do not meet the severity criteria outlined in the policy are excluded.
- Self-inflicted Injuries: Any injuries or illnesses resulting from self-harm are excluded.
- Substance Abuse: Illnesses related to drug or alcohol abuse may not be covered.
- Non-compliance with Medical Advice: If the insured fails to follow prescribed medical advice, claims may be denied.
- Waiting Period Claims: Claims made during the waiting period (often 30 to 90 days after policy starts) will not be approved.
Factors to Consider Before Buying Critical Illness Insurance
- Coverage of Illnesses: Get policies that cover a wide range of critical illnesses like cancer, heart attack, stroke, and organ failure for comprehensive protection.
- Sum Assured: Ensure the coverage amount is sufficient to handle medical expenses and income loss during recovery.
- Waiting Period: Understand the initial waiting period (30–90 days) during which claims cannot be made.
- Survival Period: Check the survival period requirement (commonly 30–90 days) post-diagnosis for claim eligibility.
- Policy Term and Renewability: Look for long-term coverage with lifetime renewability options, especially as you age.
- Premium Affordability: Balance adequate coverage with affordable premiums to ensure long-term feasibility.
- Inclusions and Exclusions: Review the covered illnesses and exclusions to avoid surprises during claims.
- Age and Health Status: Buy early to benefit from lower premiums and easier eligibility.
- Family Medical History: If there’s a history of critical illnesses in your family, prioritize this coverage.
- Financial Dependents: Consider dependents' financial needs and choose coverage that safeguards their well-being during crises.
The Need For A Critical Illness Insurance
- Coverage for High Medical Costs: Provides a lump sum payout to manage expensive treatments for illnesses like cancer or heart disease without depleting personal savings.
- Income Replacement:Acts as a financial buffer during recovery, particularly for sole breadwinners facing income loss due to illness.
- Comprehensive Coverage: Covers a broad range of critical illnesses like cancer, heart attacks, strokes, and organ failure, offering protection beyond standard health insurance.
- Supplement to Health Insurance: Fills gaps in regular health policies by addressing expenses not covered, such as advanced treatments or prolonged care.
- Peace of Mind: Reduces stress by ensuring financial support during unexpected health crises, benefiting both the insured and their families.
- Flexible Fund Usage: The lump sum can be used for medical care, rehabilitation, home care, or other personal financial needs, such as paying off loans.
Who Should Buy Critical Illness Health Insurance?
- Individuals Over 40: A higher risk of illnesses like heart disease, cancer, and stroke makes coverage essential.
- Primary Breadwinners: Protects family income stability during illness recovery.
- Family History of Illness: A higher possibility of detecting conditions like cancer or heart disease means you should get the policy for financial protection.
- High-Stress Jobs: Shields against health risks associated with high-pressure work environments.
- Pre-existing Health Conditions: Offers additional financial coverage for future complications.
- Health-Conscious Individuals: A good step to safeguard against unforeseen health challenges due to lifestyle or genetics.
- Families with Dependents: Ensures financial security for your dependents during health crises.
- Women: Provides vital coverage for conditions like breast cancer.
How to Choose the Perfect Critical Illness Cover Insurance?
- Coverage Options: Ensure the policy covers a wide range of critical illnesses. SBI General Insurance, for example, covers 13 major illnesses including cancer, heart attack, and multiple sclerosis.
- Sum Insured: Check the minimum and maximum sum insured. Policies like SBI's offer coverage from ₹3 lakhs to ₹10 lakhs, with some plans going up to ₹50 lakhs.
- Claim Process: Understand the claim process and how claims are settled. A straightforward, hassle-free claim process can significantly ease financial burdens during tough times.
- Survival Period: Be aware of any survival periods that may apply before a claim can be made.
- Policy Tenure: Look for flexible tenure options. Most insurers offer policies for 1 or 3 years, with renewal options available.
How To Buy Critical Illness Insurance at SBI General Insurance
- Eligibility: Individuals aged between 18 and 65 years can apply for SBI’s critical health insurance.
- Online Purchase: Visit the SBI General Insurance website to buy critical illness insurance online. The process is designed to be user-friendly and efficient.
- Medical Tests: Be prepared for mandatory medical tests as part of the application process, which help assess your health status and determine eligibility.
- Documentation: Gather necessary documents such as identity proof, age proof, and any medical history that may be relevant.
- Policy Customization: Consider customizing your policy based on your health needs and financial goals.
- Review Policy Terms: Carefully read through the policy terms and conditions to understand exclusions and limitations.
Why Critical Illness Insurance is Necessary Even with Mediclaim
Standard health insurance often has limitations on coverage for severe illnesses and their long-term treatment. A critical illness health insurance fills this gap by providing a lump sum that can be used flexibly.In such cases, a critical health insurance policy serves as an essential complement to regular health insurance by providing targeted financial protection against serious health conditions that can lead to significant medical and personal expenses. Its ability to offer immediate financial relief, income replacement, and peace of mind makes it important for comprehensive family health planning.
How to Make a Claim for SBI General Critical Illness Policy
| Claim Process | Cashless Claim Process | Reimbursement Claim Process |
|---|---|---|
| Step 1 | Go to a listed in-network hospital for treatment. | Notify SBI General Insurance about hospitalization or planned treatment within 24-48 hours. |
| Step 2 | Fill out the necessary forms at the insurance desk upon admission. | Collect all required documents, including hospital bills, discharge summaries, and prescriptions. |
| Step 3 | Submit the completed form to the claim management team at the hospital. | Fill out the reimbursement claim form accurately with all necessary details. |
| Step 4 | The hospital will coordinate with SBI General to settle the bill directly. | Submit the claim form along with supporting documents online or at a branch. |
| Step 5 | You will receive confirmation of approval or denial from the insurer shortly after submission. | The insurer will review your documents and process the claim, which may take some time. |
| Step 6 | No out-of-pocket expenses during treatment when the claim gets approved. | You pay for treatment upfront and await reimbursement after claim approval. |
Documents Required for Critical Illness Insurance Claim
- Claim Form: Completed claim form from the insurer’s website or customer service.
- Photo ID Proof: Copy of valid ID (e.g., Aadhaar, passport, voter ID).
- Policy Document: Copy of the critical illness insurance policy.
- Medical Certificate: Diagnosis confirmation from the treating physician.
- Medical Reports: Diagnostic tests and investigation results supporting the claim.
- Consultation Bills: Bills for medical consultations related to the illness.
- Medicine Bills: Receipts for prescribed medications.
- Discharge Summary: Hospital discharge summary, if applicable.
- Bank Details: Cancelled cheque or account details for payout processing.
Should You Buy an Add-on Rider or a Separate Policy?
When deciding between purchasing an add-on rider or a separate policy, it's essential to weigh the benefits and drawbacks of each option. Here’s a comparison based on the insights gathered from the search results:| Aspect | Add-on Rider | Separate Policy |
|---|---|---|
| Definition | An optional benefit that enhances an existing insurance policy (life or health). | A standalone insurance policy that provides coverage independently. |
| Cost | Generally cheaper as it requires only an additional premium on the base policy. | Often more expensive due to separate premium payments for each policy. |
| Management | Easier to manage as it is part of a single policy, reducing paperwork and complexity. | Requires managing multiple policies, which can be cumbersome over time. |
| Coverage Scope | Provides specific additional coverage (e.g., critical illness, accidental death) tailored to the base policy. | Offers comprehensive coverage tailored to specific needs without being tied to another policy. |
| Customization | Allows for some customization based on the base policy's features and available critical illness rider. | Greater flexibility in choosing coverage options that may not be available as riders. |
| Claim Process | Claims are processed under the same policy, simplifying the process for the insured. | Separate claims processes for each policy, which may complicate matters during stressful times. |
| Tax Benefits | Premiums paid for critical illness riders may qualify for tax deductions under applicable laws (e.g., Section 80C in India). | Premiums for separate policies also qualify for tax benefits but may have different limits or conditions. |
Conclusion
Investing in a critical illness insurance plan ensures financial security during medical emergencies. With its reliable policies, affordable premiums, and robust claim settlement process, SBI General Insurance stands out as an excellent choice. Secure your health and financial future today by getting SBI General’s critical illness health insurance policy.Frequently Asked Questions
A Critical Illness Insurance Policy is a type of health insurance that provides a lump sum payout when the policyholder is diagnosed with a critical illness covered under the plan. This payout can be used for treatment, recovery, or any financial requirements, offering comprehensive financial security during a health crisis.
The amount of critical illness benefit required depends on an individual’s financial situation, including income, existing liabilities, and medical costs. Generally, it is better to get coverage that is at least three to five times your annual income to ensure adequate protection.
No, critical illness insurance does not cover pre-existing conditions or illnesses diagnosed before purchasing the policy. You must purchase the policy while you are in good health to enjoy its benefits.
A Benefit Policy is a type of insurance policy that guarantees the payment of a predetermined sum to the policyholder or their beneficiaries on the occurrence of a specified event, such as death or disability.
Critical illness policies offer several benefits, including financial support through a lump sum payment, coverage for high-cost treatments and non-medical expenses like EMIs, and tax benefits under Section 80D of the Income Tax Act. This ensures financial stability during a difficult time.
Eligibility for critical illness insurance typically includes an age range of 18 to 65 years, although this can vary by insurer. Additionally, individuals must not have any pre-existing conditions related to the illnesses covered under the policy.
Whether medical tests are required depends on your age, sum insured, and medical history. For younger individuals or those getting lower coverage, medical tests may not be mandatory. However, older individuals or those with higher coverage requirements may need to undergo medical screening.
To purchase a critical illness insurance policy, you generally need to provide documents like identity proof (Aadhar, PAN, etc.), address proof, a completed application form, and any related medical history or diagnostic reports, depending on the insurer's requirements.
Yes, premiums paid for critical illness insurance policies are eligible for tax deductions under Section 80D of the Income Tax Act.
Pre-existing diseases refer to any medical condition or illness that the insured had been diagnosed with or treated for before purchasing the insurance policy. These conditions are typically excluded from coverage for a specified period or permanently.
Some policies allow multiple claims for different illnesses, but repeated claims for the same illness are usually not permitted. It is essential to review the terms and conditions of your policy to understand its claim rules.
In case of a claim, you should contact the claims department of your insurance provider. Most insurers provide toll-free numbers, email support, or dedicated online portals for claim assistance and filing.
In insurance, a critical illness refers to severe, life-threatening diseases like cancer, heart attack, stroke, organ failure, or multiple sclerosis that require extensive medical care and often have significant financial implications.
A critical illness plan typically covers a range of severe illnesses, including cancer, heart attack, stroke, kidney failure, organ transplant, paralysis, and multiple sclerosis. The specific illnesses covered may vary by insurer.
The waiting period is the initial period after the policy’s commencement during which claims cannot be made for covered illnesses. This period generally ranges from 30 to 90 days, depending on the insurer.
Yes, critical illness insurance is worth it as it provides financial security during expensive medical treatments. It ensures that individuals and their families do not face financial hardships while managing the costs of critical illnesses.
No, once you are diagnosed with cancer or any other critical illness, you cannot purchase a critical illness policy. Most policies exclude pre-existing conditions from coverage.
No, LASIK surgery is considered an elective procedure and does not fall under the category of critical illnesses. Such surgeries are mainly not covered under critical illness policies.
Critical illness cover policy is essential because it provides financial support for costly treatments, allowing you to focus on recovery without worrying about depleting your savings or affecting your family’s financial stability.
No, the list of illnesses covered varies from one insurer to another. It is important to review the policy document of your selected insurer to understand what illnesses are included and excluded.
Yes, as senior citizen health insurance may not fully cover critical illnesses or provide a lump sum payout. Critical disease insurance offers an additional layer of protection tailored for severe illnesses.
Generally, insurers do not allow an increase in the sum assured during the policy year. However, you can revise the coverage amount at the time of policy renewal.
The waiting period is the time after policy purchase during which no claims can be made. The survival period, on the other hand, is the minimum number of days the insured must survive after diagnosis to be eligible for the lump sum payout. This is typically 30 days, depending on the policy.
Disclaimer: The above information is indicative in nature, for more details on complete coverage and terms and conditions, please contact our nearest office and also read the policy document and sales brochure carefully before concluding a sale.
*T&C Apply
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