What is Critical Illness Plan

Ideal for diseases that are debilitating but may not require constant hospitalization; for example cancer or renal failure.

Critical Illness Insurance assures the beneficiary a lump sum one off payment in case he/ she is diagnosed with any one of the specified illnesses as covered by the policy (the degree of seriousness is also specified in the policy conditions).

The coverage is generally for some serious ones viz. heart attack, multiple sclerosis, cancer, kidney disorder, artery bypass etc. The payment meted out is tax free and may be used by the beneficiary for payment of debts or to procure some medical assistance or in any other way that is necessary. Sometimes payments are also made on condition of being permanently disabled. The policy automatically terminated once the payment is made.

Who should buy this?

Critical Illness Plan is especially beneficial for individuals with low savings and those whose employment conditions do not provide adequate medical coverage when the individual is off work due to some major illness. CIP is beneficial for all as it provides peace of mind and stress free recovery.

Points to check prior to buying

It is wise for the investor to check up on some pointers before he zeroes in on a Critical Investment Plan, viz. the illnesses being covered and NOT covered by a particular policy (including stages of illness), the formalities to be completed while filling up a claim, the time period between the filing of claim and the receipt of the proceeds, the network of hospitals covered, coverage for dependents and last but not the least, the renewal benefits in case the insurer has not filed a claim for a particular year.

On the personal front, the insurer must choose a policy after properly calculating treatment cost, recurring cost, an financial liability in case of income loss. He/ she must also evaluate any history of critical illness in the family and also determine the age at which the illness surfaced. In case the age is young then a CI should be opted for without any hesitation.

Types

Critical Illness Plans may be taken in two forms, either a standalone policy or as a rider with any pre-existing policy of the insurer. The policy terms and conditions for both cases are more or less similar. Some subtle differences being that standalone policies cost more, yet offer larger covers compared to riders.

Things not covered by this type of plans

Just like any other plan, the CIP also has certain limitations.

  • Any illness arising out of genetic disorder
  • Illness arising due to consumption of alcohol, smoking or drug abuse
  • Illness which is an offspring of HIV virus
  • Illness arising due to intentional self-injury, attempted suicide etc.
  • Any preexisting illness that remained during purchase of the plan

Our Recommendation

Religare Health Insurance Plan

ASSURE is an all-encompassing health insurance plan which includes coverage of as many as 20 critical illnesses. The policy provides a lump sum (equal to the sum insured) when any of the following critical illnesses is diagnosed or any surgical or medical procedure undergone related to the same, during the policy period. In today’s fast life ASSURE provides the right support to assure total peace of mind and complete security to the beneficiary and his/her family.

  1. Cancer
  2. End Stage Renal Failure
  3. Multiple Sclerosis
  4. Benign Brain Tumour
  5. Motor Neurone Disorder
  6. End Stage Lung Disease
  7. Major Organ Transplant
  8. Heart Valve Replacement
  9. Coronary Artery Bypass Graft
  10. Stroke
  11. Paralysis
  12. Myocardial Infarction
  13. Major Burns
  14. Coma
  15. Blindness
  16. Parkinson’s Disease (before 50 years age)
  17. Alzheimer’s disease (before 50 years age)
  18. End Stage Liver Disease
  19. Bacterial Meningitis
  20. Aplastic Anemia

OTHER KEY FEATURES:

  1. Personal Accident Cover
  2. The Company pays a lump sum amount equal to the Sum Insured in the event of Accidental Death or Permanent Total Disablement of the insured within 12 months of the occurrence of the injury. The term “Permanent/ Total Disablement” denotes
    • Total loss of sight of both eyes OR
    • Actual loss, by physical dismembering of both hands or feet or one entire hand and one entire foot OR
    • The irrecoverable loss of use of both hands or both feet or of one hand or one foot without any physical separation
    The Company is not liable to pay anything for claims made under “Permanent or Total Disablement” in the event of subsequent death of the person affected.
  3. Annual Health Check-up:
  4. The Company provides a health check-up, once in a policy year,
    AGE SUM INSURED
    UPTO 10 LAC 10LAC-50 LAC ABOVE 50 LAC
    Upto 45 years Set I Set II Set III
    45 years to 55 years Set II Set III Set IV
    Above 55 years Set III Set IV Set V
    KEY:
    SET LIST OF MEDICAL TESTS
    I Complete Blood Count, Urine Routine, Blood Group, ESR, Fasting Blood Glucose, S Cholesterol, SGPT, Creatinine
    II Complete Blood Count, Urine Routine, Blood Group, ESR, Hb I Ac, ECG, S Cholesterol, SGPT, Creatinine
    III Complete Blood Count, Urine Routine, Blood Group, ESR, Hb I Ac, ECG, Lipid Profile, Kidney Function Test, Complete Physical examination by Physician
    IV Complete Blood Count, Urine Routine, Blood Group, ESR, Hb I Ac, Lipid Profile, TWT or 2D Echo, Kidney Function Test, Liver Function Test, Complete Physical examination by Physician
    V Complete Blood Count, Urine Routine, Blood Group, ESR, Hb I Ac, Lipid Profile, TWT or 2D Echo, Kidney Function Test, Liver Function Test, Pulmonary Function Test, Complete Physical examination by Physician
  5. Second Opinion
  6. If one is suffering from any of the critical illnesses and wishes to get a second opinion of an expert/doctor, the company arranges for one, at no extra cost. The facility of second opinion is available for each of the members covered, every year or each illness.
  7. Child Education cover
  8. In case the beneficiary suffers from any of the specified Critical Illnesses or unfortunate accident leading to death or permanent (total) disablement, the Company pays an additional lump sum amount (10% of the Sum Insured) towards the education of his/her children (aged 24 years or less). Such claims are payable under Critical Illness or Personal Accident coverage.
  9. Tax Benefit
  10. Tax benefits are available on the premiums paid on the health insurance under sec 80D of the Income Tax Act, 1961.
  11. Everyday Care (add on)
  12. The Company understands that major illnesses can be averted by regularly consulting doctors. Hence, unlimited consultations to the wide network of doctors and specialists are provided at Rs.100 per consultation. Consultations are however restricted at a maximum of 4 visits for the same illness. The ADD-ON benefit of “Everyday Care” wellness package gives access to free health helpline, wellness offers and online health risk assessment etc.
  13. HIV Cover(add on)
  14. In case of being detected with HIV (not caused through parent to child transmission or transmission through unprotected sex) the Company pays a lump sum amount equal to the sum insured of this ADD-ON benefit. Payment is made once during the beneficiary’s lifetime and the benefit ceases to exist immediately when any claim is made.
    POLICY TERMS
    Duration Individual: 1year to 3 years
    Group: one year
    Free Look Period 15 days
    Minimum entry age 18 years
    Maximum entry age 65 years
    Maximum renewal age Lifelong
    Age of Proposer 18years or above
    Waiting period 90 days
    Underwriting loading 25% maybe levied on premium payable, as per company guidelines. Such loading is applicable on all renewals.
    Renewal terms
    1. The policy terminates at the end of the policy period if not renewed by mutual agreement between the Company and the insured by paying the renewal premium before the date of expiry.
    2. Renewal is possible under the then prevailing health insurance Product or its nearest substitute, as approved by IRDA.
    3. Grace period is 30 days from the expiry of the policy. No claim is entertained which may occur during the grace period.

CLAIM PROCESS

In the event of accidental injuries:

  • Immediate written notice/call should be given to the Insurance Company with all particulars
  • Claim form duly completed along with the following documents should be submitted
  • Medical Certificate about the nature and extent of accident resulting injuries
  • Medical Examiner’s Report
  • Details of treatment rendered by the attending Doctor/Hospital/Nursing home
  • Certificate from the employer to the effect that the Insured was on leave during the period
  • Fitness certificate

In the event of accidental death - The following documents are required to be submitted:

  • Post-mortem Report
  • F.I.R./Police Report
  • Punchnama
  • Departmental Inquiry, if any
  • Report of Doctor/Hospital/Nursing Home
  • Death Certificate

CANCELLATION

Cancellation or termination of the policy is possible by giving a 15 days’ notice in writing. The premium is refunded for the unexpired period of the policy as per the scales mentioned below.

Cancellation date up to (x) months from policy period start date 1 year 2 year 3 year
Up to 1 month 75.0% 87.0% 91.0%
up to 3 months 50.0% 74.0% 82.0%
up to 6 months 25.0% 61.5% 73.5%
up to 12 months 0.0% 48.5% 64.5%
up to 15 months N.A 24.5% 47%
Up to 18 months N.A 12.0% 38.5%
Up to 24 months N.A 0.0% 30.0%
Up to 30 months N.A N.A 8.0%
Beyond 30 months N.A N.A 0.0%

EXCLUSIONS OF THE POLICY

  • Any pre-existing illness or complication arising there from.
  • Any diagnosis of diseases / undergoing of surgery / occurrence of event, whose signs or symptoms first occur within 90 days of Policy Period Start date
  • Expenses arising due to self-inflicted injury (resulting from suicide, attempted suicide)
  • Expenses arising out of or attributable to alcohol or drug use / misuse / abuse
  • Expenses incurred for continuous treatment of AIDS
  • Expenses arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
  • Congenital disease
  • Expenses arising from injury caused due to participation in felony, riots, criminal misdemeanor
  • Engaging in sporting activities involving training for or participation in professional sports.
  • Cosmetic & aesthetic and obesity related treatment
  • Tests and treatment relating to infertility and invitro fertilization
  • Any mental illness or psychiatric disorder
  • War, riot, strike, nuclear, biological or chemical weapons induced hospitalization
  • People engaged in underground mines, tunneling or explosives, jockeys, circus personnel or those engaged in hazardous activities.

Cancer Care from HDFC Life Plan

This is a comprehensive cancer care policy which provides financial security to the Insured and his/her family in case of diagnosis with Early Stage, Carcinoma-in-situ (CIS) and Major Cancer.

Early Stage Cancer

Early Stage Cancer shall mean the presence of one of the following malignant conditions:

  • Tumour of the thyroid histologically classified as T1N0M0 according to the TNM classification;
  • Prostate tumour should be histologically described as TNM Classification T1a or T1b or T1c are of another equivalent or lesser classification.
  • Chronic lymphocytic leukaemia classified as RAI Stage I or II;
  • Basal cell and squamous skin cancer that has spread to distant organs beyond the skin,
  • Hodgkin’s lymphoma Stage I by the Cotswold’s classification staging system.

The Diagnosis must be based on histopathological features and confirmed by a Pathologist. Premalignant lesions and conditions, unless listed above, are excluded.

Carcinoma-in-situ

Carcinoma-in-situ shall mean a histologically proven, localized pre-invasion lesion where cancer cells have not yet penetrated the basement membrane or invaded (in the sense of infiltrating and / or actively destroying) the surrounding tissues or stroma in any one of the following covered organ groups, and subject to any classification stated:

  • breast, where the tumour is classified as Tis according to the TNM Staging method;
  • corpus uteri, vagina, vulva or fallopian tubes where the tumour is classified as Tis according to the TNM Staging method or FIGO* Stage 0;
  • cervix uteri, classified as cervical intraepithelial neoplasia grade III (CIN III) or as Tis according to the TNM Staging method or FIGO* Stage 0;
  • ovary –include borderline ovarian tumours with intact capsule, no tumour on the ovarian surface, classified as T1aN0M0, T1bN0M0 (TMN Staging) or FIGO 1A, FIGO 1B
  • Colon and rectum;
  • Penis;
  • Testis;
  • Lung;
  • Liver;
  • Stomach and oesophagus;
  • Urinary tract, for the purpose of in-situ cancers of the bladder, stage Ta of papillary carcinoma is included
  • Nasopharynx

For purposes of this Policy, Carcinoma-in-situ must be confirmed by a biopsy.

* FIGO refers to the staging method of the Federation Internationale de Gynecologie et d’Obstetrique

Pre-malignant lesions and Carcinoma-in-situ of any organ unless listed above are excluded.

Major Cancer

A malignant tumour characterised by the uncontrolled growth & spread of malignant cells with invasion & destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy & confirmed by a pathologist. The term cancer includes leukemia, lymphoma and sarcoma.

The following are excluded -

  1. Tumours showing the malignant changes of carcinoma in situ & tumours which are Histologically described as premalignant or non-invasive, including but not limited to: Carcinoma in situ of breasts, cervical dysplasia CIN-1, CIN -2 & CIN-3.
  2. Any skin cancer other than invasive malignant melanoma
  3. All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0.
  4. Papillary micro - carcinoma of the thyroid less than 1 cm in diameter
  5. Chronic lymphocytic leukaemia less than RAI stage 3
  6. All tumours of the urinary bladder histologically classified as T1N0M0 (TNM Classification) or below
  7. All tumours in the presence of HIV infection

FEATURES

  • The policy provides an Inbuilt Waiver of Premium Benefit in case of diagnosis of Early Stage or Carcinoma-in-situ (CIS).
  • The plan comes in three options: Silver Option, Gold Option or Platinum Option, each with its own set of benefits. Hence, the buyer enjoys the flexibility to choose an option suitable to his/her needs.
  • There are Premium discounts for Sum Insured above Rs 10 Lakh.
  • In case no claim is made under Gold and Platinum options, the sum insured increases by 10% annually.
  • The process of issuance is simple and the buyer is exempt from undergoing any medical tests prior to purchase.
  • The Cancer Care plan also provides tax benefits as listed under Sec80D of the Income Tax Act, 1961. The maximum deduction that can be claimed currently is Rs.35,000 (inclusive of additional deduction of Rs.20,000 in case of insurance on the health of the parents who are senior citizens) subject to the provisions contained in the Act.

OVERVIEW OF BENEFITS AS PER SPECIFIC PLANS

Silver

a) Offers lump sum benefit on diagnosis of Cancer as per the table below:

Diagnosis of % of Applicable Sum Insured
Early Stage cancer or Carcinoma-in-situ (CIS) 25
Major Cancer 100 less Early Stage Cancer or CIS claims, if any

b) Waiver of Premium: On a valid claim of Early Stage Cancer or Carcinoma-in-situ (CIS) diagnosis, premiums will be waived for a period of 3 policy years.

Gold

In addition to the above mentioned benefits, the gold option has a few additional features viz.

The sum insured increases by 10% of the initial (original) sum insured each year, commencing from the completion of the first year. This continues till

  • The increased Sum insured becomes 200% of the initial sum insured
  • OR
  • Any claim in placed.

Platinum

Additional to the benefits provided in the Gold option, this plan option provides

  • A monthly income of 1% of applicable Sum insure for 5 years on diagnosis of listed major cancer.
  • A premium discount on Sum insured above Rs.10 lakh.

PLAN FEATURES AT A GLANCE

Entry Age 18 years (minimum)
65 years (maximum)
Maturity Age 28 years (minimum)
75 years (maximum)
Policy Term 10 years (minimum)
20 years (maximum)
Sum Assured 10 lakh (minimum)
40 lakh (maximum)
Premium Frequency Annual, Half-yearly, quarterly or monthly
Free Look Period 15 days from the date of receipt of the original policy document.
30 days from the date of receipt of the original policy document for policies purchased through distance marketing (as defined by IRDA).
Waiting Period A 180 day waiting period is applicable from the date of commencement or the date of reinstatement of cover. The waiting period of 180 days will not reapply -Provided a continuous waiting period of 180 days has been served under the plan, and If the policy is revived within 60 days of lapse
For all other cases, the waiting period will begin afresh.
Survival Period 7 days between date of diagnosis of a condition and the date of eligibility of a benefit payment
Discounted Premium on Higher Sum Assured Over and above Rs. 10 lakh
Medical test Not required
Maturity Benefit Not available under this plan
Surrender Benefit Not available under this plan
Death Benefit Not available under this plan

POLICY LAPSATION

If the premiums are not paid before the expiry of the grace period the policy will lapse and the cover will cease and no benefits will be payable in case of lapsed policies.

A lapsed policy can be revived within a period of 2 years from first unpaid premium when all the outstanding premiums have been paid along with interest.

Reinstatement request adheres to the following clauses:

  • The waiting period of 180 days will not reapply –
    • Provided a continuous waiting period of 180 days has been served under the plan, and
    • If the policy is revived within 60 days of lapse
  • For all other cases, the waiting period will begin afresh

CANCELLATION IN THE FEE LOOK PERIOD

The policy may be returned within 15 days of receipt of the same by adequately stating the reason of return. In case the policy had been purchased through Distance Marketing mode, the said period is extended to 30 days.

When the request is received along with the original policy document, the Company arranges to refund the premium paid, after deducting any applicable expenses, viz. medical examination (if any) and stamp duty (if any).

Once a policy is returned, it cannot be reinstated under any circumstances, and a fresh proposal must be made for a new policy.

EXCLUSIONS

No benefit shall be payable under the policy in respect of any Major Cancer, Carcinoma-in-situ or Early Stage Cancer resulting directly or indirectly from or caused or contributed by (in whole or in part) :

  • Sexually Transmitted Diseases AIDS or HIV.
  • Any congenital conditions
  • Any pre-existing cancer condition
  • Intoxication by alcohol or narcotics or voluntarily taking or using any drug, medication or sedative unless it is an "over the counter" drug, medication or sedative taken according to package directions;
  • Nuclear, biological or chemical contamination