InsuranceSamadhan.com Blog: A-Z series on Insurance. In this series, we try to provide all the vital information about various Insurance Products and demystify the myths related to the Insurance sector. In today's blog, we are sharing details regarding covering oneself under Critical Illness Insurance Policy in India.

Ashok, age 35, is a shop keeper in Delhi. One night after closing the shop, he was driving back and had a heart attack myocardial infarction and was admitted to hospital. Luckily, he survived and was advised 3-months rest. There was a medical bill of Rs 4 lacs which was covered under cashless scheme of Medical policy. But Ashok was worried of future financial expenses as shop will be closed for over 3 months.

This happens with many people. If Ashok had Critical Illness Insurance of Rs 10 lakh, Insurance Company would pay Rs 5 lacs only on submission of proof that Ashok had a myocardial infarction.

Ravi was a consultant and one morning, he had an attack of brain hemorrhage. He was advised an operation costing Rs 5 lacs. One of his friends, took him to a naturopathy clinic and he opted for a treatment costing Rs. 2 lacs but Insurance Company declined to accept naturopathy treatment. Ravi had a Critical Illness rider of Rs 5lacs, he submitted his diagnosis paper to Life Insurer and got Rs 2.50 lakh.

Each of us must add Critical Insurance cover in their Insurance Portfolio. Let us understand what critical insurance is:

We all carry risk of suffering from critical diseases affecting our vital organs, such diseases cause two financial liability:

  • Cost of treatment
  • Financial loss due to rest period

Cost of treatment can be taken care by Health Insurance if treated as prescribed under insurance policy but refused if an alternate treatment is taken or treatment is taken abroad. Financial loss due to rest is not covered under any Health Insurance.

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Critical Illness Insurance cover such financial liabilities faced by an individual.

Health Insurance Coverage Benefits:


  • Defined sum is paid on occurrence of a defined critical disease. This means Sum Assured is paid on diagnosis and not on treatment.
  • If someone has Sum Assured of Rs 10 lacs and suffer from Heart attack then 50% of sum assured will be paid, Insured has the choice to opt for treatment and claim cost of treatment under Mediclaim.
  • After payment of 50% sum assured, client still has balance sum assured but same will not be paid for same disease but for some other disease.

Preconditions of Critical Insurance payment:


  • Disease must be same as defined under the Contract.
  • Insured must survive for 30-days after the diagnosis of disease.
  • This is a defined benefit insurance and not an indemnity insurance.
  • Each plan has an exclusion clause so that people do not take advantage of plan.
  • Sum assured is limited.

Who all sell Critical Illness?


  • Life Insurance companies sell it as rider. Cover cannot exceed sum assured of life insurance.
  • Health Insurance companies sell as independent product.
  • General Insurance companies also sell it as independent product.

How is it priced?


  • Price depends on the range of diseases covered.
  • Some companies cover 12 diseases and some cover 24 diseases.

Critical illness should be a must for all who are self-employed or running a business.

If you are facing any difficulty with regards to Critical Illness Insurance regarding claim process, claim rejection etc., you can contact us at Insurance Samadhan. We are always there to help! At InsuranceSamadhan.com, we have helped resolve over 12,600 customer grievance cases in the past related to all types of Insurances, ULIPs and other financial products.

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Call us at – 844 844 0626

Mail us at – corporate@insurancesamadhan.com

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