What is Critical Illness Cover in Health Insurance?

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Life is a beautiful journey filled with moments of joy and achievement, but it also brings uncertainties and challenges. Unexpected health crises can strike anyone at any time, and dealing with an illness can be emotionally, physically, and financially draining. An illness can be difficult to manage, especially when it is critical. A critical illness is a severe, life-threatening health condition that can significantly impact a person’s life. These illnesses are often sudden and unexpected. 

Imagine you go to the hospital, and you are detected with a critical illness for which your medical insurance covers the medical bills. However, the doctor advises taking three months off work to rest and recover. You won’t earn any money during this time and need financial support. In situations like these, having critical illness cover can be helpful. It provides you with a certain amount of money from your insurance company, a defined benefit plan specifically meant to support you during critical times like these. 

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The critical illness cover steps in as a guardian, offering a comprehensive safety net that ensures your well-being and financial security during difficult times.

Some common examples of critical illnesses include:

  • Cancer of Specified Severity: Malignant tumors that invade and spread to other parts of the body, causing significant health issues.
  • First Heart Attack of Specified Severity: This occurs when there is a sudden blockage of blood flow to the heart muscle, leading to damage to the heart tissue.
  • Open Chest CABG: The actual undergoing open chest surgery to correct one or more coronary arteries narrowed or blocked by CABG.
  • Neurosurgery/Coma of Specified Severity: A state of prolonged unconsciousness, often resulting from severe injuries or illnesses affecting the brain.
  • Organ Failure: The severe dysfunction of vital organs such as the heart, lungs, liver, or kidneys, which can be life-threatening.
  • Permanent Paralysis of Limbs: Total and irreversible loss of two or more limbs due to injury or disease of the brain or spinal cord. 

Critical Ilness Cover

Things To Consider While Choosing a Critical Illness Cover

  • Comprehensive Coverage: When selecting a Critical Illness Cover policy, carefully review the list of illnesses covered by the plan. A comprehensive policy should include common critical illnesses such as cancer, heart attack, stroke, organ failure, and others. Ensure that the policy aligns with your specific health risks and requirements.
  • Policy Term and Payout Amount: Evaluate the policy term to ensure it suits your needs. Some policies offer coverage until age, while others may provide lifelong protection. Additionally, consider the payout amount and match it to your financial obligations and responsibilities.
  • Waiting Period and Survival Period: Understand the waiting period, which is the duration from policy inception to when the coverage becomes active. Similarly, be aware of the survival period, which indicates the number of days you must survive after being diagnosed with a critical illness before the policy pays out. Knowing these periods is essential to manage your expectations effectively.

​Rider or standalone plan?

Experts highlight that critical illness riders have specific details, including the number of critical diseases covered, the lump-sum benefit amount, and the waiting and survival period. 

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​Indemnity vs Benefit Policy

If an individual is diagnosed with a critical illness, the insured will receive a lump-sum payment from the critical illness cover which implies that this is a benefit policy while he/she can submit medical bills to the insurer under the basic health insurance policy to claim reimbursement for hospitalization costs. This means that health insurance is an indemnity policy that reimburses the expenses made due to hospitalization while critical illness coverage is a benefit policy.


Critical Illness Cover is an indispensable shield, offering much-needed protection and financial security during the most challenging times. Investing in this invaluable coverage is a testament to your commitment to safeguarding your well-being and that of your loved ones. 

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Also Read:  How to Choose the Right Health Coverage Amid Rising Medical Costs

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Shikhar Vashisht

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