Critical Illness Insurance

Critical illness insurance is a type of health insurance plan that provides coverage against life-threatening diseases, such as heart disease, kidney failure, and cancer. Under the critical illness insurance, you receive a lump sum payout from the insurance provider once you are diagnosed with the illness.

You can use this amount to treat illness and manage other expenses. With this coverage, you and your family can focus on getting the right care, rather than worrying about medical bills. Critical illness insurance is available as a standalone policy or as an add-on to a health insurance plan.

Also Read: Terminal Illness vs Critical Illness

Buying a critical illness policy entails several significant benefits for you, some of which have been discussed below.

Provides Financial Support

A critical illness plan acts as a strong financial safety net when life takes an unexpected turn. A serious diagnosis doesn’t just affect your health, it can also bring emotional stress and financial strain, especially if your treatment costs coincide with a reduced or lost income.

In such situations, a critical illness insurance plan can provide significant relief. It offers a lump-sum payout upon diagnosis, giving you the freedom to use the money for treatment, recovery, or everyday expenses while you focus on getting better.

Covers Numerous Critical Illnesses

Critical illness insurance plans cover a wide range of critical illnesses, including cancer, kidney failure, blindness, and paralysis. Therefore, with one plan, you get extensive coverage against several critical illnesses.

Instead of having to shell out a significant amount of money for the cost of the treatment of a critical illness, you can benefit from the sum assured under our critical illness plan.

Substitute for Lost Income

A critical illness diagnosis can be especially tough if you’re the primary earner in your family. The inability to work during treatment can lead to significant financial pressure.

With a critical illness plan or critical illness rider, you receive a benefit payout that helps replace your lost income, allowing your family to manage daily expenses without disruption.

Affordable Premiums

Critical health insurance is available at affordable premiums that are small compared to the financial protection they provide. Choosing a critical illness health insurance plan is a smart and cost-effective way to secure your future against life’s uncertainties.

Anybody can buy a critical illness policy; however, it is especially helpful for the individuals mentioned below.

• Individuals who are over 40 years of age are at higher risk of critical illness, like heart attack, stroke, etc, should consider buying it.
• If you are the sole breadwinner for your family, it is best to have critical health insurance to protect your income stability in times of need.
• Individuals who have a family history of critical illnesses like cancer, kidney disease, etc, should also buy critical health insurance.
• If you have a pre-existing condition like hypertension, diabetes, etc, then you also need to invest in major illness insurance.

Also Read: Medical insurance for pre existing condition

TATA AIG’s Criti-Medicare Plan is a health insurance policy that covers up to 100 critical illnesses, including cancer, heart disease, and kidney failure. It pays a lump sum amount after diagnosis, allowing you to manage treatment costs, hospital bills, or daily expenses without financial stress.

The plan comes with 3 main sections and 1 optional section, which are:

• Critical Illness Cover
• Cancer Indemnity Cover
• Hospital Cash Benefit
• Optional Wellsurance Benefit (optional)

When purchasing this plan, selecting one option from the main section is essential for individuals and families. The plan comes in two variants: Smart Century Premier (100 illnesses) and Smart Half Century (50 critical illnesses). The plan does not have a maximum cover ceasing age.

It also includes preventive health check-ups, second medical opinions, global coverage, and tax benefits under Section 80D of the Income Tax Act. You can choose coverage from ₹5 lakh to ₹2 crore and get discounts for long-term or multi-member policies.

Entry Age Under TATA AIG’s Criti-Medicare Plan

To acquire critical or serious illness insurance, you need to meet the following criteria.

• Individuals must be at least 18 years of age to qualify for critical illness coverage, with a maximum age limit of 65 years.
• The plan is available for individuals and their family members, including spouses, children, parents, and others.
• The plan is available for renewability for life with a 30-day grace period for premium payment.

Let us understand the working of critical health insurance by example. Soumya, 32 years old, buys a TATA AIG’s Criti Medicare plan with a sum insured of ₹15 lakh.

Two years later, she is diagnosed with a covered illness, say breast cancer (major stage). After the diagnosis and
completion of the survival period, TATA AIG pays her a lump sum amount as per the policy terms.

Soumya can use this payout for hospital bills, treatment costs, medicines, or even daily household expenses.

There are various inclusion and exclusion offers under critical health insurance by the TATA AIG. Some of them are listed below:

Inclusion Under Critical Health Insurance

Lump Sum Pay

Upon diagnosis of the listed critical illness, policyholders will receive the lump sum payout as specified in the policy document.

Health Check-Up

The plan will also cover preventive health check-ups up to 1% of the previous policy year's sum insured and maximum up to ₹10,000. This benefit is payable in addition to the sum insured.

In-patient Treatment

The plan will cover the inpatient treatment up to the sum insured that the policyholder undergoes due to cancer during the policy period.

Pre and Post Hospitalisation Expenses

The plan will also cover pre-hospitalisation expenses for up to 60 days and post-hospitalisation expenses for up to 90 days related to cancer treatment.

Chemotherapy and Radiotherapy Cover

It will also cover the reasonable and customary expenses up to the sum insured for the chemotherapy and radiotherapy treatment.

Prolonged Hospital Cash Benefit

The plan will also offer hospital cash benefits of ₹10,000 in the event of hospitalisation due to illness or injury that exceeds a continuous period of 10 days.

Ambulance Service

The plan will also pay a lump sum amount for ambulances when patients are admitted or discharged from the hospital, as mentioned in the policy.

Post Operative Expenses

The plan will pay a lump sum amount for physiotherapy following any covered minor or major surgery, as defined in the policy documents.

Exclusion Under Critical Health Insurance

The critical health insurance plan does not cover the following scenarios.

Non-Medical Exclusions

• Any accident or injury caused due to hazardous or adventure sports.
• Any medical claim that has attempted to breach the law with criminal intent is not covered.
• Claims for self-injury or attempted suicide are not covered.

Medical Exclusions

• Claims for alcoholism, drug and other substance abuse treatment are not covered.
• Claims for weight control and obesity are not covered under the plan.
• Claims for any kind of unproven medical treatment are not covered.

TATA AIG Criti Medicare plan covers around 100 critical illnesses. Some of the illnesses are mentioned below:

When selecting a critical insurance policy, consider several key factors. Some of these factors are as follows:

Sum Assured

Ensure that your critical illness plan provides adequate coverage in line with your health insurance requirements. This is possible only when you have clarity on how much critical illness health insurance you need and what the sum assured under the policy should be.

Sub-Limits

It is essential to review the sub-limits for various expenses in your critical illness plan. There are usually sub-limits for surgeries and medical tests. Being aware of these sub-limits is crucial to understanding the actual coverage you have for a specific expense category.

Inclusions and Exclusions

Knowing what is covered under your critical illness health insurance and what is excluded is also important. Therefore, you must read the policy wording with extreme care and attention. You must pay particular attention to the list of critical illnesses covered by the insurance.

Age

Critical illness plans often have varying coverages and costs for individuals from different age groups, due to their varying health risks. This is why plans for the elderly have higher coverage and a corresponding higher premium, whereas the opposite is true for relatively young people.

Maximum Renewal Age

Since some critical illness covers have a cap on the maximum age of renewals, it is advisable to check this ceiling before selecting a plan. It is advisable to opt for plans that offer lifelong renewals.

Waiting Period

There is a waiting period associated with a critical illness plan, which means that you cannot avail of the benefits of the plan before the expiration of the said period. This is why you must check the waiting period specified in a plan before purchasing it.

Also Read: Waiting Period in Health Insurance

Opting for the best critical illness insurance plans is easy with TATA AIG. Here is how to buy critical health insurance plans.

• Open the TATA AIG website and go to the “Personal” section, and choose the “Health Insurance" option.
• Select the “TATA AIG Criti Medicare” and choose the individuals you want to cover under the plan. Hit the “Get Price” option.
• Fill up details such as date of birth, phone number, etc. Provide details about any pre-existing diseases and then hit the “See Plan” option.
• Carefully review the plan to ensure it aligns with your health needs.
• Once complete, proceed with the CKYC process and make a payment using a suitable payment method.

Once the payment is successful, the critical health insurance plan will be sent to the email address provided.

Filing a critical illness insurance claim is easy with TATA AIG. You can file a reimbursement claim for a lump sum payout or opt for a cashless claim. Here is how to file a claim.

Procedure for Reimbursement Claim

• Step 1: Notify us about your diagnosis by filing a claim via the self-service portal or calling the helpline number (022-6489-8282). This should be done within 7 days of completing treatment, consultation, or procedure.
• Step 2: Complete the claim form accurately. Submit the claim form along with other documents such as diagnosis reports, doctor’s letter and more.
• Step 3: After verifying the details, we will either approve or deny the claim request. If it is approved, we will send the amount directly to your bank account.

Procedure for Cashless Claim

• Step 1: For planned hospitalisation, notify us 48 hours in advance. In an emergency, notify us 24 hours after hospitalisation. This can be done by calling the helpline number (022-6489-8282) or using the self-service portal.
• Step 2: Complete the cashless claim form and submit it, along with the other required documents. After seeing the documents, we will issue the pre-authorisation letter.
• Step 3: Submit the pre-authorisation letter along with a health card to the hospital's TPA. The hospital will initiate the medical treatment, and we will settle the bills directly with the hospital.

Also Read: Health Insurance Claims Process: Cashless & Reimbursement

Here is the list of documents you need to submit at the time of filing a critical illness claim.

• Medical Certificate and investigation report confirming the diagnosis of Critical Illness.
• Copy of complete medical records, such as hospital discharge card or Summary, etc.
• Death certificate or death summary, if applicable
• Legal heir or succession certificate, if applicable & available
• Previous and subsequent consultation letters, medical records and prescriptions related to illness or surgery.
• Post Mortem report (wherever applicable & conducted)
• Any additional documents requested by the TATA AIG representative.

As per the new tax regulations, there is no GST on health insurance plans regardless of sum insured. Earlier the health insurance plan came with a 18% GST which increases the overall premium cost. With this change, you can now buy TATA AIG health insurance plans starting at just ₹15/- per day.

Here are the income tax benefits of a critical illness insurance plan:

A critical illness insurance plan offers a crucial safety net for individuals and families against life-threatening conditions. With the critical medical insurance by your side, you will receive the lump-sum payout that can be used for covering hospitalisation, surgeries and medication costs. However, when choosing the best critical illness insurance plans, always assess your healthcare needs, such as lifestyle and age.

TATA AIG offers a critical medical insurance plan that provides coverage for 100 critical illnesses, including kidney failure, liver disease, and others. Along with critical illness coverage, the plan also includes cancer coverage, optional wellness insurance benefits, and hospital cash.

With our multi-pay feature, individuals can also file multiple claims for different critical illnesses during the policy term, as long as each claim meets the policy’s conditions. Apart from critical health plans, we also offer other insurance options, such as parents' health insurance, a medical insurance plan specifically designed for parents over 60 years of age.

The plan ensures that parents receive quality medical treatment during medical emergencies. Our medical insurance plan offers benefits such as cashless hospitalisation, a wide network of hospitals, a cumulative bonus, and more. Get yourself and your loved ones secured with our customised health plan.