Given the high incidence of serious illnesses, a critical illness cover is a must today. But it does not replace your regular health insurance policy or life insurance policy. Instead, it works in conjecture with these to provide a more comprehensive coverage.

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Understanding Illness Insurance: Pros and Cons

When you take on a home loan, you do not want to worry about how would you repay it if you suddenly get ill. Or when you plan on building a fund for your kid’s education, an illness that may force you to divert your savings is not on your mind. But an illness of that scale can come unannounced, and you should be prepared for the worst even when you hope for the best.

What is Critical Illness Policy?

A critical illness policy may not make you better in such a situation, but it can definitely take the financial pain away. With your finances secure, you can focus on the most important aspect of the situation – your health. A critical illness policy pays a lump sum amount if the insured has any of the critical illnesses listed in the policy document. The sum assured is paid out after a defined survival period and can be used as the insured deems fit. Rather than falling prey to a financial crisis when one is diagnosed with a critical illness, it is advisable to explore the critical illness cover offered by Bharti AXA GI

The payout from a critical illness policy does not depend on your expenses. You can use the lump sum paid out on your medical expenses, or on making any changes that your house may need, or even to pay back the home loan you had taken on.

Pro: Hedge against high medical inflation

But do you even need a critical illness policy, to begin with? Given the medical advances over the last decade, you are more likely to live to a ripe old age. 55% of the premature mortality in India between the age of 30 and 69 can be attributed to serious non-communicable illnesses such as cancer, diabetes and heart diseases. You are much more likely to survive the illness than previous generations, but the treatment can severely drain your finances. For example, cancer treatment costs Rs. 10 lakh on an average today, organ transplant can cost between Rs. 5 lakh to 30 lakh. The fact remains that many of the deaths from heart diseases in the last decade could have been prevented if the families had a way to cover the expenses involved. A critical illness cover could be a boon in such a scenario.

Con: Narrow definition of critical illness

That said, it is important to remember that critical illness is defined narrowly in these policies. So, they only pay out if the definition is met. It has been observed that the most claims for income protection result from musculoskeletal or stress-related conditions – conditions that a critical illness policy does not cover.

Pro: Lump sum payment allowing to address immediate payments

Further, as a critical illness policy makes a lump sum payout it is important that the beneficiary has some money management skills. A regular income to replace the salary may be easier to manage for many. That said, the lump sum payment is important as you will have to address some immediate large payments and only then make a long-term plan.

Con: Survival period

Another point to remember is that critical illness policies require a survival period of 30 days to elapse before they pay out. Suppose an individual with a critical illness cover suffers a cardiac arrest and is hospitalized. This cover will not pay for the immediate medical expenses. Further, if the demise occurs before the survival period has elapsed, the nominee may not get any payout at all. The policy would also have a 90-day waiting period upfront. Refer to the policy document to ensure you understand the timeframes involved and have planned for these.

Pro: Comprehensive coverage when combined with a regular health insurance

A critical illness policy provides protection in conjecture with a regular health insurance policy and does not replace one. It provides cover against a set of illnesses, and you would still need your health insurance policy for covering other medical expenses.

Before you zero down a critical illness cover, consider the following points:

  • Calculate approximate coverage – Depending on where you live, try to figure out the approximate cost of treatment for life-threatening ailments. If you live in a metro, this cost would be higher than living in a tier 2 city.
  • Diseases covered – Check which are the diseases covered by the CI plan you wish to buy. You can avoid unpleasant surprises by being prepared in case certain diseases aren’t covered.