Critical Illness Cover: How Payouts Work?

A critical illness can have a significant financial impact on a family. The cost of medical care can be high, and you may have to miss work while you recover. This can lead to a loss of income and an increase in expenses. The family may also incur debt to pay for medical care. A lump sum pay out from a critical illness insurance plan helps you avoid financial distress due to prolonged medical conditions.

Critical illness insurance is a type of insurance that helps to cover the costs associated with a listed critical illness. The benefit amount and payment from the critical illness insurance plans do not depend on your actual expenses.

How does a Critical Illness Insurance Work?

Critical illness insurance works by providing you with a lump sum of cash if you are diagnosed with a covered illness. You don’t have to stop working to claim, but this cash can be used for

• Paying for medical expenses
• Make up for lost income
• Pay for other expenses

The illnesses covered and the definition of a critical illness can vary between insurers. However, IRDAI, the insurance regulatory authority, defines 20 health conditions as critical illnesses. Canara HSBC Life Insurance iSelect Smart360 Term Plan covers 40 different health conditions.

The cost of critical illness insurance varies depending on your age, lifestyle and health. For example:

• Smokers will usually pay more than non-smokers
• The premium for older insured is higher than a younger insured
• If you have a pre-existing health condition like diabetes you may have to pay a higher premium than normal

When does Critical Illness Cover Pay Out?

This will depend on the insurer, but in most cases, critical illness cover pays out once you have been diagnosed with the condition, or if it is determined that the condition is chronic and irreversible. Typically the claims can be processed within 30 days after you submit all the necessary documents.

Why is Critical Illness Cover Popular?

Critical illness insurance is popular for several reasons. It provides peace of mind knowing that you and your family will be taken care of financially if you experience a serious illness. The plan is designed to give you the financial security to take time off from work to focus on your recovery. Some other reasons for its popularity are listed below:

• The policy makes it easier to avail and pay for medical services that may otherwise be beyond the budget.
• The money can be used to pay for illnesses or lines of treatment not covered under a Mediclaim or health policy.
• Even if your Mediclaim covers most of the bills, this policy can help you pay for daily living expenses and stop worrying about incidental expenses.
• Transportation expenses, buying wheelchairs, modifying homes to make navigation easier etc. can be covered using this lump sum amount.
• Terminally ill patients can use the funds to spend the remainder of their lives doing what they enjoy the most. The amount received from this policy can be used to fund such expenses.

Which Benefits and Options to Choose in a Critical Illness Plan?

The best way to choose a critical illness insurance plan is to first assess your needs and then compare different life insurance policies to find the one that best suits your needs. You should also make sure to read the fine print carefully to understand the coverage and exclusions. There are a few factors which you must keep in mind while choosing a critical illness plan:

• The critical illness plan must have a broad list of covered illnesses. If it covers a limited number of illnesses, it may not serve its purpose when needed
• Check whether the lump sum benefit is adequate
• The waiting period should not be too long
• Look for any additional rider benefits
• Eligibility for pay-out in case of a relapse
• Conditions for pay out. For example, will the amount be disbursed on diagnosis, of say, cancer, or when cancer has spread from the primary location and becomes life-threatening?

Like other insurance policies, critical illness policies also have certain clauses that you must be cognizant of when signing up. An incident of a stroke may not be sufficient reason for an insurer to disburse a payment unless, say, the neurological damage prolongs for more than 30 days.

The chances of being diagnosed with a critical illness are relatively low. However, the chances increase as you get older. Make sure that the plan you choose covers the type of care that you need.