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What Is A Health Insurance Policy?

A health insurance policy is an insurance product that provides financial support in case of a medical emergency. The coverage amount offered by health insurance plans is pre-specified and may only be paid out if you provide proof of your medical expenses. Moreover, even life insurance plans can come with health insurance coverage if you opt for riders like the critical illness rider or accidental disability rider. Read More

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What Is A Health Insurance Policy?

A health insurance policy is an insurance product that provides financial support by covering the pre-specified healthcare expenses of the person buying the insurance policy or the person insured in case he/she needs medical attention.  

Edelweiss Life offers a health insurance plan that covers major critical illnesses. 

Importance of Health Insurance Plans

Health insurance plans are essential if you don’t want to drain your savings in case of hospitalization due to an illness or accident. Health insurance plans help you take care of all the medical expenses arising from any illness, injury, or accident, making them the perfect tool to battle any health crisis.

Health insurance not only provides various financial benefits but also guarantees peace of mind, as you will know that you are well-protected in case of a medical crisis. You can get instant access to affordable health care, protection for the entire family, and significant tax benefits³, all with just one health insurance plan.


Types of Health Insurance Plans

Most Health Insurance Plans are cashless and directly pay your medical bills once your treatment is complete. You can either choose to get treated/hospitalized without having to pay anything, or you can pay for everything yourself and then get reimbursed afterwards.

There are various types of Health Insurance Plans to suit diverse healthcare needs. These include:

Types of health Insurance Plans

Individual or Family Floater Health Plans

As the name suggests, these insurance plans are for the policyholder or their close family members. These plans provide holistic coverage for all family members including you, your spouse, parents, grandparents, in-laws, dependent siblings, and your children.

Critical Illness Plans

These plans provide coverage for life-threatening ailments such as cancer, kidney failure, permanent paralysis and more.

Personal Accident Plans

These plans provide a lumpsum payout in case of accidental death, permanent/total or partial disabilities, and any other injuries or burns arising due to an accident.

Corona Kavach and Corona Rakshak Plans

These plans either offer medical coverage or a lumpsum payout if you are diagnosed with COVID-19.

Disease-specific Insurance Plans

These plans provide extensive coverage for specific diseases such as cancer, diabetes, heart ailments, and more.

Group Health Plans

These plans provide coverage for the employees (and sometimes, their families) of a corporate group/employer/any organization.

Individual or Family Floater Health Plans

As the name suggests, these insurance plans are for the policyholder or their close family members. These plans provide holistic coverage for all family members including you, your spouse, parents, grandparents, in-laws, dependent siblings, and your children.

What Is A Critical Illness Insurance Policy?

 

Critical illnesses are serious health conditions that can have a debilitating effect on your lifestyle. Most critical illnesses also prevent you from working full time while you are undergoing treatment. Moreover, the medical costs for treatment can be quite high. Conditions categorised as critical illnesses include cancer, heart disease, kidney disease, etc. Without sufficient insurance, critical illnesses can exhaust your entire life’s savings and may also lead to a loss of income if you are unable to work.

A critical illness plan provides a lumpsum amount to the policyholder on the diagnosis of a critical illness. Note that the critical illnesses covered by a plan are usually listed within the policy document itself. If you are diagnosed with an illness not included in the policy document, then you might be denied cover. This is why it is extremely important to get a comprehensive critical illness plan that covers a wide range of critical illnesses. A critical illness plan becomes an indispensable asset as one grows older, as with age, one is more likely to develop critical illnesses that need emergency care.

Why Choose A Critical Illness Plan?

A critical illness health insurance plan offers comprehensive protection against a host of major illness. You might wonder why you need a critical illness plan when you already have a health insurance policy. The answer is that a health insurance policy alone will not be able to financially support you during your recovery. While a health insurance plan will pay for your medical bills, it will not be able to compensate for the loss of income that you will face while hospitalized.
 

Critical illnesses are serious diseases/health conditions that need utmost care and professional treatment. But this care and treatment may be extremely expensive. Now if you have a Mediclaim or a health insurance plan, it may cover your medical expenses depending on the policy's term and conditions, however, claiming this amount can be time-consuming as you may need to wait for all medical bills and records for submission.

Unlike basic health plans, critical illness plans provide a lumpsum amount on the diagnosis of a critical illness. This means that you do not have to submit your medical bills, instead, you only need to provide proof of your diagnosis. This lumpsum amount can help you pay for your treatment, but more importantly, it can provide a financial buffer against the loss of income that you will face when you are unable to work during the treatment.

You can use the lumpsum from a critical illness plan to pay for household expenses, repayment of EMIs etc. If you get a critical illness plan alongside basic health insurance, you will be able to pay off your medical bills and maintain your financial standard of living without having to completely deplete your savings.

Benefits of Health Insurance Plans Health Insurance Plan

Benefits of Health Insurance Plans

When Should You Buy Health Insurance with a Critical Illness Cover?

Having health insurance with a critical illness cover should be a priority, especially if you have a family history of critical illnesses. You should buy a health insurance plan as soon as you possibly can, and preferably get a plan that also provides security for your loved ones. If you are in your 40s or above, then a critical illness plan is indispensable, as you are far more likely to fall critically ill as you grow older. It is also important to buy a critical illness plan while you are healthy if you want to get the most affordable premium rates. Since medical emergencies can strike without warning, it is advisable to not wait until you’re face-to-face with such a situation.

 

Do Life Insurance Plans Have Critical Illness Coverage?

Whole life insurance plans and term plans generally come with an optional critical illness rider. The critical illness rider is completely optional. With a critical illness rider, your life insurance policy will be triggered if you ever get diagnosed with any of the listed critical illnesses. However, note that not all life insurance policies have a critical illness rider option.

Factors Affecting Health Insurance Premium

  • Your medical history – these include your current medical conditions, genetic health risks, lifestyle habits and family illness history. 
  • Your gender and age – the younger you are, the lower will your premiums be. Also, you can be at risk for specific diseases based on your gender. 
  • Type of policy chosen – the sum insured, the scope of benefits, and the tenure will impact the premium price.  

Factors to Consider Before Buying Health Insurance Plans

  • Scope of Coverage and Your Budget: Take a close look at the scope of coverage provided in the health policy and whether it is enough for your and your family’s needs. As important as it is to consider the premium price as per your budget, you should not compromise on the scope of benefits just to save on a few bucks. It’s better to pay a little extra to get comprehensive cover that ensures your security.
  • Cap and sub-Limits: Health insurance policies do not give unlimited coverage. There are caps and sub-limits on every benefit, treatment, or illness under the insurance policy. Always read the policy document in its entirety before you make a purchase.
  • Exclusions and Waiting Periods: Under every surgical procedure, treatment, or illness listed under the health insurance policy, there is a mandatory waiting period before you can make a claim. Moreover, there is a clear list of exclusions given that health insurance does not cover.
  • Insurer Credentials: Buying a health insurance policy from a reliable insurer is of utmost importance and will decide whether you have your claim settled in time. Before you zone in on a policy, it is vital to check the insurer’s credibility and performance metrics. Important metrics to note include their CSR, their cashless/reimbursement claim settlement time, the company’s reputation, and customer testimonials.
  • Additional Benefits: Different health insurance policies offer different benefits. However, some additional benefits are an absolute must in health insurance. Factors like automatic restoration of the SI, easy portability, convenient top-up enhancements, lifetime renewability, and a wide hospital network are all important and can impact the quality of your healthcare.

What to look for in your Critical Illness Insurance Plan?

Choosing a suitable critical illness plan is essential if you need comprehensive cover to take care of medical emergencies. Out of the many critical illness plans available in the market, you need to find a plan that is best suited for you. Here is an outline of some important features that a good critical illness plan must have –
 
  • The coverage of the plan should be sufficient to cover your medical expenses.
  • Most of the major critical illnesses, if not all, should be covered under the plan.
  • The policy term should be long enough to cover you in your old age.
  • The premiums should be constant throughout the tenure of the policy.
  • If the plan also offers health insurance benefits, then it should have a network of multiple hospitals for cashless treatments.

Apart from these factors, be sure to check the fine print for inclusions and exclusions, the minimum sum assured for the plan, the renewal terms, the No Claim Bonus, and if there are any additional benefits.

Who should Buy a Critical Illness Plan?

A medical emergency can turn up any time, and taking care of medical bills can be quite expensive. Ideally, everyone should have a health insurance plan that provides critical illness cover. However, certain individuals need a critical illness plan far more than others due to their lifestyle and medical history, and not having a plan can be a serious liability if you fall under one of these categories. Consider getting a critical illness plan as soon as possible if you relate to any of the points listed below:

Who should Buy a Critical Illness Plan?

Sole Earner of the Family

As the main or the only earning member of the family, the loss of your income can be a serious financial blow for your loved ones. With a critical illness plan, your family will be able to avoid financial hardship during a medical emergency.

People with Stressful Jobs

Those working long hours in the office are quite prone to critical illnesses at some point in their life. That indicates the need for medical attention and treatment, which in turn calls for having a critical illness policy.

People with a Medical History

Critical illnesses often run in the family. Some people have a genetic predisposition towards serious illnesses like cancer. Moreover, if a person has been affected by cancer in the past, there is a small risk that the disease might return. For such individuals, a critical illness plan is a must have.

Those above 40 years of age

Ageing makes a person’s body more vulnerable to critical illnesses. This means that those over 40 need to be extra careful with their lifestyle and healthcare choices. If you are nearing or have already crossed your 40s, critical illness cover can help you achieve peace of mind by preparing you for any unexpected medical emergencies.

Sole Earner of the Family

As the main or the only earning member of the family, the loss of your income can be a serious financial blow for your loved ones. With a critical illness plan, your family will be able to avoid financial hardship during a medical emergency.

Why should You Opt for Edelweiss Life- CritiCare+?

Edelweiss Life- CritiCare+ is comprehensive critical illness insurance plan that provides coverage against 17 critical illnesses. Some of the plan’s salient features include:

  • 3 Claims During the Policy Term
  • Claim Available from the Date of Diagnosis
  • Complete Waiver of Premium Upon Diagnosis

With this plan, you will be able to ensure that your family gets the support they need to manage their day-to-day expenses and your health expenses when you’re diagnosed with a critical illness.

Illnesses Covered by Edelweiss Life- CritiCare+

1. Open Chest CABG

2. Stroke Resulting in Permanent Symptoms

3. Blindness

4. Motor Neuron Disease with Permanent Symptoms

5. Myocardial Infarction (First Heart Attack of Specific Severity)

6. Aorta Surgery

7. Aplastic Anaemia

8. Multiple Sclerosis with Persisting Symptoms

9. Open Heart Replacement OR Repair of Heart Valves

10. Permanent Paralysis of Limbs

11. Cancer of Specified Severity

12. Kidney Failure Requiring Regular Dialysis

13. Coma of Specified Severity

14. Benign Brain Tumour

15. Major organ Transplant (Heart, Kidney)

16. Third Degree Burns

17. Major Organ Transplant (Bone Marrow, Liver, Lung, Pancreas)

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Documents Required to Buy Health Insurance Plan in India

The documents needed to buy a health insurance plan in India include:

  • Age and identity proof (Aadhar card, voter ID card, PAN Card, etc.)
  • Address proof ((Aadhar card, PAN Card, electricity bills, etc.) 
  • Medical report (carried out to see if you are eligible to buy health insurance) 
  • Passport-sized photo(s) 

What is the Difference Between General Health Insurance Plan, Cancer Insurance and Critical Illness Insurance?

Parameter General Health Insurance Cancer Insurance Critical Illness Insurance
Who should buy it? Those who want all-round healthcare Those who want coverage for cancer. Those who want cover against multiple critical illnesses
Scope of coverage Hospitalization, surgical procedures, treatment, ancillary medical needs All stages of cancer and cover for treatment Covers listed critical illnesses by providing lumpsum payout
Policy term 1-3 years, renewal possible to extend term Up to 20 years if needed Up to 20 years if needed
Policy type Indemnity-based (Reimbursement) or cashless mode of claim settlement Benefit-based policy that pays a lumpsum benefit amount on the diagnosis of cancer Benefit-based policy that pays a lump-sum benefit amount on the diagnosis of any listed critical illness
Premium payable Premium may vary year on year based on your healthcare needs Fixed premium Fixed premium

How can a multi-claim option help you? 

Critical illness cover provides the entire sum assured to the policyholder on the diagnosis of a critical illness and then the policy is terminated. This means if a policyholder is diagnosed with any listed critical illness, they receive the claim amount and will not receive any future claims. However, some critical illness plans offer multiple claims in one single plan. With a multi-claim plan, your policy will continue even after you are diagnosed with a critical illness, and you will be able to claim another payout if you are ever diagnosed with another critical illness in the future.

The multi-claim option also allows you to protect yourself against certain types of cancer that have the tendency to reoccur. Under multi-claim option, you can make up to three claims upon diagnosis of critical illnesses.

Choosing a multi-claim plan is advisable as critical illnesses have the tendency to damage other parts/organs of the body, which may lead to another critical illness in the future. If you have a multi-claim plan, you are financially prepared against the hardship brought on by reoccurring critical illnesses.

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Do I Need To Be Hospitalized To Get The Critical Illness Cover?

No, the entire critical illness cover is paid on diagnosis. The full payout is made irrespective of undergoing hospitalization or medical costs due to the illness. This amount can be utilized to meet the costs of medical care, manage regular expenses, repay any loans that you may have or for any other expense. 

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A pre-policy medical check-up is mandatory before you can get health insurance as the insurer needs to determine how risky it would be to provide you with insurance. The healthier you are the less risky you will be for an insurer, but if you are unhealthy or have preexisting medical issues, then you will be considered as a high-risk client by the company.

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CritiCare+ provides cover against 17 critical illnesses like cancer, heart disease, chronic kidney disease, etc. It provides the claim amount on the diagnosis of the pre-listed critical illness. Unlike regular health plans, you don’t have to submit hospital bills to get the claim amount. Since a critical illness plan covers major critical illnesses, the premium for critical illness plan is comparatively low for a high sum assured. 

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Yes, smoking will increase your insurance premium. Regular smoking is known to increase the chances of various diseases such as heart disease, lung disease, cancer, hypertension, etc. This is why insurers consider smokers to be high risk customers.

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A multi-claim plan will continue to remain active even if you fall critically ill and get a payout. This means to that you can get another payout in the future if you get diagnosed with another critical illness (that is covered by your policy). Multi-claim plans are ideal to protect yourself against reoccurring critical illnesses.

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Yes, you can cancel your health insurance policy after purchasing it. However, you can do so within the 15-day or 30-day free look period. If you cancel your policy after this period, you will be liable to pay cancellation fees and might not get a refund of any premiums paid. 

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For queries, write to onlinesales@edelweisslife.in

3 - As per provisions of Income Tax Act, 1961. Tax benefits are subject to changes in tax laws.

Edelweiss Life – CritiCare+ is only the name of an Individual, Non-linked, Non-Par, Pure Risk Premium, Health Insurance Product and does not in any way indicate the quality of the contract, its future prospects, or returns. Please know the associated risks and the applicable charges from your Personal Financial Advisor or the Intermediary. Tax benefits are subject to changes in the tax laws.

For more details on risk factors and terms and conditions, please read sales brochure carefully before concluding a sale.

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