Health And AccidentalCritical Illness Policy

Critical Illness Policy

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Critical Illness Policy

When a major illness strikes, it not only means high costs for medical care, but it also puts immense pressure on the family to manage their living expenses while the patient recoups.
In case of the above situation, your Critical illness insurance can come to your aid by not only covering hospitalization expenses but also providing you with lump-sum compensation that can help you meet your day to day expenses like child's school fees, Car and House EMIs, credit card payments etc.

Key Benefits

  • It acts as an income replacement: Critical ailments not only affect the person physically; it also has a major impact on the finances of the family. Critical insurance pays a lump sum amount which can be used to cover medical and household expenses.
  • It gives tax benefits: Critical illness payout is tax-free under Section 80D of the Income Tax Act.
  • It gives peace of mind: The policy provides peace of mind as now one can concentrate more on medical treatment rather than running around to arrange funds for medical and household expenses.
  • It covers treatment taking place in a foreign country: Under a critical illness insurance plan, a fixed sum is paid on the diagnosis of an acute ailment, irrespective of whether the treatment takes place in India or abroad. It means the policy can help you if you want to go overseas for further medical treatment.


  • Critical Illness
    • Cancer
    • Brain Tumor
    • First Heart Attack
    • Coronary Artery Disease
    • Coronary artery bypass surgery
    • Open heart replacement
    • Stroke
    • Kidney Failure
    • Aplastic Anemia
    • End-stage lung disease
    • End-stage liver failure
    • Coma
    • Major burns
    • major organ/bone marrow transplantation
    • Multiple Sclerosis
    • Fulminant Hepatitis
    • Motor Neuron Disease
    • Primary pulmonary Hypertension
    • Bacterial Meningitis
    • Temporary Illness
  • In-Patient Hospitalization
    • Room Rent/ICU
    • Nursing
    • Medical Drugs
    • Consumables
    • Medical Practitioner's (Surgeon, Anesthetist, Consultant etc.)
    • Blood
    • Oxygen
    • Anaesthesia
    • Diagnostic and pathological test
    • operation theatre charges
    • cost of chemotherapy
    • Dialysis
    • Pacemaker
    • Artificial Limbs
  • Pre-Hospitalization Medical Exp: It refers to those medical expenses which are incurred in preparation during the specified period before hospitalization.
  • Post-Hospitalization Medical Exp: Refers to the medical cost incurred after the patient gets discharged from hospital after the treatment for the diagnosed disease.
  • Domiciliary Treatment:It means medical treatment for illness/disease/injury which in the normal course would require care and treatment at a hospital but is taken while confined at home under any of the following circumstances:
    • The condition of the patient is such that he/she is not in need to be removed to a Hospital
    • The Patient takes treatment at home on account of non-availability of room in a Hospital.
  • Organ Donor
  • Daily Allowance
  • Emergency Ambulance
  • Day Care Procedures


  • Any Pre-existing Condition and complication arising from it
  • Any Illness, sickness or disease, other than specified as Critical Illness, as mentioned in the policy schedule
  • Any Critical Illness of which, the signs or symptoms first occurred prior to or within Ninety (90) days following the Policy Issue Date or the last Commencement Date, whichever is later
  • Any Critical Illness resulting from a physical or mental condition which existed before the Policy Issue Date or the last Commencement Date which was not disclosed
  • Intentionally self-inflicted Injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune-deficiency Virus (HIV) infection; suicide
  • War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power
  • Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel
  • The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment
  • Congenital anomalies or any complications or conditions arising there from
  • Treatment of illness or injury caused by :Participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sport, any bodily contact sport or any other hazardous or potentially dangerous sport for which you are trained or untrained
  • Any loss resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy, or
  • Any Critical Illness based on a Diagnosis made by the Insured or his/her Immediate Family Member or anyone who is living in the same household as the Insured or by a herbalists, acupuncturist or other non-traditional health care provider
  • Cosmetic or plastic surgery or any elective surgery or cosmetic procedure that improve physical appearance, surgical and non-surgical treatment of obesity (including morbid obesity) and weight control programs, or treatment of an optional nature
  • Special nursing care, routine health checks or convalescence, Custodial Care, general debility, lethargy, rest cure
  • Any investigation(s) or treatments not directly related to a Covered Illness or Covered Injury or the conditions or diagnosis necessitating hospital admission

Claim Procedure

The process of making a critical illness claim is simple and hassle-free. Once you have been diagnosed with a particular illness, you may notify your insurance provider. The insurer may need further proof, such as diagnosis proof from a specialist in the specific illness, or tests that support the diagnosis.
Below Documents required at the time of claim under Critical Illness Policy: -

  • Claim form duly filled and signed
  • Medical certificate confirming the diagnosis of critical illness
  • Discharge card/ death summary from the hospital, if applicable
  • First consultation letter and subsequent prescriptions
  • KYC documents
  • Any other document as may be required by the insurance company

Why Choose PrishaPolicy

5 Reasons why you should choose us to be your policy issuing partner of choice. Allow us to tell you why we are one of the fastest growing insurance brokers.

Customer-Centric Culture

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A Decade of Market Leadership

Our teams expertise and experience makes them the perfect guides in choosing a policy that fits your needs.

Reliable and Consistent

Rest assured that everything will be taken care of without a glitch. From shortlisting to claims processing & delivering promises without a hitch.

Guided Policy Assistance

Our experts are forever ready to assist you through each policy detail with a fine-tooth comb.

Claims Assistance

Our DNA prompts - Sales is incomplete without timely support. From start to end, we facilitate smooth processing from lodging to settlement.

Still Thinking About It?

Get on a call with us. We take pride in being associated with you for competitively managing your risks with the best insurance covers and delivering a stress-free experience.

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Questions You Might Have

What are pre and post-hospitalization expenses in health insurance?

Pre-hospitalization expenses refer to the medical expenses incurred before getting admitted to a hospital. Post-hospitalization expenses refer to the cost of follow-up tests and consultation treatment charges incurred after getting discharged from the hospital. Health plans in India mostly cover pre-hospitalization expenses up to 30 to 60 days and post-hospitalization expenses up to 60 to 90 days, depending on the plan.

At what age can I include my children in my health insurance plan?

You can include your children in a family floater policy from day 1. In some health plans, children are covered from 91 days onwards. Nonetheless, you are advised to go through the terms and conditions of a health plan carefully to know about the entry age for children.

Which diseases are not covered in health insurance?

A health insurance policy usually does not cover HIV/AIDS treatment except for a few companies. Any claims arising out of congenital disorders, venereal diseases, general debility. sexually transmitted disease and dental treatment/surgery (unless required as a part of treatment) is excluded from health insurance coverage. But do check your policy wordings to know more about the detailed list of exclusions in a health insurance plan.

What is a Cumulative Bonus in a health insurance plan?

A cumulative bonus in health insurance implies monetary benefits that the insurer provides you as a reward for not filing a claim during the previous policy year. For instance, discount on premium or sum insured enhancement. It is also called a No Claim Bonus similar to that in car insurance. However, the policy benefits differ from one health insurance company to another.

What do you mean by No claim bonus in health insurance plans?

No claim bonus (NCB) is a discount on the base premium offered if no claim on the health policy is made during the previous policy term. This bonus is usually given in the form of a premium discount or enhancement of the sum insured amount.

What is the maximum number of health insurance claims allowed in a year?

The maximum number of claims allowed under health insurance during a policy year varies from one plan to another. While some plans allow you to raise only one or two claims per policy tenure, a lot of plans do not come with any limit to the number of claims that you can file during a policy year as long as the sum insured is not exhausted. You can contact your insurer to know about the number of claims that you are permitted to file during a policy year.

What to do if my health insurance policy renewal date is missed?

Ans: If you have missed the renewal date of your health insurance policy, you must renew your policy as soon as possible. You can renew it during the grace period preventing the policy from getting lapsed. But if you renew your policy after the grace period, it will get lapsed and you may have to undergo a medical test or pay a higher renewal premium.