Critical Illness Plans: Important things to know before opting for a critical illness cover

By: |
August 7, 2020 12:50 PM

These disease-specific plans are offered by insurance policies especially for diseases such as diabetes and cancer. These critical illness plans can be opted for, even after an individual has been diagnosed with such a critical illness. However, they come at an extra cost.

Health Insurance, critical illness plan, OPD health cover, OPD health insurance, out of the pocket expenses, Max Bupa’s GoActive plan, OPD expenses, Digit’s OPD Policy, Max Bupa’s Heart BeatHere are some things to look out for while buying a critical illness cover;

There are a few health insurance companies that have now started extending their health insurance covers for policyholders above 60 years of age. Generally, however, people above 60 years of age, or senior citizens, are denied health insurance covers by insurers. They are rejected given their high-risk conditions, old age, and is prone to serious illnesses like diabetes.

Experts say these people are also rejected because they try to get a health insurance policy after getting an illness when it’s too late. Hence, buying a health insurance policy becomes tougher, and after that age, policyholders end up paying more as premium, especially after being diagnosed with a disease.

Another way out for such people are disease-specific plans. These disease-specific plans are offered by insurance policies especially for diseases such as diabetes and cancer. These critical illness plans can be opted for even after an individual has been diagnosed with a critical illness. However, they come at an extra cost.

Here are some things to look out for while opting for a critical illness cover;

Premium rates – As these covers are available at almost any age, they come at a high premium. Therefore, experts suggest that policyholders should firstly go for a basic health insurance policy if they can. The premium for the basic health policies is comparatively low if availed at an early age. With a basic health plan, it covers almost everything after a waiting period of usually 3-4 years. Having said that, if an illness is out of control, then one should buy an illness-specific plan.

Waiting period – Disease-specific policies do not come with a waiting period, unlike health insurance policies which include waiting period or existing diseases or critical illnesses. For instance, a cancer-specific policy will cover the policyholder from the first day, and other diseases such as dengue come with a minimum waiting period of 15 days. The normal health insurance policies include waiting periods ranging from 2 to 4 years depending on the type of illness.

Co-Payment and sub-limits – Insurance policies generally have the sub-limits and co-payment clauses. Co-payment is a per cent of the expenses that the policyholder has to pay from his/her pocket along with the insurer, in case of a claim. A certain percentage is decided and allotted to the policyholder at the time of buying the policy, that he/she has to pay from his/her own pocket, and the rest of the share is paid by the insurer if a claim arises.

On the other hand, sub-limit is set on some of the expenses included in the policy, wherein the insurer pays only up to a certain limit for those expenses, for instance, room rent. Almost with all health insurance room-rent comes with a sub-limit of Rs 2000, Rs 3000, or Rs 5000, depending on the type of the policy.

Treatment limits – Certain treatments come with upper limits. There are cap amounts that are put on certain treatments, within which the policyholder can claim for that particular surgery/treatment. Keep in mind, even if your sum insured is more than that particular treatment cost, you will still be restricted to only a certain amount with such caps. It is better to find out about such clauses in advance from the insurance provider while buying the policy so that you are not surprised later.

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