Health Insurance And Critical Illness Cover: An Introduction 

It can confuse buyers to understand the difference between health insurance and critical illness coverage. Indian health insurers offer different policies to cover various medical expenses. One common insurance category is critical illness health insurance. 

This category offers medical coverage for serious ailments involving cancers of various severity, kidney failures, heart attacks, brain strokes, and more. Investing in a regular health policy may help you cover critical illnesses, but that may not be possible. Why? Let us discover the differences. 

Health Insurance Vs Critical Care

It is a bad idea to assume that your health insurance plan can cover medical expenses for critical illnesses. Let’s compare health insurance and critical care policies for you to understand the difference clearly. 

1. Coverage Type 

Both critical illness and health insurance plans offer different coverage. While health insurance is an indemnity plan, a critical illness offers fixed benefits. What does it mean? You are covered up to the maximum sum insured amount for a comprehensive plan. In a critical illness health plan, you are offered the entire sum insured when diagnosed with a critical illness. 

2. Medical Expenses Covered

Your health policy will offer coverage for various expenses, such as AYUSH care, ICU care, room rent, and ambulance. 

On the contrary, a critical illness cover will provide coverage as per policy conditions for severe critical illness treatments like bone marrow transplant, organ transplant, chemotherapy, radiotherapy, etc. 

3. Waiting period Vs. survival period 

A comprehensive health cover has various waiting periods like a pre-existing disease waiting period, an initial waiting period, and more. While a critical illness cover asks you to serve a survival period after being diagnosed with a critical illness. 

4. Premium Pricing 

A comprehensive health coverage and critical illness policy premium pricing depends entirely on the treatments and additional benefits it provides. However, the premium pricing for comprehensive health insurance plans is slightly higher than critical illness insurance. 

5. Covered Members 

You can cover your entire family if you wish to under a health policy, but most critical illness plans offer individual coverage. 

Xtraordinary Facts  

• A chemotherapy session may cost anywhere between 1 to 2 Lakhs. 

• Treatments related to cardiovascular ailments start anywhere from 1 to 3 Lakhs. 

• One session of dialysis may cost you anywhere from 15,000 to 20,000. 

These skyrocketing costs for critical illness treatments are mostly not covered by your regular health insurance coverage. To understand more about critical health coverage, schedule a personalized call with us today! 

Best Health Insurance Plans 2025

Listed below are our top picks for health insurance plans in India.

Best Critical Illness Insurance Plans 2025

Listed below are our favorite picks for critical illness insurance plans in India.

Health Insurance Vs Critical Illness Insurance: The Right Plan For Me?

While there are several health insurance options out there in the market, one must be aware of their medical needs and requirements. A purchase decision for a health insurance plan or critical illness plan for yourself must be made on the following parameters:

• Consider your family history of critical illnesses like cancer, heart attacks, etc. and opt for critical illness health insurance as compared to a general health insurance plan in such a situation.
• If you have suffered any major ailment such as bypass surgeries, a critical illness plan is your best bet as the insurance plan will cover you for the same after you serve a specified waiting period.
• If you are in the pink of your health and are only looking for a comprehensive health plan look for the best health insurance plans.
• Consider a health insurance plan for yourself if you are in your early or mid-20s as there is a lower chance of developing a critical illness ailment.

However, remember one thing no matter which health insurance category you opt for, you are eligible to avail of tax benefits under section 80D for both.

How To File Health Insurance Claim?

• There are 2 ways to file a health insurance claim, it can either be a cashless claim or a reimbursement claim.
• You can raise a cashless claim when you avail of hospitalisation or medical treatments on the network hospital of your insurance provider. In this case, the network hospital will settle the hospital bill directly with your health insurance provider
• Simply inform the TPA desk in your network hospital and fill out the claim settlement form along with attaching all the necessary documents.
• After the health insurer verifies the submitted form and documents, they will settle your claim.

How To File A Critical Illness Insurance Claim?

• If you are diagnosed with a critical illness, you are required to serve a survival period after which you can file a claim with your health insurance provider.
• Fill in your claim request along with the necessary documents like diagnostic tests, doctor’s prescriptions, and others.
• Your critical illness provider will verify the submitted documents.
• After the claim request is approved, you will receive a lump sum amount which you can use for availing treatments for the same.

Concluding Note

After careful research and review, investing in health insurance will secure your health and finances. However, understanding the key differences between health cover and critical illness cover is crucial which is explained in the article above. 

Connecting with health insurance experts can help you make an informed decision giving you maximum benefit out of your health insurance.

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