Critical care health insurance plans in India compared

Sunday, March 20, 2011, 8:12 by Business Editor

A comparison of critical care health insurance plans in India from Bajaj Allianz, ICICI Prudential, TATA-AIG and HDFC

Most working professionals, or self-employed individuals, among us are likely to be having some sort of life insurance. After all, we all want our near and dear ones to be provided with some sort of financial security in the event of our premature demise.

However, what happens if one is diagnosed with a life threatening illness such as cancer or heart attack, or kidney failure? Let’s hope the person manages to survive, and he does actually–but that’s where the problems really begin for him and his family. If the patient suffers from a chronic disability (e.g. leg amputation following a cancer surgery in his leg, or something unfortunate like that) following the critical illness, then the long-term recuperating costs can be a huge burden on his family. How ironical that the bread-earner’s survival can seriously jeopardise his family’s lifestyle, with him not being able to work!

What is a critical care health insurance plan?

And that’s where “critical illness”, or “critical care”, health insurance policies can come in handy. These schemes pay out a lump-sum cash amount–ranging from Rs. 1, 00,000 to Rs. 50, 00,000–up to the Sum Insured, if the insured individual is diagnosed with a critical illness covered under the policy. And this guaranteed figure is awarded irrespective of the actual billing.

Apart from using this one-time payment for covering costs of the treatment and care, one can utilise the amount for paying off debts, recuperation aids, compensating for any lost income due to a reduced earning capacity, etc.

In short, a critical care health plan insures you and your family against the risk of a debilitating disease, in the same manner as you protect your house and your car, for example.

It goes without saying that such plans cover risk only, and don’t entail any investment returns. Also, don’t expect any maturity benefit, i.e. the premiums paid by you won’t be returned if you don’t suffer from any critical disease during the policy term.

How critical care plans work

So, if the idea of buying an additional financial security sounds appealing to you, all you need to do is to set aside a not-too-large regular amount now.

In India, critical care health plans are now being offered by both General and Life insurers. While General insurance companies have come up with standalone schemes in this space, their counterparts in the Life segment sell critical illness cover as a “rider” alongside their Life Insurance plans.

We have shortlisted herewith four plans from some of the leading private-sector vendors such as Bajaj Allianz, ICICI Prudential, Tata-AIG and HDFC ERGO. All the critical care schemes, outlined below, cover eight major diseases–Cancer, Coronary Artery Bypass Surgery, First Heart Attack, Kidney Failure, Multiple Organ Transplant, Multiple Sclerosis, Stroke and Paralysis.

Like normal hospitalisation plans, critical care health insurance policies, too, have a set of “exclusions”, which don’t provide the risk cover under specific conditions/circumstances. Each of the quartet handpicked by us has three common exclusions–any pre-existing illness/condition; any treatment arising from pregnancy, miscarriage, maternity or birth; presence of HIV/AIDS infection.

Let’s now look at critical care health insurance plan in detail.

Bajaj Allianz Critical Illness

The ‘Bajaj Allianz Critical Illness’ plan from Bajaj Allianz, a joint venture between Bajaj Group and German insurance giant Allianz, gives you an option of choosing a Sum Insured (SI) amount, ranging from Rs. 1,00,000 to Rs. 50,00,000. The critical care insurance policy covers people aged between 6 years to 59 years.

Given below are the indicative premiums one needs to pay under this plan –

Sum
Insured
AGE ( in years)
21- 25 26 – 35 36 – 40 41 – 45 46 – 50 51 – 55 56 – 60
100000 200 300 550 800 1200 1750 3000
300000 600 900 1650 2400 3600 5250 9000
500000 1000 1500 2750 4000 6000 8750 15000
1000000 2000 3000 5500 8000 12000 17500 30000

Salient featuresof Bajaj Allianz Critical Illness policy

  • The lump-sum benefit amount will be paid when the ailment is diagnosed meeting pre-defined criteria and the insured survives 30 days after the diagnosis.
  • One can pay for expenses like donor expenses in a transplant surgery, which are outside the purview of a normal health insurance policy, out of the guaranteed amount received under this cover–both in India & abroad.
  • The premium payee can avail of tax benefits under section 80-D of Income Tax Act.

Other major exclusions

  • Any critical diseases diagnosed within the first 90 days of taking the policy
  • Death within 30 days following the identification of the critical illness

ICICI Prudential Crisis Cover policy

The Sum Insured (SI) figure under ICICI Prudential’s ‘ICICI Pru Crisis Cover’ policy can range from Rs. 3, 00,000 to Rs. 20, 00,000. The scheme is applicable for individuals aged between 18 years to 60 years, with the maximum cover ceasing age set at 75 years. The policy term can be anywhere between 10-50 years.

Here’s a table outlining the annual premium amounts payable for a Sum Insured of Rs.5,00,000 for some sample policy terms, and age of entry for a healthy male life insured –

Age (years) Policy term (15 years) Policy term (20 years) Policy term (25 years)
25 2,686 2,728 3,016
30 3,194 3,535 4,123
35 4,529 5,210 6,151
40 6,930 8,032 9,313
45 10,814 12,333 13,848

Premium payment frequency can be either monthly, half-yearly, or annual. The least one has to pay yearly on account of premium is Rs. 2,400, and the company guarantees no change in the premiums for the first five years from the date of commencement of the policy.
Salient features
•    The ICICI Pru Crisis Cover plan offers risk coverage against 35 critical illnesses associated with most body organs and senses. These diseases are classified into two groups, subject to the SI payable.

Group 1: If the insured person is diagnosed with or undergoes any of the following diseases and procedures, then ICICI Pru will pay a benefit amount equal to the full Sum Insured chosen under the policy. Following the payout, the policy is terminated.

Critical Illnesses with full payout advantage – Apallic Syndrome, Benign Brain Tumour, Blindness, Brain Surgery, Chronic Lung Disease, Coma, End Stage Liver Disease, Heart Valve Surgery, Loss of Independent Existence, Loss of Limbs, Major Burns, Major Head Trauma, Surgery to Aorta, Terminal Illness

N.B. The ICICI Pru Crisis Cover plan also covers Cancer, Coronary Artery Bypass Surgery, Heart Attack, Kidney failure, Major Organ Transplant, Paralysis and Stroke under Group 1.

Group 2: In case the insured individual suffers from any of the following critical illnesses, if the Sum Insured exceeds Rs. 10,00,000, then the company will pay a benefit amount of Rs. 10 lakhs –and the cover will continue for the balance Sum Insured. ICICI Pru will amend the premium accordingly on the following policy anniversary, for the reduced SI amount.

However, if the SI is below Rs. 10 lakhs, then the benefit amount payable will be the full Sum Insured and the policy will cease to exist.

Critical Illnesses with coverage continuation advantage – Angioplasty, Alzheimer’s Disease, Aplastic Anaemia, Cardiomyopathy, Deafness, Loss of Speech, Medullary Cystic Disease, Motor Neuron Disease, Muscular Dystrophy, Parkinson’s Disease, Polio Myelitis, Primary Pulmonary Hypertension, SLE with Lupus Nephritis

N.B. The ICICI Pru Crisis Cover plan also covers Multiple Sclerosis under Group 2.

•    Death Benefit – If the insured person dies during the policy term, then his nominee will receive the Sum Insured immediately – without having to wait.
•    Total & Permanent Disability Benefit – ICICI Pru will pay the entire SI if the assured individual suffers from Total & Permanent Disability. Note that the person is entitled to the TPDB even if TPD occurs due to an accident during the waiting period.
•    The ICICI Pru Crisis Cover plan pays out the benefit amount, independent of payments granted under any other plan.
•    Premiums paid for this policy are exempt from taxes u/s. 80D and u/s. 80C of the income tax act.
Other major exclusions
•    Domiciliary treatment, non-allopathic medicine
•    Diagnosis and treatment outside India, other than mentioned in the policy document

Tata-AIG Criticare critical care health insurance plan

The Tata-AIG Criticare plan from Tata-AIG, a tie-up between Tata Group and US insurance behemoth AIG, covers anyone between the age of 18 and 60 years

Indicative annual premium amounts (for Sum Insured of Rs.5, 00,000)

Age (years) Premium (in Rs.)
18-24 1,744
25-29 2,534
30-34 3,178
35-39 4,608
40-44 8,293
45-49 14,512

Salient features
•    Free Second Opinion – The Criticare policy allows you to second opinion on your illness from a panel of doctors in the US, with Tata-AIG footing the entire bill
•    Enjoy tax benefits for premium payouts of up to Rs. 15,000 under Sec 80D of the Income Tax Act.
•    Other critical diseases covered under the plan include Coma, Major Burns (covers at least 20% of the body surface) and Total Blindness.
Other major exclusions
1.    Any critical illness diagnosed within the first 90 days of purchasing the policy
2.    Plastic or cosmetic surgery, or any elective operation or cosmetic procedure that enhance physical appearance; surgical and non-surgical treatment of obesity and weight control programs.

HDFC ERGO Critical Illness

The HDFC ERGO Critical Illness plan is valid for individuals aged between 18 years to 45 years, and requires no medical examination for those under 45.

Indicative annual premium amounts (for Sum Insured of Rs.5, 00,000)

Age (years) Premium (in Rs.)
21 1,103
26 1,379
31 1,655
36 2,758
41-45 4,136

Salient features

  • Tax exemption u/s 80D of Income Tax Act
  • One can purchase the policy instantly online

Other major exclusions

  • 90 days Waiting Period
  • Death within 30 days following the diagnosis of the critical disease

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