Samantha is a 45-year old fashion designer who was recently diagnosed with early-stage breast cancer. This revelation came as a jolt given her healthy and disciplined lifestyle. She was unmarried but had elderly parents who were dependent on her. Luckily, a few years ago, she had subscribed to critical illness (CI) insurance plan of Rs. 50 lakhs each to cover self and her parents financially for a period of 30 years against any kind of critical illnesses such as cancer, etc. Upon diagnosis of the severity of the ailment, the CI plan categorized early-stage cancer as a minor condition and provided her a lump sum benefit of Rs. 12,50,000 for her complete treatment that included second opinion costs, surgery, long chemotherapy sessions, hospitalization expenses, post-treatment nursing and, above all, a loss of income during the affected period. In addition, premium payment for the next five years of the policy period were also waived off. She thankfully recovered in a few months and got back to her normal routine.
Minor, Moderate and Major Conditions in Critical Illness Insurance plans
Based on the severity of the ailment upon diagnosis, critical illness insurance plans classify the condition of critical illnesses into three categories – minor, moderate and major. The CI plan claim benefits vary according to the severity of critical illness conditions, and all three options provide the insured a lump sum amount on diagnosis/undergoing of any critical illness treatments.
1. Minor Conditions
Commonly covered minor conditions listed under CI plans include heart-related procedures such as angioplasty, cardiac arrhythmia, infective endocarditis, cardiac artery surgery, and percutaneous heart valve surgery. They also cover treatments for early-stage cancers, carcinoma in situ, pancreatic cysts, severe COPD, ulcerative colitis, etc.
2. Moderate conditions
Critical illness conditions labelled as moderately severe largely include treatments such as pericardiectomy, surgery to place ventricular assist device or total artificial hearts, minimally invasive surgery to aorta, pacemaker insertion, cardiac arrest, secondary pulmonary hypertension, endovascular surgeries, cerebral shunt insertion, brain surgery, bacterial meningitis, small bowel transplant, liver cirrhosis, and chronic pancreatitis.
3. Major Conditions
Ailments such as myocardial infarction (first heart attack on specific severity), Open chest CABG, Open heart replacement or repair of heart valves, major surgery to aorta, heart transplant, primary pulmonary hypertension, cardiomyopathy, major stage cancer, stroke resulting in permanent symptoms, multiple sclerosis, permanent paralysis of limbs, coma of specified severity, kidney failure requiring regular dialysis, major organ/donor transplant, end-stage lung or liver failure, loss of limbs, third degree burns, blindness, major head trauma, deafness, loss of speech, apallic syndrome, benign brain tumour, lupus, Alzheimer’s, Parkinson’s disease, muscular dystrophy, poliomyelitis, etc. are some of the major conditions that a critical illness insurance plan covers.
What are claim benefit options available under critical illness insurance plans?
Claim benefit options available for the insured under the critical illness insurance plans such as the Future Generali Heart and Health Insurance plan are dependent on the severity of the ailment, as categorized into minor, moderate or major conditions as given below:
- Claim benefit for Minor Conditions – 25 percent of Critical Illness sum assured, and future premiums shall be waived off for 5 years or till the end of the policy term, whichever is earlier (applicable only on first minor claim).
- Claim benefit for Moderate Conditions – 50 percent of Critical Illness sum assured, and future premiums shall be waived off for 5 years or till the end of the policy term, whichever is earlier (applicable only on first moderate claim).
- Claim benefit for Major Conditions – 100 percent of Critical Illness sum assured post deduction of benefit amount already claimed under minor or moderate condition, if any during the policy term. Policy shall terminate post payout of major claim.
The number of critical ailments emanating out of individuals’ erratic lives and the risks associated with their lifestyles continues to multiply to the extent that the mediclaim policies offered by most employers to their employees fail to cover the high expenses incurred towards the treatment of these minor, moderate, and major conditions of the critical illnesses. This missing gap is suitably filled by the critical illness insurance plans that offer an individual with a financial cover for not only treatment of a number of uncommon critical illnesses but also other incidental costs.
It is always advisable to purchase a CI plan that covers a higher number of minor, moderate, and major critical illnesses upon diagnosis. Future Generali Heart and Health Insurance plan is one such comprehensive CI cover that provides a treatment cover for up to 59 critical illnesses and offer a lump sum benefit to the insured immediately upon the diagnosis of the severity of the condition. The plan allows the flexibility to choose from four cover options, two of which include a return of premium feature payable as maturity benefit, and it also offers a death cover from day 1 with all the four options. Importantly, this CI plan insured is also eligible to avail multiple claim benefits for 2 minor and 2 moderate conditions, provided the sum assured is not exhausted. The plan can directly be bought from their website at special discounted prices, and tax benefits can be availed for the premiums paid under sections 80C and 80D of the Indian Income Tax Act.