What are the Common Critical Illnesses Covered by Health Insurers in 2024?

Critical Illness Health Insurance is a type of policy which gives a lump sum amount for a set of critical illnesses. If you have a critical illness, more often than not, you may not be able to work for an extended period of time. This is where critical illness health insurance comes into play and acts as a temporary replacement for your income.

This amount and the list of critical illnesses will differ from insurer to insurer. It doesn’t matter what your actual medical expenses are. The entire amount is paid when you’re diagnosed with a critical illness. This brings us to the question – what are the critical illnesses that insurers cover?

Top Critical Illness Health Insurance Policies in 2024

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Common Critical Illnesses Covered by Health Insurance Companies

Well, the actual list differs from insurer to insurer, but here are some common critical illnesses that insurers cover:

1. Cancer: Cancer is one of the most common critical illnesses insurers cover. Critical illness policies generally cover even advanced or life-threatening stages of cancer, excluding non-invasive cancers. The coverage applies to malignant tumours that show uncontrolled cell growth and require substantial medical intervention, such as surgery, chemotherapy, or radiation therapy. Some insurers may also include specific types of cancer, such as leukaemia, lymphoma, or breast cancer, and may exclude the rest.
2. Heart Attack (Myocardial Infarction): A heart attack occurs when the blood supply to a part of the heart is severely reduced or blocked, causing damage to the heart muscle. Most critical illness policies cover heart attacks, usually only the first heart attack or those leading to significant impairment or requiring emergency medical intervention like angioplasty or surgery. It does not usually cover mild heart attacks.
3. Stroke (resulting in permanent symptoms): A stroke is like a heart attack but for the brain. It happens when blood flow to the brain is interrupted, leading to brain damage. This condition can cause lasting effects such as paralysis, speech impairment, or other cognitive issues. Critical illness insurance covers strokes that result in permanent symptoms – meaning the insured may be left with long-term or lifelong disabilities. Insurers generally exclude transient ischemic attacks (mini-strokes) from coverage.
4. Kidney Failure (requiring regular dialysis): Kidney failure, or end-stage renal disease, occurs when the kidneys lose their ability to function and remove waste from the body. Policies cover chronic kidney failure, where you require regular dialysis treatments or a kidney transplant. This often requires ongoing medical care, making it a significant financial burden without insurance.
5. Major Organ Transplant: Organ transplants are high-cost medical procedures, and critical illness policies usually cover transplants of major organs such as the heart, lungs, liver, kidney, or pancreas. The insurer pays out when you are placed on an official waiting list for transplant surgery. This payout helps cover the substantial expenses involved in both the surgery and post-transplant care.
6. Coronary Artery Bypass Surgery: Coronary artery bypass surgery improves blood flow to the heart by bypassing blocked or narrowed coronary arteries. It is a common treatment for coronary artery disease (CAD) and is covered by most critical illness policies. However, you must keep in mind that Insurers usually specify that the surgery must be deemed medically necessary to qualify for the payout.
7. Paralysis (total and permanent): Total and permanent paralysis can result from conditions like strokes, spinal cord injuries, or neurodegenerative diseases. Critical illness policies usually provide coverage for paralysis affecting the limbs or other parts of the body, which leaves the insured permanently disabled and unable to work. Temporary paralysis or paralysis that improves with treatment, such as physiotherapy, is usually not covered.
8. Chronic Lung Disease: Chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, or emphysema, can lead to severe respiratory impairment and require long-term treatment. These conditions may make everyday activities difficult and result in a loss of mobility. Critical illness plans usually cover the advanced stages of these diseases, where everyday life is heavily disrupted, and expensive medical care is necessary.
9. Chronic Liver Disease: Chronic liver disease, such as cirrhosis or liver failure, can lead to severe complications requiring ongoing medical intervention, including liver transplants. Advanced stages of liver disease, where the organ is no longer functioning properly, are covered under most critical illness policies.
10. Multiple Sclerosis (with persisting symptoms): Multiple sclerosis (MS) is a progressive neurological condition that affects the central nervous system, leading to symptoms such as muscle weakness, fatigue, and vision problems. Critical illness policies cover MS when it results in persistent and disabling symptoms, particularly those that worsen over time and severely impact day-to-day functions. The policy payout can help cover treatment costs or assist with day-to-day living expenses during prolonged care.

What are the Top Critical Illness Health Insurance Policies in 2024?

Here are some of the top health insurance policies that cover critical illnesses:

1. HDFC ERGO Critical Illness Platinum: This policy from HDFC ERGO covers up to 15 critical illnesses, with a cover amount of ₹ 2.5 lakh to ₹ 10 crore. It also has one of the lowest survival periods, at just 15 or 30 days (depending on what is chosen at the time of purchase). However, one significant downside is that this is one of the most expensive plans in the market.
2. Care Critical MediClaim: Care Critical MediClaim covers 32 critical illnesses, with payouts starting at ₹ 1 lakh to ₹ 2 crore. One unique feature of this policy is that it doesn’t have a specific illness waiting period. However, this has a pre-existing disease waiting period of 4 years. This policy also covers OPD expenses of 1% of the sum assured or ₹ 25k, whichever is lower.
3. Aditya Birla Activ Secure: Activ Secure by Aditya Birla covers up to 64 illnesses—one of the highest in the industry. There are 3 variants of this policy that cover 20, 50, and 64 illnesses, respectively. This policy has a unique feature: if you get diagnosed with more than one critical illness on the list simultaneously, you can get up to 1.5x of the sum assured. However, pre-existing diseases are excluded from this policy altogether.

Things to keep in mind while purchasing a Critical Illness Cover

1. Number of illnesses covered: Not all insurers cover all critical illnesses. And not all insurers cover the same number of critical illnesses. Ensure that the policy you choose includes all the critical illnesses of the highest concern to you.
2. Permanent Exclusions: Some diseases are permanently excluded from coverage. These commonly include illnesses that stem from smoking or alcoholism. It also involves STDs such as HIV/AIDS or treatment for infertility.
3. Survival period: Some critical illness policies come with a survival period. This means you must survive for a certain period of time after diagnosis to be eligible for the claim. If you don’t survive this period, the insurer will not pay the claim. Naturally, ensure that the survival period is as short as possible.
4. Pre-Existing Diseases (PEDs): Critical illness coverage may not extend to PEDs, so it’s essential to declare all health conditions honestly when purchasing the policy.

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Conclusion

While you may not want to think about critical illnesses, planning for them is crucial for long-term financial security. These are the black swan events that can disrupt your life unexpectedly, and having critical illness insurance ensures you're financially prepared to handle the high costs associated with severe medical conditions.

If you need help purchasing a health insurance policy that covers such critical illnesses, feel free to contact Ditto Insurance's IRDAI-certified advisors for honest, spam-free insurance advice.