Critical illness plan covers an individual against serious illness which has a debilitating effect on their lifestyle, financial conditions and require a considerable amount of money to take care of the treatments. Sometimes it also leads to loss of income due to inability to work or require a long leave post the treatment. However, before buying a critical illness plan, it is important to read the policy terms & conditions carefully. If you tend to ignore it, there are instances where you are bound to face claim rejection.
Let us have a look at the major terms & conditions under a critical illness policy:
Pre-existing diseases are those medical conditions that existed even before the insured had applied for a policy. Normally any pre-existing ailments are not covered from day 1. Most policies cover ped or pre-existing diseases after a waiting period of two years or four years. However, it does not guarantee that the other diseases linked to the ped will be covered during the waiting period.
Waiting period: under a critical illness plan any treatment diagnosed within first 90days since the inception of the policy is not covered. Following shall only include:-
A. First diagnosis of the below-mentioned illness more specifically described below:-
B. Undergoing for the first time of the following surgical procedures, more specifically described below:-
Occurrence for the first time of the following medical events:
Survival period: most critical illness policies or rider comes with a survival period clause. The claim will be paid for any listed critical illness only if the policyholder survives for a period of minimum 30 days from the date of the first diagnosis of the illness. In case the insured dies with the survival period, no compensation shall be paid to the nominee. However, there are certain life insurance companies which do not have any clause for waiting period or survival period.
Some of the standard permanent exclusions followed by most insurers are:
For a complete list of exclusions, it is advisable to read the policy document of the specified company.