Critical Care Insurance

Critical Care protects you or your spouse against loss of income on diagnosis of any of the 9 major medical illnesses and procedures. The first of its kind, it offers a lump sum benefit on diagnosis of Cancer, Bypass Surgery, Heart Attack, Kidney Failure, Major Organ Transplant, Stroke, Paralysis, Heart Valve Replacement Surgery or Multiple Sclerosis. Critical Care Insurance also provides cover against accidental death and permanent total disablement (PTD).

Critical Care Insurance - Policy Coverge

Critical Care offers you a choice of coverage on both the sum insured and the tenure of the policy. You can choose the sum insured of Rs 6,00,000 or Rs. 12,00,000 over a period of 3 or 5 years. The premium would be calculated accordingly.

Critical Care Sum Insured Table

Covers Sum Insured Options
Critical Illness/Major Medical Illness Diagnosis Rs. 6,00,000 or Rs. 12,00,000
Accidental Death
Permanent Total Disability (PTD)

Critical Care Premium Table

Policy Tenure/Age Groups(Years) Sum Insured = Rs. 6 Lakh Sum Insured = Rs. 12 Lakh
3 Years (Rs.) 5 Years (Rs.) 3 Years (Rs.) 5 Years (Rs.)
20 - 25 5,800 9,700 11,600 19,400
26 - 30 6,600 11,280 13,200 22,600
31 - 35 8,300 14,000 16,600 28,000
36 - 40 10,300 18,400 20,600 36,800
41 - 45 20,500 38,200 41,000 76,440

  • (Inclusive of Service Tax @ 12.36% and Education Cess at 2%)
  • The premium depends on the applicant's age* and the policy tenure opted for.
  • *Age is calculated as on the date the policy is issued (i.e.age completed as on his last birthday)

The policy provides lump sum benefit on diagnosis of any of 9 Critical Illnesses, Accidental Death and Permanent Total Disablement (PTD).

  • Critical Illness Cover
  • The Critical Care Insurance shall cover, subsequent to 90 days from the policy start date, the following major medical illnesses and procedures:

    1. Cancer
    2. Coronary Artery Bypass Graft Surgery
    3. Myocardial Infarction (Heart Attack)
    4. Kidney Failure (End Stage Renal Failure)
    5. Major Organ Transplant
    6. Stroke
    7. Paralysis
    8. Heart Valve Replacement Surgery
    9. Multiple Sclerosis
    On diagnosis of any of the above illnesses, the insured is entitled to the lumpsum benefit of the entire Sum Insured opted for.

  • Accidental Death Cover
  • In case of death of the insured due to an accident within the policy period, the nominee (mentioned in the policy) is compensated with the Sum Insured (opted at the time of policy issuance).

  • Permanent Total Disablement (PTD) Cover
  • Critical Care insures against the permanent and total loss of limbs, sight etc., due to an accident. The compensation (Sum insued opted for) is given as a lump sum benefit. It is to be noted that the compensation is payable only if the disablement results in inability to remain gainfully employed.

Permanent Total Disablement Benefits

Loss of use/Actual loss by physical separation of Percentage of Capital Sum Insured*
Sight of both eyes 100%
Both hands 100%
Both feet 100%
One hand and one foot 100%
*As stated in Part I of the Schedule.

Note: If any such injury as mentioned above shall result in the inability to remain gainfully employed, then the Capital Sum Insured payable will be 100%.

Critical Care Insurance - Key Benefits

  • Comprehensive Cover - Lump sum benefit on diagnosis of any of 9 Critical Illnesses, Personal Accident and Permanent Total Disablement (PTD) Cover.

  • Choice of coverage - Choose between Rs. 6,00,000 or Rs. 12,00,000 sum insured and 3 or 5 years of policy duration.
  • Avail of tax benefit under section 80D of Income Tax Act.
  • No health check up required
  • No 30 day waiting period, benefit paid immediately on diagnosis

Critical Care Insurance - Eligibility
  • The insured can be either you or your spouse
  • The insured needs to be between 20 - 45 years of age
  • Age is calculated as on the date the policy is issued (i.e.age completed as on his last birthday)

Critical Care Insurance - Policy Exclusions
Exclusions applicable to Critical Illness:

90 Days Exclusion:
Any illnesses and procedures within 90 days from start date of policy will not be covered. This clause does not apply for subsequent renewal (without a break) of this policy with us.

Permanent Exclusion
The Company shall not be liable under this policy for:

  • Any Pre-Existing illness
  • Absence of submission of Doctor's medical certificate confirming the diagnosis of Illness or Injury or undergoing of medical/surgical procedure
  • Any congenital Illness or condition
  • Any medical procedure or treatment, which is not medically necessary or not performed by a Doctor
  • Any physical, medical or mental condition, illness, injury or treatment or service which is specifically excluded under the Policy
  • Treatment relating to birth defects and external congenital Illnesses
  • Birth control procedures and hormone replacement therapy
  • Any treatment/ surgery for change of sex or any cosmetic surgery or treatment
  • Treatment by family member and self-medication or any treatment that is not scientifically recognized

Exclusions applicable to Personal Accident:
The Company shall not be liable under this policy for:

  • Compensation/claim under more than one of the categories specified in the Policy Coverage in respect of the same period of disablement of the Insured Person
  • Claims arising out of sickness/illness
  • Death, injury or disablement of Insured Person
    1. From intentional self-injury, suicide or attempted suicide
    2. Whilst under the influence of intoxicating liquor or drugs
    3. Directly or indirectly caused by venereal disease or AIDS
    4. Directly or indirectly caused by contributed to or aggravated or prolonged by childbirth or pregnancy or in consequence thereof.
    5. Engagement in dangerous activities
    6. Mounting into, dismounting from or traveling in any aircraft other than as a fare paying passenger on a scheduled flight
    7. Mental disorder or psychosomatic dysfunction
  • Permanent Total Disablement prior to commencement of the policy

Critical Care Insurance - Need for Critical Care
  • India is home to over 60 million coronary heart patients
  • India's economic loss due to heart related disease could be $236 billion till 2015
  • At any given time there will be 3 million cancer patients in India

However, today, with the advancement in medical science, solutions have been developed for virtually any ailment in the world. A study revealed that 50% of cancers are curable if detected early. But it has also led to rising costs of treatment.


Cost (US$)

Bone Marrow Transplant 69,000 (approx. Rs. 31, 74,000)
Liver Transplant 69,000 (approx. Rs. 31, 74,000)
Heart Surgery 8,000 (approx. Rs. 3,68,000)
Cataract Surgery 6,000 (approx. Rs. 2,76,000))
Orthopaedic Surgery 1,250 (approx. Rs. 57,500)

Please note that this is only an indicative estimate of the surgery expenses.

Critical Care Insurance - Claim Process
Know all about making a claim

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