Term Insurance with Critical Illness Cover

person stacking blocks referring to medical and life insurance

In today’s uncertain world, protecting your family’s financial future isn't just about term life insurance anymore. With rising healthcare costs and the increasing prevalence of critical illnesses, combining term insurance with critical illness coverage has become more important than ever.

This article will help you understand the benefits of term insurance with critical illness rider cover.

Table of Contents

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Key Insights About Critical Illness Rider in Term Life Insurance

A Critical Illness Rider is an optional add-on to a term life insurance policy that provides financial support if you are diagnosed with a serious health condition. Here is a brief overview:

Feature Description
Plan Purpose It provides a lump-sum payout if the policyholder is diagnosed with a specified critical illness.
Common Covered Illnesses Cancer, heart attack, stroke, kidney failure, ALS, and major organ transplants.
Payout A partial or complete lump sum is typically paid out upon diagnosis of a covered illness.
Premium Higher than regular term insurance due to added coverage.
Minimum Sum Assured ₹100,000
Maximum Sum Assured Capped at ₹25,00,000
Waiting Period Typically, it ranges from 30 to 90 days from the policy start date.
Survival Period The insured must survive for 30 days post-diagnosis.
Exclusion Pre-existing conditions or illnesses are not covered by the rider.
Cost It comes as an additional cost with term plan, and premiums are recalculated based on age and health condition.

What is Term Insurance with Critical Illness Rider?

Term insurance with critical illness riders is a comprehensive insurance product that combines two essential protections:

1. Regular-term life insurance coverage that provides a death benefit.

2. Additional coverage for specified critical illness.

This is a two-in-one safety net that protects your family financially in case of your death and critical illness rider provides financial support if you are diagnosed with a covered serious illness such as cancer, heart attack, stroke, kidney failure, and others during the policy.

This amount can then be used to cover medical expenses or other financial needs, thus ensuring that the treatment is not compromised or the family does not suffer due to scarcity of funds.

The critical illness rider in term insurance can be especially useful for people with a family history of critical diseases or who work in high-risk occupations. Depending on the insurer, it can be acquired at the start of the policy or on the plan's anniversary.

Diseases Covered Under a Term Insurance Plan with Critical Illness Benefit

A critical illness rider provides coverage against a pre-defined list of critical diseases. Though IRDAI has defined a list of 50 critical illnesses, the illnesses covered may vary from insurer to insurer.

Some common critical illnesses covered in term insurance by most insurers include:

Diseases Covered Under Critical Illness
Angioplasty Benign Brain Tumour CiS / Early Stage Cancer Blindness
Small Bowel Transplant Deafness Brain Aneurysm Surgery or Cerebral Shunt Insertion End Stage Lung Failure
Severe Osteoporosis End Stage Liver Failure Cancer of Specified Severity Loss of Speech
Myocardial Infarction - First Heart Attack of Specific Severity Loss of Limbs Open Chest CABG Major Head Trauma
Open Heart Replacement or Heart Valves Reparation Primary Pulmonary Hypertension Coma of Specified Severity Third Degree Burns
Kidney Failure Requiring Regular Dialysis Alzheimer's Disease Stroke Resulting in Permanent Symptoms Parkinson's Disease
Major Organ /Bone Marrow Transplant Aorta Graft Surgery Permanent Paralysis of Limbs Amputation of Feet Due to Complications from Diabetes
Motor Neuron Disease with Permanent Symptoms Apallic Syndrome Multiple Sclerosis with Persisting Symptoms Aplastic Anaemia
Bacterial Meningitis Loss of One Limb and One Eye Brain Surgery Medullary Cystic Disease
Cardiomyopathy Muscular Dystrophy Chronic Adrenal Insufficiency - Addison's Disease Myasthenia Gravis
Chronic Relapsing Pancreatitis Myelofibrosis CJD - Creutzfeldt Jakob Disease Necrotising Fasciitis
Crohn's Disease Other Serious Coronary Artery Disease Dissecting Aortic Aneurysm Pheochromocytoma
Eisenmenger's Syndrome Poliomyelitis Elephantiasis Progressive Scleroderma
Encephalitis Progressive Supranuclear Palsy Fulminant Viral Hepatitis Severe Rheumatoid Arthritis
Hemiplegia Severe Ulcerative Colitis HIV due to Blood Transfusion/Occupationally Acquired HIV Systemic Lupus Erythematosus with Lupus Nephritis
Infective Endocarditis Terminal Illness Loss of Independent Existence - Cover up to Age 74 Tuberculosis Meningitis

The exact list of illnesses covered may vary from one insurer to another, and some insurers may offer additional coverage for other critical illnesses. It is essential to carefully review the policy document to understand the list of illnesses covered and any exclusions that may apply.

How Does a Critical Illness Cover in Term Insurance Work?

A critical illness rider is an add-on to a term insurance policy that provides financial support if you’re diagnosed with a serious illness. Here is how it generally works:

Addition to Policy

You can add a critical illness rider to your term insurance policy when you purchase.

Qualifying Illness

The rider covers specific critical illnesses such as heart attack, cancer, stroke, kidney failure, and more. The exact illnesses covered can vary by insurer.

Waiting Period

After you buy a critical illness cover, there is usually a waiting period of 30-90 days, depending on the insurer. During this period, you can’t raise a claim.

Diagnosis of a Covered Illness

If you are diagnosed with a critical illness covered under the rider, you become eligible to receive the lump sum payment provided by the rider.

Survival Period

Before you can claim the benefit, there is usually a survival period of 15-30 days after the diagnosis.

Payout

Upon activation, you receive a lump sum or periodic payments deducted from your policy’s death benefit. This money can be used for medical bills, living expenses, or other needs.

Impact on Death Benefit

 

The policyholder receives a lump sum payment from the insurer per the claim and the policy specifications. Or the amount paid out under the critical illness rider reduces the death benefit your beneficiaries will receive.

Understanding Critical Illness Rider in Term Insurance Scenarios with Illustration

Mr. Saha bought a 15-year term plan worth 1 crore and added a critical illness rider covering 10 lac for a nominal premium. After 3 years, Mr. Saha is diagnosed with cancer. Thankfully, the disease is covered under his critical illness rider.

However, Mr. Saha had to wait for the survival period of 30 days, after which he received the coverage amount of 10 lacs. He used this amount for his chemotherapy and other best treatments possible, thus recovering completely.

Unfortunately, the cancer relapsed after 8 years. He could not claim the critical illness rider this time since it can be claimed just once. Also, he didn’t survive the required survival period of 30 days. In this case, after his demise, the beneficiary is paid the sum assured of 1 crore under his base term plan.

 

Disclaimer: The above illustration is a hypothetical example created for educational purposes only and does not represent a real-life scenario. Please read your policy documents to understand the terms and conditions clearly.

What are the Benefits of Term Insurance with Critical Illness Cover?

Critical illness insurance cover offers several benefits that can provide significant financial and emotional relief during challenging times. Here are some key benefits:

Financial Protection Against Critical Illness

A critical illness rider offers financial protection against a range of critical illnesses that may require expensive medical treatment. It provides a lump sum payment to help cover the costs of medical treatment, hospitalization, and other related expenses. Thus, it is an excellent option for individuals who want to ensure that they are protected against the financial impact of a critical illness.

Income Replacement

Being affected by a critical illness affects the individual’s ability to earn. Thus, it might be difficult for the dependent family to deal with financial requirements. In such a case, the extra payout from a critical illness rider, can serve as financial support after paying for the treatment of the illness.

Coverage for Medical Expenses

The critical illness rider covers a wide range of illnesses, as specified in the policy. With this rider in hand, expensive treatments can be afforded, and critical illnesses can be treated.

Flexibility

Critical illness riders are flexible and can be customized to suit your specific needs. You can choose the amount of coverage you need, the duration of the policy and can add it during the policy tenure, on any policy anniversary.

Affordable Premiums

Critical illness riders are relatively affordable, making them accessible to a wide range of individuals. The premiums are based on your age, health, and the amount of coverage you need. They can be added to your base plan with just a nominal additional premium.

Double Tax Benefit

When you buy term insurance with a critical illness cover, you get tax benefits under sections 80C and 10(10D) of the Income Tax Act, 1961. Adding a critical illness rider to your term plan gives you extra tax benefits under Section 80D of the Income Tax, which means more tax savings.

Increase in Survival Chances

The cost of treating critical illnesses in India is high, and many people stop treatment halfway due to lack of funds. A critical illness rider ensures you have the money needed for treatment, so you don’t have to compromise on your health. This payout helps cover medical expenses, allowing you to focus on recovery without financial stress.

Lump Sum Benefit

Term Insurance with critical illness coverage offers financial protection not just in case of death but also in critical illness. In the event of a critical illness diagnosis, policyholders receive a one-time lump sum amount, providing much-needed financial support to cover medical expenses, treatment costs, and other financial obligations.

Quick Help When You Need It

Unlike other insurance policies, critical illness insurance starts helping you sooner after a diagnosis so you can get the care and financial support you need without a long wait.

Who Should Buy Term Insurance with Critical Illness Rider?

A critical illness rider provides an added financial security and must be considered by anyone who wishes to enhance their financial protection, extending the coverage to any unfortunate medical diagnosis. These groups of people must consider it:

1. Single and Unmarried Person

Critical illnesses can strike anyone irrespective of age or gender. A critical illness benefit goes a long way to aid the complete and the best possible medical treatment. A single unmarried person might have liabilities like loan EMIs or dependent parents that might get hit if they suffer from any severe ailment and their earnings are affected.

In such a case, a critical illness benefit takes care of not just the treatment of the policyholder but also the other financial requirements. 

2. People with a Critical Illness History in the Family

Individuals with a family history of critical illnesses such as cancer or heart disease must consider adding this rider. Since they are at an increased risk of being diagnosed with such illness, a critical illness rider provides the added protection needed.

3. Primary Earners

For the primary breadwinners in a family, a critical illness rider is crucial. It ensures financial stability and support if the primary earner is diagnosed with critical illness, covering the treatment costs and the loss of income.

4. People with Dependents

If you have dependents relying on your income, this rider is a safeguard. It helps maintain their lifestyle and cover essential expenses during difficult times, ensuring their well-being.

5. For People Over 40 Years

As people get older, they often face more health issues. A term plan with a critical illness rider can help those over 40 secure their future if they get a serious illness.

6. For People in High-Pressure Jobs

Stress and unhealthy lifestyles can lead to serious illnesses. While you might not be able to change your high-pressure job, you can protect yourself by buying a term plan with a critical illness rider. This way, you are covered if something happens.

Things To Consider When Buying A Term Insurance With Critical Illness Cover

When considering a critical illness rider for your term insurance policy, it’s important to evaluate several key features:

Illnesses Covered

While major diseases are covered by most insurers, the list differs across plans and insurance providers. They have different coverage options. Choose the one that provides comprehensive coverage for the critical illnesses you will most likely face.

Premium Cost

Consider the extra cost of adding the critical illness rider to your term insurance. Compare the rider's benefits with the cost to see if it fits your budget and needs.

Consider Inflation

When deciding the coverage, consider the inflation rate. Ever-rising inflation pushes medical costs considerably every year.

Waiting Period

Most critical illness riders come with a waiting period, typically 90 days from the policy commencement date. Any diagnosis during this period is usually not covered. Understanding this feature is crucial for proper planning.

Survival Period

Insurance companies often specify a survival period (14 - 30 days) after diagnosis. The policyholder must survive this period to receive the benefit. This clause ensures the benefit serves its intended purpose of supporting treatment costs.

Premium Waiver

Some riders offer premium waiver benefits after a critical illness diagnosis, meaning you don’t need to pay further premiums while maintaining coverage.

Coverage Duration

Consider whether the rider coverage extends throughout the base policy term or has a different duration. Some riders might terminate at a certain age or after a claim.

Treatment Costs

Medical expenses and treatment costs keep rising every day. Critical illnesses are furthermore expensive. It is imperative to research the cost of treatment for significant diseases and accordingly plan your coverage. 

Coverage for the Recovery Period

Most critical illnesses require a lengthy recovery period. As a thumb rule, assume the recovery period as 5 years and get enough coverage to take care of your finances for that period.

Exclusions and Limitations in Term Insurance with Critical Illness Rider Cover

When considering a critical illness rider, it’s important to be aware of the common exclusions and limitations that may apply:

Common Exclusions

Understanding what is not covered is as important as knowing what is covered:

  • Pre-existing Conditions: Many policies exclude coverage for illnesses diagnosed before purchasing the policy.
  • Self-inflicted Injuries: Illnesses or injuries resulting from self-harm are not covered.
  • Illegal Substance Abuse: Injuries or illnesses resulting from the illegal use of drugs or abuse of prescription medications are typically excluded.
  • Alcohol Abuse: Conditions arising from chronic alcohol abuse or being under the influence of alcohol at the time of the incident may not be covered.
  • Non-standard Treatments: Treatments that are not widely accepted by the medical community or not approved by regulatory bodies (e.g., FDA) are generally excluded.
  • Certain High-Risk Activities: Injuries or illnesses resulting from participation in high-risk activities like skydiving, bungee jumping, or scuba diving are often excluded

Policy Specific Limitations

  • Maximum Coverage Age: Coverage typically extends up to age 65 or 70.
  • Claim Limits: Usually, only one claim per year per qualifying condition.
  • Cooling-off Period Between Claims: Often a 90-day waiting period between claims.
  • Geographic Restrictions on Treatments: Treatments must often be certified by a U.S.-licensed physician.
  • Documentation Required: Proof from a doctor confirming the diagnosis of a qualifying critical illness.

Steps to Claim a Critical Illness Cover in Term Insurance

First, check your policy documents to ensure that your diagnosed condition is covered under the critical illness rider. Contact your insurance company as soon as possible to inform them of your diagnosis.

Here are the five simple steps to claim critical illness in term insurance:

Step 1

Notify your insurance company within 30 days of being diagnosed with a critical illness.

Step 2

Provide medical documentation (medical reports, test results, and a statement from your doctor) to prove your diagnosis.

Step 3

Submit the claim form and medical records within 60-90 days.

Step 4

The insurance company will verify your documents and might ask for more information.

Step 5

Once everything is verified, you will receive the payment in a lump sum or staggered.

Important: Claims can be rejected if there are pre-existing conditions, missing documents, exclusions, fraudulent claims, or if you notify them late. Always review your policy carefully.

Documents Required to Claim Term Insurance with Critical Illness Rider

Here is a list of all the documents you would need to claim your term insurance with critical illness rider:

S. No Documents Required
1 Filled claims form
2 Original policy documents
3 Valid ID and address proof of the insured
4 All pre and post-hospitalization records
5 Medical test reports confirming the critical illness
6 Certificate from the attending medical practitioner
7 Cancelled cheque or bank statement of the insured

Tax Benefits of Term Insurance with Critical Illness Rider

In India, critical illness riders can offer tax benefits under the Income Tax Act. Here are the key points to consider:

Section 80D

Premiums paid for critical illness riders are eligible for tax deductions under Section 80D of the Income Tax Act. This section allows deductions for premiums paid towards health insurance policies, including critical illness riders. The maximum deduction available under Section 80D is:

  • ₹25,000 per year for individuals and their families (including spouses and children).
  • ₹50,000 per year for senior citizens (aged 60 years and above).
  • An additional ₹25,000 (or ₹50,000 if parents are senior citizens) for parents’ health insurance premiums.

Eligibility

To claim the tax benefit, the policyholder must pay the premium and not reimburse it by any other means. The payment should be made through non-cash modes like cheques, bank drafts, credit cards, etc.

Combined Benefits

If you have multiple health insurance policies, including a critical illness rider, the total premium paid for all policies can be considered for the deduction under Section 80D, subject to the specified limits.

How to Choose the Right Term Insurance Plan with Critical Illness Cover?

Choosing the perfect critical illness insurance plan involves considering several key factors to ensure it meets your needs. Here are some steps to guide you:

Sum Assured

When choosing a critical illness policy, make sure the sum assured is enough to cover medical treatment costs. This lump sum should also support your family, as critical illnesses often lead to loss of income during recovery.

Choice of Policy

If you have life insurance, you can add a critical illness rider to increase your coverage. This rider pays out a lump sum or a percentage of it, depending on the severity of the illness.

Inclusions and Exclusions

Review the inclusions and exclusions of any critical illness plan. Some stages of illnesses might not be covered, so it’s important to understand these details to avoid surprises.

Your Age

Critical illness insurance has age limits. The earlier you get it, the better your coverage and the lower your premiums. Early preparation ensures better protection against future health issues.

Waiting Period

These policies usually have a waiting period (around 6 months) before benefits can be claimed. This ensures coverage only for illnesses diagnosed after purchasing the policy.

Number of Illnesses Covered

Check the list of illnesses covered by the policy. Ensure it includes major illnesses and any specific conditions you are concerned about. This helps in choosing the right policy or rider for comprehensive coverage.

Term insurance with critical illness riders is a crucial financial planning means today. It provides comprehensive protection against death and serious illness, ensuring financial security for you and your family. While the premium might be slightly higher than basic term insurance, the additional protection justifies the cost.

When thinking about getting this rider, make sure to check which illnesses are covered, any waiting periods, exclusions, and how much it will cost.

FAQs about Term Insurance with Critical Illness Cover

How does a term plan with critical illness cover work?

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A term plan with critical illness cover provides a lump sum payout if you’re diagnosed with a critical illness covered by the policy. This payout can be used for medical expenses, paying off debts, or other financial needs during recovery.

Should I take critical illness coverage with term insurance?

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Yes, taking critical illness coverage with term insurance can be beneficial. It provides additional financial protection against major diseases like heart attack, cancer, and kidney failure. This can be especially useful if you have a family history of such illnesses or want to ensure comprehensive coverage.

Why should you buy a critical illness term insurance instead of a stand-alone critical illness plan?

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Combining critical illness coverage with term insurance can be more cost-effective than buying separate policies. It simplifies insurance management and ensures life and critical illness coverage under one plan. Additionally, some insurers offer critical illness riders at a lower cost when added to a term plan.

What is the critical illness benefit of term insurance?

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The critical illness benefit in term insurance provides a lump sum payout upon diagnosing a covered critical illness. This benefit can cover treatment costs, household expenses, or other financial needs during your illness.

Is it worth getting critical illness insurance?

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Critical illness insurance can be worth it, especially if you have high out-of-pocket medical expenses or lack sufficient savings to cover unexpected medical bills. It offers a financial safety net, allowing you to focus on recovery without worrying about finances.

Can I claim twice for the same illness under the critical illness rider in term insurance?

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No. You can’t claim more than once under a critical illness rider. It pays the claim amount once and then terminates. However, you may consider buying a new critical illness rider after the first one is terminated.

Can the payout from a term insurance with critical illness rider be used for any purpose?

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While the primary purpose of a critical illness rider is to cover the treatment expenses related to a critical illness, the payout can be used for any purpose. The financial impact of a critical illness can be significant, and the payout from the rider can help ease the financial burden on the policyholder and their family. It can be used to cover medical expenses, repay loans, or any other expenses that may arise due to the illness, thus ensuring the financial stability of the family.

Do all term insurance policies come with a critical illness rider?

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No, critical illness rider is usually an add on that needs to be purchased separately over and above the base insurance plan.

How is a term insurance with a critical illness rider different from a regular health insurance policy?

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Unlike a regular health insurance policy, a critical illness rider provides a lump sum payout upon diagnosis of a critical illness. The payout can be used to cover medical expenses or any other expenses that may arise due to the illness.

What is the eligibility for buying term insurance with critical illness rider?

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For buying a critical illness rider, the eligibility depends on several factors and might also differ across insurers. However, the most common factors include: an age limit of 18-65 years and declaring the pre-existing conditions and lifestyle habits.

What are the documents required for a term insurance with a critical illness rider claim?

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Most commonly, the following documents are required to claim a critical illness rider:  

  • Claim intimation form 
  • Attending doctor’s certificate
  • Copy of all medical records
  • Original policy certificate
  • Cancelled Cheque

Does term insurance provide critical illness rider?

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Yes, you can add a critical illness rider to your term policy for a nominal premium.

How is the payout from term insurance with critical illness rider received by the beneficiary?

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After a successful claim settlement for term insurance with critical illness benefit, the beneficiary receives a lumpsum payout.

Can I buy a term insurance with critical illness rider once I'm diagnosed with a critical illness?

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No. A term insurance with critical illness benefit usually does not cover conditions for which a person is diagnosed within 2 years prior to purchasing the policy.

How does the term insurance with critical illness rider affect the policy’s sum assured and payout structure?

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A critical illness rider may either reduce the sum assured of your base policy upon payout or provide an additional lump sum payout. Some policies deduct the critical illness payout from the death benefit, while others offer standalone coverage, which doesn’t affect the original term insurance sum.

What are the exclusions or limitations in critical illness riders in term insurance?

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Critical illness riders often exclude pre-existing conditions, certain types of cancer (such as early-stage), illnesses due to self-inflicted injuries, and conditions that arise within a waiting period. Additionally, some policies may limit the number of claims or apply age limits.

How do waiting periods and survival periods impact the effectiveness of a term insurance with critical illness rider?

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Most critical illness riders have a waiting period (e.g., 30-90 days after policy issuance) and a survival period (e.g., the insured must survive for a certain number of days after diagnosis, typically 14-30 days). Understanding these periods is crucial for assessing when benefits become available.

Can I customize the illnesses covered in a term insurance with critical illness rider, and how does that impact premiums?

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Some insurers allow customization by choosing which illnesses are covered from a list, which directly impacts premiums. Comprehensive riders that cover a wide range of illnesses (e.g., cancer, heart disease, stroke, organ transplants) are typically more expensive than riders that cover only a few key conditions.

How does the term insurance with critical illness rider differ in its benefits from a standalone critical illness policy?

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A critical illness rider is an add-on to term insurance and typically provides a lower sum assured, whereas a standalone policy may offer broader coverage options, higher payout limits, and more flexibility in terms of policy structure and premium payment.

How does age or health condition at the time of purchase impact the pricing of a critical illness rider in term insurance?

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Premiums for a critical illness rider in term insurance are higher for older individuals or those with existing health conditions. In some cases, insurers may deny adding the rider if you’re above a certain age or have significant risk factors like family history of certain illnesses or lifestyle-related conditions (e.g., smoking, obesity).

What are the tax implications of receiving a payout from a critical illness rider in term insurance?

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In many jurisdictions, critical illness payouts are tax-free since they are considered a benefit rather than income. However, policyholders should check the local tax laws, as tax treatment may vary depending on the structure of the policy and the use of the benefit.

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Disclaimer

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  • This is an informative article provided on 'as is' basis for awareness purpose only and not intended as a professional advice. The content of the article is derived from various open sources across the Internet. Digit Life Insurance is not promoting or recommending any aspect in the article or its correctness. Please verify the information and your requirement before taking any decisions.
  • All the figures reflected in the article are for illustrative purposes. The premium for Coverage that one buys depends on various factors including customer requirements, eligibility, age, demography, insurance provider, product, coverage amount, term and other factors
  • Tax Benefits, if applicable depend on the Tax Regime opted by the individual and the applicable tax provision. Please consult your Tax consultant before making any decision.

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