Aditya Birla Sun Life Insurance Company Limited

How Does a Critical Illness Insurance Plan Work?

Let's talk about Priya, a 35-year-old software developer from Hyderabad. She leads a busy life, balancing work and family, and has never really thought much about falling seriously ill. One day, Priya receives the unexpected news that she has been diagnosed with early-stage breast cancer. While emotionally challenging, Priya finds a silver lining in her critical illness insurance plan, which she had purchased as a precautionary measure. Here's how Critical Illness Insurance plan helped her:

Diagnosis and Claim: Shortly after her diagnosis, Priya files a claim with her insurance company, providing all necessary medical documents.
Lump Sum Payment: Her critical illness plan covers breast cancer, so upon validation of her claim, Priya receives a lump sum payment. The amount is based on her coverage level, which she had chosen considering her family's needs and her financial commitments.
Financial Support: The payout from her critical illness plan allows Priya to cover her medical treatment costs without dipping into her savings or stressing about work. She can afford the best treatment options available, cover her living expenses during her recovery period, and even finance additional therapies to support her recovery.
Peace of Mind: Instead of making a difficult period harder by worrying about money, Priya was able to focus on her illness and recovery. She had peace of mind knowing that the policy will take care of the financial aspects, as she always paid her premiums on time.
Priya's story highlights the essence of a critical illness insurance plan. It's not just about the financial payout; it's about providing peace of mind during one of life's toughest challenges, ensuring that a diagnosis does not lead to a financial crisis, and allowing you to focus entirely on your recovery.

Our critical illness insurance policies

Why Should You Buy Critical Illness Insurance?

In today’s fast-paced world, the rise of chronic diseases, especially in India, is a growing concern. With lifestyle changes, environmental factors, and increasing pollution levels, the incidence of critical illnesses such as cancer, heart diseases, and diabetes is on an upward trajectory.

Here’s why it's prudent to consider critical illness insurance

Rising Medical Costs

The cost of treatment for critical illnesses in India is skyrocketing. From hospitalisation to surgery, medication, and post-treatment care, the financial burden can be overwhelming. Critical illness insurance provides a lump sum payout that can help cover these expenses without draining your savings.

Protection Beyond Health Insurance

While standard health insurance covers hospital bills, many other expenses are often not covered. Critical illness insurance offers a safety net that can be used for non-medical expenses, allowing you to maintain your lifestyle without financial strain.

Loss of Income

Recovering from a critical illness often requires extended time off work, leading to loss of income. The payout from a critical illness plan can help compensate for this, ensuring your financial obligations are met during your recovery period.

Early Detection and Treatment

With advances in medical science, many critical illnesses can now be treated successfully if detected early. However, the cost of such treatments can be prohibitive. Critical illness insurance ensures that you can afford the best care without hesitation, increasing the chances of a positive outcome.

6 Benefits of ABSLI Critical Illness Plans

Aditya Birla Sun Life Insurance (ABSLI) offers comprehensive critical illness plans designed to provide financial protection and peace of mind in the event of a serious health diagnosis. Here's a look at the key features and benefits:

Flexible Plan Options: Choose from various plan options to match your coverage needs and budget, ensuring you get the right level of protection.
Wide Range of Covered Conditions: ABSLI critical illness plans cover a broad spectrum of critical illnesses, ensuring you're protected against various life-threatening diseases.
Lump Sum Payout: Upon diagnosis of any of the covered critical illnesses, the plan provides a lump sum payout, giving you the financial freedom to use the funds according to your needs, whether for treatment, rehabilitation, or household expenses.
Waiver of Premium Benefit: Some ABSLI critical illness plans offer a waiver of premium benefit, where future premiums are waived off upon diagnosis of a covered condition, keeping your policy active without further financial burden.
Tax Benefits*: Premiums paid towards ABSLI critical illness plans are eligible for tax deductions under Section 80D of the Income Tax Act, providing additional financial benefits.
Simplified Claims Process: ABSLI emphasises a streamlined and hassle-free claims process, making it easier for you and your family to access the benefits when needed.
These benefits underscore the importance of critical illness insurance in today’s context, especially in India, where the healthcare landscape is evolving rapidly. Investing in a critical illness plan is not just a financial decision; it’s a step towards ensuring peace of mind for yourself and your loved ones in the face of life’s uncertainties.

Steps to Buy a Critical Illness Plan

Purchasing a critical illness plan is a proactive step towards safeguarding your financial future against the impact of serious health conditions. Here’s a straightforward approach to buying a critical illness plan:

Assess Your Needs: Consider your health history, financial situation, and potential future medical needs to determine the level of coverage you require.
Research: Check various critical illness plans, including their covered conditions, benefits, premiums, and exclusion clauses.
Choose a Plan: Select a plan that offers comprehensive coverage for critical illnesses most relevant to you, within your budget.
Fill Out Application: Complete the application form, providing accurate personal, health, and financial information as requested by the insurer.
Undergo Medical Examination: Some plans may require a medical examination to assess your health status. Follow the insurer’s instructions for completing any required tests.
Review Your Policy: Once your application is approved, review your policy documents carefully to ensure all the details are correct and you understand the terms.
Make Payment: Pay the initial premium to activate your policy. Consider setting up automatic payments to ensure your policy remains in force.

Documents needed to buy a critical illness plan

When purchasing a critical illness plan, you may be required to provide the following documents:

Application Form: A completed and signed application form with accurate personal, medical, and occupational details.
Proof of Identity: A valid government-issued ID such as a Passport, Aadhaar Card, PAN Card, Voter ID, or Driving License.
Proof of Age: Documents like a Birth Certificate, Passport, or PAN Card that verify your age.
Proof of Address: Utility bills (electricity, water, gas), Bank statements, Aadhaar Card, or Passport showing your current residential address.
Proof of Income: Recent salary slips, Income Tax Returns, or Bank statements to demonstrate your financial capacity to pay premiums.
Medical Reports: If required, medical reports or a health declaration form that provides details of your current health status. In some cases, a medical examination arranged by the insurer may be necessary.
Photographs: Passport-sized photographs for identification purposes.
Miscellaneous: Depending on the policy’s requirements, you may be asked to provide other documents as well.
It's essential to provide accurate and complete information in all the documents to ensure smooth processing of your application and to avoid any complications at the time of claim settlement.

How to File a Claim for Critical Illness Policy?

To file a claim for your Aditya Birla Sun Life Insurance (ABSLI) Critical Illness Policy, follow these steps:

Inform ABSLI:Notify Aditya Birla Sun Life Insurance about the diagnosis as soon as possible. You can contact their customer service through phone, email, or by visiting a branch office.
Claim Intimation: Fill out the claim intimation form, which is available on the ABSLI website or at their branch offices. Provide all necessary details, including policy number, policyholder's name, and nature of the illness.
Submit Required Documents: Along with the claim form, submit the following documents: a. Duly filled and signed claim form.
b. Policyholder's ID proof (Aadhaar, PAN, etc.).
c. Medical reports confirming the diagnosis of the critical illness.
d. Discharge summary, if hospitalization occurred.
e. Any other documents requested by ABSLI.
Claim Processing: Once ABSLI receives all the required documents, they will process the claim. We may ask for additional information or documents if needed.
Claim Decision: After verifying the documents and assessing the claim, ABSLI will make a decision. If the claim is approved, the lump sum benefit amount will be paid to the policyholder or the nominee.
Payment: The benefit amount will be transferred to the bank account of the policyholder or nominee, as per the policy terms.
It's important to read your critical illness insurance policy document carefully to understand the specific terms and conditions related to claim filing and ensure that all documentation is complete and accurate to avoid any delays in the claim process. If you need assistance, you can reach out to ABSLI's customer support for guidance.

Exclusions in Critical Illness Plan

Exclusions refer to conditions or circumstances under which a critical illness claim would not be paid. Common exclusions in critical illness plans include:

Pre-Existing Conditions: Illnesses that the insured was diagnosed with or showed symptoms of before the policy start date are typically not covered.
Specific Waiting Period: Most plans have a waiting period (often 180 days from the start of the policy) during which claims for critical illnesses are not covered.
Illnesses Diagnosed Shortly After Policy Start: Critical illnesses diagnosed within the first few months (usually the first 180 days) of the policy may not be covered.
Drug or Alcohol Abuse: Illnesses resulting from the insured's abuse of drugs or alcohol.
Self-Inflicted Injuries: Conditions resulting from self-inflicted injuries or suicide attempts.
War and Nuclear Risks: Illnesses or injuries arising from war, terrorism, nuclear contamination, or civil commotion.
Participation in Criminal Activities: Illnesses or injuries resulting from the insured's involvement in criminal or illegal activities.
Certain Diseases: Some plans exclude certain diseases or conditions by name or category, such as sexually transmitted diseases.

Looking for Assistance?

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FAQs on Critical Illness Insurance

What is a Critical Illness Plan?

A critical illness plan is a type of insurance policy that provides a lump sum benefit if the policyholder is diagnosed with one of the specific illnesses covered by the policy. This benefit can help cover medical expenses, lost income, or any other financial needs during recovery.

What is the eligibility to buy a critical illness plan?

The eligibility criteria for critical illness insurance can vary from one policy to another. However, some common criteria include:

Age: Most critical illness insurance policies have a minimum and maximum entry age. The typical age range for eligibility is between 18 to 65 years, but this can vary by insurer.
Medical History: Applicants may be required to undergo a medical examination or provide a detailed medical history. Pre-existing conditions may affect eligibility or the terms of the policy.
Residency: Some plans may require that the applicant be a resident of the country where the policy is being issued.
Occupation: Certain high-risk occupations may impact eligibility or result in higher premiums.
Lifestyle Factors: Lifestyle factors such as smoking, or alcohol consumption can also affect eligibility and premium rates.
Policy Term: There may be restrictions on the policy term based on the applicant's age at the time of application and the maximum coverage age.

How does Critical Illness Insurance differ from Health Insurance?

While health insurance typically covers hospitalisation and medical bills up to a certain limit and may require bills for claim settlements, critical illness insurance pays out a lump sum upon the diagnosis of a covered critical illness, regardless of the actual medical expenses incurred.

What illnesses are typically covered by Critical Illness Insurance?

Coverage varies by insurer, but common conditions include cancer, heart attack, stroke, kidney failure, major organ transplant, and multiple sclerosis, among others. ABSLI offers two critical illness related insurance plans: ABSLI Cancer Shield Plan and ABSLI CritiShield Plan.

ABSLI Cancer Shield Plan: Specifically designed to cover various stages and types of cancer, providing financial support directly related to cancer diagnosis, treatment, and care.
ABSLI CritiShield Plan: Offers broader coverage for a range of critical illnesses beyond cancer, including heart conditions, organ failures, and other life-threatening health issues.

Illness/Condition	ABSLI Cancer Shield Plan	ABSLI CritiShield Plan
Cancer	Covered	Not Specifically Covered
Heart Attack	Not Covered	Covered
Stroke	Not Covered	Covered
Kidney Failure	Not Covered	Covered
Major Organ Transplant	Not Covered	Covered
Coronary Artery Bypass Surgery	Not Covered	Covered
Multiple Sclerosis	Not Covered	Covered
Paralysis	Not Covered	Covered

Can I buy Critical Illness Insurance if I have a pre-existing condition?

It depends on the insurer and the specific condition. Some insurers may cover pre-existing conditions after a certain waiting period, while others may exclude them entirely or offer coverage at higher premium rates.

Is there a waiting period for Critical Illness Insurance?

Yes, most critical illness policies have a waiting period, typically around 180 days from the start of the policy, during which claims for critical illnesses are not covered.

How many times can I claim Critical Illness Insurance?

Many critical illness policies allow only a single claim during the policy term, after which the policy typically ends. However, some insurers offer plans that allow multiple claims for different conditions.

How is the premium for Critical Illness Insurance determined?

Premiums are based on several factors, including the policyholder's age, health status, the sum insured, the number and type of illnesses covered, and the policy term.

Can I add Critical Illness Cover to my existing Life Insurance Policy?

Yes, many insurers allow you to add critical illness cover as a rider to your existing life insurance policy, providing additional protection against critical illnesses.

What happens to my Critical Illness Policy if I don’t make a claim?

If you do not make a claim during the policy term, there is no payout, and the policy simply expires. Unlike some life insurance policies, critical illness plans typically do not have a savings or cash value component.

What documents are needed at the time of a claim?

When filing a claim under a critical illness policy, you will typically need to provide the following documents:

Duly completed claim form
Medical certificate confirming the diagnosis of a critical illness covered by the policy
Detailed medical reports and test results supporting the diagnosis
ID proof of the policyholder (e.g., PAN card, Aadhaar card)
Original policy document
Bank details for the payout (cancelled cheque or bank statement)
Any other documents requested by the insurer specific to the claim or policy conditions
Having these documents ready can expedite the claim process, helping you receive your benefits more quickly. Always check with your insurer for any additional documentation requirements specific to your policy.

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*Tax benefits are subject to changes in tax laws. Kindly consult your financial advisor for more details.
^# Provided all due premiums are paid.
For further details regarding the above-mentioned rider, please refer to the respective rider brochure(s) available on our website.
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Critical Illness Insurance

What is a Critical Illness Insurance Plan?