Critical Illness Insurance
A Lump Sum When A Serious Illness Strikes
A cancer, heart attack or stroke diagnosis brings costs that a hospital policy never sees: months away from work, home care, travel for treatment and loan instalments that keep falling due. Critical illness insurance pays a fixed lump sum when a listed illness is first diagnosed, and you decide how to use it. MILES compares plans across insurers, reads the illness definitions line by line and helps you pick a sum insured that matches your income and family commitments.
Why A Critical Illness Cover Helps
Lump Sum Payout
The full sum insured is paid on first diagnosis of a covered illness, regardless of the actual hospital bill.
Major Illnesses Listed
Plans cover conditions such as cancer, heart attack, stroke, kidney failure and major organ transplant, as defined in the wording.
Replaces Lost Income
The payout can cover EMIs, household bills and income lost during a long recovery away from work.
Works Alongside Health Cover
It sits on top of your hospitalisation policy, so both can respond to the same illness.
Clear Definitions Checked
We compare illness definitions, waiting periods and survival periods so there are no surprises at claim time.
Claim Support From MILES
Our team helps you assemble diagnosis reports and follows up with the insurer until the claim is settled.
What is critical illness insurance?
Critical illness insurance is a benefit policy that pays a fixed lump sum when you are first diagnosed with one of the serious illnesses listed in the policy. The payout does not depend on your hospital bill, so the money can be used for treatment, living costs or loan repayments.
It is different from a regular hospitalisation policy, which reimburses or settles actual medical expenses. A critical illness plan is sold by general and standalone health insurers as a separate policy, and many life insurers offer it as a rider. It works best as a second layer on top of your main health insurance cover.
What it covers
The number of illnesses covered varies widely between plans, from a short list to several dozen conditions. Most plans include the core conditions below, and IRDAI has standardised the definitions of many of them so that wordings are more consistent across insurers.
- Cancer of specified severity
- First heart attack (myocardial infarction) and open chest bypass surgery
- Stroke resulting in permanent symptoms
- Kidney failure requiring regular dialysis
- Major organ or bone marrow transplant
- Multiple sclerosis with persisting symptoms, permanent paralysis of limbs and coma of specified severity
Some plans pay a partial benefit for early-stage conditions and continue cover for later, more severe stages. Others end the policy after one full payout. Read how each plan treats multiple claims before comparing premiums.
What is not covered
- Initial waiting period: illnesses diagnosed within the first few months of the policy, commonly 90 days, are excluded.
- Survival period: the insured usually has to survive a set number of days after diagnosis, often between 15 and 30 days, depending on the plan.
- Pre-existing conditions: excluded for a waiting period, or permanently for some illnesses, depending on underwriting.
- Conditions that do not meet the severity stated in the definition, such as some early cancers in a plan without an early-stage benefit.
- Illness caused by self-inflicted injury, substance abuse, war or nuclear risks, and other standard exclusions.
Who needs it
Critical illness cover makes the most sense for people whose household depends on their income. That includes salaried professionals with home loans, self-employed people who have no paid sick leave, and business owners whose firm would suffer during a long absence. It is also useful for anyone with a family history of heart disease or cancer, provided they buy before any symptoms appear.
Group health policies from employers rarely include a critical illness lump sum, and they stop when you change jobs. A personal plan stays with you.
How the sum insured and premium are decided
A common starting point is to cover a few years of annual income, plus any large debts. The premium then depends on:
- Age at entry and at each renewal band
- Number of illnesses covered and whether early stages pay a benefit
- Medical history, lifestyle and tobacco use, which may call for a health check-up
- Policy term and whether you choose a single or multi-year policy
Premiums paid for a critical illness policy may qualify for a deduction under Section 80D of the Income-tax Act, subject to prevailing tax laws and applicable limits.
How MILES helps
- Compare insurers: we place cover with 16+ insurers and set out the illness lists, survival periods and waiting periods side by side.
- Check the wording: we explain severity conditions in plain language, so you know what a claim would actually need to show.
- Right sizing: we look at your income, loans and existing health and term life cover before suggesting a sum insured.
- Honest disclosure: we help you fill the proposal form correctly, because non-disclosure is the most common reason a claim is disputed.
- Claims support: if you are diagnosed, we collect the reports and chase the insurer while you focus on treatment.
How a claim works
- Inform the insurer or MILES as soon as the diagnosis is confirmed by a specialist.
- Submit the claim form with the diagnosis report, histopathology or investigation results and the treating doctor’s certificate.
- Complete the survival period stated in the policy.
- The insurer reviews the documents against the illness definition and may ask for further records.
- Once approved, the lump sum is paid to the insured’s bank account. Visit our claims page for help at any stage.
For accident-related disability, which a critical illness plan does not cover, look at personal accident insurance as a companion policy.
Cover, exclusions and premiums depend on the insurer’s policy wording and underwriting. MILES Insurance Brokers Pvt. Ltd. is an IRDAI-licensed direct broker (Life & General, Reg. No. 954); the insurance is issued by the insurer. Insurance is the subject matter of solicitation.