Group Critical Illness Insurance
A Lump Sum When Your People Need It Most
A serious diagnosis such as cancer, a heart attack or a stroke brings costs that a hospital bill does not show: time off work, travel for treatment, home care and lost income. Group critical illness insurance pays an employee a fixed lump sum when a listed illness is diagnosed, on top of your group mediclaim. MILES helps employers choose the illness list, sum insured and wording that fit their workforce and budget, and supports employees through the claim.
What Group Critical Illness Cover Offers
Fixed Lump Sum Payout
The full sum insured is paid on confirmed diagnosis, whatever the actual treatment bill, so the employee decides how to use it.
Wide Illness List
Plans cover major illnesses such as cancer, heart attack, stroke, kidney failure and organ transplant, with wider lists on richer plans.
Sits Over Mediclaim
Pays independently of your group health policy, so hospital claims and the critical illness benefit can both be paid.
Flexible Group Design
Sum insured can be flat for all staff, graded by band, or linked to salary, with optional spouse cover.
Group Terms On Waiting
Group policies can often reduce or waive initial waiting periods that apply to individual critical illness plans.
Claims Support From MILES
We guide HR and the employee through the medical documents the insurer needs and follow up until payment.
What is group critical illness insurance?
Group critical illness insurance is a policy bought by an employer that pays a fixed lump sum to an employee who is diagnosed with one of the serious illnesses listed in the policy. The payout does not depend on hospital bills, so it can cover income loss, recovery costs and family needs that a mediclaim policy does not.
It is usually added to a group health insurance programme as a second layer. The mediclaim pays the hospital. The critical illness benefit supports the employee and their family through what is often a long recovery.
What group critical illness cover includes
Each insurer publishes its own list of covered conditions and definitions. IRDAI has standardised the definitions of several common critical illnesses, which makes comparison easier, but the number of illnesses covered and the exact wording still differ. Typical lists include:
- Cancer of specified severity
- First heart attack of specified severity 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, paralysis and similar neurological conditions
Richer plans cover a longer list, and some add a smaller partial payout for early-stage conditions. The benefit is normally paid once per illness event, after which cover for that person may end.
What is not covered
- Survival period: most policies pay only if the employee survives a set number of days after diagnosis, commonly around 15 to 30 days depending on the insurer.
- Waiting period: a waiting period after cover starts may apply, although group terms can reduce or waive it.
- Pre-existing conditions: treatment of an illness diagnosed before joining may be excluded unless the group terms say otherwise.
- Conditions outside the definitions: an illness that does not meet the policy's severity definition will not qualify, even if serious.
- Self-inflicted injury, substance abuse and other standard exclusions set out in the wording.
Who needs it
It suits employers who want a benefit that goes beyond hospitalisation. It is valued by teams with a mid-career age profile, by companies competing for senior talent, and by firms whose group mediclaim sum insured is modest. It also helps where an employee may be unable to return to work for months and the company wants a clear, fair way to support them. Individuals who want cover of their own can look at personal critical illness insurance, which stays with them if they change jobs.
How the sum insured and premium are decided
Employers usually choose one of three structures:
| Structure | How it works | Best for |
|---|---|---|
| Flat cover | Same sum insured for every employee | Simple administration, uniform benefit |
| Graded cover | Sum insured varies by grade or band | Companies with clear salary bands |
| Salary multiple | Sum insured set as a multiple of annual pay | Linking the benefit to income replacement |
The premium depends on the age profile of the group, the sum insured, the illness list, the number of members, whether spouses are included, and any past claims on the policy. Larger groups are generally priced on their own profile. Smaller groups are often priced using the insurer's standard rates.
How MILES helps
- Compare insurers: we place the requirement with several insurers from our panel of 16+ and set out illness lists, definitions and prices side by side.
- Check the wording: we read the survival period, waiting period and severity definitions, because these decide whether a claim is paid.
- Fit it to your programme: we align it with your group mediclaim, group term life and accident cover so the benefits do not overlap or leave gaps.
- Support claims: our claims team helps HR and the employee assemble medical evidence and follows up with the insurer until the payout is made.
How a claim works
- The employee or HR informs the insurer, through MILES, soon after diagnosis.
- The employee submits the claim form, diagnosis reports, specialist opinion and relevant test results.
- The insurer checks the diagnosis against the policy definition and confirms the survival period has passed.
- Once approved, the lump sum is paid to the employee's bank account.
Share your census and current group policy details and we will prepare options. You can also contact us to discuss the design first.
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.