Paisawiki is a Part of Logo
Get insured from the comfort of your home No medicals required

Tell us about you

National Critical Illness Policy
250+ Plans 18 Insurance Companies
₹ 5 Lakh Coverage @ ₹ 10/day
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

National Critical Illness Policy

A fast-paced life results in an increased risk of stress and vulnerability to critical illnesses. Adverse effects are observed on the overall quality of life, and the reducing lifespan.

Therapy for critical illnesses requires specialized medical intervention. This results in increased costs for diagnosis, hospitalization, and treatment. Add to it the expenses for check-ups by medical personnel, follow-up screening, and post-hospitalization recovery. The result? Inflated medical bills and exhausted financial savings.

Therefore, there is a need for a critical illness insurance plan that does not burn a hole in finances. National Critical Illness Policy under National Health Insurance provides a solution to this, which is an affordable medical cover to finance the expenses for critical illnesses.

What is National Critical Illness Policy?

National Critical Illness Policy is a policy that covers critical illnesses and is ideally suited for those investing in a single critical illness insurance plan, resulting in saving of finances.

Upon the diagnosis of a critical illness, policy terms state the entire sum insured amount to be released as lump-sum. Therefore, the financial costs of the treatment are covered completely. The remaining amount can be utilized for covering other expenses, such as loans and EMIs.

Therefore, National Critical Illness Policy functions not only as an effective and secure family health coverage plan but also offers adequate financial coverage.

Features and Benefits of National Critical Illness Policy

The policy features are as mentioned below:

  • Varied Sum Insured– National Critical Illness Policy offers a wide range of sum insured from Rs 1 lakh to Rs 75 lakh. Policy coverage offers a great deal of flexibility. There are a total of 23 sum insured options available. Additionally, plan details assign separate slabs for non-earning individuals and senior citizens.
  • A Comprehensive Range of Illnesses Covered– Policy terms cover a specific number of critical illnesses – Plan A (11) and Plan B (Plan A+26). This is the maximum coverage of illnesses offered by a critical illness insurance plan. Consequently, sum insured options are common to both. However, plan details state that the monthly premium varies as per the plan selected.
  • Medical Screening Reimbursement– The proposer needs to undergo a medical examination before policy coverage. The following parameters are assessed –
    • Physical examination – height, weight, BMI
    • Blood test – Glycated hemoglobin, lipid profile, serum creatinine
    • Urine examination – routine and microscopic
    • ECG
    • Eye test (with retinoscopy)
    • Any other examination as required
    • According to policy terms, in case medical examination results are satisfactory, and the application is accepted, 50% of medical screening expenses are reimbursed.
  • Coverage for Pre-existing Conditions– National Critical Illness Policy covering pre-existing conditions in case no claims are made for 4 continuous years. This is a unique advantage that is not seen in other critical illness insurance plans. These illnesses include hypertension, diabetes mellitus, and stroke.

Benefits offered under this policy are:

Critical Illness Benefit – According to National Critical Illness Policy, critical illness benefit is offered beyond the survival period as given below -

Survival period

30 days

90 days

6 months

Date of

diagnosis

Undergoing the treatment procedure

Date of

diagnosis

Permanent impairment

Cancer of specified grade

Stroke with permanent symptoms

Open Chest Bypass Graft Surgery

Complete blindness

Heart attack

Total paralysis

Heart Valve Repair

Deafness

Coma

Motor Neuron Disease

Organ transplant

Speech loss

Renal failure

Idiopathic Hypertension

Aorta Graft

Surgery

 

Multiple sclerosis

Parkinson’s disease

Brain surgery

 

Liver failure

Alzheimer’s disease

Trauma in head

 

3rd degree burn

Brain tumour

Loss in limb function

 

Goodpasture’s Syndrome

Lung

Failure

 

 

Apallic Syndrome

Creutzfeldt-Jakob Disease

 

 

Bacterial meningitis

Encephalitis

 

 

Aplastic anaemia

 

 

 

Systemic Lupus Erythematosus

 

 

 

 Enhancement of Existing Plan – Although National Critical Illness Policy provides a specific sum insured, the proposer might require a wider policy coverage due to the following reasons –

  • More critical illnesses covered in the same sum insured
  • Greater sum insured but maintaining the plan

Plan details permit the enhancement of the existing plan during renewal.

Savings – National Critical Illness Policy offers various savings at different levels for the benefit of the insured.

Type

Percentage

What is offered

 

Early entry

 

5%

Insured entering policy before age 42 with renewing for 3 continuous years, the fourth year will have 5% savings.

 

Family

 

10%

Policy for family – insured and spouse and/or children and/or parents

Staff

15%

Employees of insurance provider and families

Online, walk-in, POS

10%

Policies bought online through direct sales and POS.

 *All savings provided by the insurer are as per the IRDAI approval. Standard T&C apply

Portability Benefits – From an existing older insurance policy, the insured may want to port to National Critical Insurance Policy. However, portability is permitted, provided both policies offer similar benefits. This is because portability involves the transfer of funds from one policy to another.

As per policy terms, this benefit also applies to the insured and family under a general insurance policy covering critical illnesses.

For dependent children, the National Critical Illness Policy offers benefits till 25 years. Subsequently, portability is permitted to an insurance plan by another provider offering similar benefits.

Tax Benefits – As per the Income Tax Act (1961), all critical illness insurance plans provide tax benefits as follows –

Policy covered for

Tax benefit (maximum)

Self and family

Rs 25,000

Self (senior citizen)

Rs 50,000

Parents

Rs 25,000

Parents (senior citizens)

Rs 50,000

 Based on the family coverage in the policy, the tax benefits will be applied accordingly.

*Tax benefit is subject to changes in tax laws 

Inclusions of the National Critical Illness Policy

The policy covers the following conditions:

  • Rare Diseases – Rare diseases require specialist medical intervention and expensive treatment. National Critical Illness Policy possesses the advantage of financing expenses for rare diseases. The policy coverage includes rare critical illnesses such as Apallic Syndrome, Goodpasture’s Syndrome, Creutzfeldt-Jakob Disease, etc. Diagnosis, intervention, and treatment are effectively financed, enabling patient recovery.
  • Mid-term Spousal Inclusion – Health insurance policiesdo not permit any change in policy coverage mid-term. In other words, any changes to be made in plan details are permitted only during renewal. However, the National Critical Illness Policy permits the mid-term inclusion of the spouse within 2 months of the date of marriage. The premium payment is made on a pro-rata basis.

Exclusions of the National Critical Illness Policy

Under the category of exclusions, the National Critical Illness Policy restricts its scope of coverage to:

  • Congenital or genetic disorders, chromosomal anomalies
  • Sterility, Infertility and Pregnancy
  • Consumption, addiction, an overdose of alcohol and/or drugs
  • The occurrence of HIV/AIDS in the insured
  • Plastic or cosmetic surgery
  • Hormonal Replacement Therapy and sex-change surgery
  • Unscientific and experimental treatment
  • Any injury or illness due to war, radioactivity, or social unrest

Eligibility Criteria to Buy the National Critical Illness Policy

Eligibility criteria to apply for the plan are:

  • Age limits for entry –

Age

Adult

Children

Minimum

18 years

5 years

Maximum

65 years

18 years

  • For children, the policy ends at the age of 18 years.
  • If children are being covered, parent(s) should also be included.
  • Based on the insured individuals, the National Critical Illness Policy can include the following for coverage -
  • Self (proposer)
  • The family includes spouse, dependent children, and parents
  • After insured children turn 18 years, they have the option to port to another policy.
  • Post-marriage spousal inclusion is permitted mid-term provided the coverage occurs within two months of marriage.

Except for spousal inclusion, addition or removal of other family occurs only during policy renewal.

  • Policy tenure – 1 year
  • Plan details – Plan A (11 illnesses) and Plan B (37 illnesses = Plan A + 26 illnesses)
  • Sum insured – Each plan has a total of 23 slabs available.
  • From Rs 1 lakh to Rs 10 lakh, there are 10 slabs. Subsequently, the sum insured slab increases by every Rs 5 lakh, until the maximum amount of Rs 75 lakh.

The eligibility criterion for sum insured is the earning of the insured.

Earning Insured

Non-earning Insured

Self (proposer) – 5 times annual income

Self (proposer) – Rs 1 lakh to Rs 10 lakh

Spouse –

• Earning – 5 times annual income

• Non-earning – Not exceeding 50% of the proposer

 

Spouse – Not exceeding 50% of the proposer

Dependent children – Not exceeding 25% of the proposer

In case both the proposer and the spouse are non-earning, dependents are not permitted to be included.

Dependent parents – Not exceeding 50% of the proposer

  • New insured aged 60 years and above (senior citizens) are provided with a sum insured of Rs 25 lakh only.
  • Waiting Period –
  • Minimum – 3 months
  • Maximum – 4 continuous years

*This is the payout period for financing pre-existing critical illnesses. According to policy terms, if the sum insured amount has not been claimed for 4 continuous years, pre-existing critical illnesses become eligible for policy coverage.

  • Limit for pre-existing critical illness payout –
  • Dependent children – Rs 1 lakh
  • Others – Rs 10 lakh or sum insured (as lower)
  • The time period for sum insured payment – 30 days, 90 days, 6 months (depending on the survival period for the ailment)
  • Medical examination – Plan details state a customer is eligible for a medical screening under one of the following three conditions:
  • Being above the age of 45 years
  • Sum insured of Rs 25 lakhs, age notwithstanding
  • Non-earning spouse with a sum insured of Rs 5 lakhs
  • Renewal – If the policy is unclaimed, it has lifelong renewability.

Claim Process for National Critical Illness Policy

 According to the National Insurance Company Critical Illness Policy, claiming the policy is possible in ways – cashless and reimbursement.

Cashless Claim – This is only for a network hospital. According to policy terms, the claim procedure is performed with the help of a third-party administrator (TPA).  The claim steps are:

  • Inform the insurance provider regarding the hospitalization.
  • Planned – 72 hours’ prior
  • Emergency – Within 24 hours
  • Fill up the pre-authorization form. Submit it to the medical authority for signing. It will be sent to the TPA.
  • The form is submitted with the documents for an insurance If accepted, the insurance provider covers the expenses of the hospitalization.
  • Original documents will be required for submission. Ask for copies of the documents for future reference.

Reimbursement claim – This is for a non-network hospital. The hospitalisation bills are to be paid initially by the insured. The claim steps under this claim types are:

  • The insured or a suitable designated authority should inform the insurance provider about the policy claim within 15 days of the incident.
  • The claim application should contain the policy ID, name of insured, and date and reason for hospitalization, which is part of policy coverage.
  • Download the claim form from the website of the insurance provider and fill it up with the required details.
  • Submit the claim application along with the duly filled claim form and required documents.
  • The claim application is valid if the insured outlives the survival period specified for the illness.
  • After the claim application is accepted, the sum insured amount is transferred to the bank account of the insured.

Required Documents for Claim Submission

The documents required to seek policy claim under cashless and reimbursement methods:

  • Application for the policy claim requesting the payout
  • Duly-filled claim form with a copy of the health insurance card (cashless claim)
  • Letter from a medical practitioner stating the nature of the ailment or procedure resulting in hospitalization
  • Discharge report to be signed and stamped by the hospital
  • Documentation regarding financial transactionsfor medical procedures, such as bills and receipts
  • For any recommended treatment, the doctor’s prescription and the pharmacist’s receipt are required to be submitted
  • Reports of diagnostic scans and laboratory tests performed
  • A document describing the treatment provided in the hospital and the required post-hospitalization therapy
  • Copy of PAN card for ease of fund transfer to the insured
  • Other documents required by the insurance provider

How to Buy National Critical Insurance Policy?

Online purchase of National Critical Illness Policy comprises of three major steps -

Determination of the Premium Amount

  • On the website, paisawiki.com, select "Health", and go to "Critical Illness Insurance". The person registering should provide their details such as name, gender, and contact number.
  • If the proposer is earning, provide details of the income. This will determine the basic sum insured. As per policy terms, if the proposer is not earning, the sum insured will be reduced.
  • Under the critical illness insurance plan, provide the number of family members to be included.
  • For policy coverage, the premium calculator works out the monthly premium to be paid.

Plan Details

  • Enter the correspondence details with the name and gender of the proposer. Additionally, for family insurance, provide details of the spouse and dependents (children/parents).
  • Give the residential area. This is followed by the listing of various critical illness insurance plans. The option ‘View Features’ gives details of the plan.
  • The plan details include claim settlement, the premium to be paid, the claim process to be followed, policy coverage, and the hospitals linked. The most appropriate plan is determined by the plan comparison.
  • After choosing “Proceed to Buy”, the specific critical illness insurance plan is displayed, with the specific sum insured for each member of the family covered. Accordingly, two brochures can be downloaded – policy terms and conditions, as well as the finalized plan. Therefore, all plan details are made completely clear to the proposer, before payment is made.
  • National Critical Illness Policy has a policy period of 1 year. Therefore, multi-year options are not available for financial savings. However, specific savings offered to the policy coverage depending on the investment made.
  • Choose "Proceed". In case of family coverage, the ages of all the family members should be provided. Afterwards, click on "Done".
  • The plan details are updated and displayed again. Confirm and choose “Proceed”.
  • Additional information needed - insured details, contact information, medical status, nominee, and declaration.

Payment

  • Verify and upload the required documents. Make the payment.
  • The proposal form can be downloaded from the official website of the insurance provider. It is filled up and submitted with documents at the nearest branch office. 18% GST is levied on the premium, which can be paid digitally.

Offline modes of purchasing National Critical Illness Policy include –

  • Nearest branch office
  • Third-party agents
  • Point-of-sale kiosks

Documents Required for Purchasing the Plan

For purchasing National Critical Illness Policy, the documents required are -

  • Identity proof – PAN card, Aadhar card, passport, voter I-card
  • Age proof – Birth certificate, passport
  • Address proof – Aadhar card, driving license, electricity/phone bill
  • Passport-size photographs

Additional documents required in the following cases:

  • Latest IT certificate – Income proof of proposer. This decides the sum insured
  • Medical reports/tests as required
  • Portability request form (if porting)

Renewal Process for National Critical Illness Policy

National Critical Insurance Policy has the option of lifelong renewability – in case no claim has been made. The policy can be easily renewed through Paisawiki.com. The renewal steps to be followed are -

  • Go to paisawiki.com. Choose “Renewal” and “Health Renewal”. Or, log in to “Policy Renewal”.
  • Enter policy number and date of birth. Choose “Plan Renewal”.
  • Plan details are displayed – family coverage, the sum insured, premium payment, etc. Update changes as required.
  • Based on the new plan details, the new premium amount is displayed.
  • The payment is made, and the policy coverage is renewed.
  • The new policy document will be mailed to the registered email Id.

FAQs

Written By: Paisawiki - Updated: 22 October 2020

Top Articles

Best Health Insurance Plans in India

Best Health Insurance Plans in India

Best Health Insurance Plans in India 2020 Drafting a sound financial plan is challenging to an individual for reasons more than one. The primary aim of the plan is to cater for financial cover for life goals and long term wealth creation in the fo...
Best Health Insurance Plan For Senior Citizens

Best Health Insurance Plan For Senior Citizens

Best Health Insurance Plan For Senior Citizens When it comes to a health insurance plan it is more than a necessity in today’s times. As we know and will even agree that any eventuality does not come with prior notice or information. In any cas...
Best Health Insurance Companies in India 2020

Best Health Insurance Companies in India 2020

Best Health Insurance Companies in India 2020 Agent: Sir, what type of health policy do you want? Buyer: Yaar kuch bhi de de, sare to same he hote hai almost. Agent: No sir, there are multiple types as per the requirement. Buyer: Achcha, policy...
Best Maternity Insurance Plans in India

Best Maternity Insurance Plans in India

Best Maternity Insurance Plans in India Health insurance with maternity cover and childcare benefits provide for the expenses incurred before, after, and during the delivery process of a child. Expecting parents are often bombarded with expenses ...
Best Dental Insurance Plans in India

Best Dental Insurance Plans in India

Best Dental Insurance Plans in India One of the scariest aspects of everyday life is going to see a dentist. A simple toothache can turn a happy day into a painful experience. And we can’t ignore the expenses associated that can’t assume to be...