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Claim process for critical illness insurance – Here’s what you need to know

Critical illness insurance these days is more critical for people with the widespread pandemic. Also, these days the cost of medical treatment is rising dramatically to protect yourself from the overbearing cost of the hospital. Not only pandemic but a comprehensive health insurance plan keeps you covered from the huge treatment cost of critical illnesses such as – cancer, stroke, heart attack, heart surgery, and many more, along with maternity and senior citizen plans. 

It is always advisable to get critical illness insurance to ensure you are not alone in the fight with your illness. So, if you are looking for how the claim process works, this article is just for you.

What is a critical illness insurance policy?

Critical illness insurance offers comprehensive coverage against critical and long-term diseases such as – kidney failure, heart valve and other organ replacement. The treatment costs of such illnesses are very high; hence, you need a critical illness health insurance plan. It helps you to be financially equipped when any medical emergencies arise. 

In addition to all the advantages, the claim settlement process in critical illness medical plans is very smooth. The claims are usually made in lump sums based on diagnosis, compensation for the loss of income, and many more. 

What are the benefits of a critical illness insurance plan?

Below are the benefits that a critical illness insurance plan will offer –

  • Several illnesses covered: Under critical illness insurance, you are covered for several illnesses that might adversely impact your bank account. Hence, this policy helps you rest under such circumstances and not panic about money. You can always go through the policy document to check the illness covered under this policy.
  • Income backup: Chances are you might not be able to work if you are under any critical illness, which could put you in a compromised financial state. Hence, your family might suffer. So, the insurer will cover your family if you have a critical illness insurance plan.
  • Financial coverage: In case you are diagnosed with any critical illness covered under the policy, the insurer pays the amount for the hospital charges. This reduces your stress on the financial part and lets you take care of yourself. 
  • Reasonable premiums: The premiums for the critical mediclaim policy are very affordable and will help you cover extensively along with keeping the premium low.

How does the claim process work for critical illness insurance?

Raising a claim for critical illness insurance is easy. However, the process might differ from insurer to insurer. Below are a few steps that will give you an idea of how to raise a claim for critical illness insurance –

  • Inform your insurer if you are diagnosed with a critical illness and raise a claim.
  • Submit the documents required by the insurance provider. 
  • Based on the terms and conditions of the policy and the details submitted by you, the insurance provider will accept or decline your claim. 
  • After the submitted documents are verified, a claim amount will be released by the insurance provider that you can utilise at your convenience. 

Just like any other health insurance plan, a critical illness plan can also be claimed via two processes –

  • Cashless claim process – Under this process, the claim is made at the network hospital, and the insurance provider pays the medical dues. Hence, you do not have to pay anything from their pocket.
  • Reimbursement claim process – Under this process, the treatment can be received in any hospital as per your choice, and they will be paying for the treatment, which the insurance provider can later reimburse. 

What are the documents required to file a critical mediclaim policy?

The insurance provider will ask you for the following documents at the time of raising a claim –

  • Duly filled mediclaim form
  • Photocopy of the ID proof
  • Medical certificates with the diagnosis of the critical illness 
  • A statement from the attending physician attests that the claim is unrelated to any pre-existing conditions or injuries, as well as any conditions discovered within the first 90 days of the policy’s commencement.
  • First prescription and consultation letter
  • KYC documents include Aadhar cards, PAN cards, and voter cards.
  • If the critical illness is due to an accident, a medico-legal certificate and an FIR copy will be required.
  • Pharmacy bill with the prescription
  • Detailed discharge summary from the hospital. 
  • Any other document may be required if the insurance provider demands it. 

Important points to remember

Below are some important points to remember while buying a critical illness mediclaim policy and making a claim later –

  • The sum insured must be at least three times your annual income.
  • The waiting period must be less
  • Premium should be low and affordable as per your current income
  • Critical illness insurance can only be used once. Hence, it does not have any recurring benefits.
  • Buying a critical illness plan does not require hospitalisation in the past or recently. 
  • You can raise the claim even if you are not admitted to the hospital.
  • It is always advisable to buy a critical illness plan along with a health insurance plan for comprehensive coverage.
  • After being diagnosed with a critical illness, buying a critical illness is impossible. 
  • If your family has a history of critical illness, consider buying a critical illness plan. 

Raising a critical illness insurance claim is relatively easy. All you need to do is provide proper documents and enough proof to ensure your claim is accepted. Also, you must inform the insurance provider as early as possible to ensure the claim settlement process begins on time. You must also read the terms and conditions thoroughly to avoid complications and inconvenience during the claim settlement process. 

Disclaimer –  The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.



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