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Claim Settlement Process Under A Critical Illness Insurance Policy

Updated On Sep 30, 2021

Health insurance has become more important for the people over the last few years as the global spread of the coronavirus pandemic has made people realise the importance of having financial aid for the medical treatments as the cost of treatments has increased drastically with the rise in inflation rate. Health insurance providers have rolled out health insurance policies of different types to meet the varying needs of the people. Some of the common types of health insurance plans are senior citizen plans, individual health insurance plans, critical illness plans, maternity benefit plans, etc. Out of these different types of health insurance plans, critical illness plans are very essential as they provide compensation to the individuals for the treatment of chronic diseases.

Critical illness plans can be bought from any health insurance provider as it is widely available in the insurance market. It comes with extensive coverage as the cost of treatment of chronic diseases is high and can potentially burn a hole in the pocket of the policyholders. The critical illness plans offer lump sum payments, easy claims are made on the basis of the diagnosis reports, compensation for loss of income, and much more.

Claim Settlement Process Under A Critical Illness Insurance Policy

About Critical Illness Health Insurance Policy

A critical illness health insurance plan supports the policyholders with a lump sum payment of the claimed amount for medical expenses like medical treatments, paying off debts, replacement of lost income, etc.This type of health insurance plan offers a high amount of sum assured when compared to other regular health insurance covers. You can invest in an additional critical illness plan or it can be bought as a standalone policy. Following are some of the prominent features of a critical illness health insurance plan:

Must Read: Best Critical Illness Plans To Buy In 2021

  • Around 36 critical disorders are compensated for under a critical illness plan including cancer, kidney failure, heart disease, etc.
  • For medical dues, a lump sum amount of the claimed amount under the policy is provided.
  • The critical illness policy can be claimed easily, on the basis of the patient’s diagnosis report.
  • The coverage under the policy is provided only after the completion of the waiting period specified by the insurer, and it may differ from one insurer to the other.

Claim Settlement Process Under A Critical Illness Plan

The most important step after investing in a health insurance policy is to claim the purchased health insurance cover. This process must be conducted on time and with ease to minimize the stress and get the maximum possible benefits that can be availed under a policy. Let us look at some of the common documents that are necessary to make claim of your critical illness health insurance policy:

  • Carefully and duly filled claim settlement form
  • Photocopy of an ID card
  • Details of the discharge summary
  • Medical certificate stating the diagnosis of the chronic disease.

Just like any other health insurance plan, critical illness health insurance plans can also be claimed via two different processes. One being the cashless claim process, under which the claim is made at the network hospital of the insurer and the medical dues are cleared directly by the insurer without any hassles. The other way being the reimbursement claim settlement process, under which the treatment can be received at any hospital of the policyholder’s choice and the claim can be made after the discharge from the hospital. However, under reimbursement claim, the medical dues are to be paid off by the policyholders and later the amount is reimbursed, while in case of a cashless claim, the policyholder need not pay a penny from their pocket.


The policyholder must inform the health insurance provider about the hospitalization as early as possible to make sure that the claim settlement process begins on time. It is also important to go through the policy terms carefully to avoid any inconvenience at the time of the claim settlement process.

Also Read: How Does A Critical Illness Insurance Policy Work?

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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