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Exclusions Under Critical Illness Plans

Updated On Oct 04, 2021

Health insurance plans have become an integral part of everyone's day to day life due to the increase in the rate of mishaps and unforeseen events in the lives of the people. It is important to have some financial aid for medical emergencies so that the quality of the treatment is not compromised due to the financial constraints. Health insurance plans are of different types and they can be bought according to the needs of the policyholder. Therefore, it is important for the policyholder to analyze their requirements before investing in a certain health insurance plan. Some of the commonly bought health insurance plans are maternity benefit plans, critical illness covers, personal accident covers, senior citizen plans, and much more.

Critical illness health insurance plans are meant to support the individuals at the time of the treatment of a life-threatening chronic disease. Due to the rapid increase in the inflation in different sectors, the cost of basic treatments has also increased drastically thus leading to the exhaustion of the financial savings of the individuals. Critical illness health insurance plans have their own set of unique features like the lump sum payments, shorter waiting period, easy claims, and much more.

Exclusions Under Critical Illness Plans

About Critical Illness Health Insurance Plans

Critical illness health insurance plans are health insurance plans which provide financial support to the policyholders for the medical bills incurred during the treatment of a life-threatening chronic disease like diabetes, heart attack, stroke, cancer, and much more. It covers a limited number of chronic disorders and offers the claim amount in lump sum payments to the policyholders at the time of claim settlement process. Policyholders get support in looking after their finances that are affected due to the loss of income due to the treatments. Following are some of the prominent and key features of critical health insurance plans:

Must Read: Bajaj Allianz Critical Illness Policy

  • Critical illness plans provide aid for the treatment of a range of diseases that are pre-specified by the insurers in the policy terms.
  • Lump sum payments of the claim assured is provided to the policyholder on the approval of the claim request.
  • Claim requests can be filed on the basis of the diagnosis report of the policyholder, which makes the claiming process smooth and hassle-free.
  • The features and perks of this plan are available after a waiting period, which is specified by the insurer at the time of the purchase of the policy.
  • The lump sum payment of the claim amount can be taken into use for compensating the loss of income of the policyholder incurred due to the treatment of the chronic disease.

Exclusions of The Critical Illness Health Insurance Plans

Following are some of the basic exclusions that are generally not compensated for by the insurer at the time of the claim settlement process:

  • Critical illnesses diagnosed during the waiting period are not covered.
  • Death within 30 days of the treatment procedure or diagnosis is not covered.
  • Congenital diseases are excluded from most of the critical illness covers.
  • Critical conditions related to pregnancy or childbirth are off-limits.
  • HIV/AIDS related conditions are not a part of the plan.
  • Dental care treatments and cosmetic surgeries are excluded from the coverage of the plan.
  • Illnesses developed due to self harm, suicide attempts, intake of harmful substances like alcohol, etc. are not compensated for by the insurer.
  • Infertility treatments and hormone replacement treatments are also not a part of the critical illness plan.
  • Financial aid for medical treatments received outside the frontier of the Indian subcontinent is not provided .
  • Illness or disorder due to war, civil war, terrorism, or military operations, are not looked after under critical illness plans.


To understand the exclusions of your desired critical illness health insurance plan, you must carefully go through the policy related documents during the free-look period provided by the insurer. You can also compare the plans before investing in a certain plan at the time of choosing a suitable critical illness health insurance plan.

Also Read: Dental Insurance: Coverage, Claims and Exclusions

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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