Critical Illness Insurance for Heart Patients: A Complete Guide

Treatment for heart disease, including bypass surgery, angioplasty, and stent placement, along with long-term medication, often requires multiple hospital visits and is an expensive process. A critical insurance plan provides complete coverage and a lump-sum payout on diagnosis of conditions of the heart, major cardiac surgery, or heart failure. While there is a limited number of insurers in India offering standalone heart-specific health insurance plans, critical illness insurance policies exist, which cover the majority of heart ailments. 

On average, heart disease kills around 28.6 lakh Indians every year, which sheds light on the lack of proper healthcare facilities, high treatment costs, and discrepancies in secure healthcare plans. This is why patients with healthcare issues need to have a healthcare plan in place for treatment during medical emergencies. This content piece would provide you with an insight into the plan available, how it works out for heart patients, and what the parameters are to check before buying a plan. 

Comprehensive Critical Illness Insurance for Heart Patients

There is no standalone policy that provides full coverage for heart conditions. However, a comprehensive heart ailment protection plan is made available through two options:

• Heart-Specific Health Insurance Plan: Under these plans, the patient gets to claim for a reimbursement for the cost of their cardiac treatment. 
• Critical Illness Insurance Policy:  This health care plan has inclusions for major heart conditions, where the patient would be paid a lump-sum amount upfront on the diagnosis of their medical condition. 

What is Critical Illness Insurance?

Critical Illness Insurance is a specialised insurance policy that gives financial protection against severe life-threatening conditions like kidney failure, heart attack, stroke, paralysis, and cancer. Quite distinctive from a general health insurance plan, which follows reimbursement for hospital bills, a critical illness pays a lump-sum amount upfront once the diagnosis is made for an illness. It helps you to plan for treatment cost, which hospital to choose, pre-and post-hospitalisation charges, along with other miscellaneous expenses. Since the finances are managed efficiently, your savings won't be drained. 

How is Critical Health Insurance Different From General Health Insurance?

There is a marked difference between general health insurance and a critical health insurance plan. While one caters specifically to critical conditions, the other one covers all the general medical conditions that a patient can suffer. The table below discusses in detail what is the basic differences between these insurance types:

What Parameters to Look While Choosing a Plan?

It is always a point of worry how to choose a health plan that would suit our needs and requirements. Especially for heart patients, medical care tends to be the top-most priority throughout their lives. Some simple tricks act as tips to help you choose the best insurance as a heart patient:

• Look at Pre-Existing Condition Coverage: If you are a person with a pre-existing heart condition, look for a plan that covers your specific needs and requirements as part of the treatment plan chosen. 
• Drawing Out a Comparison: Always ensure that you look at the cost of the plan you choose to buy. Check the coverage cost, initial payment amount, service fee, and the total cost cap offered under different insurance plans, so that you can make the right choice with the plan. 
• Comprehensive Coverage: The right plan is the one that helps you with all the required services and treatments as part of your heart condition, inclusive of medication, tests, hospital stays, surgery and post-hospitalisation charges. Choose the plan that provides comprehensive coverage for your heart condition. 
• Choose Based on Needs: With varying severity of illness, every heart patient looks for different aspects in a plan. For instance, if you are someone taking several medications throughout the day, it is best to choose the plan that has a lower copay on medicine prescriptions. Make sure to run through the plan and match all your needs before you finalise it. 

Why Heart Patients Need a Specialised Health Care Policy?

Being a heart patient,  there is the constant cycle of hospital visits, regular health check-up and follow-ups, expensive treatment plans, and prolonged pre- and post-treatments. So, if you have a general health insurance plan with you, it does not always give full coverage for all the expenses incurred during the heart-specific treatments you take. This will put you under stress to manage your finances. 

Once you buy health insurance for heart patients, it helps you to cover the cost of expensive treatments, including angioplasty, stent placement, post-surgery recovery care, medications, and lifestyle changes you make. Interestingly, some plans even include insurance claims for patients who have a long history of heart illness. 

How Is a Critical Illness Claim Processed?

The entire process for a successful claim for health insurance for heart patients depends on diagnosis verification, and much less attention is given to the total cost of treatment. There is a structured process to be followed, and this is how it maps out:

• Intimation: Once the diagnosis is made, make sure to inform the insurer about the same.
• Document Submission: All the necessary paperwork needs to be submitted, including:
• Filled claim form. 
• Diagnostic tests and medical reports. 
• The specialist provided a medical certificate.   
• Claim Eligibility Window: The claim will be processed by the insurer only after the required eligibility window is met. 
• Final Verification and Payout: Once verification is done, the insurer will release the total claim amount into your bank account, within the time period specified. 

Which is Better- Add-On or Individual?

While choosing a plan, you are faced with the dilemma of whether you should opt for an add-on to your existing policy or take up an entirely new individual policy, given your current medical state you are in. 

The biggest pro of taking an add-on policy is that it is affordable, as the insurance gets covered through the base policy. This is where the drawback lies: once the base policy timeline ends, the insurance will lapse.

On the other hand, buying an entirely new policy that works to provide medical support for your heart condition turns out to be more exclusive, giving comprehensive coverage. The issue with this policy is that the premium would be much higher. 

How to Buy Critical Illness Insurance for Heart Patients?

The process to buy a critical insurance plan for a heart patient is a multi-step process, which is has been discussed in detail below:

• Need Assessment: You need to first identify your heart condition, specifically needs, and estimate treatment cost, along with calculating the sum to be insured. 
• Research Insurers: Make a list of all the insurers providing heart-related or critical illness plans, draw out a comparison and then check for settlement ratios. 
• Checking Eligibility: As a patient, make sure to check the age eligibility, pre-existing conditions, and the waiting period for your illness. 
• Submission of Medical History: All the necessary medical reports, cardiologist certificate and latest test would need to be submitted with the insurer for pre-existing conditions. 
• Insurer Verification: The verification of all the documents will be done by the insurer, based on which they will approve or deny the coverage. 
• Policy Approval: Once the approval is done, you can proceed with buying the plan, after which the policy will be finalised and approved. 
• Premium Payment and Policy Receipt: Make the final payment for buying the plan, after which you will receive the policy document, and the coverage will start after the waiting period. 

Critical Illness Insurance: Eligibility Requirements to be Met

Certain terms and conditions fall under the eligibility criteria, which you need to fulfil to avail the benefits of the critical illness insurance, which consists of:

• Patient’s Medical History: All pre-existing medical conditions tend to have a waiting period of around 3 years, after which the claim would get approved. 
• Age: Most of the policies cover the age group of 18 to 65 years, with some offering services and coverage for children. 
• Total Sum Insured: The total sum that gets insured varies as per the plan chosen, where it usually is between the range of 5 lakhs to 1 crore. 
• Policy Validity: The plan and policy validity usually is between 1 to 3 years, with options to renew it within a given time frame. The terms and conditions can vary as per the waiting period, also. 

Claim Documents for Critical Illness Insurance

To have a seamless experience while getting the claim approved, certain documents need to be in hand and kept ready:

• Duly filled claim form. 
• Original copy of the discharge summary under cases of hospitalisation. 
• Diagnostic reports.
• Medical certificate from the doctor with diagnosis confirmation. 
• Cancelled cheque and KYC documents (NEFT transfer). 

Wrapping Up 

Above all, the health insurance for heart patients you buy acts as a protection barrier for you as well as your loved ones, in case they have a heart condition. The increasing inflation and the rising medical costs, along with the innumerable diseases that one gets affected with, medical insurance serves as the only way out without creating a hole in your pocket. The decision that you make today to buy the best plan will help secure your health as well as the health of your loved ones in the future. 

This is where the Niva Bupa Health Insurance comes into the picture. For a patient with a heart condition, it offers comprehensive health care plans that are designed for patients with pre-existing heart conditions and critical illness. They offer you base policies with riders, or exclusive plans like the CritiCare Plan. You can choose the plan that best suits your prerequisite being a heart patient. 

FAQs

1. Is tax benefit provided under the Critical Illness Insurance Policy?

Yes, under Section 80D of the Income Tax Act, the premium that you pay for critical illness is eligible for deduction in taxes. It goes up to 25,000 for family/self, and for senior citizens, it can be up to 50,000.

2. What are the exclusions in the policy?

There are certain exclusions in the critical insurance policy provided. Knowing about the same helps you to avoid rejection during the claim process:

 

• Self-Inflicted Harm and Substance Abuse
• Pre-Existing Diseases (PED)
• Excluded Events (Cosmetic Surgery, War/Nuclear Illness, Experimental Treatments)
• Minimum Exclusion Period
  
   

3. Is it possible to make a claim for the lump sum amount more than once in a Critical Illness Insurance Policy?

Under most scenarios, the lump sum amount is paid only once for a specific illness or ailment, with the policy termination after the payout. Given that, there are certain plans that do offer multiple claims. 

4. What is the total waiting period in case of pre-existing heart conditions?

Under pre-existing heart conditions, the waiting period is usually around 3 years, from the time the policy has been processed for you. An illness that occurred during this waiting period is not subject to payment and coverage.