Multiple Claims
Multi-Claim Benefit
Some plans allow more than one claim for unrelated illnesses, subject to the plan's terms.
Support your family's finances if a serious illness strikes.
Listed conditions defined in the policy
Lump sum paid on diagnosis, as per terms
Works alongside health insurance
Beyond Hospital Bill Reimbursement
Protecting income when health and career collide
Health insurance reimburses hospital and treatment bills. A serious diagnosis can also stop your income for months, while EMIs, school fees and household costs continue. A critical illness policy pays an agreed lump sum when a listed illness is diagnosed and meets the policy definition, which you can use as you need. A Distroo Advisor helps you decide how much cover makes sense.
Lump Sum on Diagnosis, as per Policy Terms
Independent of the Actual Hospital Bill
Use the Money for Treatment, Income or Loans
Optional Premium Waiver on Diagnosis, in Some Plans
Claim Guidance
How a Critical Illness Claim Works
A critical illness claim depends on clinical proof rather than hospital bills. Here is how it usually works, and where your Advisor helps. The insurer decides the claim.
Step 01
Inform the Insurer
Inform the insurer and your Advisor once the diagnosis is confirmed, within the time stated in your policy.
Step 02
Submit Clinical Reports
Share the specialist's reports, such as biopsy, ECG, angiogram, scans or pathology, that confirm the diagnosed condition.
Step 03
Medical Review by the Insurer
The insurer's medical team checks whether the diagnosis meets the policy's definition of the illness.
Step 04
Survival Period
Most plans require you to survive a stated period after diagnosis, commonly 30 days, before the benefit is paid.
Step 05
Payment of the Benefit
If the claim is admitted, the insurer pays the agreed benefit by bank transfer.
Policy Add-Ons
Optional Benefits and Riders
Some plans offer additional benefits. Each has its own terms, limits and cost, so check them carefully.
Premium Waiver
Waiver of Future Premiums
In some plans, future premiums are waived after a first claim while cover continues, as per the plan.
Family Support
Child Education Support
A few plans offer an additional benefit for children's education after a claim. Availability varies.
Second Opinion
Medical Second Opinion
Some insurers provide a second medical opinion service from specialists. Check what is on offer.
Talk to an Advisor
Want help choosing critical illness cover?
Share your needs and a Distroo Advisor will explain suitable options in plain language.
Know the Terms
Critical Illness Cover Inclusions & Exclusions
What typically qualifies, and what waiting limitations apply. Your policy wording is the final word.
What Is Covered
CoveredConditions are defined in each policy; IRDAI has standard definitions for key illnesses
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Cancer of Specified Severity
Malignant tumours that meet the policy definition and are confirmed by a specialist and histopathology.
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First Heart Attack
Heart attack that meets the policy definition, supported by cardiac markers and ECG findings.
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Bypass Surgery & Stroke
Coronary artery bypass surgery, and stroke resulting in permanent neurological deficit, as defined in the policy.
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Kidney Failure & Organ Transplant
End-stage kidney disease needing regular dialysis, and major organ or bone marrow transplants, as defined.
What Is NOT Covered
ExcludedTypical exclusions and waiting periods
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Pre-Existing Conditions
Conditions diagnosed or treated before the policy began may be excluded or have a waiting period.
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Initial Waiting Period
Many plans do not pay for illnesses diagnosed within an initial period after the start of the policy, commonly 90 days.
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Survival Period
If the insured does not survive the stated period after diagnosis, the benefit is generally not payable.
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Substance Abuse & Self-Harm
Conditions directly resulting from substance abuse, alcohol abuse or intentional self-harm are generally excluded.
Eligibility Checklist
Documents Required for Critical Illness Claims
Complete clinical records help the insurer assess the claim without delay.
Cardiologist / Neurologist Consultation Notes
The specialist's first consultation notes and diagnostic summary.
ECG & Coronary Angiogram CD/Report
Report confirming the findings, as the insurer requires.
Cardiac Enzyme Test (Troponin / CK-MB)
Blood tests that support the diagnosis, as per the policy definition.
Histopathology & Biopsy Report
Laboratory report confirming the nature of the growth.
Oncologist TNM Staging Assessment
Staging report confirming classification and severity.
PET-CT or Radiographic Scan
Imaging that shows the extent of the disease.
Nephrologist Dialysis Records
Records confirming end-stage kidney disease and regular dialysis.
Transplant Approval
Authorisation from the relevant authorised committee for organ transplant, where applicable.
Cancelled Cheque & Bank Proof
For direct bank transfer of the benefit.
Free Advisory Call
Book a One-on-One Consultation
Discuss your health history, dependants and goals with a Distroo Advisor.
Policy Review
Get Your Existing Policy Reviewed
Share your policy schedule and we will explain its key terms and possible gaps.
Free Critical Illness Review
Estimate Your Protection Gap
Your Advisor looks at your loans, monthly expenses and income dependence to suggest a sensible range of cover and explains the options from partner insurers.
- Illness definitions compared across plans
- Help understanding waiting and survival periods
- A named Advisor as your point of contact
FAQs
Frequently Asked Questions on Critical Illness Insurance
Clear answers on illness definitions, survival periods and tax benefits.
Health insurance is an indemnity cover that pays eligible hospital and treatment bills up to the sum insured. Critical illness insurance is a benefit cover that pays an agreed lump sum when a listed illness is diagnosed and meets the policy definition, irrespective of the actual bills.
Many critical illness plans pay the benefit only if the insured survives a stated period after the diagnosis, commonly 30 days. The period is stated in the policy.
In most cases yes, because they cover different things. Health insurance pays the bills, while critical illness cover pays the lump sum as per its terms. Check your policies for any conditions.
Usually yes. Many plans have an initial waiting period after the policy starts, commonly 90 days, during which a diagnosis is not payable. Pre-existing conditions may also be excluded or carry a longer wait, depending on the insurer.
Premiums for a health policy that includes critical illness cover may qualify for a deduction under Section 80D, within limits, if you choose the old tax regime. A critical illness rider on a life policy may be treated differently. Please check with a tax adviser.