Critical Illness Cover in Group Health Insurance Plans

According to the World Health Organization (WHO) and the Indian Council of Medical Research (ICMR), India is fast witnessing a rise in the number of people affected by critical illnesses like cancer, heart attack, kidney failure, strokes, etc. As per the report published on December 30, 2021, by the Institute for Health Metrics and Evaluation (IHME), cancer cases have increased at an average annual rate of 1.1-2 per cent during the period 2010-2019 in India. These staggering metrics establish the need for critical illness to be an important component of healthcare plans. Critical illnesses can be a result of factors, including but not limited to lifestyle, genetics, and stress levels.

It is a general understanding that a regular health insurance policy covers the treatment cost for a critical illness. But, actually, this may not be the scenario. People assume they're fully protected with a common health insurance plan, but the unimaginable cost of treating critical diseases outweighs most of the expenses that are covered by it. Critical illness is a rider that can be added to the basic plan. Some of the critical illnesses that this rider covers include heart attack, paralytic stroke, multiple sclerosis, cancer, etc. Usually, individual health insurance plans or group plans are indemnity based, that is, one needs to claim for hospitalization expenses to get the benefit. However, with a critical illness cover, one gets a lump sum benefit to make up for all the expenses of dealing with a life-threatening ailment. A normal healthcare plan will only reimburse your hospitalization costs, whereas, health insurance with a critical illness plan, can help your employees with the treatment cost, the cost incurred in making lifestyle changes post-illness, or cover for the lost income.

This becomes an important consideration for employers to opt for group health insurance that provides cover for critical illness, in addition to pre-existing diseases cover, maternity benefit, pre and post hospitalization expenses, amongst others. Some employers even opt for plans (with riders) that can cover chemotherapy, radiotherapy, pacemaker costs, etc. Even if a group insurance plan doesn’t provide for any lump sum benefit like the critical illness cover, the expenses incurred due to critical illness are, in most cases covered in a group insurance plan.

For example, hypertension falls under the pre-existing disease clause which is covered under group health insurance. But a heart attack arising out of hypertension will fall under the category of critical illness which may or may not be part of your group health insurance cover. However, the expenses arising out of pre-existing diseases will be part of the cover depending on the riders selected. Also, the payouts in critical illness cover are usually generic, that is, they aren’t necessarily salary-dependent. They’re mostly standard for employees across all levels. However, the premium amount for it will be higher as it will cover a higher risk.

Thanks to the continuous technological and digital advancements, as a Human Resource (HR) manager, you can now experience a fast and seamless process of buying or renewing a policy. Giving your employees an added benefit with easy and hassle-free claims processing ensures that your workforce is motivated, and you retain and attract quality talent.

Normally to avail this cover, one doesn’t require any pre-medical checkups. But, for a certain age limit, a pre-medical checkup might be required, which is not uncommon. Depending on the type of policy, blood relatives such as parents and children, and spouse can also be covered under a critical illness insurance plan.

Almost every insurance company provides an option to customize your group health cover such as the addition of various top-ups, etc. The premiums in such cases also vary due to different factors. They offer an easy renewal process, hassle-free claim agreement procedure, and a cashless claim facility, thereby making insurance plans accessible and convenient for everyone. With the availability of more inclusive options and advanced benefits, HR managers need to make an informed decision about selecting the right bundle of health insurance plans and riders for their employees.