Critical Illness Insurance: Beyond Just Cancer Coverage
A lot of people are under the false conception that cancer is the only critical illness that is covered by critical illness insurance provided by various insurance companies. In fact, critical illness insurance covers a wide range of ailments, which may vary, depending on your insurance provider. Also, critical illness insurance covers most of the ailments that health insurance policy does not cover. Some of the main ailments that are covered under critical illness insurance are as follows:
Cancer
Though cancer is covered under most of the insurance policy, not all cases of cancer are applicable for coverage. Only people suffering from a certain severity of the disease are eligible for coverage. According to the IRDA, cancer is a malignant tumor characterized by the uncontrolled growth & spread of malignant cells, resulting in the invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy and should be confirmed by a pathologist. Cancer can include leukemia, lymphoma, and sarcoma. The following, however, are excluded:
1. Tumors showing malignant changes of carcinoma-in-situ and tumors that are histologically described as pre-malignant or non-invasive, including, but not limited to: carcinoma-in-situ of the breasts, cervical dysplasia: CIN-1, CIN-2, and CIN3
2. Any skin cancer, other than invasive malignant melanoma
3. All tumors of the prostate, unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0
4. Papillary micro-carcinoma of the thyroid, less than 1 cm in diameter
5. Chronic lymphocytic leukemia, less than RAI stage 3
6. Micro-carcinoma of the bladder
7. All tumors in the presence of an HIV infection
Heart Attacks
Heart attacks could be a result of several reasons. It could be stress, pre-existing diseases, a non-adaptable lifestyle for the body, and so on. Keeping yourself safe is not always possible. The first heart attack of a certain severity is usually covered under the critical insurance plan. The severity of the attack can be defined as per the extent of damage that it can cause to you and your body. Therefore, you should always read the policy documents for critical illness insurance to make sure that you are aware of the intensity of the heart attack that would be covered as part of the medical benefits. The following are generally covered:
1. Open Chest Coronary Artery Bypass Grafting: Colloquially known as bypass surgery, many Indians are usually recommended to go for it to avoid blockage of blood flow to the coronary artery. In case the blood flow is obstructed, it hampers the breathing process and causes a lot of discomfort to an individual. Early diagnosis calls for grafting and surgery to help restore the normal physiological functions of the heart. Undiagnosed coronary artery blockage can lead to paralysis, stroke, or even death.
2. Replacement of the Valves of the Heart: The circulatory system is one of the most crucial structures in the human body, in which, the heart plays an important role. It might occur that due to old age or a poor lifestyle, the valves of the heart get damaged and call for replacement.
3. Primary Pulmonary Hypertension: It is characterized by elevated pulmonary artery pressure, with no apparent cause and substantial right ventricular enlargement, which is confirmed by a cardiologist with the help of diagnostics, including cardiac catheterization.
4. Myocardial Infarction: The first occurrence of myocardial infarction, which means the death of a portion of the heart muscle, as a result of inadequate blood supply to the relevant area, is covered under critical illness insurance. The diagnosis for this needs to be evidenced by all of the following criteria
a. History of typical clinical symptoms consistent with the diagnosis of acute myocardial infarction (for e.g. typical chest pain).
b. New characteristic electrocardiogram changes.
c. Elevation of infarction specific enzymes, troponins, or other specific biochemical markers. The following are excluded
1. Non-ST segment elevation myocardial infarction (NSTEMI) with an elevation of Troponin I or T.
2. Other acute coronary syndromes.
3. Any type of angina pectoris.
Coma of a Particular Severity
A partially-dead state that renders you immobile and devoid of most senses is usually referred to as a coma. It could last for a day or even years, depending on the severity of the case. The insured avail coverage under the critical illness insurance where it covers the medical expenses for a certain severity of coma. The IRDA defines a coma as a state of unconsciousness, with no reaction or response to external stimuli or internal needs. This diagnosis must be supported by evidence of all of the following:
1. The patient gives no response to external stimuli, continuously for at least 96 hours.
2. If life-support measures become necessary to sustain life.
3. If the patient undergoes a permanent neurological deficit, which could be assessed at least 30 days after the onset of the coma.
4. The condition has to be confirmed by a specialized medical practitioner. Coma resulting directly from alcohol or drug abuse is not covered.
Failures, Strokes, Transplants, and Other Issues
Functional disabilities of the human body can lead to a lot of problems. The IRDA defines a stroke as any cerebrovascular incident that produces permanent neurological sequelae. This includes infarction of the brain tissue, thrombosis in an intracranial vessel, hemorrhage, and embolization from an extra-cranial source. In the case of a stroke, the diagnosis has to be confirmed by a medical practitioner and evidenced by typical clinical symptoms as well as typical findings in CT scans or MRIs of the brain. The evidence of permanent neurological deficit lasting for at least 3 months has to be produced. It is important that you go through the entire list of ailments that are covered under your critical illness policy.
Life Support Processes
Life supporting processes such as dialysis are essential when one suffers from a diabetic condition. Dialysis is a system where the functions of the kidney are carried out by a machine. The IRDA also entails that critical illness insurance policies should cover end-stage renal failure, which is a disease that is presented as a chronic irreversible failure of both kidneys, a result of which is either regular renal dialysis or renal transplantation.
Paralysis
Paralysis is identified as a critical illness due to the severity of its impact. Not only does one become immobile for an uncertain period of time, but also has difficulties in performing regular activities. A stroke is not only one of the primary causes of paralysis, but can also cause internal organ failure. Since the intensity of the condition is so severe, it is counted as one of the critical illnesses that are covered under the policy.
Transplantation of Bone Marrow
Transplantation of bone marrow is a necessity for curing multiple conditions.
Multiple Sclerosis
According to the IRDA, the occurrence of multiple sclerosis needs to be supported by all of the following:
1. Investigations including typical MRI and CSF findings, which unequivocally confirm the diagnosis to be multiple sclerosis
2. Current clinical impairment of motor or sensory function, persisting for a continuous period of at least 6 months
3. Well documented clinical history of exacerbations and remissions of said symptoms or neurological deficits with at least two clinically documented episodes one month apart
Other causes of neurological damage, such as SLE and HIV are excluded.
Major Organ Transplant
Patients can avail coverage for undergoing transplantation of one of the following human organs:
1. Heart, lung, liver, kidney, pancreas, resulting from the irreversible end-stage failure of relevant organs
2. Human bone marrow, using hematopoietic stem cells
The undergoing of a transplant has to be confirmed by a medical practitioner. Other stem-cell transplants where only islets of Langerhans are transplanted are excluded from coverage.
End-Stage Liver Disease
This refers to the irreversible chronic alteration of the hepatic parenchyma or the biliary ductal system, resulting in life-threatening liver dysfunction. The above coverage is excluded if the etiology of the disease is due to chronic alcohol consumption or self-inflicted toxic or drug consumption.
Major Burns
This refers to an injury or burn that touches about one third (33%) or more of the body, causing a loss of soft tissue resulting in impairment or loss of function of the injured organ.
While all kinds of diseases do not qualify as critical illness and are not eligible for critical illness insurance, the scope of coverage of the insurance does extend beyond cancer.
**To understand exactly about the policy coverage, exclusions, etc read the Policy Wordings carefully.**
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