Critical illness cover: What’s covered, benefits and claim process

Updated on February 18, 2021

Getting diagnosed with a critical condition can completely disrupt your life. Besides, you may end up spending all your life savings on treatment and recovery.

But that’s not all; you begin to worry about your chances of survival as well as the future of your loved ones. The good news is, you can put all these worries and uncertainties to rest by getting a critical illness cover.

This policy provides you and your family the much-needed financial cushioning as you get through the diagnosis, treatment, and recovery from a critical illness. Keep scrolling to learn what’s covered, the benefits, and the claim process for the policy.

What does the critical illness policy cover?

The critical illness policy covers a wide range of illnesses but not all of them. When applying for one, it’s important that you carefully review this to confirm that your needs are covered.

Although different policy providers offer different covers, here are some of the common illnesses that fit the description of critical illness:

  • Some stages of cancer
  • Major organ failure (transplants)
  • Stroke
  • Heart attacks
  • Kidney failure

Please ensure you counter check with your provider to be 100% sure of the illnesses covered – we can’t stress that enough. Also, note that critical illness and terminal illness are two different descriptions – a lot of people tend to confuse the two.

If you get diagnosed with a terminal illness (the healthcare provider gives you a short period to live), a standard life insurance cover is best suited to support you. 

Are there any exceptions or limitations?

Yes, there are! Below are some of the circumstances or reasons why you may not qualify for a critical illness cover:

  1. Illnesses like stroke, cancer, and heart attack are usually covered sparingly. For instance, your cancer must have spread to a specified stage to get covered under the policy.
  2. Thanks to technological and medical advancements, there has been a review of what’s considered a critical illness. For example, some types of cancer are manageable which means they’re not covered under the policy.
  3. Some policies won’t cover critical illnesses resulting from pre-existing medical conditions. Therefore, be sure to provide every detail about any medical condition you’ve had during the underwriting process.

What benefits are available in the critical illness cover?

The policy pays out a tax-free lump sum if you get diagnosed with a critical illness or have to undergo major surgery. Put otherwise, if eligible for support, the policy will only pay out you once for the full sum assured.

The best part is that it may also provide financial support if your child gets diagnosed with a critical condition covered in your policy document.

The idea is to alleviate you and your family from any financial distress during the diagnosis, treatment, and recovery process. This is considering you may no longer be in a position to work and earn a living. You can use the benefit payout for whatever you deem appropriate. For example, you can:

  • Pay for critical medical services and treatments that might not be covered by the standard health insurance policy.
  • Cater for household bills and expenses as you commit your time and energy towards treatment and recovery.
  • Pay for transport expenses like getting to and from the treatment facilities.
  • Afford childcare services

What’s the claim process for critical illness cover?

Like most other forms of insurance, your claiming process begins by contacting your critical illness policy provider for a claim form, usually sent via mail or electronically. You’re then required to fill it out and send it back as soon as possible for review.

The insurer’s claims specialist will evaluate and review the application to determine whether you’re eligible for benefits based on your specific policy provisions. They may call you to seek further clarification and, if necessary, request medical reports from your GP to confirm that your condition is critical.

Note that there are clear-cut qualifying conditions, critical illness severity levels, and diagnosis criteria that you must fulfil for the benefits to become payable. Also, different insurers have varying waiting periods that you must survive for the claim to get processed.


Hopefully, this guide has explained everything you needed to know about critical illness cover as well as the benefits of taking out the policy. Treating acute illnesses like cancer or major organ failure can be extremely expensive off the pocket. Take advantage of this plan to guarantee your peace of mind no matter what unfolds in the future.

The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.