What is a Critical Illness Rider?

Critical illnessrider is a necessity in today’s times with rising costs of healthcare. Critical Illness benefit provides coverage against specific life-threatening diseases. Treating such critical illnesses may require multiple visits to the hospital over a long period. In addition to the hospitalisation expenses, there will be other costs like fees for doctor visits, medical expenses, and more. A Critical Illness benefit pays a lump sum amount that can be used to cover these high expenses. The good thing is that this lump sum payout is in addition to any of your mediclaim or health insurance policy.

Health problems, in most cases, strike unexpectedly. In such cases, the burden of paying for treatment costs can fall on your family. There could also be a loss of income due to the illness. Most of the time, the family dips into their savings kitty built for either their child’s education or one’s own retirement to overcome these expenses. But a critical illness benefit can offer the required funds at the right time.

Why should one buy a Critical illness benefit?

A Critical Illness benefit can help you cover expenses like doctor consultation fees, the cost of medicines, and more. You can use the money from a critical illness benefit to cover ambulance costs and room rent along with pre and post-hospitalisation expenses. Besides, if you have any outstanding loans like a home loan or a car loan, the payout can help with dealing with the EMIs. The payout can also be used by your family as a substitute for your income that may be compromised due to an illness.

If you do not have a Critical Illness benefit, you may have to dip into all the hard-earned money that you have saved. The high cost of treatment can erode years of savings in just a few months. However, a critical illness benefit offers the financial support you need at the time and helps keep your other savings intact for their respective objectives.


Benefits of our
top selling term^
plan with Critical Illness RIDER





High life cover` at affordable rates so that your loved ones are financially secure.


Get payout up to 1 Crore in case of 34 life critical illnesses#on the first diagnosis.



Save tax^ up to 54,600/- under Sections 80C^ & 80D^ of the Income Tax Act, 1961. Get Life Cover` & Health Cover in one plan.



In case of death due to an accident+, the nominee will be paid the accidental death benefit Sum Assured.


In case of permanent disability++ due to an accident, your policy continues without you having to pay any premiums.



If diagnosed with a Terminal Illness##, we pay you the complete Sum Assured.





Features of critical illness benefit

  • Lump sum payment option:

    On the diagnosis of a critical illness, the insurance company provides a lump sum payout@ to the policyholder to cover all associated costs of the treatment

    @( Please refer to policy terms & conditions)

  • Hassle-free experience:

    Thanks to the digital era, policyholders can enjoy a smooth, customer-friendly experience while purchasing or renewing their policies or making claims

  • Monthly income:

    On being diagnosed with a critical illness, a part of the sum assured is paid out that can substitute for monthly salary<. This benefit is available under ICICI Pru Heart/Cancer Protect

    < (Customer need to opt for the benefit option).

  • Critical illness benefit coverage:

    The coverage is wide and vast with 34 major critical illnesses# covered under the policy

Why should you buy a critical illness rider?

A critical illness# rider is critical nowadays. A few days of being sick can lead to exorbitant hospital bills, making it hard to maintain a favourable standard of living. With a critical illness benefit, you can rest assured that your loved ones will not struggle to meet hospital expenses, doctor’s fees, and other expenses. The payouts on the diagnosis of disease are instantly credited to you and can be used to cover varied costs.

How to choose the perfect critical illness cover?

Here are some things you should pay attention to:

  • Sum assured:

    A high sum assured can offer you a safety net of sufficient funds in tough times. Make sure to select a high sum assured amount

  • Age:

    Buying a critical illness rider at a young age can offer you a high sum assured with lower premiums

  • Critical illness covered:

    The more illnesses covered, the wider is the plan’s coverage. The ICICI Prudential iProtect Smart Term Plan’s critical illness rider (optional) covers 34 critical illnesses#

  • Renewal limit:

    It may help to pick a plan that comes with a high age limit of renewal to maximise the benefits of your policy

  • Inclusions and exclusions:

    It may be advised to check the inclusions and exclusions of your policy and understand the features, terms, and limitations of your plan

How is a critical illness# benefit different from other health insurance plans?

Before you invest in health insurance, you need to remember that all costs are not covered by them. Let’s look at a couple of examples to understand the difference a bit better.

Mr. A was suffering from a health condition for which he used his health insurance plan. While his health insurance plan offered financial protection, he was required to submit hospital bills and could only cover the costs of the expenses incurred during his treatment. Auxiliary costs and the loss of income due to the illness were liabilities that Mr. A and his family had to bear on their own.

Mr. B was suffering from a similar health condition and could no longer continue with his job. However, he opted for a critical illness benefit. He received a lump sum payment. He used a portion of it to pay for his treatment, while the other part took care of his family’s expenses.

1. How much critical illness benefit is required for an individual?

Recovery from a critical illness# may need long-term follow-up treatments and rest. Therefore, when you decide the critical illness benefit amount, think about how long you might have to undergo treatments. Some of the factors to consider include:

  1. Medical expenses for the duration of recovery, such as:
    • Treatment costs
    • Prices of medicine and medical aids
    • Nursing charges
    • Doctors' fees
    • Diagnostic test costs
  2. Your family's monthly expenses, so that they can be financially supported, in case you need to stop working to improve your health
  3. Financial liabilities, such as loans or your children's college admissions
  4. Inflation

A general rule of thumb is to multiply your annual income by the number of years you might need to recover. This calculation gives you the minimum coverage you should look for.

2. Is it worth buying a critical illness# benefit?

Yes, it is worth buying a critical illness benefit. The costs of treatment for critical illnesses are substantially high1. Moreover, these illnesses can require long-term care. The expenses of hospitalisation, medicines and other costs can diminish your savings and cause a lot of financial stress. However, a critical illness benefit can help you cover all health-related expenses of a critical illness#. The premiums are affordable, and you can purchase a high sum assured without burdening your pocket.

3. How much critical illness benefit does one require?

The cover amount for critical illness benefit can depend on a number of factors, such as your age, income, savings, and more. It would help if you also considered medical inflation and the costs of healthcare in your city. Given the fact that critical illness treatments can be long and extensive, it may be advised to pick a high sum assured.

4. Is there any medical test required before purchasing a critical illness rider?

If you buy a critical illness# rider as an add-on benefit with the ICICI Pru iProtect Smart term plan, you need to undergo a medical examination.

When you fill the application form, you need to mention your medical history and PIN code. Based on this data we will decide the diagnostic tests you need as per your health status. According to the tests needed, either a medical practitioner will visit your home or you will have to go to a medical centre near you. You can select the date and time for the tests as per your convenience.

Your health condition decides the premium you need to pay for your term plan and critical illness benefit. Such medical tests are necessary to assess the state of your health and assign the correct premium. If you suppress any health details or misstate facts, the insurer can deny claims later. Hence, a medical test before purchasing the policy ensures hassle-free claim settlements in future.

5. Can I purchase a critical illness benefit once I am diagnosed with an illness?

Critical illness# benefit provides a payout on the first diagnosis of the disease covered under the plan. If you are already suffering from the ailment, you will not be able to buy this insurance. It does not cover health conditions for which you would have received treatment or medical advice within 48 months before purchasing the policy.

However, certain lifestyle disorders such as high blood sugar, increased blood pressure and elevated cholesterol levels increase the risk of critical ailments. These are precursors of life-threatening conditions such as heart attack, stroke, kidney failure, liver damage, and more. Hence, if you get diagnosed with such disorders due to today's fast-paced lifestyle, you can buy a critical illness rider. It will safeguard your finances against the steep medical costs if the listed ailments arise later.

6. How does critical illness rider payout?

If you are diagnosed with any of the 34 critical illnesses# covered by ICICI Pru iProtect Smart for the first time, you will receive a lump sum payout from your critical illness benefit. All you need is a copy of the diagnosis report to process the claim.

7. List of the documents required for critical illness rider

Here are the documents you would need for a critical illness rider:

  • The claimant's statement or the claim intimation form
  • A certificate from the attending doctor
  • A copy of all medical records like admission notes, discharge summary, as well as test reports
  • The original policy certificate
  • A cancelled cheque

8. Does term insurance cover critical illness?

Yes, term insurance covers critical illnesses. You can add a critical illness# benefit on top of your base plan at an additional cost and be financially protected against the costs of 34 critical illnesses#.

9. What are the tax benefits that can be availed with a critical illness rider?

Since a critical illness rider is a health cover, you can claim a deduction subject to conditions prescribed under Section 80D^ of the Income Tax Act, 1961. You can get deduction up to 25000 under Section 80D for yourself and your family ( 50000 if age of insured is 60 years or above) and up to 25000 ( 50000 if age of insured is 60 years or above) for your parents

10. What major critical illnesses are covered under a critical illness rider?

The critical illness# rider covers 34 critical illnesses, including:

  1. Cancer of Specified Severity
  2. Angioplasty
  3. Heart Attack
  4. Heart Valve Surgery
  5. Surgery to Aorta
  6. Cardiomyopathy
  7. Primary Pulmonary hypertension
  8. CABG
  9. Blindness
  10. Chronic Lung Disease
  11. Chronic Liver Disease
  12. Kidney Failure
  13. Major Organ/ Bone Marrow Transplant
  14. Apallic Syndrome
  15. Benign Brain Tumour
  16. Brain Surgery
  17. Coma
  18. Major Head Trauma
  19. Permanent Paralysis of limbs
  20. Stroke resulting in permanent symptoms
  21. Alzheimer's Disease
  22. Motor Neurone Disease with permanent symptoms
  23. Multiple Sclerosis with persisting symptoms
  24. Muscular Dystrophy
  25. Parkinson's Disease
  26. Poliomyelitis
  27. Loss of Independent Existence
  28. Loss of Limbs
  29. Deafness
  30. Loss of Speech
  31. Medullary Cystic Disease
  32. Systematic lupus Eryth. w. Renal Involvement
  33. Major Burns
  34. Aplastic Anaemia

11. What is the difference between a critical illness rider and a health insurance policy?

A critical illness# rider is added to a term life insurance cover and above the base cover. This is not a separate plan, but an optional add-on cover that you can buy with life insurance. This means that the critical illness rider will only be active until the policy term of the life insurance plan. A health insurance plan, on the other hand, is an individual policy. It is not linked to your life insurance and offers a unique set of features, terms, and premium.

12. What are some of the common exclusions under a critical illness rider?

Here are some common exclusions under a critical illness# rider:

  • Pre-Existing Conditions
  • Sexually Transmitted Disease (STD), Acquired Immune Deficiency Syndrome (AIDS) or the presence of any Human Immuno-deficiency Virus (HIV)
  • Self-inflicted injury, suicide, insanity and deliberate participation in an illegal or criminal act
  • Use of intoxicating drugs, alcohol, or solvent
  • War
  • Aviation other than as a fare-paying passenger or crew in a licensed commercial aircraft
  • Treatment for injury or illness caused by activities such as hunting, mountaineering, steeple-chasing, professional sports, racing of any kind, scuba diving, aerial sports, activities such as hand-gliding, ballooning, or any other deliberate exposure to exceptional danger
  • Radioactive contamination due to nuclear accident
  • Failure to seek or follow medical advice
  • Any treatment of a donor for the replacement of an organ
  • Congenital conditions

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* Only a doctor’s certificate confirming the diagnosis needs to be submitted.

` Life cover is the benefit payable on the death of the Life Assured during the policy term.

^ Tax Benefits of ₹ 46,800 under Section 80C & ₹ 7,800 under Section 80D is calculated at the highest tax slab of 31.2% (including cess excluding surcharge) on life insurance premium under Section 80C of ₹ 1,50,000 and health premium under Section 80D of ₹ 25,000. Tax benefits are subject to conditions under Sections 80C, 80D, 10(10D), 115BAC and other provisions of the Income Tax Act, 1961. Goods and Services tax and Cesses, if any will be charged extra as per prevailing rates. Tax laws are subject to amendments made thereto from time to time. Please consult your tax advisor for more details.

# Accelerated Critical Illness Benefit (ACI Benefit) is optional and available under Life & Health and All in One option. This benefit is payable, on the first occurrence of any of the 34 illnesses covered. Medical documents confirming the diagnosis of critical illness need to be submitted. The benefit is payable only on the fulfilment of the definition of the diagnosed critical illness. The ACI Benefit is accelerated and not an additional benefit, which means the policy will continue with the Death Benefit reduced by the extent of the ACI Benefit paid. The future premiums payable under the policy will reduce proportionately. If ACI Benefit paid is equal to the Death Benefit, the policy will terminate on payment of the ACI Benefit. To know more in detail about the ACI Benefit and terms & conditions governing it, kindly refer to the sales brochure. ACI Benefit term would be equal to the policy term or 30 years or (75-Age at entry), whichever is lower.

+ Accidental Death Benefit (ADB) is up to ₹ 2 crore (Subjected to Underwriting guidelines). ADB is available in Life Plus and All in One option. In case of death due to an accident, Accidental Death Benefit will be paid out in addition to Death Benefit. Accidental Death Benefit will be equal to the policy term or (80-Age at entry), whichever is lower.

++ On the diagnosis of Permanent Disability (PD) due to an accident, the future premiums under your policy for all benefits are waived. To know more about the definitions and terms & conditions applicable for permanent disability due to an accident, kindly refer to the sales brochure of ICICI Pru iProtect Smart.

## A Life Assured shall be regarded as Terminally Ill only if that Life Assured is diagnosed as suffering from a condition which, in the opinion of two independent medical practitioners specialising in the treatment of such illness, is highly likely to lead to death within 6 months. The terminal illness must be diagnosed and confirmed by medical practitioners registered with the Indian Medical Association and approved by the Company. The Company reserves the right for independent assessment.

1 Cost of Medical Treatment & Duration - https://www.indiahealthcare.org/average_cost_treatment

2 A discount of 5% on the first year’s premium will be offered on the purchase of ICICI Pru Heart/Cancer Protect when the life assured and his/her spouse is covered under the same policy. The policy benefits of both the Lives Assured shall be independent of each other. The Sums Assured of both the lives could be different. A claim made by one Life Assured under the policy does not the affect benefits of the other Life Assured. This Family benefit has to be chosen at the inception of the policy only, spouse cannot be added once the policy is issued. This discount is not applicable on Single Pay Policy. With one policy, you can avail either Family Benefit or Loyalty Benefit.

3 Existing customer discount of 5% on the first years premium is available only for policies with the Regular Premium Payment Option, it is not applicable for Single Pay Policies. With one policy, you can avail either Family Benefit or Loyalty Benefit.

4 A lump sum is paid out on the diagnosis of any of the listed conditions. This payout is based on the level of the condition. In any case, the total payout in the policy cannot exceed 100% of the Sum Assured of the cover selected. Please refer to the sales brochure to know about the payouts at different level of conditions.

5 The Company shall waive all future premiums on a claim of Minor condition under the chosen cover; or on the diagnosis of Permanent Disability (PD) of the Life Assured due to an accident. If both Cancer cover and Heart cover are chosen such waiver is allowed on a minor/major condition claim under either Cancer cover or Heart cover; or on the diagnosis of PD. This benefit is available only if the policy is in force on the date of diagnosis of the condition/at the time of the accident.

6 In case of Minor Conditions, the total payout will be capped at 100% of the Sum Assured.

7 Under the Income Benefit, the Sum Assured has to be chosen at the inception of the plan. An amount equal to 1% of the Sum Assured chosen at inception will be paid to the policyholder each month, for a period of 5 years upon a valid claim under any of the listed Major conditions. Where the Cancer cover and Heart cover are taken together, payout under Income Benefit will be triggered for only that cover for which a claim of Major condition is registered and all Benefits through other cover remains unaffected.

8 With Increasing Income Benefit, the Sum Assured chosen at inception increases by 10% simple interest on each policy anniversary, for every claim-free year. The maximum Sum Assured under the cover will be capped at 200% of the Sum Assured chosen at inception. This increase in Sum Assured will stop on the occurrence of the first claim under the cover. Where Cancer cover and Heart cover are chosen together, the Sums Assured for both the covers increase by 10% simple interest on each policy anniversary, for every claim-free year. The maximum sum assured will be capped at 200% of the Sum Assured chosen at inception for each type of cover. In case of the occurrence of the first claim under any one type of cover, the increase in Sum Assured will stop for that cover type and Increasing Cover Benefit will continue for the other type of cover, for which no claim has occurred.

ICICI Prudential Life Insurance Company Limited. IRDAI Regn No. 105. CIN: U66010MH2000PLC127837

ICICI Pru iProtect Smart UIN (Non-Linked Non-Par Life Individual pure risk premium product)

ICICI Pru Heart/Cancer Protect UIN (This is a non-linked non-participating health individual pure risk product)

ADVT No: W/II/0640/2023-24

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