Health Insurance & Critical Illness Plans - Limitations and conditions- who can buy and who can not buy?

06 February 2022 | Views | By BioSpectrum Knowledge Resource

A slight twist is enough to change your entire life. Let us suppose that you are a happy family of four: you, parents, and spouse. As life goes smoothly one fine day due to some health hiccup, you get yourself checked, and to your utter surprise, you get to know that you are diagnosed with cancer.

Image Source : Public Domain

Image Source : Public Domain

A single piece of news and the fate for all the other three family members changed. Cancer comes in handy not only with emotional stress; it adds to economic pressure and uncertainty. Cancer treatment can exhaust over 30 lakhs - 35 lakhs, and it is a vast amount and dream for many in India. 


You have a health insurance plan, but that will not be able to support your other needs related to critical illness.


And, it is nearly impossible to obtain a cancer insurance plan while they are already diagnosed with cancer or a cancer survivor. However, a critical illness plan can be added to their existing term plan to act as a savior in a dire time. 


This blog will help you understand and, 


  • Find the checks and balances applied to cancer insurance plans
  • Who can and cannot apply for a cancer insurance plan
  • Having a critical illness plan is important 


If you are ready, let us take a deeper dive into this topic to understand a cancer insurance plan in a more detailed manner. 


What is Critical Illness Cover? 


A critical illness plan will cover all your hospital and non-hospital-related expenditures and comes with other benefits that will not only help you but your family members if you meet with an untimely death.


Buying health insurance and critical insurance plans is essential because with changing lifestyles, things are changing, imposing numerous changes within our body and hormones. 


With such changing phenomena, our bodies are also exposed to multiple diseases, and cancer is one of them. This mere five-lettered word comes with a destructive magnitude that is enough to shatter your family and career. 


And this is where the importance of a critical illness plan is understood. So, what is a critical illness plan? 


Many assume that health and critical illness plans are the same, so those who think you live in a bubble. Health insurance is an efficient plan to help you sail through hospital expenditures. On the other hand, a critical illness policy helps provide monetary aid when diagnosed with any critical ailments such as cancer. 


Factors Affecting Health Insurance Premium


A health insurance is designed to pay all the medical-related bills of the life insured. However, it doesn't cover the expenses of any critical ailments. In a nutshell, it reimburses the incurred expenses that the life insured has to bear or ends up paying directly to the hospital. 


When you buy health insurance, the premiums paid by the life insured towards the insurance company can be influenced due to the following factors, and they are as follows:


Pre-existing medical ailments: Before you opt for any health insurance, the user is expected to undergo specific medical examinations, and the medical report needs to be submitted to the insurance company. It guarantees that there are no pre-existing health issues. However, if the user has any pre-existing health problems, the insurance company can accept them in their policies or even opt not to cover them. And if accepted, there is a fair chance of paying higher premiums compared to others. 


Family medical history: If any critical illness runs in the family as hereditary, the premiums might be affected. 


Harmful substance intake: If you are a smoker, drinker, involved in drugs and other harmful substance intakes then, it acts as a disadvantage for the user because these things are against healthy life and raise the threat rate for the user to get ill soon. 


Marital status: Even though it is uncertain whether married souls live longer, insurance premiums are often lower for them. However, a change in marital status acts as a benefit for men as it helps them reap better benefits. 


Gender: There might be certain differences when a female buys health insurance compared to a man, resulting in variation in premium payments. Experts say that - women are more likely to perform doctor's visits, have medications, and be afflicted with chronic ailments.


Age: It is said that buying insurance for a younger generation is always beneficial because the premiums are low, and there aren't many health issues that one shall face compared to the elderly souls. The death risk is also lesser compared to an old life insured. 


Profession: For instance, if the user works in a hazardous or life-threatening environment such as construction sites, labs that deal with chemicals, radiations, coal mines, and many more. They are required to pay higher premiums because they are more prone to chronic diseases such as heart-related ailments, etc. 


Conditions to Buy a ABSLI Cancer Shield Plan


Every insurance plan comes with certain checks and balances, and while planning for insurance, you should be well aware of the plan. Apart from the benefits and features, one should also be mindful of the constraints and conditions of the critical illness plan.


Let us take the Aditya Birla Sun Life Insurance Cancer Shield Plan into consideration to understand the limitations that a person planning to buy a critical illness plan should know. The list of ifs and buts in the world of ABSLI Cancer Shield Plan are as follows:


  • If you have indulged in smoking and tobacco in the last 1 year or were advised by the doctors/medical practitioners to quit tobacco consumption or smoking due to health reasons, it is a red flag.
  • The condition of 7 days survival is important for claims to pass.
  • The user has been advised by the doctor to halt the consumption of alcohol due to health-related reasons or ever diagnosed with liver problems as a result of alcohol consumption. Therefore, if you continue to consume, you aren’t eligible for cancer insurance.
  • If anyone from your near family has suffered or is suffering from cancer and have succumbed to the deadly disease before the age of 60? You will not be eligible to avail this cancer insurance plan.
  • If the life insured is diagnosed with more than one cancer in a single go then, the insurance company shall pay for only one. That benefit will be the amount corresponding to the cancer stage with the highest benefit amount.
  • Ever been hospital to get checked, advised, diagnosed, undergone surgery, been treated, or observed any of the following clinical signs-


  1. a) Bleeding, pus, or discharge from any part of your body, such as your nose, ears, mouth, skin, rectum, vagina, anus, blood in your stool/sputum/urine/vomit?
  2. b) Prolonged fever, headache, cough, difficulty swallowing, hoarseness of voice (for more than two weeks), vision problems, seizures/epilepsy, unconsciousness, blood diseases, irregular blood cell count.

c)Have you or your partner been tested for HIV/AIDS or other sexually transmitted diseases (STDs)?


  • You will not be eligible if the interested user has ever been diagnosed with cancer or early signs of cancer such as tumors or unusual symptoms such as discharge of body fluids, bleeding, pus, etc.
  • If the doctor has advised you to perform the below-mentioned medical tests in the last six months concerning cancer detection or suspicion - ultrasound (USG), body scan, MRI, CT scan, cytology, pap smear, mammogram, colonoscopy, blood tests, cancer/tumor markers, you will not be eligible to buy.




Life can be challenging, especially when health issues and financial crunch hovers over life. It is why insurance is vital in your good healthy days as it acts as a messiah in disguise during your adverse times. 


Don't forget to opt for the right plan from a credible insurance provider rather than falling for sugar-coated insurance plans provided by any tom dick and harry.


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