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What Our Plans Cover
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The listed conditions specified in...
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Cancer of defined severity
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Heart attack of defined severity a...
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Stroke with permanent symptoms
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Kidney failure requiring regular d...
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Major organ and bone marrow transp...
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Paralysis and specified neurologic...
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Spouse cover
Who Can Consider This Plan?
- A registered organisation with employees on its payroll
- A minimum group size, commonly seven to twenty depending on the cover
- Employees actively at work on the date cover commences
- Accurate census data — pricing follows the population profile
- Uniform benefit design within each defined grade
What May Not Be Covered?
- Conditions not on the scheme's list, however serious
- A listed condition that does not meet the severity definition
- Death within the survival period, commonly 14 to 30 days
- Diagnosis within the initial waiting period, usually 90 days
- Cover after the employee leaves the organisation
Always check the policy wording before you commit.
Why Choose Wealth & Covers?
- Expert advice to choose the right plan
- Plans from leading insurance companies
- Hassle-free process and documentation
- End-to-end support, including claim assistance
- Dedicated relationship manager
Our Insurance Partners
- Star Health Insurance
- Care Health Insurance
- Niva Bupa Health Insurance
- HDFC ERGO
- ICICI Lombard
- Bajaj Allianz
We represent multiple providers to help you find the most suitable option at the best price.
- Expert Guidance Personalised advice from experienced insurance professionals.
- End-to-End Support From choosing the right plan to claim assistance, we are with you always.
- Claims Assistance Hassle-free claim support to ensure you get what you deserve.
- Transparent Process Clear information, easy documentation and a hassle-free experience.
Overview
Group critical illness pays a lump sum to an employee diagnosed with one of the conditions listed in the scheme, subject to a survival period. It pays regardless of what the treatment cost, and the employee decides what the money is for.
It complements group health rather than duplicating it. The health scheme pays the hospital; this pays for everything the hospital does not bill — income lost during months of treatment, a spouse who stops working to provide care, travel to a specialist centre, a home loan that still has to be serviced.
For employers it is a comparatively inexpensive addition that materially changes the outcome for the small number of employees who need it, which is a good description of what a benefit should do.
Who should consider it
Employers with an established group health scheme looking to add depth. Organisations with an older workforce profile. Companies where a single earner supports a household is the common pattern.
Benefits
- A lump sum paid on diagnosis, with no bills to submit
- Replaces income during treatment, which health cover never does
- No individual underwriting for employees within the free cover limit
- Covers employees who could not obtain retail critical illness cover
- Inexpensive relative to the sum insured provided
- Can be extended to spouses on many schemes
What is covered, and what is not
Read the right-hand column first. It is the one that decides whether a claim is paid.
Typically covered
- The listed conditions specified in the scheme
- Cancer of defined severity
- Heart attack of defined severity and major heart surgery
- Stroke with permanent symptoms
- Kidney failure requiring regular dialysis
- Major organ and bone marrow transplant
- Paralysis and specified neurological conditions
- Spouse cover, where the scheme extends to dependants
Typically not covered
- Conditions not on the scheme's list, however serious
- A listed condition that does not meet the severity definition
- Death within the survival period, commonly 14 to 30 days
- Diagnosis within the initial waiting period, usually 90 days
- Cover after the employee leaves the organisation
- Early-stage cancers, where the scheme covers only major stages
Inclusions and exclusions vary between providers and between plans from the same provider. The wording in your own policy document is what governs — we will walk you through it before you buy.
How it works with us
- 1 We profile the workforce, not just the headcount Age bands, salary bands, locations and dependants. A scheme priced on headcount alone is priced on the wrong data.
- 2 Benefit design before market approach Sum insured basis, family definition, waiting periods and co-payment. These decide the premium far more than the choice of insurer.
- 3 Quotes compared on claims service as well as price A cheap scheme with a slow TPA costs you in employee goodwill every single month.
- 4 Onboarding and employee communication We run the enrolment, produce the cards and explain the scheme to your people. Benefits nobody understands are benefits nobody values.
- 5 Mid-term additions and an annual review Joiners and leavers handled by endorsement, and a renewal built on your actual claims data rather than a standard loading.
Important considerations
The things a brochure tends to leave out. Read these before you decide.
- Compare the condition definitions, not the number of conditions. A list of thirty with strict severity thresholds can pay less often than a list of fifteen with reasonable ones.
- The survival period is a real condition. An employee who dies within it produces no critical illness payout, which is why group term life sits alongside this cover rather than being replaced by it.
- Set the sum insured against household income rather than treatment cost. This benefit exists to replace earnings, not to pay hospital bills.
- Check the free cover limit. Senior employees above it may need individual underwriting, and that is where schemes most often have gaps.
- Explain to employees that this pays in addition to the health scheme. Many assume the two offset each other and never claim.
Documents required
- Company registration and GST details
- Employee census — age, gender, salary band and location
- Details of dependants where family cover is included
- Existing policy schedule and claims data, where renewing
- Organisation chart, where cover varies by grade
- Signed proposal form from an authorised signatory
Frequently Asked Questions
How is this different from group health insurance?
Group health reimburses hospital bills. This pays a lump sum on diagnosis with no restriction on use, addressing the costs a hospital never bills for — lost income, a carer leaving work, travel for treatment, loans still being serviced. Both pay on the same event without offsetting each other.
What is a survival period?
A window after diagnosis, commonly fourteen to thirty days, that the employee must survive for the benefit to become payable. It makes this a living benefit rather than a death benefit, which is why group term life remains a separate necessity.
Does the number of conditions matter?
Less than the definitions do. A scheme listing thirty conditions with very strict severity thresholds can pay less frequently than one listing fifteen with reasonable ones. Read the definitions for cancer, heart attack and stroke in particular — those three drive most claims.
Can spouses be covered?
Many schemes extend to spouses, usually at additional premium. Given that a spouse's serious illness affects household finances as much as an employee's, it is worth pricing.
What sum insured is appropriate?
Think in terms of household income rather than medical costs — commonly one to three years of the employee's salary. The health scheme handles the treatment; this handles the period during which the household is earning less.
Want a shortlist instead of a catalogue?
Tell us the situation and an advisor comes back with two or three options that actually fit — and names what each one gives up.