What critical illness insurance covers

Critical illness insurance protects against large costs after a diagnosis that requires complex and expensive treatment. A typical list includes cancer, myocardial infarction (heart attack), stroke, heart surgery (such as coronary artery bypass grafting), organ transplantation and kidney failure. The list and the definition of each diagnosis vary between insurers — read them in the policy wording.

Two policy formats

  • Cash payout. On a first diagnosis from the list, the insurer pays a fixed sum or a percentage of it. The money can be spent on treatment, rehabilitation or replacing lost income. This cover is often added to life insurance.
  • Arranged and paid treatment. Through a medical partner, the insurer arranges diagnostics, a second opinion, treatment at listed clinics and medicines up to the sum insured. It resembles a narrow DMS programme, but with a large sum for one serious case.

There are cancer-only programmes and comprehensive ones covering several groups of illnesses.

Who needs it

Such a policy is useful for people without financial reserves for treatment, those with a family history of cancer or cardiovascular disease, and those who want access to private treatment or a second opinion without waiting. Cover can also be arranged for children.

Laws and regulation

This is a voluntary type of insurance: the contract is concluded under Chapter 48 of the Russian Civil Code and the insurer's policy wording. Cancer and other serious illnesses are also treated under OMS (compulsory medical insurance) — the policy does not cancel that right but adds options. The contract can be cancelled within 14 calendar days under Bank of Russia Directive No. 3854-U if there have been no insured events. If the cover is part of a life insurance contract concluded from 2025 for at least 10 years, the long-term savings deduction under Article 219.2 of the Tax Code may be available for the premiums.

Waiting period and exclusions

Almost all programmes have a waiting period — a period after purchase during which a diagnosed illness is not treated as an insured event. It exists so that people do not buy a policy when they already suspect an illness. Its length is stated in the wording.

Typical exclusions: illnesses diagnosed or showing symptoms before purchase; consequences of alcoholism and drug addiction; HIV infection; early stages of certain tumours if the wording expressly excludes them. Each insurer has its own list.

How it fits with other policies

Critical illness cover is bought as a separate policy or as an additional risk under life insurance. Corporate DMS usually does not cover treatment of cancer and other serious illnesses, or covers it only in part, so these policies complement rather than duplicate each other.

A critical illness policy also does not replace accident insurance: the first pays on illness, the second on injury from an external event. Before buying, check which risks are already covered through your employer or bank so you do not pay twice for the same thing.

What drives the price

  • age and sex: risk and price rise with age;
  • the list of illnesses and the format of cover;
  • the sum insured;
  • territory of treatment: Russia only or other countries too;
  • health and family history — from the medical questionnaire.

You can get an estimate with the calculator.

How to choose a plan and insurer

  1. Decide what matters more: cash in hand or arranged treatment.
  2. Compare the lists of illnesses and their definitions — the main differences between programmes are in the details.
  3. Check the waiting period and the limits for medicines, rehabilitation and accommodation for a companion.
  4. Find out where treatment is possible and who arranges it — the insurer itself or a medical partner.
  5. Study insurer profiles in the directory of insurers.

How to get a payout or treatment

  1. Once the diagnosis is confirmed, call the insurer on the number in the policy.
  2. Send medical documents: discharge summaries, histology and test results.
  3. The insurer checks that the diagnosis matches the definition in the wording and decides on the payout or arranges treatment.

More in the Insurance claim section.

Common mistakes

  • Not reading the definitions of diagnoses. The name of an illness in the policy and in medical practice may not match on criteria.
  • Hiding symptoms at purchase. This is grounds for refusal.
  • Forgetting the waiting period. A diagnosis during it is not covered.
  • Too small a sum insured. Modern treatment of serious illness is expensive, and the sum is chosen once.