Why cover?
  • affects 1 in 4 women / 1 in 5 men before retirement
  • 94.1% of the critical illness claims are paid
  • protect yourself and your family if you get seriously ill
Why us?
  • get the cover that will pay when you need it
  • save up to 35%, cover from £5 a month
  • free, fast and without obligation quotes
Insurers: Aviva, Legal & General, Liverpool Victoria, Scottish Widows, Vitality, Zurich

Critical Illness vs. Hospitalization and Surgical plan: What are the differences?

A Hospitalization and Surgical Plan is also known as a health insurance plan and will pay for a set of specific hospitalization and surgical expenses. This usually includes the room charges, prescription medicines, surgical fees, anaesthesiologist fees and other related fees. There are maximum benefit limits for every benefit prescribed, as well as an overall maximum limit for a specific sickness and for the entire plan.

On the other hand, a critical illness insurance policy will pay a lump sum upon diagnosis of a covered serious illness.

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These two work differently and are really distinct from each other. Here’s a table outlining the differences of the two kinds of plans:

  Critical Illness Insurance Hospitalization & Surgical Plan
Purpose of coverage

To help fund treatments for the critical illness.

To help pay for the hospitalization and surgical expenses of the Insured.

Claims payment method

Lump sum when the insured is diagnosed with a serious illness.

Reimbursement (when the Insured pays for the treatments) or direct payment to hospital.

What is paid

Lump sum equivalent to the face amount.

What is actually spent during the hospitalization and surgery, up to specified limits and up to a limited number of days. The policy will usually have a schedule of benefits that outline what the insurance will pay.

Reason for claims payment

Diagnosis of a covered serious illness. There are only a number of specific illnesses that are covered in the policy. This will not pay if the illness does not qualify under the definitions of the policy.

Basically, hospitalization that is a result of any illness or injury due to accident. Self-inflicted injuries are usually excluded.


This is only for critical illnesses.

  • Is limited only to hospitalization.
  • Will only pay up to the limits. Anything over the limit will be shouldered by the Insured.
  • Depending on the type of plan, direct payments by the Insurance company to the hospital or medical provider are limited only to accredited hospitals.
Length of coverage

Once a claim is paid, the insurance policy terminates.

Is usually renewable yearly. The cover will continue even after a claim as long as the policy is effective.

Weighing the Need, Pros and Cons of Critical Illness vs. Hospitalization and Surgical Plan

  Critical Illness Insurance Hospitalization and Surgical Plan
Why buy?

This will provide a lump sum that a critically ill person can use to pay for medical treatments (including out-of-pocket expenses) or to supplement the family income when one is no longer able to work.

This pays for the hospitalization expenses so that the family is not financially crippled with hospital bills.

  • The lump sum can be used not just for hospital expenses but also other out-of-pocket expenses that entail a hospital stay.
  • The lump sum enables you to have the freedom to choose the kind of treatment you want, as well as the hospital (whether local or abroad).
  • Provides a longer length of cover.
  • Covers hospitalization costs such as room and board, doctor’s fees, surgeon’s fees, diagnostic tests and a long list of other benefits.
  • Provides a more comprehensive cover for illnesses, covering most hospital and surgical care needed.
  • Plans can also cover dental and diagnostic costs, depending on the plan you choose.
  • Provides hospitalization expenses not just for illness but also for accidents
  • The cover is limited only to a specific list of critical illnesses.
  • You need to meet the definition of the critical illness for the claim to be payable.
  • You are limited to the treatment options listed in the benefit schedule.
  • Hospitalization payments have a maximum limit per treatment or benefit and per illness.
  • You will need to cover out-of-pocket expenses.
  • There may be co-payments or deductions, meaning you will also pay a certain portion of the hospital expenses. The health insurance plan will kick in to pay the rest.

Want to know about other health-related insurance covers? Here are some articles about options you can think about:

Last updated on: 18.1.2013

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