Which Diseases Come Under Critical Illness And How To Get Them Covered Under An Insurance Plan?

There was a time when critical illnesses were associated with ageing but times have changed. These days, more and more people from the younger age groups are also being diagnosed with critical illnesses.

We explain critical illness and what you can do to keep yourself and your loved ones protected at all times.

What is critical illness?

Critical Illness refers to the below list of conditions as defined by your insurance policy. These are life-threatening conditions requiring a patient to undergo intense medical and pharmacological care. Mechanical support may also be required to support affected vital organs to keep the patient alive.

Some common critical illnesses are stroke, kidney failure, heart disease and cancer.

Heart diseases were the number one cause of death in Malaysia in 2020, with 166,507 deaths, while stroke is Malaysia’s third leading cause of death, with 19,928 deaths in 2019.

Critical illness list

Besides those mentioned above, there are other critical illnesses that you should be aware of, including:

  • Alzheimer’s disease

  • Coronary artery disease

  • Bacterial meningitis

  • Benign brain tumour

  • Blindness

  • Brain surgery

  • Cancer

  • Cardiomyopathy

  • Chronic aplastic anaemia

  • Coma

  • Coronary artery bypass surgery

  • Deafness

  • Encephalitis

  • End-stage liver failure

  • End-stage lung disease

  • Full-blown AIDS

  • Fulminant viral hepatitis

  • Heart attack

  • Heart valve surgery

  • HIV infection due to blood transfusion

  • Kidney failure

  • Loss of independent existence

  • Loss of speech

  • Major head trauma

  • Major organ/bone marrow transplant

  • Medullary cystic disease

  • Motor neuron disease

  • Multiple sclerosis

  • Paralysis of limbs

  • Parkinson’s disease

  • Primary pulmonary arterial hypertension

  • Serious coronary artery disease

  • Stroke

  • Surgery to aorta

  • Systemic lupus erythematosus with severe kidney complications

  • Third-degree burns


Critical illness may sound worrisome. In addition to getting treatment and resting to recuperate, there are also other medical expenses to consider. One way to ensure that you're financially covered if you contract a critical illness is to have a critical illness insurance policy.

What is critical illness insurance?

Critical illness insurance protects one financially by giving out a lump sum of money to you or your family upon diagnosis of one of the critical illnesses mentioned above in exchange for a premium.

What does critical illness insurance cover?

Critical insurance provides financial assistance in the event of an emergency or disease that results in higher than the usual medical expenses.

For example, stroke, heart attack and being diagnosed with cancer are conditions that generally cost a lot more than the usual sickness such as influenza or gastric. In fact, at private hospitals, a coronary bypass can cost between RM25,000 - RM80,000, while stroke treatment can cost between RM3,300 to RM9,000 onwards.

While government hospitals are an option for all Malaysians, they are usually overcrowded. As such, given a choice, most people would prefer to seek treatment and comfort in a private hospital.

This is when having critical illness insurance would come in handy, as upon diagnosis, the policyholder receives a lump sum payout. The money for the payout can be utilised for treatments, daily expenses, travel costs, and even a holiday to help one rest and recover.

Types of critical illness insurance plans

Generally, insurance companies offer two types of critical illness policies - term and investment-linked policies.

Term policy

Term policy of a critical insurance cover offers coverage to the policyholder and his/her family, which is equivalent to the plan chosen.

Upon a critical illness diagnosis or death due to critical illness, the beneficiary will receive a sum of money according to the policy benefits. The plan is then terminated upon payout.

Investment-linked policy

Investment-linked policies cover critical illnesses and also have some investment components included.

Part of the premium paid will be used to purchase investment units/funds of your choice. Dividends from the investment component are used to pay for insurance and other charges while the rest are invested.

Thus, with investment-linked policies, the value of your policy can grow over time.

Critical illness insurance vs medical card

Often there’s a misconception that critical illness insurance and medical cards are the same. Unfortunately, it’s not, and you need both to ensure that all your health-related expenses are fully covered.

Here are the main differences between having a medical card and a critical illness cover:


Medical Card

Critical Illness Insurance


Hospitalisation bills/ medical treatment

Listed critical illnesses

Type of financial support

Hospitalisation bills only

Lump sum payment that can be used for anything


The lump sum of payment from a critical illness plan can thus be used for any expenses that you incur during your recovery process.

Why is critical illness insurance important?

Critical illness insurance is important because it helps cover huge expenses beyond hospitalisation bills.

For example, someone who is diagnosed with cancer will not only have to pay for chemotherapy, which can cost between RM50 - RM4,000 per cycle but also consider the following:

  • Loss of income due to inability to work.

  • Daily living expenses.

  • Transportation costs to medical centres.

  • Lifestyle adjustments such as getting a wheelchair or installing a lift in your home.

  • Alternative treatments.


Thus, a critical illness cover doesn’t only pay for your medical bills. It also provides the necessary finances to help you through the recovery time.

How much critical illness insurance do I need?

When considering a critical insurance plan, you should consider your family’s medical history or any medical conditions you have.

Generally, your critical illness plan should provide a sufficient payout for your living expenses. It should equal ten times your annual income or at least 60 months of living expenses.

For more on how to gauge the amount you’ll need, read ‘4 Considerations When Buying A Critical Illness Plan.’

How many times can I claim critical illness insurance?

The number of times you can claim critical illness insurance depends on the type of plan you have. Let’s look at some examples:

1)   Single claim

With single-claim plans, the policyholder can only make one claim upon diagnosis. Once the claim is made, the policy is terminated.

2)   Multiple claims

Some critical illness policies allow the policyholder to claim for different illnesses from the same policy. These policies are quite beneficial as they provide additional protection for medical emergencies.

3)   Multiple claims of the same illness

Multiple claims of the same illness can be made if you have more than one policy to cover yourself or if it is part of the benefits that you sign up with your insurer provider.

However, before signing up for one plan, you must disclose any other existing plan to your agent and the company. Only then would you be able to make multiple claims without being red flagged by your insurer.

Where to buy a critical illness insurance plan in Malaysia?

Numerous insurance providers offer critical illness coverage in Malaysia. You can talk to an insurance agent or purchase a critical illness plan online or via the insurer’s website.

If you’re looking for a reliable provider, Prudential’s critical illness policy covers up to 190 critical illnesses for as low as RM100 a month. In fact, Prudential’s PRUAll Care insurance plan offers protection beyond critical illness - it includes mental health coverage and post-surgery recovery benefits.

Critical illness FAQ

Is cancer a critical illness?

Yes, cancer is a critical illness that, upon fulfilling policy terms and conditions, can be covered by critical illness insurance.

This is good as cancer treatment is costly, and having a critical illness policy will come in absolutely handy.

Is Covid-19 a critical illness?

Covid-19 is not a critical illness as it ranges from mild to severe, depending on a patient’s underlying conditions.

However, severe Covid-19 may mean a stay in the ICU, resulting in large medical bills. Thus, insurance companies such as Prudential now have pandemic coverage that allows you to claim if you’re hospitalised for severe Covid-19.  

Does critical illness insurance cover heart attack?

Yes, critical illness insurance covers Heart Attack as defined by your insurance policy as long as it is not an underlying medical condition.

Is mental health covered under critical illness?

No, mental health is not covered by critical illness insurance.

What are the top critical illnesses?

The top 5 critical illnesses, in no particular order, are:

  1. Cancer

  2. Heart attack

  3. Stroke

  4. Kidney failure

  5. Multiple Sclerosis

How long does critical illness take to pay out?

The time taken for payout depends on the submission of all the required documentation accurately.

Once all this is completed, the insurer will process and make the payment soonest possible.

Can I get critical illness cover after diagnosis?

Yes, you can. However, you should always disclose any pre-existing conditions to avoid problems with future claims.


Critical illnesses do not discriminate. Anyone can potentially be diagnosed with it at any point in life. Therefore, it is best to safeguard yourself and your loved ones against deadly illnesses.

Reach out to us at Prudential, and we will customise a plan according to your needs and budget. Of course, it’s always best to be prepared for the worst from a young age.