Critical Illness Policy

When a major illness strikes, it not only means high costs for medical care, but it also puts immense pressure on the family to manage their living expenses while the patient recoups.
In case of the above situation, your Critical illness insurance can come to your aid by not only covering hospitalization expenses but also providing you with lump-sum compensation that can help you meet your day to day expenses like child's school fees, Car and House EMIs, credit card payments etc.

Key Benefits

• It acts as an income replacement: Critical ailments not only affect the person physically; it also has a major impact on the finances of the family. Critical insurance pays a lump sum amount which can be used to cover medical and household expenses.
• It gives tax benefits: Critical illness payout is tax-free under Section 80D of the Income Tax Act.
• It gives peace of mind: The policy provides peace of mind as now one can concentrate more on medical treatment rather than running around to arrange funds for medical and household expenses.
• It covers treatment taking place in a foreign country: Under a critical illness insurance plan, a fixed sum is paid on the diagnosis of an acute ailment, irrespective of whether the treatment takes place in India or abroad. It means the policy can help you if you want to go overseas for further medical treatment.

Coverage

• Critical Illness
  • Cancer
  • Brain Tumor
  • First Heart Attack
  • Coronary Artery Disease
  • Coronary artery bypass surgery
  • Open heart replacement
  • Stroke
  • Kidney Failure
  • Aplastic Anemia
  • End-stage lung disease
  • End-stage liver failure
  • Coma
  • Major burns
  • major organ/bone marrow transplantation
  • Multiple Sclerosis
  • Fulminant Hepatitis
  • Motor Neuron Disease
  • Primary pulmonary Hypertension
  • Bacterial Meningitis
  • Temporary Illness
• In-Patient Hospitalization
  • Room Rent/ICU
  • Nursing
  • Medical Drugs
  • Consumables
  • Medical Practitioner's (Surgeon, Anesthetist, Consultant etc.)
  • Blood
  • Oxygen
  • Anaesthesia
  • Diagnostic and pathological test
  • operation theatre charges
  • cost of chemotherapy
  • Dialysis
  • Pacemaker
  • Artificial Limbs
• Pre-Hospitalization Medical Exp: It refers to those medical expenses which are incurred in preparation during the specified period before hospitalization.
• Post-Hospitalization Medical Exp: Refers to the medical cost incurred after the patient gets discharged from hospital after the treatment for the diagnosed disease.
• Domiciliary Treatment:It means medical treatment for illness/disease/injury which in the normal course would require care and treatment at a hospital but is taken while confined at home under any of the following circumstances:
  • The condition of the patient is such that he/she is not in need to be removed to a Hospital
  • The Patient takes treatment at home on account of non-availability of room in a Hospital.
• Organ Donor
• Daily Allowance
• Emergency Ambulance
• Day Care Procedures

Exclusions

• Any Pre-existing Condition and complication arising from it
• Any Illness, sickness or disease, other than specified as Critical Illness, as mentioned in the policy schedule
• Any Critical Illness of which, the signs or symptoms first occurred prior to or within Ninety (90) days following the Policy Issue Date or the last Commencement Date, whichever is later
• Any Critical Illness resulting from a physical or mental condition which existed before the Policy Issue Date or the last Commencement Date which was not disclosed
• Intentionally self-inflicted Injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS), Human Immune-deficiency Virus (HIV) infection; suicide
• War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power
• Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel
• The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment
• Congenital anomalies or any complications or conditions arising there from
• Treatment of illness or injury caused by :Participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sport, any bodily contact sport or any other hazardous or potentially dangerous sport for which you are trained or untrained
• Any loss resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy, or
• Any Critical Illness based on a Diagnosis made by the Insured or his/her Immediate Family Member or anyone who is living in the same household as the Insured or by a herbalists, acupuncturist or other non-traditional health care provider
• Cosmetic or plastic surgery or any elective surgery or cosmetic procedure that improve physical appearance, surgical and non-surgical treatment of obesity (including morbid obesity) and weight control programs, or treatment of an optional nature
• Special nursing care, routine health checks or convalescence, Custodial Care, general debility, lethargy, rest cure
• Any investigation(s) or treatments not directly related to a Covered Illness or Covered Injury or the conditions or diagnosis necessitating hospital admission

Claim Procedure

The process of making a critical illness claim is simple and hassle-free. Once you have been diagnosed with a particular illness, you may notify your insurance provider. The insurer may need further proof, such as diagnosis proof from a specialist in the specific illness, or tests that support the diagnosis.
Below Documents required at the time of claim under Critical Illness Policy: -

• Claim form duly filled and signed
• Medical certificate confirming the diagnosis of critical illness
• Discharge card/ death summary from the hospital, if applicable
• First consultation letter and subsequent prescriptions
• KYC documents
• Any other document as may be required by the insurance company