How do I claim in the event of a Critical Illness(CI):
You can claim at the first diagnosis of any critical illness provided the critical
illness has been diagnosed after 90 days of the policy commencement date or the
date of renewal of policy, whichever is valid.
You would be eligible for the lump sum amount (Sum Assured) provided you have survived
at least 30 days after the diagnosis of the critical illness.
You need to ensure that Critical Illness is confirmed by a registered medical practitioner,
including a relevant specialist acceptable to the company (the cost of which shall
be borne by the policyholder).
“Medical Practitioner” means a person who holds a recognized qualification
in allopathic medicine, is registered by the Indian Medical Council and is practicing
within the scope of such license, and shall not include:
a)the Policyholder’s close Relative; or
b)a person who resides with the Policyholder; or
c)a person covered under this Policy.
“Specialist” means a person who holds a recognized post graduate
qualification in any specialized stream of allopathic medicine, is registered by
the Indian Medical Council and is practicing within the scope of such license, and
shall not include:
a)any relative of the Policyholder/Insured; or
b)any person who resides with the Policyholder/Insured; or
c)any person covered under the Base Plan or this Rider
You are required to file a claim with all the required documents within 90 days
from the date of diagnosis of Critical Illness. Claim intimation after 90 days is
acceptable provided the Company finds reasons for delay satisfactory.
What is not covered (exclusions)?
No benefit amount will be payable if the Insured suffers from any of the covered
Critical Illnesses directly or indirectly by attempting suicide within one year
from the date of commencement of risk or date of reinstatement of the policy, whichever
is later.
No benefit will be payable if the critical illness is caused or aggravated directly
or indirectly by:
• Alcohol or drug abuse including drug taking
other than prescribed by a registered and qualified medical practitioner, any actual
or alleged crime committed by the Insured, willful self inflicted injury, attempted
suicide or negligence in seeking or following medical advice.
• Failure to seek and follow medical treatment
and advice from a registered and qualified medical practitioner within a reasonable
period of time following an accident.
• Engaging in racing of any kind other than
athletics or swimming.
• Any form of war, invasion, hostilities
(whether war be declared or not), civil war, rebellion, riots, social disorder,
insurrection, military or usurped power, or wilful participation in acts of violence.
• Radioactive contamination due to a nuclear
accident.
• Any mental or functional disorder.
• Participation in sports or pastimes of
a hazardous nature including (but not limited to) parachuting, potholing, mountaineering
and hot air ballooning.
• Any condition existing prior to the Commencement
Date except as stated in the Schedule.
There are disease specific exclusions in addition to general exclusions mentioned
above. Click here to view details
What happens if I am unable to pay premiums on time?
You get a grace period of 30 days from due date to pay the premium without any interest.
If the premium is not received within the grace period, your policy will lapse and
the cover will cease immediately. The policy does not acquire any surrender value
or paid up value (cash value).
Can I reinstate lapsed Policy?
A lapsed policy may be revived during the policy term within a revival period of
1 year from the date of first unpaid premium by submitting the proof of continued
insurability to the satisfaction of the Company and making the payment of all due
premiums.
Policy holder will be subject to the then underwriting requirements at the time
of reinstatement, basis which the company may either accept or decline the reinstatement.
Further Company, reserves the right to impose any extra premium as a results of
underwriting. The revival of a lapsed policy is also subject to payment of revival
fee of ` 250/-. At the time of revival, the cost of medical examination and special
tests, if any, will be borne by the Policyholder.
If at the end of the revival period, the policy is not revived, the policy shall
terminate and no benefit shall be payable thereafter.
Can I review the terms and conditions under the policy: The Policy
Terms and conditions can be reviewed within 30 days from the date of receipt of
the policy document. If the policy is cancelled during this Free look Period, the
Company will refund the premium paid after deducting proportionate risk premium
and expenses incurred on medicals and stamp duty.
Cost of medical examination: At the time of purchase of the policy,
the cost of medical examination and special tests, if any, will be borne by the
Company. At the time of revival of a lapsed policy, the cost of medical examination
and special tests, if any, will be borne by you.
Nomination & Assignment: Nomination, in accordance with Section
39 of Insurance Act, 1938, is permitted under this policy. Assignment, in accordance
with Section 38 of Insurance Act, 1938, is permitted under this policy.
Loan: Loan will not be allowed under this plan