The Critical Illness benefit purchased by the policyholders is payable on any of the following critical illnesses or happening of any of the following 12 critical illnesses irrespective of the expenses incurred in its treatment.
| a) Minimum Sum Assured: |
Rs. 1,00,000/- |
| b) Maximum Sum Assured: |
The basic policy's sum assured or Rs. 6, 00,000/- including cover under all previous policies with the Company, whichever is lower. |
| c) Minimum Entry Age: |
18 years. |
| d) Maximum Entry Age: |
55 years |
| f) Minimum Policy Term: |
10 years |
| h) Maximum Maturity Age: |
65 years |
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Means the presence of one or more malignant tumours. The malignant tumour is to be characterizes by the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue for which major interventionist treatment or surgery (excluding endoscopic procedures alone) is considered medically necessary.
The following tumours are excluded:
• Tumours showing the malignant changes of carcinoma in situ (including cervical dysplasia CIN-1, CIN-2 and CIN-3 or which are histologically described as pre-malignant;
• All skin cancers, including hyperkeratoses, basal cell carcinomas, squamous cell carcinomas and Melanomas of less than 1.5 mm maximum thickness as determined by histological examination using the Breslow method, unless there is evidence of metastases;
• All forms of lymphoma in the presence of any Human Immunodeficiency Virus;
• Kaposi's Sarcoma in the presence of any Human Immunodeficiency Virus;
• Non Life-threatening Cancers, such as Prostatic cancers which are histologically described as TNM Classification T1 or are of another equivalent or lesser classification, Papillary Micro-Carcinoma of the Thyroid or Bladder, Chronic Lymphocytic Leukaemia less than RAI Stage 3.
Means the actual undergoing of Coronary Artery by-pass Surgery by way of thoracotomy to correct or treat Coronary Artery Disease but not including angioplasty, other intra-arterial, 'keyhole' or laser procedures.
First Ever Myocardial Infarction (Heart Attack)
Death of a portion of the heart muscle arising from inadequate blood supply to the relevant area. The diagnosis shall be supported if three or more of the following four criteria being consistent with a new heart attack, are present:
• A history of typical chest pain;
• New electrocardiogram (ECG) changes proving infarction;
• Diagnostic elevation of cardiac enzyme CK-MB
• Diagnostic elevation of Troponin (T or I) and left ventricular ejection fraction less than 50% measured 3 months or more after the event.
Means the actual undergoing of surgery via a thoractomy or laparotomy to repair or correct an aortic aneurysm, an obstruction of the aorta or a coarctation of the aorta. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches. Surgery performed using catheter techniques only are specifically excluded..
Means the undergoing of open chest surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities. Repair via valvotomy, catheter, 'keyhole' surgery or similar techniques are specifically excluded.
Complete and permanent loss of function of two or more limbs or the complete severance of two or more limbs above the wrist or ankle through accident or disease.
End stage renal failure presenting chronic irreversible failure of both kidneys to function, as a result of which regular renal dialysis is intiated or renal transplant is carried out.
Means the human to human organ transplant from a donor to the Life Insured of one or more of the following organs: kidney, liver, heart, lung or the transplantation of bone marrow. The transplantation of any other organs, parts of organs, tissues or cells is excluded.
A cerebrovascular incident including infarction of brain tissue, cerebral and subarachnoid haemorrhage, cerebral embolism and cerebral thrombosis, where all of the following conditions are met:
• There is evidence of permanent neurological damage confirmed by a neurologist at least 6 weeks after the event;
• There are findings on Magnetic Resonance Imaging, Computerised Tomography or other reliable imaging techniques consistent with the diagnosis of a new stroke.
The following are excluded:
• Transient Ischaemic Attacks;
• Brain damage due to an accident or injury, infection, vasculitis and inflammatory disease;
• Vascular disease affecting the eye or optic nerve; and
• Ischaemic disorders of the vestibular system.
Paralysis means the permanent and total loss of function of two or more limbs as a result of injury to or disease of the spinal cord. Limb is defined as the complete arm or the complete leg.
A coma that persists for at least 96 hours where all the following conditions are met:
• There is no respose to external stimuli for at least 96 hours;
• Life support measures are necessary to sustain life;
• There is brain damage that results in a permanent neurological deficit. The permanence of the neurological deficit must be assessed at least 30 days after the onset of the coma.
• Coma resulting directly from alcohol or drug abuse is excluded.
Means tissue injury caused by thermal, electrical or chemical agents causing third degree or full thickness burns to at least 20% of the body surface area as measured by The Rule of 9 of the Lund and Browder Body Surface Char.
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