Critical Illness product (accelerated benefit) is basically offered as an optional Rider benefit to all Employer-Employee group policyholders (both existing and new schemes) along with Group term insurance schemes i.e. OYRGTA ( One year renewal group term assurance ) type schemes. Schemes along with which the rider can be given shall include Group insurance, Group Gratuity (CA), Group Leave Encashment and Group insurance in conjunction with Superannuation. The Benefit will not be extended to spouses or dependants. Only full time permanent employees who are actively at work will be eligible for Critical Illness cover. The relevant premium is to be paid by the Group Policyholder.
- The Group critical illness rider benefit to employees is given as an add on benefit to the Group policy which has an element of life cover.
- The Group Critical Illness rider allowable for each member shall be a minimum of 20 % of sum assured under the base plan and shall not exceed 100% of the sum assured under the base plan subject to minimum of Rs. 50 Thousands and maximum of Rs 20 lac per member.
- All members of the attached policy should participate at inception and all eligible new members should compulsorily participate.
- The diseases covered under the rider (subject to certain exclusions) are :
- Cancer 2. Coronary Artery (Bye pass) Surgery 3. Heart attack (Myocardial infarction) 4. Stroke
- Kidney failure (End stage renal disease) 6. Aorta (Surgery of Aorta) 7. Heart valve replacement
- Major Burns.
- The Critical Illness Accelerated benefit is payable upon the first incidence of any of the 8 specified diseases and evidenced as per the diagnostic criteria specified. The rider shall terminate on payment of the Critical Illness benefit.
- The Group Critical illness (Accelerated) Benefit pays a lump sum amount as a percentage of Sum assured out of the Sum assured under the life cover in the event of occurrence of 8 diseases covered under the rider.
- No Critical Illness Benefit shall become payable to a member if the disease occurs within 90 days of the start of the coverage for that member of the scheme. This period of 90 days shall be called “Waiting period”.
- In case of death nothing is payable under this rider. However, under the base plan (i.e., the scheme on which the rider is opted for) benefits as under shall become payable :
1. A benefit equal to base sum assured if no critical illness benefit is payable or has been paid earlier.
2. If critical illness benefit is payable or already paid, the benefit is reduced by the amount of critical illness benefit payable or already paid. In other words, the difference between the base sum assured and the critical illness benefit already paid is payable on death.
- Diseases in the presence of an HIV infection.
- Diseases that have previously occurred in the life of the member of the scheme i.e. the benefit is payable only if the disease is a first incidence , regardless of whether the earlier incidence occurred before the individual was covered or whether the insured was covered by us or another insurer.
- Any disease occurring within 90 days of the start of the coverage for each member of the scheme. (I.e. during the waiting period).
- No payment will be made for any claim directly or indirectly caused by, based on, arising out of, or howsoever, to any Critical Illness for which care, treatment, or advice was recommended by or received from a Physician, or which first manifested itself or was contracted before the start of the policy period, or for which claim has or could have been made under any earlier policy.
- Any congenital condition.
- Alcohol or solvent abuse or taking of drugs, narcotics or psychotropic substances unless taken in accordance with the lawful directions and prescription of a registered medical practitioner.
- Failure to seek or follow medical advice.
- War, invasion, act of foreign enemy, hostilities(whether war be declared or not),armed or unarmed truce, civil war ,mutiny, rebellion, revolution, insurrection, military or usurped power, riot or civil commotion, strikes.
- Taking part in any naval, military or air force operation during peace time.
- Participation by the member of the scheme in any flying activity, except as a bona fide, fare-paying passenger of a recognised airline on regular routes and on a scheduled timetable.
- Participation by the member of the scheme in a criminal or unlawful act.
- Engaging or taking part in professional sport(s) or any hazardous pursuits, including but not limited to , diving or riding or any kind of race, underwater activities involving the use of breathing apparatus or not, hunting, mountaineering, parachuting , bungee-jumping.
- Nuclear contamination, the radio active, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident arising from such nature.
- Intentional self inflicted injury, suicide or attempted suicide, while sane or insane.
- Existing diseases are not covered.
Additional exclusions may be disease-specific and would be incorporated into the definition of the disease.
- All benefits under the policy are also subject to the Tax Laws and other financial enactments as they exist from tome to time.
- The premium payable are exempted under section 80D of Income Tax act.