Shri Criticare Illness Insurance Policy (UIN: SGLHLIP21483V022021)

What is Critical illness?

Critical illness refers to life-threatening and severe health conditions, requiring extensive medical attention. Generally, treatment for such diseases requires prolonged medical care, whether in the hospital or at home. Therefore, the expense involved with treatment for critical illnesses are generally higher when compared to the treatment for other diseases.

Who can take the policy?

Critical illness covers only resident Indian citizens.

What Type of plan Available

Standard	Superior	Advanced
1. Cancer of specified severity	1. Cancer of specified severity	1. Cancer of specified severity
2. Myocardial Infarction (First heart attack - of specified severity)	2. Myocardial Infarction (First heart attack - of specified severity)	2. Myocardial Infarction (First heart attack - of specified severity)
3. Open chest CABG	3. Open chest CABG	3. Open chest CABG
4. Open heart replacement or repair of heart valves	4. Open heart replacement or repair of heart valves	4. Open heart replacement or repair of heart valves
5. Kidney failure requiring regular dialysis	5. Kidney failure requiring regular dialysis	5. Kidney failure requiring regular dialysis
6. Stroke resulting in permanent symptoms	6. Stroke resulting in permanent symptoms	6. Stroke resulting in permanent symptoms
7. Major organ /bone marrow transplant	7. Major organ /bone marrow transplant	7. Major organ /bone marrow transplant
8. Permanent paralysis of limbs	8. Permanent paralysis of limbs	8. Permanent paralysis of limbs
9. Multiple sclerosis with persisting symptoms	9. Multiple sclerosis with persisting symptoms	9. Multiple sclerosis with persisting symptoms
10. Primary (Idiopathic) Pulmonary Hypertension	10. Primary (Idiopathic) Pulmonary Hypertension	10. Primary (Idiopathic) Pulmonary Hypertension
	11. Coma Of Specified Severity	11. Coma Of Specified Severity
	12. End Stage Liver Failure	12. End Stage Liver Failure
	13. Loss Of Limbs	13. Loss Of Limbs
	14. Major Head Trauma	14. Major Head Trauma
	15. Angioplasty	15. Angioplasty
		16. Benign Brain Tumor
		17. Blindness
		18. Deafness
		19. End Stage Lung Failure
		20. Loss Of Speech
		21. Third Degree Burns
		22. Motor Neuron Disease With Permanent Symptoms

What is the Age Covered?

The minimum insurable age is 18 years except for dependent children for whom the minimum insurable age is 5 yrs.

The general maximum age of entry is 65 years. The requirement of medical reports will depend on the entry age and maximum renewal age is 70 years.

What is the Sum Insured optional Available?

Sum insured available in the range of ₹ 50,000 to ₹ 3 Cr.

What is the policy tenure?

This policy available for 1 Year, 2 Year and 3 Year.

What are the advantages of Critical Illness Insurance cover

• The benefit amount is payable once the disease is diagnosed meeting specific criteria and the insured survives 30 days after the diagnosis.

• The insured member can utilize this amount for treatment of the disease, lifestyle changes, donor expenses or a planned treatment in India etc.

• Hassle-free In-House claim process

• Premium paid is exempt under section 80-D of Income Tax Act.

General Exclusions

This entire Policy does not provide benefits for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of:

• All pre-existing disease/ condition/injuries which are existing when this insurance cover incepts for the first time. And the same will be covered after lapse of 48 months.

• Any Illness, sickness or disease, other than specified as Critical Illness, as mentioned in the policy schedule, or

• 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, or

• 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, or

• 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; or

• Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel; or

• The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment; or

• 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; or

• 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; and

• 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;

General Conditions

• Free Look Period

You have a period of 15 days from the date of receipt of the first policy document to review the terms and conditions of this Policy. If You have any objections to any of the terms and conditions, You have the option of cancelling the Policy stating the reasons for cancellation. If you have not made any claim during the Free look period, you shall be entitled to refund of premium subject to,

1. a deduction of the expenses incurred by Us on Your medical examination, stamp duty charges, if the risk has not commenced,
2. a deduction of the stamp duty charges, medical examination charges & proportionate risk premium for period on cover, If the risk has commenced
3. a deduction of such proportionate risk premium commensurating with the risk covered during such period, where only a part of risk has commenced

 Free Look Period will not be applicable for renewal Policies.

• Fraud

If the Insured and/ or Named Insured shall make or advance any claim knowing the same to be false or fraudulent as regards amount or otherwise, this Policy shall be void and all claims or payments hereunder shall be forfeited.

• Notice of claim/loss:

It is a condition precedent to Our liability hereunder that written notice of claim must be given by You to Us within 7 days after an actual or potential loss begins or as soon as reasonably possible and in any event not later than 30 Days after an actual or potential loss begins.   

• Time for filing claim forms and evidence:

Completed claim forms and written evidence of loss must be furnished to Us within thirty (30) Days after the date of such loss. Failure to furnish such evidence within the time required shall not invalidate nor reduce any claim if You can satisfy us that it was not reasonably possible for You to give proof within such time.  However, no proof will be accepted if furnished later than one (1) year from the time the loss occurred. 

• Portability

Portability means transfer by an individual health insurance policyholder (including family cover) of the credit gained for pre-existing conditions and time bound exclusions if he/she chooses to switch from one Insurer to another.

If the Policyholder/ Insured Person renew with the Company, without break, any similar individual health insurance policy from any insurance company registered with IRDA, then the Waiting Periods as defined in exclusions shall be reduced by the number of years of continuous coverage under such health insurance policy with the previous insurer(s).

The Company's total liability for payment of all claims in aggregate, incurred during the Policy Period, on account of Portability shall not exceed Sum Insured Limit for Portability as defined in Policy Schedule.

The Waiting Periods as defined in policy exclusions shall be applicable individually for each Insured Person and Claims shall be assessed accordingly.

• Misstatement of Age:

If Your Age has been misstated, all amounts payable under this Policy shall be adjusted to the coverage amount that would have been purchased for the premium paid.  In the event Your Age has been misstated, and if according to Your correct Age, the coverage provided by the Policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then Our liability during the period You are not eligible for coverage, shall be limited to the refund, upon written request, of all premiums paid for the period not covered by the Policy. 

• Limitations:

Multiple policies: If an Insured Person suffers a covered Illness or Sickness or Disease for which benefits, are payable under more than one Critical Illness Policy issued by Us, the maximum amount payable under all Policies combined will not exceed the amount payable under the Policy which pays the largest benefit.  

• Change of occupation:

If You sustain a loss after having changed occupation to one We classify as more hazardous than the stated in the Proposal or while doing for compensation anything pertaining to an occupation so classified, We will pay such portion of the indemnities provided in this policy as the premium paid would have purchased at the rates and within the limits We have fixed for such more hazardous occupation. 

• Territory:

This Policy applies to incidents anywhere in the world unless limited by Us through endorsement

• Cancellation

We may at any time cancel the Policy on grounds of misrepresentation, fraud, non-disclosure of material fact by sending notice in writing by Registered A/D to Insured Person at Insured Person’s last known address at least 15 days in advance in which case We shall refund pro-rata premium for the unexpired portion of the policy on the date of cancellation, provided no claim has occurred upto the date of cancellation.

The Insured may also give 15 days’ notice in writing, to the Company, for the cancellation of this policy, in which case the Company shall refund the premium as specified below: -

Period on risk	% of Annual Premium refunded
	1 Year Policy	2 Year Policy	3 Year Policy
Upto 1 month	70%	75%	80%
Exceeding 1 month and upto 3 months	55%	70%	70%
Exceeding 3 months and upto 6 months	30%	55%	65%
Exceeding 6 months and upto 12 months	NIL	30%	45%
Exceeding 12 months and upto 18 months		10%	30%
Exceeding 18 months and upto 24 months		NIL	10%
Exceeding 24 months and upto 30 months			5%
Exceeding 30 months			NIL

How to claim?

• Inform our 24x7 Claim Help Desk about the loss on Toll Free Numbers & Mail id:-

 

Toll Free: 1800-103-3009, 1800-300-30000         

Mail ID: chd@shriramgi.com

Please refer the policy wording for more details.

Frequently Asked Question for Criticare Illness insurance

1. What is a Critical Illness?

Critical Illness is a serious long-term disease such as Heart Disease, Cancer, Paralysis, Stroke and Coronary Artery Bypass Surgery etc.

2. What is meant by disease?

Disease means a pathological condition of a part, organ, or system resulting from various causes, such as infection, pathological process, or environmental stress, and characterized by an identifiable group of signs or symptoms.

3. What is a Critical Illness Insurance?

Critical Illness Insurance is a benefit policy that pays out a lump sum amount up to the Sum Insured upon diagnosis of a critical illness those covered under the policy.

4. What is a benefit policy?

Benefit policy is a kind of policy where the insurance company pays to policyholder a lump sum amount on happening of an insured event.

5. Why should I purchase Critical Illness Insurance?

Critical Illness Insurance provides you and your family, the additional financial security on diagnosis of a critical illness. The amount could be used for:

• Costs of the care and treatment
• Recuperation aids
• Debts pay off like Home loan, Car Loan etc.
• Any lost income due to a decreasing ability to earn
• Fund for a change in lifestyle.
• Fund which can be used for modification of home facility like building of new ramp or stair and room.

6. Why should I buy a critical illness policy if I already have a health cover?

A Mediclaim health insurance policy only covers the inpatient hospital bill and pre & post hospitalization expenses. Also, most of time sum insured is not enough to cope all the expenses.

There are a so many expenses like consumable items cost, vitamins, portable medical device etc are not covered under basic health policy. In contrast, a critical illness policy pays the sum assured as a lump sum, in the event of diagnosis of any one of the listed critical illnesses that you can use in paying the medical treatment bills plus convalescence expenses.

7. Is critical illness rider enough to the existing health cover?

A critical illness policy when taken standalone proves to be more beneficial than taken as a rider with a health insurance policy. An independent critical illness policy provides better, comprehensive coverage for critical illnesses as compared to a critical illness rider. Also, it remains valid even if your health insurance policy lapses.

8. Can I buy Shri Critical Illness policy online?

Yes, If willing to purchase Shri Critical Illness, you can explore the official website of Shriram General Insurance Co. Ltd. www.shriramgi.com

9. When the benefit is payable?

The company will pay the Sum Insured as lump sum on first diagnosis of any one of the following Critical Illness, provided that the Insured Person survives a period of 30 days from the date of the first diagnosis.

The following Critical Illnesses are covered under our plan: -

1. Cancer of specified severity

2. Myocardial Infarction (First heart attack - of specified severity)

3. Open chest CABG

4. Open heart replacement or repair of heart valves

5. Kidney failure requiring regular dialysis

6. Stroke resulting in permanent symptoms

7. Major organ /bone marrow transplant

8. Permanent paralysis of limbs

9. Multiple sclerosis with persisting symptoms

10. Primary (Idiopathic) Pulmonary Hypertension

11. Coma Of Specified Severity

12. End Stage Liver Failure

13. Loss Of Limbs

14. Major Head Trauma

15. Angioplasty

16. Benign Brain Tumour

17. Blindness

18. Deafness

19. End Stage Lung Failure

20. Loss Of Speech

21. Third Degree Burns

22. Motor Neuron Disease

10. Does a Critical Illness policy pay for the hospitalization benefit?

No, a critical illness policy is a benefit plan and only pays a lump sum compensation when the policyholder is diagnosed with any one of the listed specified diseases in the policy documents.

11. What are not covered under a critical illness policy?

The exclusions of the policy may differ from one insurer to another. These are the common health conditions which are not covered under a critical illness policy-

• Pre-existing disease upto 48 month
• Self-inflicted Injuries
• HIV, AIDS, or other STDs
• Pregnancy or childbirth
• Any congenital conditions
• Cosmetic treatment/surgery
• Nuclear, biological or chemical contamination
• Alcohol consumption, smoking, other tobacco intake or drug abuse
• Any form of war, invasion, civil war, rebellion
• Ionising radiation or contamination by radioactivity
• Mental or functional disorder, etc.
• Participation in dangerous sports.

12. What are the option available for sum insured under this policy?

You can choose from Sum Insured ranging from Rs. 50,000 to Rs. 3 Cr Subject to health underwriting guideline issued.

13. Is there any age eligibility criteria for purchasing this policy?

• Entry age for this policy is 5 year to 65 year
• Proposer age should be more than 18 plus.
• Children between 5 years to 18 years would be covered only when both the parents are also insured under the policy.

14. Is policy available for Family floater basis also?

No, You can purchase policy individual basis only however, you can cover all the family member under single policy individual basis.

15. Is there any Pre-Medical Health check- up for enrolment in this policy?

No pre-policy medical check-up is required for individuals up to age 45 years.

16. Who will bear the cost of medical health check-up? if any

We will be pay 50% of medical check-up expenses on proposal accepted.

17. What kind of documentation is required to purchase this policy?

The best part of this policy is that you do not require to submit any documentation. All you need to do is submit a duly signed and complete proposal form with relevant details. Choose the Sum Insured and pay vide a cheque or fill the credit card details in the form.

18. What do you mean by Pre-Existing Diseases?

Any condition, ailment or injury or related condition(s) for which insured person had signs or symptoms and/or was diagnosed and/or received medical advice/treatment within 48 months prior to your first policy with the company.

19. Can I make multiple claims for same or any other listed Critical illnesses?

No, you can make only one claim during the lifetime of the policy.

20. Whom to contact in case of Claim?

In case of a claim under the Policy, you should immediately intimate us on our helpline numbers mentioned at policy documents.

On receipt of the intimation, we would register the claim and assign a unique claim reference number which may be used for all future correspondence.

21. What all documents are required at the time Claim?

1. Duly Completed Claim Form
2. Original Discharge Summary.
3. Consultation Note/ Relevant treatment papers.
4. All relevant medical reports along with supporting invoices and doctors requisition advising the same.
5. Original and Final hospitalization bills with detailed breakup.
6. Pharmacy Bills along with prescriptions.
7. Any other documents as may be required by the Company.
8. On receipt of claim documents claim will be processed in accordance with the terms and conditions of the Policy.

22. What is the waiting period under this policy?

There is a waiting period of 90 days before you can claim under this policy.

23. What is Survival Period?

Survival period means that Insurance benefit is payable, only if the Insured is alive for a period of more than or equal to 30 days from the date of the first diagnosis of the illness/medical event or undergoing illness related surgical procedure for the first time.

24. Is a Free- Look option available in this policy?

You have a period of 15 days from the date of receipt of the first policy document to review the terms and conditions of this Policy. If You have any objections to any of the terms and conditions, You have the option of cancelling the Policy stating the reasons for cancellation. If you have not made any claim during the Free look period, you shall be entitled to refund of premium subject to,

i. a deduction of the expenses incurred by Us on Your medical examination, stamp duty charges, if the risk has not commenced,

ii. a deduction of the stamp duty charges, medical examination charges & proportionate risk premium for period on cover, If the risk has commenced

iii. a deduction of such proportionate risk premium commensuration with the risk covered during such period, where only a part of risk has commenced

25. Is a Free- Look option available on renewal of this policy?

Free Look Period will not be applicable for renewal Policies.

26. Can I port any other policy into this policy?

Portability is applicable only within similar products. In this case, you can port your existing critical illness policy into this policy.

27. Is there any Grace Period for continuity benefit?

Yes, At the end of the Policy Period, the policy shall terminate and can be renewed within the 30 days Grace Period to maintain continuity of benefits with Break in Policy.

28. Is Coverage available in Grace Period?

No, Coverage is not available during the grace period.

29. What are the tax benefits that can be availed on this plan?

Deduction u/s 80 D of income tax act is available from taxable income for premium paid towards health insurance.

Family Member Age	Total Exemption Limit (₹)	Bifurcation of Limit (₹)
Individual and Parent both are below 60 year	50,000	i.                     25,000 for Individual ii.                   25,000 for Parent
Individual is below 60 and Parent above 60 year	75,000	i.                     25,000 for Individual ii.                   50,000 for Parent
Individual and Parent both are above 60 year	1,00,000	i.                     50,000 for Individual ii.                   50,000 for Parent

However, please note that tax benefits are subject to change in tax laws.