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Bajaj Allianz Lifetime Care - Health Policy : FAQ

Frequently Asked Questions (FAQs) about Bajaj Allianz Lifetime Care - Health Policy Document:

1. What are the guaranteed benefits under the Bajaj Allianz Lifetime Care - Health policy?

• The guaranteed benefits include:
  • On the death of the Life Assured: The minimum guaranteed death benefit would be the sum assured. The policy terminates upon the death of the life assured.
  • On the survival of the Life Assured to age 80: The minimum guaranteed benefit is the sum assured. After reaching the age of 80, the policy terminates.

2. What happens if the policyholder survives beyond age 80?

• If the policyholder survives beyond age 80, the policy will continue until that point, providing coverage as per the terms and conditions mentioned in the policy document. However, no additional benefits are payable beyond age 80, and the policy terminates thereafter.

3. What happens if the policy is terminated or surrendered?

• After the contract has been terminated or surrendered, the company bears no liability to pay any further benefits. It's essential to review the terms and conditions regarding termination or surrender outlined in the policy document.

4. Can the policy be renewed or extended beyond age 80?

• The policy does not mention provisions for renewal or extension beyond age 80. Policyholders should review the terms and conditions of the policy document to understand the options available at that stage.

5. Are there any additional benefits or riders available with this policy?

• The FAQ section does not mention any additional benefits or riders. Policyholders seeking additional coverage or riders should consult with Bajaj Allianz representatives for available options.

6. Is there a grace period for premium payments?

• Information regarding the grace period for premium payments is not provided in this excerpt. Policyholders are advised to refer to the policy document for details on premium payment terms and grace periods.

7. How can I make a claim under this policy?

• The process for making a claim should be outlined in the policy document. Policyholders are encouraged to review this section carefully and follow the specified procedures in the event of a claim.

8. Are there any exclusions or limitations to the coverage provided?

• Exclusions and limitations to coverage are typically detailed in the policy document. It is crucial for policyholders to understand these exclusions to avoid any misunderstandings regarding coverage.

9. Can I surrender the policy before reaching age 80?

• The surrender terms and conditions should be outlined in the policy document. Policyholders considering surrendering the policy are advised to review these conditions carefully and understand any potential implications.

10. How can I obtain a copy of the full policy document?

• Policyholders can request a copy of the full policy document from Bajaj Allianz representatives or through their customer service channels. It is recommended to keep a copy of the policy document for reference and review.

11. What are the bonus benefits provided under the Bajaj Allianz Lifetime Care - Health policy?

• The bonus benefits include:
  • Reversionary Bonus: Annually, the Company declares a reversionary bonus rate, applied to the sum assured plus existing declared reversionary bonuses to determine the bonus amount.
  • Interim Bonus: In the event of a claim partway through a financial year or before the valuation result is declared, an interim bonus will be payable based on the actuary’s recommendation.
  • Terminal Bonus: Upon death after 15 policy years or on the policy anniversary date when the policyholder attains age 80, the company may pay a terminal bonus for in-force and fully paid-up policies.

12. How is the Reversionary Bonus calculated?

• The Reversionary Bonus is calculated based on a percentage declared by the Company at the end of each financial year. This percentage is applied to the sum assured plus existing declared reversionary bonuses to determine the bonus amount added to the policy at the year end.

13. What is the purpose of the Interim Bonus?

• The Interim Bonus is payable in the event of a claim partway through a financial year or before the valuation result is declared. It serves to provide interim benefits based on the actuary’s recommendation until the final bonus is determined.

14. Under what circumstances is the Terminal Bonus paid?

• The Terminal Bonus may be paid under two circumstances:
  • Upon death after 15 policy years.
  • On the policy anniversary date when the policyholder attains age 80.
• It is important to note that the payment of the terminal bonus is subject to the policy being in force and fully paid-up.

15. Is the Terminal Bonus guaranteed?

• The policy document does not specify the Terminal Bonus as a guaranteed benefit. Policyholders should review the terms and conditions outlined in the policy document for clarity on the eligibility and calculation of the Terminal Bonus.

16. Can policyholders opt out of receiving bonuses?

• The policy document should provide information regarding the options available for policyholders regarding bonuses. It is recommended to consult with Bajaj Allianz representatives for clarification on bonus-related queries and options.

17. Are the bonus rates fixed or subject to change?

• Bonus rates, including the Reversionary Bonus, are typically subject to change and are declared annually by the Company. Policyholders should review the policy document for information on bonus rate declarations and any associated terms.

18. How can policyholders track their bonus accruals?

• Policyholders can track their bonus accruals by reviewing their policy statements, which should detail the accumulated bonuses, including reversionary, interim, and terminal bonuses.

19. Are bonuses taxable?

• Information regarding the taxation of bonuses should be outlined in the policy document or provided by Bajaj Allianz representatives. Policyholders are encouraged to seek professional tax advice for clarification on bonus taxation implications.

20. Can bonuses be surrendered or withdrawn?

• The policy document should provide details on the surrender or withdrawal options for bonuses. Policyholders considering such actions should review the terms and conditions of the policy document and consult with Bajaj Allianz representatives for guidance.

21. What are the premium payment terms under the Bajaj Allianz Lifetime Care - Health policy?

• Premiums are payable on the due dates specified in the policy. A grace period of up to 30 days is allowed for premium payment under any circumstances. If the death of the Life Assured occurs during the grace period, the benefits payable on death shall be paid after deducting the premium then due and the premiums falling due during the current policy year.

22. Is there any obligation on the company to notify policyholders of premium due dates?

• No, there is no obligation on the company to notify the Life Assured or Policyholder of the premium due dates. It is the responsibility of the policyholder to ensure timely premium payments. Failure to pay premiums within the specified due dates or grace period may result in policy lapse, except for those policies with paid-up value.

23. What happens if premiums are not paid within the grace period?

• If premiums are not paid within the grace period allowed, the policy shall lapse, except for those policies with paid-up value. It is crucial for policyholders to adhere to premium payment deadlines to maintain the continuity of their policy coverage.

24. Can policyholders reinstate a lapsed policy?

• Policyholders may have the option to reinstate a lapsed policy, subject to certain conditions and procedures outlined in the policy document. It is recommended to contact Bajaj Allianz representatives for guidance on reinstating lapsed policies and any associated requirements or fees.

25. What is the paid-up value of the policy?

• The policy document should provide information on the paid-up value of the policy, which typically refers to the reduced benefits available under a lapsed policy where premiums have been paid for a certain period. Policyholders should refer to the policy document for details on the calculation and availability of paid-up values.

26. Are there any exceptions to the grace period for premium payment?

• The policy document should outline any exceptions or special circumstances regarding the grace period for premium payment. Policyholders should review the terms and conditions of their policy for clarity on grace period provisions and any associated exceptions.

27. Can policyholders request changes to premium due dates?

• Policyholders should refer to the policy document or contact Bajaj Allianz representatives to inquire about the possibility of changing premium due dates. Any changes to premium due dates may be subject to company policies and approval processes.

28. Is there a penalty for late premium payments within the grace period?

• The policy document should specify any penalties or charges associated with late premium payments within the grace period. Policyholders should review the terms and conditions of their policy for information on late payment penalties and charges.

29. What happens in the event of nonpayment of premiums within the grace period?

• If premiums are not paid within the grace period, the policy will continue in paid-up form, provided that at least three full years' premiums have been paid. This means that the policy will be converted to a reduced benefit policy, and the policyholder may be entitled to certain benefits as per the paid-up value of the policy.

30. What does it mean for the policy to continue in paid-up form?

• Continuing the policy in paid-up form means that the policy remains in force with reduced benefits, based on the premiums already paid. The policyholder may no longer be required to pay premiums but will receive reduced benefits compared to the original policy terms.

31. How is the surrender value of the policy determined?

• The surrender value of the policy is the amount that the policyholder is entitled to receive upon surrendering the policy to the insurance company. The policy document should provide details on how the surrender value is calculated, taking into account factors such as premiums paid, policy duration, and any applicable charges or deductions.

32. Can policyholders access the surrender value of the policy?

• Policyholders may have the option to surrender the policy and receive the surrender value, subject to the terms and conditions outlined in the policy document. Surrendering the policy means terminating it before the maturity date and receiving the accumulated cash value or surrender value, as determined by the insurance company.

33. Are there any penalties or charges associated with accessing the surrender value?

• The policy document should specify any penalties or charges associated with surrendering the policy and accessing the surrender value. Policyholders should review the terms and conditions of their policy for information on surrender charges and any applicable deductions from the surrender value.

34. Can policyholders convert a paid-up policy back to its original form?

• Policyholders should refer to the policy document or contact Bajaj Allianz representatives to inquire about the possibility of converting a paid-up policy back to its original form. Any changes to the policy status or benefits may be subject to company policies and approval processes.

35. Is there a waiting period before the policy acquires surrender value?

• The policy document should specify any waiting periods or conditions that must be met before the policy acquires surrender value. Policyholders should review the terms and conditions of their policy for information on surrender value eligibility criteria and waiting periods.

36. When does a policy accumulate surrender value?

• A policy accumulates surrender value only after the payment of premiums for three full years. This means that policyholders must maintain their premium payments for at least three years before the policy becomes eligible for surrender value.

37. How is the surrender value calculated?

• The surrender value of the policy is calculated by applying a surrender value factor to the paid-up value, including accrued reversionary bonuses. The policy document should provide details on the surrender value calculation methodology used by Bajaj Allianz.

38. What is the minimum guaranteed surrender value?

• Bajaj Allianz guarantees a minimum surrender value of 30% (thirty percent) of all premiums paid, excluding the first-year premium and premiums for all additional benefits. This means that policyholders are entitled to receive at least 30% of the total premiums paid, subject to certain exclusions, upon surrendering the policy.

39. Are there any exclusions from the surrender value calculation?

• Yes, the surrender value calculation excludes the first-year premium and premiums paid for all additional benefits. Only premiums paid after the first year and for the base policy are considered when calculating the surrender value.

40. What happens to the policy after it has been surrendered?

• After a policy has been surrendered, it ceases to be in force, and all benefits and additional benefits associated with the policy also cease. Policyholders should carefully consider the implications of surrendering their policy, as they will no longer be entitled to any benefits or coverage provided by the policy.

41. What is the paid-up value of the policy?

• The paid-up value becomes available if premium payments cease after three full years' premiums have been paid. However, a paid-up policy does not retain the original benefits mentioned in the policy conditions. Instead, the sum assured is reduced by a factor equal to the proportion of the number of premiums paid compared to the total number of premiums payable.

42. What happens to bonuses in a paid-up policy?

• The vested bonus as of the paid-up date remains attached to the policy. However, a paid-up policy will not accrue any further bonus from that point onwards.

43. What benefits are payable under a paid-up policy in the event of death?

• In the event of death, the reduced sum and bonuses vested up to the paid-up date are paid out. This means that the beneficiaries will receive the reduced sum assured along with any bonuses accrued up to the point when the policy became paid-up.

44. What benefits are payable under a paid-up policy upon reaching age 80 (eighty)?

• Upon survival to age 80 (eighty), the reduced sum and vested bonuses as of the paid-up date are paid out. Policyholders should note that the benefits payable under a paid-up policy are based on the reduced sum assured and accrued bonuses up to the point when the policy became paid-up.

45. How is the surrender value calculated for a paid-up policy?

• If a paid-up policy is surrendered, the surrender value is calculated by applying a surrender value factor to the reduced sum assured and vested reversionary bonuses up to the date when the policy became paid-up.

46. What happens if the paid-up sum assured, including bonuses, is less than Rupees 100 (one hundred)?

• If the paid-up sum assured, including bonuses, falls below Rupees 100 (one hundred), the policy will be terminated, and the surrender value will be paid to the policyholder. This provision ensures that policyholders receive some value for their policy even if the sum assured is very small.

47. What is the policyholder's obligation regarding disclosure?

• Policyholders are required to provide accurate and complete information during the application process. Failure to disclose relevant information, or any instances of fraud or misrepresentation in any document submitted to the company that influences the acceptance of the risk, may have serious consequences.

48. What actions can the company take in case of non-disclosure, fraud, or misrepresentation?

• In the event of non-disclosure, fraud, or misrepresentation in any document leading to the acceptance of the risk, the company reserves the right to repudiate the claim at its discretion. However, this action is subject to Section 45 of the Insurance Act, which may provide certain protections or guidelines regarding the handling of such situations. It's important for policyholders to understand their obligations regarding disclosure to avoid any potential complications during the claims process.

49. How does the policy premium calculation work based on the age of the Life Assured?

• The premium payable for the policy is determined based on the age of the Life Assured as declared in the Proposal. If the Company has not admitted the age declared, the Proposer or Life Assured must provide acceptable proof of age to the Company for admission.

50. What happens if the admitted age differs from the age declared in the Proposal?

• If the admitted age ("the correct age") differs from the age declared in the Proposal, certain actions are taken without prejudice to the Company's rights and remedies under the Insurance Act, 1938.

51. What are the possible actions if the correct age differs from the declared age?

• If the correct age would have made the Life Assured uninsurable under the specified plan of assurance, the plan of assurance may be altered to a plan generally granted by the Company for the correct age. Alternatively, if no other plan of assurance is feasible, the Policy may be cancelled from the date of issue, and a refund of the premium paid will be made after deducting expenses incurred by the Company on the Policy.

52. What happens if the correct age is higher than the age declared in the Proposal?

• If the correct age of the Life Assured is higher than declared, the premium payable under the Policy will be adjusted to correspond with the correct age ("the corrected premium") from the Policy's commencement date. The Proposer or Life Assured must pay the accumulated difference between the corrected premium and the original premium, along with interest charged by the Company for late payment, from the Policy's commencement until the date of payment.

53. What if the Life Assured fails to pay the difference in premium with interest?

• If the Life Assured fails to pay the difference in premium along with interest, it will be considered a debt owed to the Company. The Company may recover this debt, along with further interest, from the moneys payable under the Policy.

54. What if the correct age of the Life Assured is lower than the age declared in the Proposal?

• If the correct age of the Life Assured is lower than declared, the premium payable under the Policy will be adjusted to correspond with the correct age ("the corrected premium") from the Policy's commencement date. The Company may, at its discretion, refund the accumulated difference between the original premium paid and the corrected premium without interest.

55. How is the issue age of the policyholder calculated?

• The issue age of the policyholder is determined based on the age attained (i.e., age last birthday) as of the date of commencement of the related benefit.

56. Can a lapsed policy be reinstated?

• Yes, a policy that has lapsed due to non-payment of premiums after the grace period may be reinstated under certain conditions.

57. What are the conditions for reinstatement of a lapsed policy?

• The conditions for reinstatement include:
  • (a) Submitting an application for reinstatement within 5 (five) years from the date of the first unpaid premium.
  • (b) Providing satisfactory evidence of the health of the Life Assured at the applicant's expense.
  • (c) Clearing the arrears of premiums along with interest at the company's specified rate for late payment.
  • (d) Acceptance of the reinstatement may be subject to different terms than those applicable before the policy lapsed.
  • (e) The reinstatement becomes effective only after communication from the Company to the Life Assured or the applicant.

58. How can I assign this policy to someone else?

• An assignment of this Policy can be made by an endorsement on the Policy itself or through a separate stamped instrument signed by the assignor. The assignment must specifically state the fact of assignment and be duly attested. The first assignment may only be made by the Life Assured or the Proposer. The assignment becomes effective against the Company upon serving a written notice to the Company and recording the assignment in its books.

59. Can I nominate someone to receive the policy benefits in case of my death?

• Yes, if you are the holder of the Policy, you can nominate someone to receive the policy benefits in the event of your death, provided it is done before survival till age 80 (eighty). If the nominee is a minor, a person must be appointed to receive the money during the nominee's minority. Nomination should be endorsed on the Policy and communicated in writing to the Company. Any changes to the nomination before survival till age 80 (eighty) should also be communicated to the Company.

60. Does the Company validate or accept responsibility for assignments or nominations?

• The Company does not express any opinion on the validity or accept any responsibility for assignments or nominations when recording the assignment or registering the nomination or change in nomination.

61. What is the Free Look Period?

• The Free Look Period allows the Policyholder to review the Policy terms and conditions within 15 days of receiving the Policy. If dissatisfied for any reason, the Policyholder can provide written notice of cancellation to the Company along with reasons and return the Policy Document.

62. What happens if I cancel the Policy during the Free Look Period?

• If the Policy is canceled during the Free Look Period, the Policyholder will receive a refund comprising all Regular Premiums paid, less any extra premium, proportionate Additional Rider Benefit premium, proportionate risk premium for the period the Life Assured was on cover, and expenses incurred on medical examination and stamp duty charges.

63. Are there any limitations on canceling the Policy during the Free Look Period?

• Financial constraint is not considered a sufficient reason for cancellation of the Policy within the Free Look Period.

64. Can I take a loan against my policy?

• Yes, loans can be granted against the policy provided it has acquired a surrender value.

65. What is the maximum loan amount I can get?

• Loans can be granted up to 90% of the surrender value of the policy.

66. How is the interest rate for the loan determined?

• The company decides the interest rate for the loan at the date when the loan is granted.

67. How often do I need to pay interest on the loan?

• The interest on the loan shall be paid compounding half-yearly.

68. What happens if benefits become payable or a claim occurs?

• If benefits become payable due to survival till age 80 or a claim occurs, the company is entitled to deduct the outstanding loan amount together with all interest from the benefits.

69. What if I fail to pay premiums or interest on the loan?

• In case of non-payment of premium or interest, if the outstanding policy loan and interest exceed the surrender value, the company has the right to terminate the policy and appropriate the amount towards the dues. In such an event, all benefits under the policy shall cease.

70. Are the premium rates for critical illness benefit guaranteed for the entire policy duration?

• No, the premium rates for the critical illness benefit are guaranteed for five years only from the date of commencement of the policy.

71. What happens after the initial five-year period for critical illness benefit premiums?

• After the initial five-year period, the company reserves the right to carry out a general review of the experience and change the premium rates accordingly.

72. Will I be notified if there is a change in the premium rates for critical illness benefit?

• Yes, the company will give written notice about the change in premium rates for critical illness benefit. The insured person will have the option not to pay an increased premium, but in such a case, the critical illness coverage will be excluded.

73. What about the premium rates for the hospital cash benefit?

• The premiums for the hospital cash benefit are yearly reviewable.

74. Will I be informed about any changes in the premium rates for hospital cash benefit?

• Yes, the company will provide written notice about any changes in the premium rates for the hospital cash benefit. The insured person will have the option not to pay an increased premium, but in such a case, the hospital cash coverage will be excluded.

75. What is the policy's stance on suicide?

• If the Life Assured commits suicide, whether sane or insane, within one year from the date of commencement of risk under this Policy, the contract of insurance shall be void.

76. Will any premiums paid be refunded in the event of suicide?

• Yes, premiums paid under the policy shall be refunded if the Life Assured commits suicide within one year from the date of commencement of risk under the policy.

77. Are there any special provisions associated with the policy?

• Yes, any special provisions subject to which this Policy has been entered into and endorsed in the Policy or in any separate instrument shall be deemed to be part of this Policy and shall have effect accordingly.

78. How are notices handled under this policy?

• Any notice, direction, or instruction required under this policy shall be in writing and delivered by hand, post, facsimile, or email to the specified addresses:
  • Policyholder/Life assured/Assignee: As per the details specified by the Policyholder/Life assured/assignee in the Proposal form or change of address intimation submitted by him to the company.
• Notices and instructions shall be considered served 7 (seven) days after posting or immediately upon receipt in the case of hand delivery, facsimile, or email.
• The company shall not be responsible for any consequences arising from non-intimation of a change of address.

79. What recourse is available if I am dissatisfied with the company's decision?

• If you are not satisfied with the decision or resolution of the Company regarding insurance claims, delays in settlement, disputes concerning premiums, or non-receipt of insurance documents, you may refer the matter in writing to the office of the insurance ombudsman.
• Details of the insurance ombudsman can be found in the document titled 'Our Company’s Grievance Redressal Mechanism'. For the latest list of insurance ombudsmen, please refer to the IRDA website at IRDA Website.

80. What documents are required for processing a claim?

• Before any death claim becomes payable or before any amount becomes payable due to survival till age 80 (eighty), the Company may require the delivery of the original Policy document.
• The supporting documents required by Bajaj Allianz Life Insurance Company for a death claim may include, but are not limited to: a) Medical records from the last attending physician. b) Coroner’s or postmortem report. c) Report from the police in the case of accidental or unnatural death. d) Death certificate. e) Copy of crematorium record specifying the date, day, and time of cremation. This would be accepted only if none of the above is available and if so stated in an affidavit, as an exception, not as a rule. f) Documents to establish the right of the claimant in case of no valid nomination.

81. How are electronic transactions handled?

• The Customer must adhere to and comply with all terms and conditions prescribed by the Company.
• All transactions conducted remotely, including those via the Internet, World Wide Web, electronic data interchange, call centers, teleservice operations (voice, video, data, or combination thereof), or through electronic, computer, automated machine networks, or other means of telecommunication established by or on behalf of the Company, are considered legally binding and valid transactions.
• These transactions must be conducted in adherence to and compliance with the Company's terms and conditions for such facilities, as may be prescribed from time to time.

82. How should changes in occupation be handled?

• The applicant or insured must inform the Company in writing within 10 days of any change in occupation.
• The new occupation will be classified according to the Company's underwriting rules at the time of the change.
• If the new occupation falls into a class declined by the Company:
  • Critical illness rider and hospital cash rider coverage will cease from the date of the occupation change.
  • The Company will refund the unearned premium.
• If the new occupation falls into a class accepted by the Company:
  • A new premium will be calculated by the Company and payable from the next policy year.
  • The current premium remains unchanged during the remaining period of the current policy year.
• Failure to notify the Company and paying the renewal premium based on the former occupation class:
  • For a higher-risk class: The Company will pay the benefit based on the ratio of the premium paid to the premium that would have been paid for the higher-risk class.
  • For a lower-risk class: The Company will refund the difference between the premium paid and the premium that would have been paid for the lower risk, with a maximum difference of one policy year.

83. What are the conditions for Critical Illness Benefit?

• Critical illness coverage is available for individuals aged 18 to 50 years.
• Coverage continues until the premium ceasing age or age 65, whichever is earlier.
• There is a waiting period of 6 months from the date of commencement or reinstatement of risk before the benefit can be claimed.
• If diagnosed with a critical illness after the waiting period and while the policy is in force for the full sum assured, the company pays a sum equal to the critical illness benefit mentioned in the policy.
• The policy continues with other benefits, but critical illness and hospital cash benefits cease immediately, and premiums are adjusted accordingly.
• If the life assured dies within 60 days of diagnosis for which critical illness benefit is payable, the death benefit will be reduced by the critical illness benefit.
• No benefit is payable until satisfactory proof of the critical illness is provided to the company by a registered Medical Practitioner appointed by the company, supported by clinical, radiological, histological, and laboratory evidence.
• The company must be informed of the diagnosis within 30 days.
• If the life assured decides not to renew, reaches age 65, ceases premium payment, or has already claimed critical illness benefit, the right to renew the critical illness benefit is lost.

84. What constitutes a "First Heart Attack" under the Critical Illness Benefit?

• It refers to the death of a portion of heart muscle due to inadequate blood supply to the relevant area.
• Diagnosis criteria include:
  • History of typical chest pain
  • New and recent electrocardiographic changes indicating myocardial infarction
  • Elevation of cardiac enzymes
• Diagnosis solely based on Troponin T Test elevation is not considered diagnostic.
• Angina or chest pain are explicitly excluded from this definition.

85. What does "Coronary Artery Disease Requiring Surgery" entail under the Critical Illness Benefit?

• It involves undergoing heart surgery to correct:
  • Narrowing or blockage of the left main coronary artery
  • Narrowing or blockage of three or more coronary arteries with bypass grafts
• Patients must exhibit limiting anginal symptoms and compromised blood supply supported by investigations.
• Non-surgical techniques like balloon angioplasty or laser relief of obstruction are excluded.
• The narrowing of the affected artery should be more than 75%.

86. What constitutes a "Stroke" under the Critical Illness Benefit?

• A cerebrovascular incident resulting in neurological sequelae lasting over twenty-four hours.
• Includes brain tissue infarction from thrombosis, hemorrhage, or embolization from an extracranial source.
• Permanent neurological deficit for over six months must be evident.
• Diagnosis based on CT scan or MRI changes certified by a recognized consultant neurologist.
• Excludes transient ischemic attacks, reversible ischemic neurological deficits, migraine, cerebral injury from trauma or hypoxia, and vascular diseases affecting the eye or optic nerve.

87. What defines "Cancer" under the Critical Illness Benefit?

• Presence of one or more malignant tumors, including leukemia (except chronic lymphocytic leukemia), lymphomas, and Hodgkin's disease.
• Characterized by uncontrollable growth and spread of malignant cells, invading and destroying normal tissue.
• Diagnosis by a consultant oncologist medical practitioner.
• Excludes certain conditions such as carcinoma in situ, melanomas of less than 1.5-mm thickness, basal cell carcinomas of the skin, squamous cell carcinomas of the skin without spread to other organs, Kaposi’s sarcoma, certain prostate and bladder cancers, and stage 1 Hodgkin's disease.

88. What constitutes "Kidney Failure" for the Critical Illness Benefit?

• End-stage renal disease characterized by chronic irreversible failure of the kidneys.
• Requires regular peritoneal dialysis or hemodialysis, or the individual has undergone renal transplantation.

89. What qualifies as "Major Organ Transplantation" under the Critical Illness Benefit?

• Receiving a transplant of a major organ such as the heart, heart and lung, liver, kidney, pancreas (excluding islets of Langerhans transplantation), or bone marrow.

90. What constitutes a diagnosis of "Multiple Sclerosis" for the Critical Illness Benefit?

• A confirmed diagnosis by a recognized consultant neurologist in a major hospital.
• Presence of symptoms affecting tracts (white matter) involving the optic nerves, brain stem, and spinal cord, resulting in clear neurological deficits.
• Multiple distinct lesions observed over a continuous six-month period.
• Documented history of symptom exacerbations and remissions.
• Confirmation through modern investigational techniques.

91. What does "Aorta Graft Surgery" entail for the Critical Illness Benefit?

• Surgery to correct narrowing, dissection, or aneurysm of the thoracic or abdominal aorta.
• Excludes narrowing of the aorta due to congenital conditions.
• Excludes surgery on branches of the abdominal aorta and traumatic injuries to the aorta.

92. What is "Primary Pulmonary Arterial Hypertension" covered by the Critical Illness Benefit?

• Primary pulmonary hypertension leading to substantial right ventricular enlargement.
• Diagnosis must include investigations like cardiac catheterization.
• Results in permanent physical impairment equivalent to at least class 3 of the NEW YORK Heart Association Classification.
• The insured must be unable to perform their usual occupation.
• Condition must be documented for at least three months.

93. What constitutes "Alzheimer’s Disease" covered by the Critical Illness Benefit?

• Deterioration or loss of intellectual capacity or abnormal behavior resulting from Alzheimer’s disease.
• Excludes neurosis, psychiatric illness, drug or alcohol-related disorders.
• Results in significant reduction in mental and social functioning requiring continuous supervision.
• Diagnosis must be clinically confirmed by a recognized consultant neurologist in a major hospital.

94. What constitutes "Paralysis" covered by the Critical Illness Benefit?

• Complete and permanent loss of use of:
  • Both arms
  • Both legs
  • One arm and one leg
• Paralysis of grade 0-2/6 motor power caused by illness.
• Must persist for at least six months from the date of illness.
• Diagnosis must be certified by a recognized consultant neurologist in a major hospital.

95. What are the exclusions under the Critical Illness Benefit?