Critical Illness

Insurance done against critical illness condition is called critical illness insurance. This is a rider option that may be attached with almost all plans but cannot be taken in isolation. Under this Insurance, if insured is diagnosed with the listed and defined critical illness diseases, company will pay covered amount in lump sum as agreed in the policy to the life insured.

Any person between the age 18 to 55 years and does not have any existing medical problems can take this insurance coverage.

Critical Illness Sum Assured can be equal to or less than the Sum Assured under basic plan, not exceeding Rs. 50,00,000/-.

Unfortunately, you cannot take critical illness sum assured for more than Rs. 50 lakhs within JyotiLife. However, there is no restriction in basic plan.

Critical illness insurance coverage will be provided up to policy maturity period or for 20 years term whichever is less. For E.g. If someone takes 25 years policy term, Critical Illness benefit will be provide up to 20 years term only and will expire at completion of 20 years.

Critical Illness rider coverage will be provided up to 60 years of age of insured or till the maturity of policy whichever happens earlier. Critical Illness benefit will be discontinued once insured reaches age 60 at policy anniversary date or at maturity date.E.g. If 50 years insured has taken life insurance product with policy term of 20 years, critical illness will be provide up to insured’s age 60 only, i.e. critical illness benefit be provided for next 10 years term only (i.e up to his/her age 60).

Diagnosis of any diseases means final medical conclusion made by the specialist doctor that a person is suffering from particular disease which should be based upon such specific evidence as defined for particular Critical Illness disease definitions mentioned in the rider document. In the absence of such specific evidence, it should be based upon acceptable radiological, clinical, histological or laboratory evidence.

As per international practice and definition, 90 days period from the date of commencement of policy or from the date of revival of policy is known as waiting period. Critical Illness risk coverage starts after 91 days from the date of commencement of policy or from the date of revival.

Critical Illness will not be covered if someone is diagnosed or if any signs or symptoms of such critical illness seen within 90 days waiting period.

As per international practice and definition, from the date of diagnosis of any listed diseases, such disease should continue to exist for 30 days and the insured has to survive for 30 days. If insured perishes within 30 days from the date of diagnosis of disease, only basic death benefit shall be paid. This 30 days period is known as survival period.

For any rider benefit, insured is eligible to claim once. Similarly, for critical illness rider, critical illness benefit is paid for any one critical illness condition within the coverage term after which the rider will be terminated. Whereas basic benefits of the policy will continue and there will not be any deduction in basic benefits for paid critical illness amount.

Yes, you have to be medically fit at the time of applying to be eligible for this insurance coverage.

No, you will not be eligible to take critical illness insurance if you are already suffering from any disease.

On the basis of answers/declaration provided by insured regarding medical and occupational questions and on basis of medical tests (if required as per company’s requirement table), the company determines whether a person is insurable or not for critical illness insurance coverage. Generally, if someone is suffering from any disease or working in risky occupation, company can deny the critical illness coverage for that person.

Based on company’s medical requirement chart, you may have to do medical test to take this coverage.

Preexisting condition is any illness, deformity or disability that occurred before the commencement of the policy or before reinstatement of policy about which insured have reasonable knowledge of its existence. A Life Assured may be considered to have reasonable knowledge of a pre-existing condition where the condition is one for which:-

• The Life Assured had received or is receiving treatment;
• Medical advice, diagnosis, care or treatment has been recommended;
• Clear and distinct symptoms are or were evident;
• Its existence would have been apparent to a reasonable person in the circumstances. Critical illness insurance does not cover for any pre exiting conditions.

Generally, you should notify the company for critical illness claim within 30 days after date of diagnosis of such diseases.

In order to get critical illness benefit, you must pay your premium within due date. Company will not pay any benefit under this rider if any premium for the policy is not received within due date.

Upon notification of claim for critical illness, company will provide the list of documents and evidence required in order to further process for critical illness claim.

As per international practice, in following conditions company will not be able to pay for critical illness claim even if an insured is diagnosed with listed critical illness:

• In case premium is not paid within due date.
• Critical illness due to any preexisting condition. (Please refer point no. 16).
• Critical illness resulting from AIDS, AIDS-related complex or infection by HIV.
• Any Critical illness occurred due to attempted suicide or self-inflicted injuries or willful misuse of drugs or alcohol.
• Critical illness resulted due to donation of any of the Life Assured’s organs
• Any exclusion as stated in main policy.

We have two package options for number of different critical illness coverage that you can choose from.

Critical Illness Gold: Coverage for 35 Critical Illness Diseases

Critical Illness Silver: Coverage for 18 Critical Illness Diseases