ICICI Lombard Critical Care Insurance

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ICICI Lombard Health Smart Benefits details

Policy CovergeBenefitsKey BenefitsEligibilityExclusions

Policy Coverge

Critical Care Insurance - Policy Coverge

Critical Care offers you a choice of coverage on both the sum insured and the tenure of the policy. You can choose the sum insured of Rs 6,00,000 or Rs. 12,00,000 over a period of 3 or 5 years. The premium would be calculated accordingly.

Critical Care Sum Insured Table

Covers	Sum Insured Options
Critical Illness/Major Medical Illness Diagnosis	Rs. 6,00,000 or Rs. 12,00,000
Accidental Death
Permanent Total Disability (PTD)

Critical Care Premium Table

Policy Tenure/Age Groups(Years)	Sum Insured = Rs. 6 Lakh		Sum Insured = Rs. 12 Lakh
Policy Tenure/Age Groups(Years)		3 Years (Rs.)	5 Years (Rs.)	3 Years (Rs.)	5 Years (Rs.)
20 - 25	5,800	9,700	11,600	19,400
26 - 30	6,600	11,280	13,200	22,600
31 - 35	8,300	14,000	16,600	28,000
36 - 40	10,300	18,400	20,600	36,800
41 - 45	20,500	38,200	41,000	76,440

(Inclusive of Service Tax @ 12.36% and Education Cess at 2%)
The premium depends on the applicant's age* and the policy tenure opted for.
*Age is calculated as on the date the policy is issued (i.e.age completed as on his last birthday)

The policy provides lump sum benefit on diagnosis of any of 9 Critical Illnesses, Accidental Death and Permanent Total Disablement (PTD).

Critical Illness Cover - The Critical Care Insurance shall cover, subsequent to 90 days from the policy start date, the following major medical illnesses and procedures:
1. Cancer
2. Coronary Artery Bypass Graft Surgery
3. Myocardial Infarction (Heart Attack)
4. Kidney Failure (End Stage Renal Failure)
5. Major Organ Transplant
6. Stroke
7. Paralysis
8. Heart Valve Replacement Surgery
9. Multiple Sclerosis
On diagnosis of any of the above illnesses, the insured is entitled to the lumpsum benefit of the entire Sum Insured opted for.
Accidental Death Cover
In case of death of the insured due to an accident within the policy period, the nominee (mentioned in the policy) is compensated with the Sum Insured (opted at the time of policy issuance).
Permanent Total Disablement (PTD) Cover
Critical Care insures against the permanent and total loss of limbs, sight etc., due to an accident. The compensation (Sum insued opted for) is given as a lump sum benefit. It is to be noted that the compensation is payable only if the disablement results in inability to remain gainfully employed.

Benefits

Permanent Total Disablement Benefits

Loss of use/Actual loss by physical separation of	Percentage of Capital Sum Insured*
Sight of both eyes	100%
Both hands	100%
Both feet	100%
One hand and one foot	100%
*As stated in Part I of the Schedule.

Note: If any such injury as mentioned above shall result in the inability to remain gainfully employed, then the Capital Sum Insured payable will be 100%.

Key Benefits
Critical Care Insurance - Key Benefits
- Comprehensive Cover - Lump sum benefit on diagnosis of any of 9 Critical Illnesses, Personal Accident and Permanent Total Disablement (PTD) Cover.
- Choice of coverage - Choose between Rs. 6,00,000 or Rs. 12,00,000 sum insured and 3 or 5 years of policy duration.
- Avail of tax benefit under section 80D of Income Tax Act.
- No health check up required
- No 30 day waiting period, benefit paid immediately on diagnosis
Eligibility
Critical Care Insurance - Eligibility
- The insured can be either you or your spouse
- The insured needs to be between 20 - 45 years of age
- Age is calculated as on the date the policy is issued (i.e.age completed as on his last birthday)

Exclusions

Critical Care Insurance - Policy Exclusions

Exclusions applicable to Critical Illness:
90 Days Exclusion:
Any illnesses and procedures within 90 days from start date of policy will not be covered. This clause does not apply for subsequent renewal (without a break) of this policy with us.
Permanent Exclusion
The Company shall not be liable under this policy for:

Any Pre-Existing illness
Absence of submission of Doctor's medical certificate confirming the diagnosis of Illness or Injury or undergoing of medical/surgical procedure
Any congenital Illness or condition
Any medical procedure or treatment, which is not medically necessary or not performed by a Doctor
Any physical, medical or mental condition, illness, injury or treatment or service which is specifically excluded under the Policy
Treatment relating to birth defects and external congenital Illnesses
Birth control procedures and hormone replacement therapy
Any treatment/ surgery for change of sex or any cosmetic surgery or treatment
Treatment by family member and self-medication or any treatment that is not scientifically recognized

Exclusions applicable to Personal Accident:
The Company shall not be liable under this policy for:

Compensation/claim under more than one of the categories specified in the Policy Coverage in respect of the same period of disablement of the Insured Person
Claims arising out of sickness/illness
Death, injury or disablement of Insured Person
1. From intentional self-injury, suicide or attempted suicide
2. Whilst under the influence of intoxicating liquor or drugs
3. Directly or indirectly caused by venereal disease or AIDS
4. Directly or indirectly caused by contributed to or aggravated or prolonged by childbirth or pregnancy or in consequence thereof.
5. Engagement in dangerous activities
6. Mounting into, dismounting from or traveling in any aircraft other than as a fare paying passenger on a scheduled flight
7. Mental disorder or psychosomatic dysfunction
Permanent Total Disablement prior to commencement of the policy

Critical Care Insurance - Need for Critical Care

India is home to over 60 million coronary heart patients
India's economic loss due to heart related disease could be $236 billion till 2015
At any given time there will be 3 million cancer patients in India

However, today, with the advancement in medical science, solutions have been developed for virtually any ailment in the world. A study revealed that 50% of cancers are curable if detected early. But it has also led to rising costs of treatment.

Procedure	Cost (US$)
Bone Marrow Transplant	69,000 (approx. Rs. 31, 74,000)
Liver Transplant	69,000 (approx. Rs. 31, 74,000)
Heart Surgery	8,000 (approx. Rs. 3,68,000)
Cataract Surgery	6,000 (approx. Rs. 2,76,000))
Orthopaedic Surgery	1,250 (approx. Rs. 57,500)

Please note that this is only an indicative estimate of the surgery expenses.

Critical Care Insurance - Claim Process

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