Page 165 - IC38 GENERAL INSURANCE

 Motor Neuron disease
 Permanent paralysis of limbs
 Permanent disability due to major accidents

The list of critical illnesses is not static and keeps evolving. In a few
international markets insurers classify conditions into „core‟ and
„additional‟, even covering conditions like Alzheimer‟s disease. Sometimes
„terminal illness‟ is also included for coverage though premium would
obviously be very high.

f) While most critical illness policies provide for a lump sum payment on
diagnosis of illness, there are a few policies which provide
hospitalization expenses cover only in the form of reimbursement of
expenses. Few products offer combination of both covers i.e. indemnity
for in patient hospitalization expenses and lump sum payment upon
diagnosis of major diseases named in the policy.

g) Critical illness policies are usually available for persons in the age group
of 21 years to 65 years.

h) The sum insured offered under these policies is quite high as the primary
reason of such a policy would be to provide for the financial burden of
long term care associated with such diseases.

i) Under these policies generally 100% of the sum insured is paid on
diagnosis of a critical illness. In some cases compensation could vary
from 25% to 100% of sum insured depending on the policy terms and
conditions and severity of illness.

j) A standard condition seen in all critical illness policies is the waiting
period of 90 days from inception of policy for any benefit to become
payable under the policy and the survival clause of 30 days after
diagnosis of the illness. The survival clause has been included as this
benefit must not be confused with a “death benefit” but more
interpreted as a “survival (living) benefit” i.e. the benefit provided to
overcome the hardships that may follow a critical illness.

k) Rigorous medical examinations are to be undergone for persons
especially over 45 years of age who wish to take the critical illness
policy. Standard exclusions are quite similar to those found in health
insurance products, failure to seek or follow medical advice, or delaying
medical treatment in order to dodge the waiting period is also
specifically excluded.

l) The insurer may compensate the insured only once for any one or more
of the covered diseases of the policy or offer multiple payouts but up to
a certain limited number. The policy terminates, once compensation is
paid under the policy in respect of any of the insured person.

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