Critical Illness Insurance Policy Universal Sompo

With the many uncertainties that we are faced with in life, we would want to secure it by preparing for the unexpected. Critical Illness Insurance can help remove many of your financial worries and concentrate on getting better if you became critically ill.

Who can take the Policy?
The Policy can be taken by an Individual for covering himself/herself, his/her spouse, his/her and/ or parents/ parents-in-law
The Sum Insured under the Policy shall be available on individual basis only

Eligibilit

For Proposer
You must be a resident of India
Entry age for you (the proposer) is 18 years and you can opt for this policy up to the age of 65 years.
Other eligibility conditions for all persons proposed for insurance under the Policy
Minimum Entry age: 5 years as on last birthday
Maximum Entry age Policy : 65 years as on last birthday

Medical Examination
We may ask you or any person proposed for insurance under the Policy to undergo below mentioned medical tests for purpose of consideration of your proposal under following circumstances

You/ Your family member are/is above 55 years of age as on the last birthday
On basis of Your declaration in the Proposal Form of Your/ Your family member's medical conditions



What is covered under the Policy?
If you or any person insured by you suffer any of the listed Critical Illness or undergoes a listed Surgical Procedure during the policy period and while the policy is in force, we will pay the Sum Assured specified as opted by you provided that:

1. Such Critical Illness first occurs or manifests itself during the policy period; and

2. The signs or symptoms of such Critical illness commence after 90 days from the date of commencement of the Policy and

3. You/the Insured Person survives for a minimum period of at least 30 days from the date of diagnosis of such Critical Illness for the claim to be admissible

Critical Illnesses and Surgical Procedure

The coverage shall be up to the Sum Insured as selected by you under the Policy.
Cancer of specified severity
First Heart Attack of specified severity
Open Chest CABG
Open Heart Replacement
Coma of Specified Severity
Kidney Failure requiring regular dialysis
Stroke resulting in permanent symptoms
Major Organ /Bone Marrow Transplant
Motor Neurone Disease with Permanent Symptoms
Permanent Paralysis of Limbs
Multiple Scelerosis with persisting symptoms

What is covered under the Policy?

i .Long Term Policy: Policy terms 1 year to 3 years are available under the policy. The following discounts will be offered if the Policy is taken by paying the appropriate premium for 2 years/ 3 years at once. No installment facility in payment of premium is available to you if you choose to opt for a long term policy,



ii .Wide range of Sum Insureds: The Policy provides for a wide range of Sum Insured starting from 2.5 Lakh to 20 Lakh Rupees

iii .Portability:

1. If You were insured continuously and without a break under another Indian retail health insurance policy with Us or any other Indian General Insurance company, it is understood and agreed that:

a) If You wish to exercise the Portability Benefit, We should have received Your application with complete documentation at least 45 days before the expiry of Your present period of insurance;

b) The Portability Benefit shall be applied subject to the following:

i) Your proposal shall be subject to Our medical underwriting

ii) We reserve the right to modify or amend the terms and the applicability of the Portability Benefit in accordance with the provisions of the regulations and guidance issued by the Insurance Regulatory and Development Authority as amended from time to time.

iv. Free Look-up Period:

1. The Policy shall have a free look period. The free look period shall be applicable at the inception of the policy and:

i. You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable

2. If You have not made any claim during the free look period, You shall be entitled to

i. A refund of the premium paid less any expenses incurred by Us on Your medical examination and the stamp duty charges or;

ii. where the risk has already commenced and the option of return of the policy is exercised by You, a deduction towards the proportionate risk premium for period on cover or;

iii. Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period.

What is not covered under the Policy?
1. Any Illness, sickness or disease, other than specified as Critical Illness, as mentioned in the Policy schedule, or

2. Any Critical Illness of which, the signs or symptoms first occurred prior to or within Ninety (90) days following the Policy Issue Date or the last Commencement Date, whichever is later, or

3. Any Critical Illness based on a diagnosis made by the you or your Immediate Family Member or anyone who is living in the same household as you or by a herbalists, acupuncturist or other non-traditional health care provider; and

4. 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;

5. Special nursing care, routine health checks or convalescence, Custodial Care, general debility, lethargy, rest cure;

6. Any investigation(s) or treatments not directly related to a Covered Illness or Covered Injury or the conditions or diagnosis necessitating hospital admission;

7. Pre-existing diseases will not be covered until 48 months of continuous coverage have elapsed, since inception of the first Policy with us; but:

A. If You are presently covered and have been continuously covered without any break under:

i) any other similar health insurance plan covering critical illness risks from Us or from any other insurer, then, Pre-existing diseases exclusion of the Policy stands deleted and shall be replaced entirely with the following:

a) The waiting period for all Pre-existing diseases shall be reduced by the number of Your continuous preceding years of coverage under the previous similar health insurance policy covering critical illness risks;

b) If the proposed Sum Insured for you is more than the Sum Insured applicable under the previous similar health insurance policy covering critical illness risks, then the reduced waiting period shall only apply to the extent of the Sum Insured under the previous similar health insurance policy.

B. The reduction in the waiting period specified above shall be applied subject to the following:

i. We will only apply the reduction of the waiting period if we have received the database and claim history from the previous Indian insurance company (if applicable);

ii. We are under no obligation to insure all Insured Persons or to insure all Insured Persons on the proposed terms, or on the same terms as the previous similar health insurance policy covering critical illness risks even if you have submitted to Us all documentation

iii. We shall consider only completed years of coverage for waiver of waiting periods. Policy Extensions if any sought during or for the purpose of porting insurance policy shall not be considered for waiting period waiver

8. Payment of compensation in respect of Illness resulting

a. From intentional self-injury, suicide or attempted suicide.

b. Due to liquor or drugs or other intoxicants.

c. Emotional distress

d. Whilst engaging in aviation or ballooning whilst mounting into, dismounting from or travelling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world.

e. Directly or indirectly, caused by venereal disease, AIDS or insanity.

f. Arising or resulting from committing any breach of law with criminal intent or participating in an actual or attempted felony, riot, crime, misdemeanor or civil commotion.

g. Due to war or ionizing radiation or nuclear perils.

h. Whilst working in underground mines or explosive mines, electric installation with high tension supply, or as jockey or circus personnel or any such occupations of similar hazard.

i. Congenital Anomalies or any complications or conditions arising therefrom; or

9. Any treatment not performed by a Physician or that is Unproven/ Experimental treatment.

10. Circumcision, cosmetic or aesthetic treatments of any description change of life surgery or treatment, plastic surgery (unless necessary for the treatment of Illness or accidental Bodily Injury as a direct result of the Insured Event and performed within 6 months of the same).

11. Naval or military operations of the armed forces or air force and participation in operations requiring the use of arms or which are ordered by military authorities for combating terrorists, rebels and the like.

12. All kind of Alternate Treatment