01-4169082/83/85

Critical Illness Rider

This is a non-participating rider . It offers protection to policyholder on being diagnosed with the specific illness as defined under this plan during the term of the policy. This rider should be sold with the attached to specific base products.

Under this Rider we cover 18 types of Critical Illness

SALIENT FEATURES:

  • Age at Entry : 18 years to 65 years
  • Maximum Maturity Age : 70 years
  • Terms of Policy : 5 year to 20 years
  • Minimum Sum Assured : 50,000
  • Maximum Sum Assured : NRs. 50,00,000
  • Premium Payment Mode:  Equal to Policy Term , single premium
  • Loan : not applicable

Basic Benefits:

  • Death Benefit – Not Applicable
  • Maturity Benefit – Not Applicable

If the Life Assured being diagnosed with the specific illness as defined under the contract during the term of the policy, a lump sum equal to the Sum Assured of this rider will be paid. The Sum Assured of the Critical Illness Rider should be less than or equal to the basic plan death benefit sum assured. Upon payment of the rider’s Sum Assured amount, the rider shall be automatically terminated and the basic plan sum assured will remain unchanged.

  • Cancer
  • Kidney Failure (End Stage Renal Failure)
  • Primary Pulmonary Arterial Hypertension
  • Multiple Sclerosis
  • Major Organ Transplant
  • Coronary artery by-pass graft (with surgery to divide the breastbone)
  • Surgery to Aorta 
  • Heart Valve Surgery
  • Stroke
  • Myocardial Infraction (First Heart Attack)
  • Coma
  • Total Blindness
  • Paralysis
  • End Stage Liver Failure
  • End-Stage Lung Disease
  • Alzheimer’s Disease / Severe Dementia
  • Parkinson’s Disease – resulting in permanent inability to perform Activities of Daily Living
  • Third Degree Burns – of specified severity
  • Only one Critical Illness claim is allowed

 Waiting Period

A waiting period of 90 days shall be applicable under this rider from the date of commencement of date of reinstatement of the rider .No claim can be made during first 90 days from risk start date on account of new issuance or reinstatement of rider cover.

 Survival Period :

A survival period of 30 days shall be applicable from the diagnosis date of Critical Illness. In case of death within 30 days of diagnosis, no claim shall be paid under this rider and the rider will terminate.

1. Cancer (All Types of Cancer)

Any malignant tumour positively diagnosed with histological confirmation and characterized by the uncontrolled growth of malignant cells and invasion of tissue. The term malignant tumour includes leukemia, lymphoma and sarcoma.

For the above definition, the following are not covered:

(i) All cancers which are histologically classified as any of the following:                                                           

- pre-malignant 

- non-invasive

- carcinoma in situ

- having borderline malignancy - having malignant potential

(ii) All tumours of the prostate histologically classified as T1N0M0 (TNM classification)

(iii)  All tumours of the thyroid histologically classified as T1N0M0 (TNM classification)

 (iv) All tumours of the urinary bladder histologically classified as T1N0M0 (TNM classification)

 (v) Chronic Lymphocytic Leukemia less than RAI Stage 3

(vi) All cancers in the presence of HIV

(vii) Any skin cancer other than malignant melanoma

 2. Kidney Failure (End Stage Renal Failure)

End-stage kidney failure presenting as chronic irreversible failure of both kidneys to function, as a result of which regular dialysis is initiated or kidney transplantation is carried out.

3. Primary Pulmonary Arterial Hypertension

A definite diagnosis of primary pulmonary arterial hypertension with substantial right ventricular enlargement established by investigations including cardiac catheterization, resulting in permanent physical impairment to the degree of at least Class III of the New York Heart Association (NYHA) classification of cardiac impairment.

Pulmonary arterial hypertension resulting from other causes shall be excluded from this benefit.

 The NYHA Classification of Cardiac Impairment for Class III and Class IV means the following:

 Class III:  Marked limitation of physical activity. Comfortable at rest but less than ordinary activity causes symptoms. Class IV:  Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.

4. Multiple Sclerosis

A definite diagnosis of multiple sclerosis by a neurologist. The diagnosis must be supported by all of the following: 

 - Investigations which confirm the diagnosis to be Multiple Sclerosis; 

- Multiple neurological deficits resulting in impairment of motor and sensory functions occurring over a   

  continuous period of at least 6 months; and

- Well documented history of exacerbations and remissions of said symptoms or neurological deficits 

5. Major Organ Transplant The receipt of a transplant of: 

- Human bone marrow using hematopoietic stem cells preceded by total bone marrow ablation; or

- One of the following human organs: heart, lung, liver, kidney, pancreas that resulted from irreversible end-  

   stage failure of the relevant organ.   

Other stem cell transplants are not covered.

6. Coronary artery by-pass graft (with surgery to divide the breastbone)

Refers to the actual undergoing of open-chest surgery to correct or treat Coronary Artery Disease (CAD) by way of coronary artery by-pass grafting.

For the above definition, the following are not covered:

(i) angioplasty;

(ii) other intra-arterial or catheter based techniques;

(iii) keyhole procedures;

(iv) laser procedures

7. Surgery to Aorta

The actual undergoing of surgery via a thoracotomy or laparotomy (surgical opening of thorax or abdomen) to repair or correct an aortic aneurysm, an obstruction of the aorta or a dissection of the aorta. For this definition, aorta shall mean the thoracic and abdominal aorta but not its branches.

For the above definition, the following are not covered:

 (i) angioplasty;

(ii) other intra-arterial or catheter based techniques;

(iii) other keyhole procedures;

(iv) laser procedures

8. Heart Valve Surgery

The actual undergoing of open-heart surgery to replace or repair cardiac valves as a consequence of heart valve defects or abnormalities. 

 For the above definition, the following are not covered:

(i) Repair via intra-arterial procedure

(ii) Repair via key-hole surgery or any other similar techniques

9. Stroke

Death of brain tissue due to inadequate blood supply, bleeding within the skull or embolization from an extra cranial source resulting in permanent neurological deficit with persisting clinical symptoms.  The diagnosis must be based on changes seen in a CT scan or MRI and certified by a neurologist. A minimum Assessment Period of three ( 3) months applies. 

For the above definition, the following are not covered:

(i) Transient ischemic attacks

(ii) Cerebral symptoms due to migraine

(iii) Traumatic injury to brain tissue or blood vessels

(iv) Vascular disease affecting the eye or optic nerve or vestibular functions

10. Myocardial Infraction (First Heart Attack)

Death of heart muscle, due to inadequate blood supply, that has resulted in all of the following evidence of acute myocardial infarction: 

(i) A history of typical chest pain;

(ii) New characteristic electrocardiographic changes; with the development of any of the following: ST    

      elevation or  depression, T wave inversion, pathological Q waves or left bundle branch block and

 (iii) Elevation of the cardiac biomarkers, inclusive of CPKMB above the generally accepted normal laboratory levels or Troponins recorded at the following levels or higher: -  Cardiac Troponin T or Cardiac Troponin I > / = 0.5 ng/ml 

The evidence must show the occurrence of a definite acute myocardial infarction which should be confirmed by a cardiologist or physician. 

For the above definition, the following are not covered: 

i.occurrence of an acute coronary syndrome including but not limited to unstable angina. 

ii.a rise in cardiac biomarkers resulting from a percutaneous procedure for coronary artery disease.

11. Coma

A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously for at least ninety six (96) hours, requiring the use of life support systems and resulting in a permanent neurological deficit with persisting clinical symptoms. A minimum Assessment Period of thirty (30) days applies.  Confirmation by a neurologist must be present. 

The following is not covered:

(i) Coma resulting directly from alcohol or drug abuse 

12. Total Blindness

Permanent and irreversible loss of sight as a result of accident or illness to the extent that even when tested with the use of visual aids, vision is measured at 3/60 or worse in both eyes using a Snellen eye chart or equivalent test and the result must be certified by an ophthalmologist.

13. Paralysis

Total, permanent and irreversible loss of use of both arms or both legs, or of one arm and one leg, through paralysis caused by illness or injury. A minimum Assessment Period of six (6) months applies.

14. End-Stage Liver Failure

End-stage liver failure as evidenced by all of the following: 

 (a) Permanent jaundice; 

(b) Ascites (excessive fluid in peritoneal cavity); and 

(c) Hepatic encephalopathy. 

Liver failure secondary to alcohol or drug abuse is not covered.

15. End-Stage Lung Disease

End-stage lung disease causing chronic respiratory failure. All of the following criteria must be met: 

(a) The need for regular oxygen treatment on a permanent basis;

(b) Permanent impairment of lung function with a consistent Forced Expiratory Volume (FEV) of less than 1 litre during the first second;

(c) Shortness of breath at rest; and 

(d) Baseline Arterial Blood Gas analysis with partial oxygen pressures of 55mmHg or less.

16. Alzheimer’s Disease / Severe Dementia

Deterioration or loss of intellectual capacity confirmed by clinical evaluation and imaging tests arising from Alzheimer's Disease or Severe Dementia as a result of irreversible organic brain disorders. The covered event must result in significant reduction in mental and social functioning requiring continuous supervision of the Life Insured. The diagnosis must be clinically confirmed by a neurologist. 

From the above definition, the following are not covered:

 (a) Non organic brain disorders such as neurosis; 

(b) Psychiatric illnesses;

(c) Drug or alcohol related brain damage.

17. Parkinson’s Disease – resulting in permanent inability to perform Activities of Daily Living

A definite diagnosis of Parkinson's Disease by a neurologist where all the following conditions are met:

 (a) Cannot be controlled with medication;

 (b) Shows signs of progressive impairment; and 

(c) Confirmation of the permanent inability of the Life Insured to perform without assistance three (3) or more of the Activities of Daily Living. 

Only idiopathic Parkinson's Disease is covered. Drug-induced or toxic causes of Parkinsonism are not covered. 

18. Third Degree Burns – of specified severity

Third degree (i.e. full thickness) skin burns covering at least twenty percent (20%) of the total body surface area