Critical Illness Cover Clause Samples
Critical Illness Cover. Page 8 Kotak Mahindra General Insurance Company Ltd., Kotak Health Premier UIN: KOTHLIP18089V011718 Policy Wording If the Insured Person is first diagnosed to be suffering from any of the following Critical Illnesses during the Policy Period, We will pay sum insured upto the limit specified in the Policy Schedule for this Cover, subject to the following:
(a) On payment of additional premium, cover would be provided to each individual for the Policy Period.
(b) We shall not be liable to accept any Claim under this Cover if it pertains to any Critical Illness diagnosed within 90 days of the commencement of the first Policy Period of this Cover with Us;
(c) We shall not be liable in case any of the Critical Illnesses is a consequence of or arises out of any Pre-Existing Condition(s) /Disease.
(d) We shall not be liable to make payment under this Cover for more than once in respect of any Insured Person across all Policy Periods; Further,
(a) This cover is applicable on an individual basis irrespective of type of policy (Individual/ Floater) and available for Insured Persons aged 18 years or above.
(b) The payment under this benefit is over and above the Base Sum Insured and will not impact the Base Sum Insured or the Cumulative Bonus (if any).
(c) Once a Claim has been accepted and paid for any of the listed Critical Illness, this benefit shall cease in respect of that Insured Person, but shall continue to be in force for other Insured Persons.
(d) Notwithstanding any provision to the contrary in the Policy, this Cover will be applicable on a worldwide basis;
(e) In the event of a Claim arising under this Cover, We shall be given written notice of the Claim within 30 days from the date of the first diagnosis of the Critical Illness and We shall be provided the following information and documentation:
(i) The Claim documents stated in the Policy, provided that We will accept duly certified copies of the listed documents if the originals are required to be submitted to any other insurance company;
(ii) Written confirmation of the diagnosis of the Critical Illness from the treating Medical Practitioner; “Critical Illness” for the purpose of this Cover is as mentioned below: • First diagnosis of the below-mentioned Illnesses more specifically described below
1. Cancer of specified severity
2. Kidney failure requiring regular dialysis;
3. Multiple Sclerosis with persisting symptoms;
4. Motor Neurone Disease with Permanent Symptoms 5. Benign Brain Tumor
Critical Illness Cover. This cover is subject to the following condition:
a. The diagnosis of a Critical illness must be verified by a Medical Practitioner. For the purpose of this Policy, ‘Critic al Illness’ means the following illnesses;
Critical Illness Cover. In the event that you suffer a critical illness then the sum assured under the contract will become payable. Once this sum assured has been paid the life cover will/will not remain in force. Definitions of a critical illness vary between different insurers and you can find a list of which illnesses are covered within the Key Features Document. A Critical Illness plan is designed to pay out a lump sum if you are diagnosed as suffering from any of the specified critical illnesses but survive for a period of time after diagnosis (normally 28 days). The lump sum could be used to pay for things like nursing care, home help, adapting your house to accommodate a disability, paying off your mortgage or for a holiday to recover from treatment. Critical illnesses usually include cancer, coronary artery bypass, heart attack, kidney failure, multiple sclerosis, major organ transplant and stroke. These are known as core conditions and account for the majority of claims. The comprehensiveness of conditions covered by different critical illness policies varies enormously and details of which conditions are/are not covered by the policy we are recommending will be fully explained in any supporting literature which you should check to ensure it meets your purposes. It is usual to include cover for permanent total disability within the contract. The definition of Permanent Total Disability does vary and some insurers define it as the life assured being unable to follow his/her normal occupation as a result of sickness or accident whilst others will define it as the life assured being unable to independently perform a specified number of Activities of Daily Living (such as dressing or feeding) as a result of sickness or accident. The policy may be set up under a Business trust. This type of trust is especially designed for use in conjunction with partnership protection arrangements and incorporates some important areas of flexibility. The beneficiaries will be anyone who is a partner in the firm, in the proportions in which they own shares. This allows for departing partners to be removed from the trust automatically and new partners to be added, it also provides for changes in partnership shares. In the event that you cease to be associated with the firm, the life policy would revert back to you. Using a trust provides a number of benefits, specifically: You can identify who the beneficiaries should be (and with some trusts you have the ability to change this). Your cho...
Critical Illness Cover. If an Insured Person is diagnosed to be suffering from a Critical Illness (as defined below) while the Policy is in force then We will pay the Sum Insured subject to the following conditions - ▪ The Critical Illness, which the Insured Person is suffering from, occurs or manifests itself during the Policy Period as a first incidence; and ▪ The Insured Person survives for at least 30 days from the date of diagnosis of the Critical Illness. For the purpose of this Policy, Critical Illness shall mean any Illness, medical event or Surgical Procedure as specifically defined below whose signs or symptoms first commence at least 90 days after the Inception of Policy Period.