Critical Illness Insurance Policy

To be completely aware of the scope of coverage for IFFCO-Tokio’s online critical illness policy, it is important to know what it does not cover. These are some of the most prominent exclusions under the policy:

• Any kind of medical treatment pertaining to pre-existing diseases.

• Any medical treatment for a disease that occurs during the first 120 days of commencement of critical care insurance cover.

• Any costs incurred to treat Human T-Cell Lymphotropic Viruses Type II (HTLV-III) or Lymphadinopathy Associated Viruses (LAV) or their mutant derivatives or variations. The same applies for any syndrome or condition of a similar kind referred to as AIDS.

• Any medical treatment for ailments arising out of drug addiction or alcoholism.

• Any instances of self-harm or suicide.

• Any person who is under 5 years or is aged 60 years or more.

• Anyone undergoing circumcision except for diseases not excluded here or Injury, vaccination or inoculation or change of life or cosmetic or aesthetic treatment of any description.

• Anyone suffering from Convalescence, General Debility, Run Down condition or rest cure, congenital external diseases or defects or anomaly and sterility venereal diseases.
• Any critical Illness which is caused directly or indirectly or contributed to by or arises from the following external threats: 
  • Ionizing Radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel or nuclear weapon materials.
  • War, Invasion, Act of foreign enemy, Hostilities, Civil war, Rebellion, Revolution, Insurrection, Mutiny, Military or usurped Power, Seizure, Capture, Arrest, Restraints, and Detainments of all kinds, Princes of whatever nation conditions or quality so ever.

Limitations of the Critical Illness Policy

Numbers of claims

Did you know that one critical illness can be covered during the entire term of the policy? Insured will receive the claim amount after being diagnosed with a critical illness. We will make payment to Insured Person only once in respect of the treatment of any particular critical illness or injury. This is more of a technicality than a limitation because fortunately the majority of patients are usually affected by only one critical illness which entails an extensive treatment.

Waiting Period in critical illness policy

A minimum of 4 years is always applicable to most of the health insurance plans in India. However, for critical illness insurance plan it is usually 90 days after the policy has been purchased and 30 consecutive days of survival before the sum assured is paid out. Moreover, it is beneficial for critical illness policyholders.

Stage or Specified Severity of Disease

Diseases such as a case of heart attack, cancer, angioplasty or arthritis need to reach a certain level of criticality such that it qualifies to be considered as critical. There is always a level which the disease has to reach in order to be considered as critical. As per IRDA, there are certain stages which are explained in medical terminology which states that the diseases are critical enough to be covered under the online critical illness policy.

Cancellation

We will not ordinarily cancel the critical care insurance policy unless it is a case of misrepresentation or concealment of material fact. In case of cancellation of the policy due to above reasons, policy shall be void and all premium paid thereon shall be forfeited to the Company and the same shall be communicated to you by sending a 15 (Fifteen) notice by registered Post to your last known address You may cancel the Policy by sending at least 15(Fifteen) days written notice to us under Registered Post. We will then allow a refund on a given scale provided there is no claim. Where the claim is preferred, no refund will be made.

Download Forms

• Critical Illness Insurance Policy Proposal Form.pdf
• Critical Illness Insurance Policy Wording_0.pdf
• Day Care Procedures.pdf
• Guidebook_1.pdf
• Health Cashless Request Form_1.pdf
• Health Claim Form_5.pdf
• KYC Form_0.pdf
• List of excluded Hospitals.pdf
• List of Network Hospitals.pdf
• List of Non Payable Items_1.pdf