New LIC Plans Policies: Health Insurance

It is a non-linked, regular premium payment health insurance plan which provides fixed benefit in
case the Life Assured is diagnosed with any of the specified Early and/or Major Stage Cancer
during the policy term, subject to certain terms and conditions.

The policy can be purchased Offline as well as Online.
The plan has two benefit options which have to be chosen by the proposer at the outset. The
premium rates will vary depending on the option chosen.

Option I Level Sum Insured: The Basic Sum Insured shall remain unchanged throughout the policy term.
Option II Increasing Sum Insured: The Sum Insured increases by 10% of Basic Sum Insured each year for first five years starting from the first policy anniversary or until the diagnosis of first event of Cancer, whichever is earlier. On diagnosis of any specified cancer,all the claims payable shall be based on the Increased Sum Insured at the policy anniversary coinciding or prior to the diagnosis of the first claim and further increases to this Sum Insured will not be applicable.

The benefits payable under the plan shall be based on the Applicable Sum Insured, where the Applicable Sum Insured shall be equal to–

The Basic Sum Insured for policies taken under Option I; or
Basic Sum Insured during first year and Increased Sum Insured there after,as per the provisions detailed in Option II above, for policies taken under Option II.

BENEFITS

Early Stage Cancer: Provided the policy is in force, on first diagnosis, of any one of the specified Early Stage Cancers.
- Lump sum benefit: 25% of Applicable Sum Insured shall be payable.
- Premium Waiver Benefit: Premiums for next three policy years or balance policy term, whichever is lesser, shall be waived from the policy anniversary coinciding or following the date of diagnosis. Premium(s) falling due from the date of diagnosis and before the next policy anniversary shall be deducted from the claim amount.

Major Stage Cancer: Provided the policy is in force, on first diagnosis of any one of the specified Major Stage Cancers.
- Lump Sum: 100% of Applicable Sum Insured less any previously paid claims in respect of Early Stage Cancer shall be payable.
- Income Benefit: In addition to above lump sum benefit, Income Benefit of 1% of Applicable Sum Insured shall be payable on each policy month following the payment of Lump Sum, for a fixed period of next ten years irrespective of the survival of the Life Insured and even if this period of ten years goes beyond the policy term. In case of death of the Life Assured while receiving this Income Benefit, the remaining installments, if any, will continue to be paid to his/her nominee.
- Premium Waiver Benefit: All the future premiums shall be waived from the next policy anniversary and the policy shall be free from all liabilities except to the extent of Income Benefit as specified above. Premium(s) falling due from the date of diagnosis and before the next policy anniversary shall be deducted from the claim amount.
Maturity Benefit : There is no maturity benefit payable under this plan.
Death Benefit : There is no death benefit payable under this plan.

ELIGIBILITY CONDITIONS AND RESTRICTIONS:

Minimum age at entry: 20 years (completed)
Maximum age at entry: 65 years (last birthday)
Minimum Policy Term: 10 years
Maximum Policy Term: 30 years
Minimum cover ceasing age: 50 years
Maximum cover ceasing age: 75 years
Minimum Premium:Rs. 2400/- p.a. for all modes
Minimum Basic Sum Insured: Rs.10,00,000/-
Maximum Basic Sum Insured: Rs. 50,00,000/- The maximum Basic Sum Insured under this plan shall not exceed an overall limit of Rs. 50 lakh taking all existing Critical Illness Cover policies and Basic Sum Insured under this plan in respect of existing policies as well as new proposal under consideration.

LIMITS AND RESTRICTIONS :

The list and definitions of the Cancer covered under this plan:
- Early Stage Cancer: The diagnosis of any of the listed below conditions must be established by histological evidence and be confirmed by a specialist in the relevant field.
  - Carcinoma-in-situ : Carcinoma-in-situ means the presence of malignant cancer cells that remain within the cell group from which they arose. It must involve the full thickness of the epithelium but does not cross basement membranes and it does not invade the surrounding tissue or organ. The diagnosis of which must be positively established by microscopic examination of fixed tissues.
  - Prostate Cancer – early stage: Early Prostate Cancer that is histologically described using the TNM classification as T1N0M0 with a Gleason Score 2 (two) to 6 (six).
  - Thyroid Cancer – early stage: All thyroid cancers that are less than 2.0 cm and histologically classified as T1N0M0 according to TNM classification.
  - Bladder Cancer – early stage: All tumors of the urinary bladder histologically classified as TaN0M0 according to TNM classification.
  - Chronic Lymphocytic Leukaemia – early stage: Chronic Lymphocytic Leukaemia categorized as stage 0 (zero) to 2 (two) as per the Rai classification.
  - Cervical Intraepithelial Neoplasia – Severe Cervical Dysplasia reported as Cervical Intraepithelial Neoplasia 3 (CIN3) on cone biopsy.The following are specifically excluded from all Early stage cancer benefits (Exclusions):
    • All tumors which are histologically described as benign, borderline malignant, or low malignant potential
    • Dysplasia, intra-epithelial neoplasia or squamous intra-epithelial lesions
    • Carcinoma in-situ of skin and Melanoma in-situ
    • All tumors in the presence of HIV infection are excluded
- Major Stage Cancer: A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term cancer includes leukemia, lymphoma and sarcoma.The following are excluded from major stage cancer benefits (Exclusions):
  - All tumors which are histologically described as carcinoma in situ, benign, pre- malignant, borderline malignant, low malignant potential, neoplasm of unknown behavior, or non-invasive, including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 and CIN-3.
  - Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
  - Malignant melanoma that has not caused invasion beyond the epidermis;
  - All tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0
  - All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
  - Chronic lymphocytic leukaemia less than Rai stage 3
  - Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,
  - All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs;
  - All tumors in the presence of HIV infection.The explanation of TNM and Rai classification is as given below:
    TNM Classification:
    TNM classification referenced above is as per the 7th edition 2010 AJCC Cancer Staging Manual. A brief explanation of the TNM classification is provided below.
    The TNM classification system is internationally recognized and is used to stage and measure a tumour. The “T” element measures the size and extent of the primary tumour, “N” element measures the degree of spread to regional lymph nodes and the “M” element measures the presence of distant metastasis (spread of cancer from one part of the body to another part of the body).
    Rai Classification: Any reference to ‘Rai classification’ will be in accordance to the table mentioned below Stage Description
    0 Lymphocyte count >15,000mm3 (15 x 109/L)
    No other abnormalities i.e. no lymph nodes, no hepatosplenomegaly,
    hemoglobin >11 g/dl,
    platelets >100,000mm3
    I Lymph nodes present
    II Enlarged liver or spleen
    III Anemia – hemoglobin <11 g/dl
    IV Thrombocytopenia – platelets <100,000mm3
Early Stage Cancer Benefit shall be payable only once for the first ever event and Life Assured shall not be entitled to make another claim for the Early Stage Cancer of same or any other cancer. However, the coverage for the Major Stage Cancer under the policy shall continue until the policy terminates.
Once a Major Stage Cancer Benefit is paid no payment for any future claims under Early Stage Cancer or Major Stage Cancer would be admissible.
Total benefit under the Policy including Early Stage Cancer Benefit and Major Stage Cancer Benefit shall not exceed the maximum claim amount of 220% (i.e. 100% as lump sum plus 120% in the form of Income benefit) of Applicable Sum Insured.
If the life assured claims for different stages of the same Cancer at the same time, the benefit shall only be payable for the higher claim admitted under the policy. However, such benefit shall be payable only after 7 days survival period from the date of diagnosis of such Major stage cancer.
If there is more than one Cancer diagnosed in an event, the Corporation will only pay one benefit. That benefit will be the amount relating to the stage of Cancer which has the highest
benefit amount. However, such benefit shall be payable only after 7 days survival period from the date of diagnosis of such Cancer.

WAITING PERIOD:

A waiting period of 180 days will apply from the date of issuance of policy or date of revival of risk cover whichever is later, to the first diagnosis of “any stage” cancer. “Any stage” here means all stages of Cancer that occur during the waiting period. This would mean that nothing shall be paid under this policy and the policy shall terminate if any stage of Cancer occur: At any time on or after the date of issuance of the Policy but before the expiry of 180 days reckoned from that date; or Before the expiry of 180 days from the Date of Revival.

SURVIVAL PERIOD:

No benefit shall be payable if the Life Assured dies within a period of 7 days from the date of diagnosis of any of the specified Early Stage Cancer or Major Stage Cancer. The 7 days survival period includes the date of diagnosis.
Benefit under this plan shall be payable subject to fulfilling all of the below criteria:

7 days survival period from the date of diagnosis
Signs and symptoms relevant to the cancer should have been present and documented before death
All investigations to confirm the diagnosis of cancer should have been done before the death of the insured.
Satisfaction of the cancer definition as per the policy condition

EXCLUSIONS:

The Corporation shall not be liable to pay any of the benefit under this product if the covered conditions resulting directly or indirectly from any of the following causes:
Any Pre-Existing Condition i.e. any cancer condition (primary or metastatic); precancerous condition or related condition(s) for which the policyholder had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months prior to the date of issuance of policy or revival of the policy.

If the diagnosis of any stage of Cancer was made within 180 days from the Date of issuance of policy or date of revival of risk cover whichever is later;

For any medical conditions suffered by the life assured or any medical procedure undergone by the life assured if that medical condition or that medical procedure was caused directly or indirectly by Acquired Immunodeficiency Syndrome (AIDS), AIDS related complex or infection by Human Immunodeficiency Virus (HIV);

For any medical condition or any medical procedure arising from the donation of any of the Life Assured’s organs;

For any medical conditions suffered by the Life Assured or any medical procedure undergone by the Life Assured, if that medical condition or that medical procedure was caused directly or indirectly by alcohol or drug (except under the direction of a registered medical practitioner)

For any medical condition or any medical procedure arising from nuclear contamination; the radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident arising from such nature.

TERMINATION OF POLICY:

The policy shall be terminated upon the happening of the first of the following events.

On the death of the Life Assured; or
On the date of maturity; or
On payment of the Major Stage Cancer, however, Income Benefit shall continue to be payable as and when due; or
On the diagnosis of any stage cancer during the waiting period; or
On cancellation of the policy by the Life Assured or insurer; or
On expiry of revival period; or
On grounds of misrepresentation, fraud, non-disclosure or non-cooperation of the insured; or
In case the policyholder does not renew the policy after premium review, if any.

MODES OF PREMIUM PAYMENT:

Premiums can be paid regularly during the policy term at yearly or half-yearly intervals.

REVIEW OF PREMIUMS:

The premium rates are guaranteed for a period of first 5 years from the date of issuance of the policy. Based on the experience of the portfolio under this plan, the Corporation reserves the right to revise the premium rates any time after the completion of 5 policy years starting from the date of issuance of the policy, the premium rates for future years will be subject to applicable revised rates. However, such revised rates shall be guaranteed for a further period of at least 5 years. The instalment premium on each review will be based on age at entry i.e. age as on the date of issuance of policy and original policy term.

Any such revision in premium rates under a policy shall be notified to each policy holder at least ninety days prior to the date when such revision or modification comes into effect. However, the Life Assured shall have the right to discontinue this plan in case the revised instalment premium is not acceptable. These rates shall be applicable to the new policyholders also.

GRACE PERIOD FOR PAYMENT OF PREMIUM:

A grace period of one month but not less than 30 days shall be allowed for payment of yearly or half
-yearly premiums. If the premium is not paid before the expiry of grace period, the Policy lapses.

In case of diagnosis of any Early Stage or Major Stage Cancer under an in force policy wherein all the premiums due till the date of diagnosis have been paid and where the mode of payment of premium is other than yearly, balance premium(s), if any, falling due from the date of diagnosis and before the next policy anniversary shall be deducted from the claim amount.