LIC Critical Illness Benefit Rider

What is the Benefit Offered Under the Rider?

In case the policyholder is diagnosed with any one of LIC's 15 pre-specified critical illnesses, a Critical Illness Sum Assured is paid out by the insurer. The rider, on the other hand, is paid only once during the term of the policy, while it is still in-force. The rider will be rendered invalid once the Critical Illness Sum Assured is paid by LIC.

What are the 15 Critical Illnesses Covered Under the Rider?

The following critical illnesses are covered under the rider:

1. Cancer of a specified severity: Cancer in this regard is defined as a malignant tumor that is characterised by an uncontrollable growth of malignant cells, resulting in the destruction and invasion of normal tissues of the body. A histological evidence and accurate reports will be required to support the said diagnosis. Cancer encompasses the following:The following conditions fall under the category of 'exclusions':
   1. Lymphoma
   2. Leukemia
   3. Sarcoma
2. Open Chest CABG: This includes the procedure of heart surgery that is performed on the life assured, in order to treat the existing blockage. Additionally, it includes narrowing of one or more coronary arteries through coronary artery bypass grafting, that is done via a sternotomy (invasion of the breast bone) or a procedure that is essentially a minimally invasive keyhole coronary artery bypass. A coronary angiography and an authorisation for the surgery from a cardiologist are two of the most important elements that must be provided to support the diagnosis. Exclusions: Any intra-arterial surgical procedure and/or angioplasty are excluded.
3. Myocardial Infarction: This includes the complete impairment of a portion of the heart muscle that in turn resulted because of inadequate blood supply to the necessary areas. This indicates the first instance of a heart attack of a particular severity. The very first instance of a myocardial infarction or a heart attack will be covered under the rider. A diagnosis for heart attack or myocardial infarction will mandatorily have to be supported with the following evidence:
   1. History of clinical symptoms that are in line with the acute myocardial infarction diagnosis. A very common example in this regard would be prolonged chest pains.
   2. New changes and development in the normal electrocardiogram of the life assured.
   3. A sharp increase in the infarction-related enzymes like Troponins, or such biochemical markers.
4. Renal Failure Necessitating Regular Dialysis: This category includes total malfunction of the kidneys which is known as end-stage renal disease. As a result, to facilitate recovery, the individual is either in need of a regular renal dialysis (peritoneal dialysis or haemodialysis) or a renal transplantation. The diagnosis will obligate confirmation from a certified medical practitioner or specialist.
5. Bone marrow transplant or a major organ transplantation: This will include the actual undergoing of the transplant surgery of the following:Exclusions:The elements included in this case are stem-cell transplants that are different from the ones specified above (of a different nature) or surgeries where only islets of langerhans are operated.
   1. Surgery of one of the following organs in the human body: heart, liver, kidney, lung, pancreas as a result of an irrevocable failure of the relevant organ, or
   2. Transplant of the human bone marrow by making use of haematopoietic stem cells. The entire surgical procedure will require authorisation and confirmation from a medical specialist or doctor.
6. Permanent symptoms as a result of a stroke: Conditions included under this category are any cerebrovascular incident that produces a permanent neurological condition. Further, components under the permanent neurological conditions include brain tissue infarction, an intracranial vessel thrombosis, embolisation and haemorrhage caused by an extracranial source. The diagnosis in this regard will require evidences like typical findings in a CT scan, or general clinical symptoms over the period of time as well as confirmation and authorisation from a certified medical practitioner. Permanent neurological deficit evidence caused for a period of at least three months have to be produced by the life assured.Exclusions:The following exclusions are applicable in this case:
   1. Transient ischemic attacks
   2. Traumatic injury received by the brain
   3. Vascular disorder that affects only the eye or vestibular functions or the optic nerve
7. Paralysed Limbs - Permanent Paralysis: Complete loss of function of either one or both the limbs, that has either been caused by an injury or a disease to/of the spinal cord or to/of the brain. The diagnosis will require confirmation and authorisation of a certified medical practitioner who is of the opinion that the condition (paralysis) is permanent and has no chances of recovery. The condition must also have been existent for a period of at least three months.
8. Multiple sclerosis with ongoing symptoms: Includes the unmistakable diagnosis of multiple sclerosis that has been evidenced and confirmed by the following:This excludes any other cause that might have resulted in neurological damage such as HIV or SLE.
   1. Examinations and inspections that have been conducted on the life assured and that confirm the presence of multiple sclerosis. These examinations include findings from the MRI.
   2. Existence of clinical impairment of the sensory or motor function, which must have been present for a period of at least six months.
9. Aortic surgery: This includes the occurrence of a surgery for the purpose of correction or repairment of an aneurysm, obstruction, narrowing, or dissection of the aorta through surgical opening of either the abdomen or the heart. More specifically, aorta in this case will mean the abdominal and thoracic aorta, however, it will not include its branches.
10. Exclusions: Surgeries performed by means of minimally invasive or intra-arterial techniques are not included in this.
11. Primary pulmonary hypertension: An unmistakable diagnosis of primary (idiopathic) pulmonary hypertension by either a medical expert in respiratory medicine or a cardiologist with evidence that indicates enlargement of the right ventricle and the pressure of the pulmonary artery over 30 mm of Hg on Cardiac Cauterization. A physical permanent impairment must be present to the extent of Class IV of the New York Heart Association Classification of cardiac impairment.The classification provided by NYHA are:Exclusions: Pulmonary hypertension caused due to chronic hypoventilation, lung disease, pulmonary thromboembolic disease, diseases of the left side of the heart, drugs and toxins, congenital heart disease, and any other secondary reason for the disorder are excluded.
    1. Class III: Noted restriction in physical activity of the concerned person. The person may be comfortable while resting, but any activity that is less than ordinary causes distress and symptoms.
    2. Class IV: The person is not able to undertake any physical activity without feeling discomfort. The symptoms may be present even if the individual is at rest.
12. Alzheimer's Disease or Dementia: This includes a loss in the mental capacity of an individual or a deterioration of one's intellectual function, as has been confirmed by certain imaging tests and a clinical evaluation. The disorder has to have been a result of either Alzheimer's Disease or irrevocable organic disorders that have ultimately resulted in substantial degradation of the Life Assured's mental health and has also impacted his/her social functioning. The Life Assured has to have been under thorough medical supervision for a period of at least six months from the date of diagnosis of the illness. The diagnosis has to be supported by the medical confirmation of a medical practitioner who is registered and who is also a certified neurologist and has the Corporation-appointed doctor's support. Exclusions: Diseases of non-organic nature such as psychiatric disorders and neurosis are specifically excluded. Additionally, brain damage caused due to alcohol consumption is also excluded.
13. Permanent Blindness: The inclusions herein are total, permanent, and irrevocable blindness caused due to an accident or a critical illness. However, complete blindness of both eyes will have to be supported by a corrected visual acuity number of 3/60 in both eyes, a field of vision of 10 degrees (or less) in both eyes, and an incurable blindness that cannot be healed through operations.
14. Third degree burns: The inclusions herein are third-degree burns that cover more than 20% of the body's surface along with scarring. The diagnosis must be made accurately and the total surface area covered must be tested accurately by using standardised, clinically accepted surface area body charts to positively ascertain the percentage of the body covered in third-degree burns.
15. Heart valve repairment or open heart replacement: The inclusion herein is the actual procedure of an open heart valve surgery on the Life Assured, for the purpose of either repairing or replacing more than one (or one) heart valves, as a result of defects in his/her cardiac valves or abnormalities of the same or dysfunction of the cardiac valves due to a certain disease. An echocardiography is mandated in order to support the diagnosis of the valve abnormality. The absolute necessity of the operation has to be confirmed by a medical practitioner or a specialist of the same domain. Exclusions: Techniques that are catheter-based and which include balloon valvotomy/valvuloplasty are specifically excluded.
16. Brain Tumor - Benign: The term benign brain tumor essentially stands for a non-cancerous yet life-threatening tumor that has metastasised in the brain, or in the skull meninges, or in the cranial nerves. The occurrence of this benign brain tumor will have to be supported by medical tests such as CT scan, MRI, and so on. The presence of the tumor will also have to be supported by a certified medical practitioner. The inclusions herein are permanent neurological deficit including severe clinical symptoms that has to have subsisted for a period of at least ninety days. Inclusions also encompass radiation or chemotherapy in order to treat the said tumor or a surgical resection.
17. Exclusions: Artery malformations, granulomas, cysts, abscesses, hematomas, skull bone tumors, pituitary gland tumors, and spinal cord tumors are specifically excluded.

Eligibility Criteria:

The Critical Illness Benefit Rider is attached to the base plan that is offered to the Life Assured. The eligibility criteria of the base plan will be applicable to this plan, along with a few other limits:

1. Minimum entry age for the rider: The life assured should have completed at least 18 years
2. Maximum entry age for the rider: The life assured should have turned 65 years old as of the last birthday
3. Minimum sum assured amount: Rs.1 lakh
4. Maximum sum assured amount: The maximum rider sum assured is equivalent to the base plan's Sum Assured on Death amount. However, it is subject to the maximum amount as fixed in the base policy but will not surpass the amount of Rs.25 lakh.
5. Premium paying terms: The terms for making premium payments are the same as the base plan, however, are subject to the following limitations:
   1. For regular premium policies - 5 to 35 years
   2. For limited premium policies - 5 to (policy term - 1) years
6. Policy term limitations: The limitations to the policy terms are the same as the base plan, however, are subject to the following limits:
   1. For regular premium policies - 5 to 35 years
   2. For limited premium policies - 10 to 35 years
7. Maximum age for cover ceasing: 75 years
8. Mode of premium payment: Same as the base plan

What are premium rates under the rider?

The premium rates under the Critical Illness Benefit Rider are guaranteed by the Corporation for the initial five years since the commencement date of the policy. The future premium rates will however be dependent on revision conducted by the Corporation depending on the experience held by the Corporation under the particular rider. A sample of tabular premium rates per thousand of Critical Illness Sum Assured has been given below:

For regular premium policies:

For limited premium policies:

Grace period of the rider:

The grace period provided under the Critical Illness Benefit Rider will be equivalent to the one offered under the base plan, which is a period of one month, but no less than a timeframe of thirty days for premiums that are paid on a yearly, half-yearly, and quarterly basis towards the rider. A grace period of 15 days is provided in case the premiums are paid on a monthly basis towards the rider.

Revival policy:

The terms and conditions surrounding the revival policy of the base plan will be applicable for the rider as well.

Paid-up value:

No paid-up value is acquired under the rider

Surrender value:

The rider typically does not offer any amount of money on surrender by the Life Assured. However, if a base policy that is in-force and has incorporated the Critical Illness Benefit Rider, is surrendered, then the additional rider premiums will be refunded.

Taxes:

Statutory taxes that are implemented by the Government of India according to the tax law and the rate of tax at that point of time will be applicable to the rider. The GST applicable along with the premium amounts of the rider will be payable by the policyholder. The tax payable will be over and above the total premium amount paid by the policyholder during the term of the policy.

Free look period:

If the 'terms and conditions' of the rider fail to satisfy the policyholder, then he/she will have the full liberty to return the rider to the Corporation. This, however, has to be done within a period of 15 days from from the receiving date of the policy bond. The policyholder will also be required to state his/her reasons for returning the policy to the Corporation. After the request has been placed, the Corporation will nullify the rider and return the total premium amount to the policyholder. However, the proportionate risk premium for Critical Illness Benefits till the receiving date of the returned policy document, medical examination charges, special reports, stamp duty charges, etc., will be deducted.

What are some of the exclusions stated under this rider?

1. The Corporation will not be obliged to cover any critical illness that has occurred due to the following:
   1. Any of the critical disorders that are listed in the policy wherein death of the Life Assured takes place within a period of thirty days from the actual date of diagnosis.
   2. Any condition related to the illnesses that are covered under the rider and which manifests itself within a period of ninety days from the risk commencement date or revival of the risk cover.
   3. Injury that is self-inflicted or an attempt to suicide. The mental condition of the Life Assured in this scenario is not taken into consideration.
   4. Abuse of alcohol or any other substance, except when the same is consumed in quantities strictly prescribed by a certified medical practitioner.
   5. War hostilities of any nature (whether or not war has been declared), civil war, rebellion, civil commotion, riots, and so on.
   6. Injury inflicted because of involvement in a criminal activity.
   7. Any medical condition that pre-existed in the policyholder, which has been diagnosed, or for which the policyholder has received medical advice and subsequent treatment within a period of 48 months before the commencement date or policy revival date.
   8. If the policyholder is HIV positive.
   9. If the policyholder fails to avail treatment for a certain illness, as prescribed by a certified medical practitioner.
   10. If the policyholder is exposed to radiation and contracts contamination, because of a nuclear accident.