GENERAL INSURANCE

Q1 – What is illness?

It means a sickness or a disease or pathological condition leading to the impairment of normal physiological function which manifests itself and requires medical treatment.

Q2 – Please define Critical Illness in respect to policy with exclusions if any?

Critical illness means any diseases which the Insured person is diagnosed to have suffered and are:-

(i) Stroke resulting in Permanent Symptoms: Any cerebrovascular incident producing permanent neurological sequelae. This includes infarction of brain tissue, thrombosis in an intracranial vessel, haemorrhage and embolization from an extracranial source.  Evidence ofk permanent neurological deficit lasting for at least 3 months has to be produced

EXCLUSION:

• Transient ischemic attacks.
• Traumatic injury of the brain.
• Vascular disease affecting only the eye or optic nerve or vestibular functions.

(ii) Cancer of Specified Severity: A malignant tumour characterized by the uncontrolled growth & spread of malignant cells with invasion and destruction of normal tissues. The terms cancer includes leukemia, lymphoma and sarcoma.

EXCLUSION:

• Tumours showing the malignant changes of carcinoma in situ & tumours which are histologically described as premalignant. Carcinoma in situ of breasts, cervical dysplasia CIN-1,CIN-2 & CIN-3.
• Any skin Cancer other than invasive malignant melanoma.
• All tumors of the prostate unless histologically classified as having Gleason score.’
• Papillary micro-carcinoma of the thyroid less than 1 cm in diameter.
• Chronic lymphocytic leukaemia less than RAI stage 3
• Microcarcinoma of the bladder.
• All tumours in the presence of HIV infection.

(iii) Kidney failure requiring regular dialysis: End-stage renal disease presenting as a chronic irreversible failure of both kidneys to function, as a result, which either regular renal dialysis is instituted or renal transplantation is carried out.

(iv) Open Chest CABG: The actual undergoing of open chest surgery for the correction of one or more coronary arteries, which is/are narrowed or blocked, by coronary artery bypass graft (CABG)

EXCLUSION:

• Angioplasty &/or  any other intra-arterial procedures.
• Any Key-hole or laser surgery.

(v) Major Organ/Bone Marrow Transplant: The actual undergoing of a transplant of

(a) One of the following human organs:heart, lung, liver, kidney, pancreas, that resulted from irreversible end-stage failure of the relevant organ or

(b) Human Bone Marrow using haematopoietic stem cells.

EXCLUSION:

• Other stem cell transplants.
• Where only islets of Langerhans are transplanted.

(vi) End Stage Liver Disease: It means an irreversible chronic alteration of the pepatic parenchyma or the biliary ductal system resulting in a life-threatening liver dyfunction.

EXCLUSION:

This coverage is excluded if the etiology of the disease is due to chronic alcohol consumption or any self-inflicted toxic or drug consumption.

(vii) Major Burns: An injury due to any form of burn touching one third (33%) or more of the body area causing in loss of soft tissue resulting in impairment of loss of function of the injured organ.

(viii) Coma of Specified Severity: A state of unconsciousness with no reaction or response to external stimuli or internal needs. This diagnosis must be supported by evidence.