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Aapki Zaroorat
Living with Impaired Health
Toll Free : 1800 2121212 . Email : care@edelweisstokio.in . Visit us at www.edelweisstokio.in
7 Reasons
why choose this plan
Stay protected against
17 Critical Illness
You can claim three times
during the policy term under
Multiclaim option
Get discounts for higher
Sum Assured
Get lump sum benefit on the
diagnosis of Critical Illness
For Multiclaim option; get waiver
of future premiums on occurrence
of first claim and stay protected for
the remaining term of the policy
Simplified benefit design for
better understanding of the
product
1
3
5
2
4
6
Get tax benefits for premium
and claim amount7
Insurance se badhkar hai
aapki zaroorat
Why Edelweiss Tokio Life Insurance?
At Edelweiss Tokio Life Insurance, we realize that your needs
are more important than anything else. That’s why it is our
constant aim to understand your needs first before offering
any advice or even an insurance solution. Your needs, based
on your priorities are first understood, then evaluated
against your future goals so that we are able to ensure that
we can offer you the best solution suited to your needs.
Why Edelweiss Tokio Life - CritiCare+?
Edelweiss Tokio Life – CritiCare+ is a non-participating, non
linked critical illness plan that covers a truly wide range of 17
critical illnesses. In case you are faced with the unfortunate
onset of a critical illness, you will be able to ensure that your
family gets the required support to manage their day-to-
day expenses as well as your health care expenses. Under
the multiclaim option, you can also make claims up to 3
times during the policy term in case you develop any other
Critical Illness from different group. We also ensure that the
future premiums are waived after the first claim so that you
continue to get the benefit of protection for your family.
What can you do?
You can visit our website to get more details about this
offering if it meets your current needs. We offer the
convenience of purchasing this plan online so that you
can complete your financial plan from the comfort of your
home. You can also request for an advisor so that they can
understand your needs and help you prioritize them.
Do reach us at 1800 2121212 or sms NEED to 57575.
Why Critical Illness Plan?
In today’s fast-paced world technology is making rapid
advances. Improvements in our quality of life have
increased our lifespan but the increased stress has also led
to chances of facing a critical illness such as heart attack or
cancer. A critical illness may reduce your ability to continue
working and also put added pressure on account of the
medical expenses involved. Hence, it is important for you
to plan well and ensure that your family does not suffer as
much as you do when you are faced with a serious illness.
An impaired health solution helps you ensure that you
and your family can work towards your recovery to health
without worrying about the finances.
You can avail tax benefits under Section 80D
and Section 10 (10D) of Income Tax Act,
1961. Tax benefits are subject to change in
the tax laws.
Minimum Entry Age								18 years
Maximum Entry Age (Last birthday) 						 65 Years
Maximum Maturity Age (Last birthday) 						 70 Years
Minimum Policy Term 								5 Years
Maximum Policy Term 								30 Years
Premium Paying Term (PPT) 							Regular pay
Premium Payment Frequency 							Annual
Minimum Premium 								Rs 2,000
Minimum Sum Assured 								Rs 5,00,000
Maximum Sum Assured 								Rs 1,00,00,000
Initial Waiting Period 								90 days
Survival Period 									28 days
Waiting Period between claims 							365 days
This is a non participating non-linked health insurance plan providing cover for
Critical Illnesses.
Plan Summary
Initial Waiting Period: Claim for critical illness will only be accepted if the illness has occurred after the expiry of 90 days from
the date of issue/date of revival of policy.
Survival Period: The Life Insured should survive for 28 days from the date of confirmed diagnosis of the Critical Illness. The
diagnosis is confirmed once it is established through medical tests or is certified by a medical practitioner.
Waiting Period between claims: The waiting period between claims is the minimum required time between two critical
illness incidences for Multiclaim option.
Rate reviewability
The premium rates are guaranteed for the first five years and
are reviewable after five years with prior approval from the IRDA
of India.
1
1
2
3
#
2
3
# As per Service Tax law, service tax and education cess will be separately levied on the premium.
5,00,000 -
9,99,000
10,00,000 –
24,99,000
25,00,000
and above
5-19Sum Assured 20-24 25-29 30
Rs. 140
Rs. 70
Rs. 140
Rs. 150
Rs. 73
Rs. 145
Rs. 155
Rs. 78
Rs. 150
Rs. 160
Rs. 83
Rs. 160
Extra Benefits Available:
per Rs. 1,00,000 sum assured exceeding 5 lakh
per Rs. 1,00,000 sum assured exceeding 10 lakh
per Rs. 5,00,000 sum assured exceeding 25 lakh
Discount available for large Sum Assured: Discount rates are given as per the table below:
Open Chest CABG
First Heart Attack - of Specified Severity
Open Heart Replacement OR Repair of Heart Valves
Kidney Failure Requiring Regular Dialysis
Major Organ Transplant (Heart, Kidney)
Stroke Resulting in Permanent Symptoms
Aorta Surgery
Permanent Paralysis of Limbs
Coma of Specified Severity
Major Burns
Total Blindness
Motor Neurone Disease with Permanent Symptoms
Multiple Sclerosis with Persisting Symptoms
Aplastic Anaemia
Cancer of Specified Severity
Benign Brain Tumour
Major Organ Transplant (Bone Marrow, Liver, Lung, Pancreas)
Single Claim option: Under this option, a lump-sum benefit equal to the
Sum Assured will be payable on the survival of life insured for 28 days
following the date of confirmed diagnosis of Critical Illness and the policy
will get terminated.
MultiClaim option: Under this option, the life insured can get benefit for
upto 3 claims. Life insured can claim for Critical Illness only once from one
group. Subsequent to a claim, the Life insured will still be eligible for bene-
fits for critical illnesses falling under the other groups.
The benefits on each claim are as below and are payable on survival of life
insured for 28 days following the date of confirmed diagnosis:
1st Claim – Sum Assured is payable and all future premiums are waived off
2nd Claim – Sum Assured is payable
3rd Claim – Sum Assured is payable and policy will get terminated
When are benefits payable? What are the benefits?
*
Group 1
Group 2 Group 4
Group 3
The product offers two options as follows:
• Single Claim option 	 • MultiClaim option
* Conditions for Critical Illness:
• Claim for critical illness will only be accepted if the illness has occurred after the expiry of 90 days from the date of
issue/date of revival of the policy.
• The life insured should survive for 28 days from the date of confirmed diagnosis of the Critical Illness. The diagnosis is
confirmed once it is established through medical tests or is certified by a medical practitioner.
• 365 days waiting period is the minimum required time between two critical illness claims for MultiClaim option.
The premium rates are guaranteed for the first five years and are reviewable after five years with prior approval from the IRDA
of India.
Benefit Summary
Under this plan, 17 Critical Illnesses are covered.
These Critical Illnesses have been divided in four groups for the multiclaim option as given below:
a) On Critical Illness
(as specified in the table above)
b) On Death of Life Insured during the Policy Term
c) On Maturity of Policy
d) On Surrender of Policy
No benefit is payable
No benefit is payable
No benefit is payable
Critical Illness
Definitions
1. Open Chest CABG
3. Open Heart Replacement OR Repair of Heart Valves
5. Major Organ Transplant (Heart, Kidney)
7. Aorta Surgery
2. First Heart Attack - of Specified Severity
4. Kidney Failure Requiring Regular Dialysis
6. Stroke Resulting in Permanent Symptoms
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). The diagnosis must be supported by a coronary
angiography and the realization of surgery has to be
confirmed by a specialist medical practitioner.
Excluded are:
•	 Angioplasty and/or any other intra-arterial procedures
•	 Any key-hole or laser surgery.
The actual undergoing of open-heart valve surgery
is to replace or repair one or more heart valves, as a
consequence of defects in, abnormalities of, or disease-
affected cardiac valve(s). The diagnosis of the valve
abnormality must be supported by an echocardiography
and the realization of surgery has to be confirmed by a
specialist medical practitioner. Catheter based techniques
including but not limited to, balloon valvotomy/
valvuloplasty are excluded.
The actual undergoing of a transplant of one of the
following human organs: heart or kidney that resulted
from irreversible end-stage failure of the relevant organ.
The undergoing of a transplant has to be confirmed by a
specialist medical practitioner.
The following are excluded:
•	 Other stem-cell transplants are excluded.
Undergoing of a laporotomy or thoracotomy
to repair or correct an aneurysm, narrowing,
obstruction or dissection of the aortic artery. For this
definition, aorta means the thoracic and abdominal
aorta but not its branches. Surgery performed using
only minimally invasive or intraarterial techniques
such as percutaneous endovascular aneurysm repair
are excluded.
The first occurrence of myocardial infarction which
means the death of a portion of the heart muscle as a
result of inadequate blood supply to the relevant area.
The diagnosis for this will be evidenced by all of the
following criteria:
1.	 a history of typical clinical symptoms consistent
with the diagnosis of Acute Myocardial Infarction
(for e.g. typical chest pain)
2.	 new characteristic electrocardiogram changes
3.	 elevation of infarction specific enzymes, Troponins
or other specific biochemical markers.
The following are excluded:
1.	 Non-ST-segment elevation myocardial infarction
(NSTEMI) with elevation of Troponin I or T
2.	 Other acute Coronary Syndromes
3.	 Any type of angina pectoris.
End stage renal disease presenting as chronic
irreversible failure of both kidneys to function, as a result
of which either regular renal dialysis (hemodialysis or
peritoneal dialysis) is instituted or renal transplantation
is carried out. Diagnosis has to be confirmed by a
specialist medical practitioner.
Any cerebrovascular incident producing permanent
neurological sequelae. This includes infarction of
brain tissue, thrombosis in an intracranial vessel,
haemorrhage and embolisation from an extracranial
source. Diagnosis has to be confirmed by a specialist
medical practitioner and evidenced by typical clinical
symptoms as well as typical findings in CT Scan or MRI
of the brain. Evidence of permanent neurological deficit
lasting for atleast 3 months has to be produced.
The following are excluded:
•	 Transient ischemic attacks (TIA)
•	 Traumatic injury of the brain
•	 Vascular disease affecting only the eye or optic nerve
or vestibular functions.
8. Permanent Paralysis of Limbs
10. Major Burns
12. Aplastic Anaemia
14. Benign Brain Tumour
9. Coma of Specified Severity
11. Total Blindness
13. Cancer of Specified Severity
Total and irreversible loss of use of two or more limbs as
a result of injury or disease of the brain or spinal cord. A
specialist medical practitioner must be of the opinion
that the paralysis will be permanent with no hope of
recovery and must be present for more than 3 months.
There must be third-degree burns with scarring that
cover at least 20% of the body’s surface area. A certified
physician must confirm the diagnosis and the total area
involved using standardized, clinically accepted, body
surface area charts.
Chronic persistent bone marrow failure which results
in Anaemia, Neutropenia and Thrombocytopenia
requiring treatment with at least one of the following:
•	 Regular Blood Product Transfusion
•	 Marrow Stimulating Agents
•	 Immunosuppressive Agents or
•	 Bone Marrow Transplantation
The diagnosis and suggested line of treatment must be
confirmed by a Haematologist using relevant laboratory
investigations including Bone Marrow Biopsy. Two out
of the following three values should be present:
•	 Absolute Neutrophil count of 500 per cubic
millimetre or less;
•	 Absolute Reticulocyte count of 20,000 per cubic
millimetre or less; and
•	 Platelet count of 20,000 per cubic millimetre or less.
A benign tumour in the brain where all of the following
conditions are met:
• The tumour is life threatening;
• It has caused damage to the brain;
• It has undergone surgical removal or, if inoperable,
has caused a permanent neurological deficit; and
•	 Its presence must be confirmed by a neurologist
or neurosurgeon and supported by findings on
Magnetic Resonance Imaging, Computerised
Tomography, or other reliable imaging techniques.
•	 The following are excluded:
•	 Cysts
•	 Granulomas
•	 Vascular Malformations
•	 Haematomas;
•	 Tumours of the pituitary gland or spinal cord; and
•	 Tumours of Acoustic Nerve (Acoustic Neuroma)
A state of unconsciousness with no reaction or response
to external stimuli or internal needs. This diagnosis must
be supported by evidence of all of the following:
• No response to external stimuli continuously for at least
96 hours;
• Life support measures are necessary to sustain life; and
• Permanent neurological deficit which must be assessed
at least 30 days after the onset of the coma.
The condition has to be confirmed by a specialist medical
practitioner. Coma resulting directly from alcohol or drug
abuse is excluded.
Total, permanent and irreversible loss of all vision in both
eyes as a result of illness or accident. The diagnosis must
be clinically confirmed by an appropriate consultant. The
blindness must not be correctable by aides
or surgical procedures.
A malignant tumour characterised by the uncontrolled
growth & spread of malignant cells with invasion &
destruction of normal tissues. This diagnosis must be
supported by histological evidence of malignancy &
confirmed by a pathologist. The term cancer includes
leukemia, lymphoma and sarcoma.
The following cancers are excluded:
• Tumours showing the malignant changes of
carcinoma in situ & tumours which are histologically
described as premalignant or non invasive, including
but not limited to:
• Carcinoma in situ of breasts, Cervical dysplasia CIN-1,
CIN -2 & CIN-3.
• Any skin cancer other than invasive malignant
melanoma
• All tumours of the prostate unless histologically
classified as having a Gleason score greater than 6 or
having progressed to at least clinical TNM
classification T2N0M0.........
• Papillary micro - carcinoma of the thyroid less than 1
cm in diameter
• Chronic lymphocyctic leukaemia less than RAI stage 3
• Microcarcinoma of the bladder
• All tumours in the presence of HIV infection.
15. Major Organ Transplant
(Bone Marrow, Liver, Lung, Pancreas)
16. Motor Neurone Disease with Permanent Symptoms
17. Multiple Sclerosis with Persisting Symptoms
The actual undergoing of a transplant of:
--- One of the following human organs: lung, pancreas
or liver, that resulted from irreversible end-stage failure
of the relevant organ, or
--- Human bone marrow using haematopoietic
stem cells. The undergoing of a transplant has to be
confirmed by a specialist medical practitioner.
The following are excluded:
•	 Other stem-cell transplants are excluded.
•	 Where only islets of langerhans are transplanted
Motor neurone disease diagnosed by a specialist
medical practitioner as spinal muscular atrophy,
progressive bulbar palsy, amyotrophic lateral sclerosis
or primary lateral sclerosis. There must be progressive
degeneration of corticospinal tracts and anterior horn
cells or bulbar efferent neurons. There must be current
significant and permanent functional neurological
impairment with objective evidence of motor
dysfunction that has persisted for a continuous period
of at least 3 months.
The definite occurrence of multiple sclerosis. The
diagnosis must be supported by all of the following:
• Investigations including typical MRI and CSF findings,
which unequivocally confirm the diagnosis to be
multiple sclerosis;
• There must be current clinical impairment of motor
or sensory function, which must have persisted for a
continuous period of at least 6 months, and
• Well documented clinical history of exacerbations
and remissions of said symptoms or neurological
deficits with atleast two clinically documented
episodes atleast one month apart.
Other causes of neurological damage such as SLE and
HIV are excluded.
Apart from the exclusions mentioned in the definitions section, the following exclusions shall apply to the benefits
admissible under this policy.
•	 Any critical illness or its signs or symptoms having occurred within 90 days of policy issue date.
•	 For a policy which was lapsed and has subsequently been revived, any critical illness or its signs or symptoms
having occurred within 90 days of revival date.
•	 For all pre-existing diseases or health conditions at proposal stage or reinstatement*, the benefits would be
available after 48 months from date of commencement or reinstatement*. (Pre-existing illness is defined as
“any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were
diagnosed, and / or received medical advice / treatment within 48 months to prior to the first policy issued by
the insurer.”
*Reinstatement would be applicable only for policies which were lapsed and subsequently been revived
•	 Unreasonable failure to seek or follow medical advice.
•	 Existence of any sexually Transmitted Disease (STD) and its related complications or Acquired Immune
Deficiency Syndrome (AIDS) or the presence of any Human Immuno-deficiency Virus (HIV).
•	 Self-inflicted injuries, attempted suicide, insanity, and immorality, and deliberate participation of the life
insured in an illegal or criminal act.
•	 Use of intoxicating drugs / alcohol / solvent, taking of drugs except under the direction of a qualified medical
practitioner.
•	 War – whether declared or not, civil commotion, breach of law, invasion, hostilities (whether war is declared or
not), rebellion, revolution, military or usurped power or wilful participation in acts of violence.
•	 Radioactive contamination due to nuclear accident.
•	 Engaging in hazardous sports / pastimes, i.e. taking part in (or practising for) boxing, caving, climbing, horse
racing, jet skiing, martial arts, mountaineering, off pastel skiing, pot holing, power boat racing, underwater
diving, yacht racing or any race, trial or timed motor sport, bungee jumping, hand gliding etc. or Any injury,
sickness or disease received as a result of aviation (including parachuting or skydiving), gliding or any form
of aerial flight other than as a fare-paying passenger on regular routes and on a scheduled timetable unless
agreed by special endorsement.
Critical Illness Exclusions
Statutory Information
Suicide Claim
Nomination and Assignment
Grace Period
If the life insured, whether sane or insane, commits
suicide, within one year from the date of issuance
or from the date of revival, then the policy shall be
void and 80% of the premiums received (excluding
extra mortality premium) will be payable, provided
the policy is in force on the date of death.
Nomination:
If policyholder is also the life insured, he/she can make a nomination at any time before the Maturity or
Termination date of the policy under section 39 of the Insurance Act, 1938 as amended by the Insurance
laws (Amendment) Ordinance, 2014 for the purpose of payment of the money secured by the policy in the
event of his/ her death. Where the nominee is a minor, he/she may also appoint an appointee i.e. a person to
receive the money during the minority of the nominee. Any change of nomination, which may be effected
before the Maturity or Termination Date of policy shall also be communicated to the Company.
Assignment:
Assignment, if applicable, may be done as per Section 38 of the Insurance Act 1938, as amended by The
Insurance laws (Amendment) Ordinance, 2014 and any other amendments from time to time.
Grace period is of 30 days.
The policy will remain in force during the grace
period without loss of continuity benefits such
as waiting periods and coverage of pre-existing
diseases. Coverage is not available for the period
for which no premium is received. If any premium
remains unpaid at the end of the grace period, the
policy shall lapse.
After you receive your policy, please go through it carefully to check the coverage amount, policy specifications
and the other terms and conditions under the policy. If you are disagreeable with the terms and conditions, you
can return the policy within 15 days* from the date of receiving your policy, stating the reason for your
cancellation. Premium paid will be refunded after deducting proportionate risk premium, stamp duty and cost of
medical expenses, if any.
* Free look period of 30 days will be applicable for policies sold through distance marketing (where distance
marketing means sale of insurance products through any means of communication other than in person).
Free Look Period
Revival Prohibition of Rebate: Non Disclosure Clause:
If premiums are not paid within the
grace period, the policy will lapse.
The policy may be revived within
two years from the date of the first
unpaid premium. The revival will
be considered on receipt of written
application from the policyholder
along with the proof of continued
insurability of life insured and on
payment of all overdue premiums.
Company will charge simple interest
of 1% per month, as decided from
time to time, on the unpaid premium
for every completed month from the
date of first unpaid premium. The
rate of interest would be reviewed
subject to board approval. The proof
of continued insurability and medical
examination if required (medical
examination cost to be borne by the
policyholder) and the results thereof
would be interpreted and if the life
is acceptable from the underwriting
point of view then it will be allowed
to revive. Revival would be as per
Board approved underwriting
guidelines. All the benefits of the
policy will be reinstated on the
policy revival.
(SECTION 41 OF INSURANCE ACT 1938
AS AMENDED BY THE INSURANCE
LAWS (AMENDMENT) ORDINANCE,
2014) No person shall allow or offer to
allow, either directly or indirectly, as
an inducement to any person to take
out or renew or continue an Insurance
in respect of any kind of risk relating
to lives in India, any rebate of the
whole or part of the commission
payable or any rebate of the premium
shown on the policy nor shall any
person taking out or renewing or
continuing a policy accept any rebate
except one such rebate as may be
allowed in accordance with the
published prospectus or tables of the
Insurer. Any person making default in
complying with the provisions of this
section shall be liable with a penalty
which may extend to ten lakh rupees.
(SECTION 45 OF INSURANCE ACT 1938 AS AMENDED
BY THE INSURANCE LAWS (AMENDMENT) ORDINANCE,
2014 AND ANY OTHER AMENDMENTS FROM TIME TO
TIME)
(1) No policy of life insurance shall be called in question
on any ground whatsoever after the expiry of three
years from the date of the policy, i.e., from the date of
issuance of the policy or the date of commencement of
risk or the date of revival of the policy or the date of the
rider to the policy, whichever is later.
(2) A policy of life insurance may be called in question
at any time within three years from the date of issuance
of the policy or the date of commencement of risk or
the date of revival of the policy or the date of the rider
to the policy, whichever is later, on the ground of fraud:
Provided that the insurer shall have to communicate
in writing to the insured or the legal representatives or
nominees or assignees of the insured the grounds and
materials on which such decision in based.
(3) Notwithstanding anything contained in sub-
section(2), no insurer shall repudiate a life insurance
policy on the ground of fraud if the insured can prove
that the mis-statement of or suppression of a material
fact was true to the best of his knowledge and belief or
that there was no deliberate intention to suppress the
fact or that such mis-statement of or suppression of a
material fact are within the knowledge of the insurer:
Provided that in case of fraud, the onus of disproving
lies upon the beneficiaries, in case the policyholder is
not alive.
(4) A policy of life insurance may be called in question
at any time within three years from the date of issuance
of the policy or the date of commencement of risk or
the date of revival of the policy or the date of the rider
to the policy, whichever is later, on the ground that any
statement of or suppression of a fact material to the
expectancy of the life of the insured was incorrectly
made in the proposal or other document on the basis
of which the policy was issued or revived or rider
issued:
Provided that the insurer shall have to communicate
in writing to the insured or the legal representatives
or nominees or assignees of the insured the grounds
and materials on which such decision to repudiate the
policy of life insurance is based:
Provided further that in case of repudiation of the
policy on the ground of misstatement or suppression
of a material fact, and not on the ground of fraud,
the premiums collected on the policy till the date of
repudiation shall be paid to the insured or the legal
representatives or nominees or assignees of the
insured within a period of ninety days from the date of
such repudiation.
(5) Nothing in this section shall prevent the insurer
from calling for proof of age at any time if he is entitled
to do so, and no policy shall be deemed to be called
in question merely because the terms of the policy are
adjusted on subsequent proof that the age of the life
insured was incorrectly stated in the proposal.
Corporate Identity Number: U66010MH2009PLC197336
Edelweiss House, Off CST Road, Kalina, Mumbai 400098
Tel: +91 22 4088 6015 . Fax No.: +91 22 4342 8161 . Toll Free : 1800 2121212
care@edelweisstokio.in . www.edelweisstokio.in
Edelweiss Tokio Life Insurance Company Limited
Edelweiss Tokio Life Insurance is a new generation Insurance Company, set up with a start up capital of INR 550 Crores, thereby showing our commitment to
building a long term sustainable business focused on a consumer centric approach. The company is a joint venture between Edelweiss Financial Services, one of
India’s leading diversified financial services companies with business straddling across Credit, Capital Markets, Asset Management, Housing finance and Insurance
and Tokio Marine Holdings Inc, one of the oldest and the biggest Insurance companies in Japan now with presence across 39 countries around the world.
As a part of the company’s corporate philosophy of customer centricity, our products have been developed based on our understanding of Indian customers’
diverse financial needs and help them through all their life stages.
Edelweiss Tokio Life – CritiCare+ is only the name of the
non participating non linked critical illness plan and does
not in any way indicate the quality of the contract, its future
prospects, or returns. Please know the associated risks and the
applicable charges from your Personal Financial Advisor or the
Intermediary. Tax benefits are subject to changes in the tax
laws. Insurance is the subject matter of the solicitation.
Flower & Edelweiss (as displayed above) are trademarks of
Edelweiss Financial Services Limited;“Tokio”is Trademark of
Tokio Marine Holdings Inc. and used by Edelweiss Tokio Life
Insurance Co. Ltd. under license.
BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/
FRAUDULENT OFFERS
IRDA of India clarifies to public that
– IRDA of India or its officials do not involve in activities like
sale of any kind of insurance or financial products nor invest
premiums.
– IRDA of India does not announce any bonus. Public
receiving such phone calls are requested to lodge a police
complaint along with details of phone call, number.
Reg. No.: 147
UIN: 147N030V01
Advt No.: Br/100/Feb 2015 ver. 1
Toll Free : 1800 2121212 . Email : care@edelweisstokio.in . Visit us at www.edelweisstokio.in
Disclaimer:

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7 Reasons why we choose term plan

  • 1. Aapki Zaroorat Living with Impaired Health Toll Free : 1800 2121212 . Email : care@edelweisstokio.in . Visit us at www.edelweisstokio.in
  • 2. 7 Reasons why choose this plan Stay protected against 17 Critical Illness You can claim three times during the policy term under Multiclaim option Get discounts for higher Sum Assured Get lump sum benefit on the diagnosis of Critical Illness For Multiclaim option; get waiver of future premiums on occurrence of first claim and stay protected for the remaining term of the policy Simplified benefit design for better understanding of the product 1 3 5 2 4 6 Get tax benefits for premium and claim amount7
  • 3. Insurance se badhkar hai aapki zaroorat Why Edelweiss Tokio Life Insurance? At Edelweiss Tokio Life Insurance, we realize that your needs are more important than anything else. That’s why it is our constant aim to understand your needs first before offering any advice or even an insurance solution. Your needs, based on your priorities are first understood, then evaluated against your future goals so that we are able to ensure that we can offer you the best solution suited to your needs. Why Edelweiss Tokio Life - CritiCare+? Edelweiss Tokio Life – CritiCare+ is a non-participating, non linked critical illness plan that covers a truly wide range of 17 critical illnesses. In case you are faced with the unfortunate onset of a critical illness, you will be able to ensure that your family gets the required support to manage their day-to- day expenses as well as your health care expenses. Under the multiclaim option, you can also make claims up to 3 times during the policy term in case you develop any other Critical Illness from different group. We also ensure that the future premiums are waived after the first claim so that you continue to get the benefit of protection for your family. What can you do? You can visit our website to get more details about this offering if it meets your current needs. We offer the convenience of purchasing this plan online so that you can complete your financial plan from the comfort of your home. You can also request for an advisor so that they can understand your needs and help you prioritize them. Do reach us at 1800 2121212 or sms NEED to 57575. Why Critical Illness Plan? In today’s fast-paced world technology is making rapid advances. Improvements in our quality of life have increased our lifespan but the increased stress has also led to chances of facing a critical illness such as heart attack or cancer. A critical illness may reduce your ability to continue working and also put added pressure on account of the medical expenses involved. Hence, it is important for you to plan well and ensure that your family does not suffer as much as you do when you are faced with a serious illness. An impaired health solution helps you ensure that you and your family can work towards your recovery to health without worrying about the finances. You can avail tax benefits under Section 80D and Section 10 (10D) of Income Tax Act, 1961. Tax benefits are subject to change in the tax laws.
  • 4. Minimum Entry Age 18 years Maximum Entry Age (Last birthday) 65 Years Maximum Maturity Age (Last birthday) 70 Years Minimum Policy Term 5 Years Maximum Policy Term 30 Years Premium Paying Term (PPT) Regular pay Premium Payment Frequency Annual Minimum Premium Rs 2,000 Minimum Sum Assured Rs 5,00,000 Maximum Sum Assured Rs 1,00,00,000 Initial Waiting Period 90 days Survival Period 28 days Waiting Period between claims 365 days This is a non participating non-linked health insurance plan providing cover for Critical Illnesses. Plan Summary Initial Waiting Period: Claim for critical illness will only be accepted if the illness has occurred after the expiry of 90 days from the date of issue/date of revival of policy. Survival Period: The Life Insured should survive for 28 days from the date of confirmed diagnosis of the Critical Illness. The diagnosis is confirmed once it is established through medical tests or is certified by a medical practitioner. Waiting Period between claims: The waiting period between claims is the minimum required time between two critical illness incidences for Multiclaim option. Rate reviewability The premium rates are guaranteed for the first five years and are reviewable after five years with prior approval from the IRDA of India. 1 1 2 3 # 2 3 # As per Service Tax law, service tax and education cess will be separately levied on the premium. 5,00,000 - 9,99,000 10,00,000 – 24,99,000 25,00,000 and above 5-19Sum Assured 20-24 25-29 30 Rs. 140 Rs. 70 Rs. 140 Rs. 150 Rs. 73 Rs. 145 Rs. 155 Rs. 78 Rs. 150 Rs. 160 Rs. 83 Rs. 160 Extra Benefits Available: per Rs. 1,00,000 sum assured exceeding 5 lakh per Rs. 1,00,000 sum assured exceeding 10 lakh per Rs. 5,00,000 sum assured exceeding 25 lakh Discount available for large Sum Assured: Discount rates are given as per the table below:
  • 5. Open Chest CABG First Heart Attack - of Specified Severity Open Heart Replacement OR Repair of Heart Valves Kidney Failure Requiring Regular Dialysis Major Organ Transplant (Heart, Kidney) Stroke Resulting in Permanent Symptoms Aorta Surgery Permanent Paralysis of Limbs Coma of Specified Severity Major Burns Total Blindness Motor Neurone Disease with Permanent Symptoms Multiple Sclerosis with Persisting Symptoms Aplastic Anaemia Cancer of Specified Severity Benign Brain Tumour Major Organ Transplant (Bone Marrow, Liver, Lung, Pancreas) Single Claim option: Under this option, a lump-sum benefit equal to the Sum Assured will be payable on the survival of life insured for 28 days following the date of confirmed diagnosis of Critical Illness and the policy will get terminated. MultiClaim option: Under this option, the life insured can get benefit for upto 3 claims. Life insured can claim for Critical Illness only once from one group. Subsequent to a claim, the Life insured will still be eligible for bene- fits for critical illnesses falling under the other groups. The benefits on each claim are as below and are payable on survival of life insured for 28 days following the date of confirmed diagnosis: 1st Claim – Sum Assured is payable and all future premiums are waived off 2nd Claim – Sum Assured is payable 3rd Claim – Sum Assured is payable and policy will get terminated When are benefits payable? What are the benefits? * Group 1 Group 2 Group 4 Group 3 The product offers two options as follows: • Single Claim option • MultiClaim option * Conditions for Critical Illness: • Claim for critical illness will only be accepted if the illness has occurred after the expiry of 90 days from the date of issue/date of revival of the policy. • The life insured should survive for 28 days from the date of confirmed diagnosis of the Critical Illness. The diagnosis is confirmed once it is established through medical tests or is certified by a medical practitioner. • 365 days waiting period is the minimum required time between two critical illness claims for MultiClaim option. The premium rates are guaranteed for the first five years and are reviewable after five years with prior approval from the IRDA of India. Benefit Summary Under this plan, 17 Critical Illnesses are covered. These Critical Illnesses have been divided in four groups for the multiclaim option as given below: a) On Critical Illness (as specified in the table above) b) On Death of Life Insured during the Policy Term c) On Maturity of Policy d) On Surrender of Policy No benefit is payable No benefit is payable No benefit is payable
  • 6. Critical Illness Definitions 1. Open Chest CABG 3. Open Heart Replacement OR Repair of Heart Valves 5. Major Organ Transplant (Heart, Kidney) 7. Aorta Surgery 2. First Heart Attack - of Specified Severity 4. Kidney Failure Requiring Regular Dialysis 6. Stroke Resulting in Permanent Symptoms 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). The diagnosis must be supported by a coronary angiography and the realization of surgery has to be confirmed by a specialist medical practitioner. Excluded are: • Angioplasty and/or any other intra-arterial procedures • Any key-hole or laser surgery. The actual undergoing of open-heart valve surgery is to replace or repair one or more heart valves, as a consequence of defects in, abnormalities of, or disease- affected cardiac valve(s). The diagnosis of the valve abnormality must be supported by an echocardiography and the realization of surgery has to be confirmed by a specialist medical practitioner. Catheter based techniques including but not limited to, balloon valvotomy/ valvuloplasty are excluded. The actual undergoing of a transplant of one of the following human organs: heart or kidney that resulted from irreversible end-stage failure of the relevant organ. The undergoing of a transplant has to be confirmed by a specialist medical practitioner. The following are excluded: • Other stem-cell transplants are excluded. Undergoing of a laporotomy or thoracotomy to repair or correct an aneurysm, narrowing, obstruction or dissection of the aortic artery. For this definition, aorta means the thoracic and abdominal aorta but not its branches. Surgery performed using only minimally invasive or intraarterial techniques such as percutaneous endovascular aneurysm repair are excluded. The first occurrence of myocardial infarction which means the death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis for this will be evidenced by all of the following criteria: 1. a history of typical clinical symptoms consistent with the diagnosis of Acute Myocardial Infarction (for e.g. typical chest pain) 2. new characteristic electrocardiogram changes 3. elevation of infarction specific enzymes, Troponins or other specific biochemical markers. The following are excluded: 1. Non-ST-segment elevation myocardial infarction (NSTEMI) with elevation of Troponin I or T 2. Other acute Coronary Syndromes 3. Any type of angina pectoris. End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis (hemodialysis or peritoneal dialysis) is instituted or renal transplantation is carried out. Diagnosis has to be confirmed by a specialist medical practitioner. Any cerebrovascular incident producing permanent neurological sequelae. This includes infarction of brain tissue, thrombosis in an intracranial vessel, haemorrhage and embolisation from an extracranial source. Diagnosis has to be confirmed by a specialist medical practitioner and evidenced by typical clinical symptoms as well as typical findings in CT Scan or MRI of the brain. Evidence of permanent neurological deficit lasting for atleast 3 months has to be produced. The following are excluded: • Transient ischemic attacks (TIA) • Traumatic injury of the brain • Vascular disease affecting only the eye or optic nerve or vestibular functions.
  • 7. 8. Permanent Paralysis of Limbs 10. Major Burns 12. Aplastic Anaemia 14. Benign Brain Tumour 9. Coma of Specified Severity 11. Total Blindness 13. Cancer of Specified Severity Total and irreversible loss of use of two or more limbs as a result of injury or disease of the brain or spinal cord. A specialist medical practitioner must be of the opinion that the paralysis will be permanent with no hope of recovery and must be present for more than 3 months. There must be third-degree burns with scarring that cover at least 20% of the body’s surface area. A certified physician must confirm the diagnosis and the total area involved using standardized, clinically accepted, body surface area charts. Chronic persistent bone marrow failure which results in Anaemia, Neutropenia and Thrombocytopenia requiring treatment with at least one of the following: • Regular Blood Product Transfusion • Marrow Stimulating Agents • Immunosuppressive Agents or • Bone Marrow Transplantation The diagnosis and suggested line of treatment must be confirmed by a Haematologist using relevant laboratory investigations including Bone Marrow Biopsy. Two out of the following three values should be present: • Absolute Neutrophil count of 500 per cubic millimetre or less; • Absolute Reticulocyte count of 20,000 per cubic millimetre or less; and • Platelet count of 20,000 per cubic millimetre or less. A benign tumour in the brain where all of the following conditions are met: • The tumour is life threatening; • It has caused damage to the brain; • It has undergone surgical removal or, if inoperable, has caused a permanent neurological deficit; and • Its presence must be confirmed by a neurologist or neurosurgeon and supported by findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques. • The following are excluded: • Cysts • Granulomas • Vascular Malformations • Haematomas; • Tumours of the pituitary gland or spinal cord; and • Tumours of Acoustic Nerve (Acoustic Neuroma) A state of unconsciousness with no reaction or response to external stimuli or internal needs. This diagnosis must be supported by evidence of all of the following: • No response to external stimuli continuously for at least 96 hours; • Life support measures are necessary to sustain life; and • Permanent neurological deficit which must be assessed at least 30 days after the onset of the coma. The condition has to be confirmed by a specialist medical practitioner. Coma resulting directly from alcohol or drug abuse is excluded. Total, permanent and irreversible loss of all vision in both eyes as a result of illness or accident. The diagnosis must be clinically confirmed by an appropriate consultant. The blindness must not be correctable by aides or surgical procedures. A malignant tumour characterised by the uncontrolled growth & spread of malignant cells with invasion & destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy & confirmed by a pathologist. The term cancer includes leukemia, lymphoma and sarcoma. The following cancers are excluded: • Tumours showing the malignant changes of carcinoma in situ & tumours which are histologically described as premalignant or non invasive, including but not limited to: • Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 & CIN-3. • Any skin cancer other than invasive malignant melanoma • All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0......... • Papillary micro - carcinoma of the thyroid less than 1 cm in diameter • Chronic lymphocyctic leukaemia less than RAI stage 3 • Microcarcinoma of the bladder • All tumours in the presence of HIV infection.
  • 8. 15. Major Organ Transplant (Bone Marrow, Liver, Lung, Pancreas) 16. Motor Neurone Disease with Permanent Symptoms 17. Multiple Sclerosis with Persisting Symptoms The actual undergoing of a transplant of: --- One of the following human organs: lung, pancreas or liver, that resulted from irreversible end-stage failure of the relevant organ, or --- Human bone marrow using haematopoietic stem cells. The undergoing of a transplant has to be confirmed by a specialist medical practitioner. The following are excluded: • Other stem-cell transplants are excluded. • Where only islets of langerhans are transplanted Motor neurone disease diagnosed by a specialist medical practitioner as spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis. There must be progressive degeneration of corticospinal tracts and anterior horn cells or bulbar efferent neurons. There must be current significant and permanent functional neurological impairment with objective evidence of motor dysfunction that has persisted for a continuous period of at least 3 months. The definite occurrence of multiple sclerosis. The diagnosis must be supported by all of the following: • Investigations including typical MRI and CSF findings, which unequivocally confirm the diagnosis to be multiple sclerosis; • There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months, and • Well documented clinical history of exacerbations and remissions of said symptoms or neurological deficits with atleast two clinically documented episodes atleast one month apart. Other causes of neurological damage such as SLE and HIV are excluded.
  • 9. Apart from the exclusions mentioned in the definitions section, the following exclusions shall apply to the benefits admissible under this policy. • Any critical illness or its signs or symptoms having occurred within 90 days of policy issue date. • For a policy which was lapsed and has subsequently been revived, any critical illness or its signs or symptoms having occurred within 90 days of revival date. • For all pre-existing diseases or health conditions at proposal stage or reinstatement*, the benefits would be available after 48 months from date of commencement or reinstatement*. (Pre-existing illness is defined as “any condition, ailment or injury or related condition(s) for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice / treatment within 48 months to prior to the first policy issued by the insurer.” *Reinstatement would be applicable only for policies which were lapsed and subsequently been revived • Unreasonable failure to seek or follow medical advice. • Existence of any sexually Transmitted Disease (STD) and its related complications or Acquired Immune Deficiency Syndrome (AIDS) or the presence of any Human Immuno-deficiency Virus (HIV). • Self-inflicted injuries, attempted suicide, insanity, and immorality, and deliberate participation of the life insured in an illegal or criminal act. • Use of intoxicating drugs / alcohol / solvent, taking of drugs except under the direction of a qualified medical practitioner. • War – whether declared or not, civil commotion, breach of law, invasion, hostilities (whether war is declared or not), rebellion, revolution, military or usurped power or wilful participation in acts of violence. • Radioactive contamination due to nuclear accident. • Engaging in hazardous sports / pastimes, i.e. taking part in (or practising for) boxing, caving, climbing, horse racing, jet skiing, martial arts, mountaineering, off pastel skiing, pot holing, power boat racing, underwater diving, yacht racing or any race, trial or timed motor sport, bungee jumping, hand gliding etc. or Any injury, sickness or disease received as a result of aviation (including parachuting or skydiving), gliding or any form of aerial flight other than as a fare-paying passenger on regular routes and on a scheduled timetable unless agreed by special endorsement. Critical Illness Exclusions
  • 10. Statutory Information Suicide Claim Nomination and Assignment Grace Period If the life insured, whether sane or insane, commits suicide, within one year from the date of issuance or from the date of revival, then the policy shall be void and 80% of the premiums received (excluding extra mortality premium) will be payable, provided the policy is in force on the date of death. Nomination: If policyholder is also the life insured, he/she can make a nomination at any time before the Maturity or Termination date of the policy under section 39 of the Insurance Act, 1938 as amended by the Insurance laws (Amendment) Ordinance, 2014 for the purpose of payment of the money secured by the policy in the event of his/ her death. Where the nominee is a minor, he/she may also appoint an appointee i.e. a person to receive the money during the minority of the nominee. Any change of nomination, which may be effected before the Maturity or Termination Date of policy shall also be communicated to the Company. Assignment: Assignment, if applicable, may be done as per Section 38 of the Insurance Act 1938, as amended by The Insurance laws (Amendment) Ordinance, 2014 and any other amendments from time to time. Grace period is of 30 days. The policy will remain in force during the grace period without loss of continuity benefits such as waiting periods and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received. If any premium remains unpaid at the end of the grace period, the policy shall lapse. After you receive your policy, please go through it carefully to check the coverage amount, policy specifications and the other terms and conditions under the policy. If you are disagreeable with the terms and conditions, you can return the policy within 15 days* from the date of receiving your policy, stating the reason for your cancellation. Premium paid will be refunded after deducting proportionate risk premium, stamp duty and cost of medical expenses, if any. * Free look period of 30 days will be applicable for policies sold through distance marketing (where distance marketing means sale of insurance products through any means of communication other than in person). Free Look Period
  • 11. Revival Prohibition of Rebate: Non Disclosure Clause: If premiums are not paid within the grace period, the policy will lapse. The policy may be revived within two years from the date of the first unpaid premium. The revival will be considered on receipt of written application from the policyholder along with the proof of continued insurability of life insured and on payment of all overdue premiums. Company will charge simple interest of 1% per month, as decided from time to time, on the unpaid premium for every completed month from the date of first unpaid premium. The rate of interest would be reviewed subject to board approval. The proof of continued insurability and medical examination if required (medical examination cost to be borne by the policyholder) and the results thereof would be interpreted and if the life is acceptable from the underwriting point of view then it will be allowed to revive. Revival would be as per Board approved underwriting guidelines. All the benefits of the policy will be reinstated on the policy revival. (SECTION 41 OF INSURANCE ACT 1938 AS AMENDED BY THE INSURANCE LAWS (AMENDMENT) ORDINANCE, 2014) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an Insurance in respect of any kind of risk relating to lives in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy nor shall any person taking out or renewing or continuing a policy accept any rebate except one such rebate as may be allowed in accordance with the published prospectus or tables of the Insurer. Any person making default in complying with the provisions of this section shall be liable with a penalty which may extend to ten lakh rupees. (SECTION 45 OF INSURANCE ACT 1938 AS AMENDED BY THE INSURANCE LAWS (AMENDMENT) ORDINANCE, 2014 AND ANY OTHER AMENDMENTS FROM TIME TO TIME) (1) No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the date of the policy, i.e., from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later. (2) A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground of fraud: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision in based. (3) Notwithstanding anything contained in sub- section(2), no insurer shall repudiate a life insurance policy on the ground of fraud if the insured can prove that the mis-statement of or suppression of a material fact was true to the best of his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis-statement of or suppression of a material fact are within the knowledge of the insurer: Provided that in case of fraud, the onus of disproving lies upon the beneficiaries, in case the policyholder is not alive. (4) A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever is later, on the ground that any statement of or suppression of a fact material to the expectancy of the life of the insured was incorrectly made in the proposal or other document on the basis of which the policy was issued or revived or rider issued: Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or nominees or assignees of the insured the grounds and materials on which such decision to repudiate the policy of life insurance is based: Provided further that in case of repudiation of the policy on the ground of misstatement or suppression of a material fact, and not on the ground of fraud, the premiums collected on the policy till the date of repudiation shall be paid to the insured or the legal representatives or nominees or assignees of the insured within a period of ninety days from the date of such repudiation. (5) Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof that the age of the life insured was incorrectly stated in the proposal.
  • 12. Corporate Identity Number: U66010MH2009PLC197336 Edelweiss House, Off CST Road, Kalina, Mumbai 400098 Tel: +91 22 4088 6015 . Fax No.: +91 22 4342 8161 . Toll Free : 1800 2121212 care@edelweisstokio.in . www.edelweisstokio.in Edelweiss Tokio Life Insurance Company Limited Edelweiss Tokio Life Insurance is a new generation Insurance Company, set up with a start up capital of INR 550 Crores, thereby showing our commitment to building a long term sustainable business focused on a consumer centric approach. The company is a joint venture between Edelweiss Financial Services, one of India’s leading diversified financial services companies with business straddling across Credit, Capital Markets, Asset Management, Housing finance and Insurance and Tokio Marine Holdings Inc, one of the oldest and the biggest Insurance companies in Japan now with presence across 39 countries around the world. As a part of the company’s corporate philosophy of customer centricity, our products have been developed based on our understanding of Indian customers’ diverse financial needs and help them through all their life stages. Edelweiss Tokio Life – CritiCare+ is only the name of the non participating non linked critical illness plan and does not in any way indicate the quality of the contract, its future prospects, or returns. Please know the associated risks and the applicable charges from your Personal Financial Advisor or the Intermediary. Tax benefits are subject to changes in the tax laws. Insurance is the subject matter of the solicitation. Flower & Edelweiss (as displayed above) are trademarks of Edelweiss Financial Services Limited;“Tokio”is Trademark of Tokio Marine Holdings Inc. and used by Edelweiss Tokio Life Insurance Co. Ltd. under license. BEWARE OF SPURIOUS PHONE CALLS AND FICTITIOUS/ FRAUDULENT OFFERS IRDA of India clarifies to public that – IRDA of India or its officials do not involve in activities like sale of any kind of insurance or financial products nor invest premiums. – IRDA of India does not announce any bonus. Public receiving such phone calls are requested to lodge a police complaint along with details of phone call, number. Reg. No.: 147 UIN: 147N030V01 Advt No.: Br/100/Feb 2015 ver. 1 Toll Free : 1800 2121212 . Email : care@edelweisstokio.in . Visit us at www.edelweisstokio.in Disclaimer: