Section

Insured Event Applicable

Sum Insured (Rs.)

1.Major Medical Illness and Procedures

a) First diagnosis of the below mentioned illnesses more specifically described below:-

1. Cancer of specified severity

2. Kidney failure requiring regular dialysis

3. Multiple Sclerosis with persisting symptoms

4. Benign brain tumor

5. Parkinson’s disease before the age of 50 years

6. Alzheimer's disease before the age of 50 years

7. End stage liver disease

b) Undergoing for the first time of the following surgical procedures, more specifically described below:-

1. Major organ/bone marrow transplant

2. Open heart replacement or repair of heart valves

3. Open chest CABG

4. Surgery of aorta

c) Occurrence for the first time of the following medical events more specifically described below:-

1. Stroke resulting in permanent symptoms

2. Permanent paralysis of limbs

3. First heart attack of specified severity.

4. Major burns

5. Loss of speech

6. Deafness

7. Coma of specified severity

760270

2.Personal Accident

a) Death of the insured on account of an accident

b) Permanent total disablement of the insured due to accident

Sl No.

Policy Condition

Cause (s)

1.

Policy wording Section B 2.2: Exclusions applicable to Benefit 2 under Section B

The company shall not be liable to make any payment for any claim under Benefit 2 of Section B of this policy in respect of an insured person, directly or indirectly for, caused by, arising from or in any way attributable to any of the following:

Any critical illness where the symptoms indicative of such critical illness have first manifested or first occurred prior to the Risk Inception Date or arisen within first 90 days of commencement of the period of cover.

Remarks

As per death summary of Civil Hospital, Ludhiana dated 03 May 2021, insured was hospitalized for Bilateral Covid Pneumonitis and Respiratory Failure on 03 May, 2021 which falls within first three months of the commencement of the policy start date i.e. 27 Feb 2021. Hence the claim falls outside the purview of policy terms and conditions.

SL No.

Policy Condition

Clause(s)

1

Policy wording Section B 2.2:Exclusions applicable to Benefit 2 under Section B

The company shall not be liable to make any payment for any claim under Benefit 2 of Section B of this Policy in respect of an Insured Person, directly or indirectly for, caused by, arising from or in any way attributable to any of the following:

Any critical Illness where the symptoms indicative of such Critical Illness have first manifested or first occurred prior to the Risk Inception Date or arisen within first 90 days of commencement of the Period of Cover.

Remarks

As per Death Summary of Civil Hospital, Ludhiana dated 03 May 2021, Insured was hospitalized for Bilateral Covid Pneumonitis and Respiratory Failure on 03 May 2021, which falls within first three months of the commencement of the policy start date i.e. 27 Feb 2021.  Hence the claim falls outside the purview of Policy Terms and Conditions.