Edelweiss Tokio Insurance Plans

Edelweiss Tokio CritiCare+ Insurance

Edelweiss Tokio Life - CritiCare+ is a critical illness plan which covers 17 Critical Illnesses and an individual insured. It provides a lumpsum benefit on the diagnosis of any critical illness that is predefined in the plan. With the multi-claim option the insured can claim the sum assured up to 3 times on diagnosis of different illnesses.While one may already have an individual health insurance plan or a health insurance coverage on their own or with provided by their organization, it may not always be sufficient to take care of ballooning medical expenses. Unlike health insurance plans, in this is a non participating non-linked health insurance plan the money can be claimed on diagnosis, the submission of hospitalization bills is not required.
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Edelweiss Tokio Life insurance review

Edelweiss Tokio Insurance Plans
Distribution - Number of branches pan India (March 2019)
123
Entry Age Minimum/Maximum (Years) - Term Plans
18/65
Sum Assured Minimum / Maximum - Term Plans
25 lacs / Unlimited
Policy Term Minimum / Maximum (Years) - Terms Plans
10/62
Solvency Ratio (FY 2018-19) *
2.29
Number of Policies Sold (Ind+Group) *
79,913
Number of Lives Covered (Ind+Group) **
266,160
Claims Settlement Ratio (Ind+Group) ***
98.41%
* - As per IRDAI data 2018-19 - The solvency ratio of an insurance company is the size of its capital relative to all the risk it has taken, which is all liabilities subtracted from total assets. In other words, solvency is a measurement of how much the company has in assets versus how much it owes
** - as per L-25 Public Disclosure of Insurance Companies for 2019-20  |  *** - Claims Settlement Ratio = Claims Settled in the year / Claims Reported in the year - as per IRDAI data published

Edelweiss Tokio CritiCare+ Insurance overview

  • Key Features
  • Eligibility
  • Benefit Description
  • Exclusions

Features of CritiCare+ Insurance

  • Multiple Claims Option : The insured can claim three times during the policy term
  • Cover Against 17 Critical Illnesses named under this plan (see below on this page for this list of the 17 illnesses)
  • No Hospital Bills required for a claims - All the insured needs is their diagnosis report to make a claim
  • Waiver Of Premium : All future premiums are waived after the first claim
  • Discount on large Sum Assured : Get discounts for higher Sum Assured (se table below)
  • Get lump sum benefit on thediagnosis of Critical Illness
  • Simplified benefit design forbetter understanding of theproduct
  • Tax Benefits : You can avail tax benefits under Section 80D and Section 10 (10D)

Eligibility criteria of CritiCare+ Insurance

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 ₹ 2,000
Minimum Sum Assured Rs 5,00,000
Maximum Sum Assured Rs 1,00,00,000
The premium rates are guaranteed for the first five years and are reviewable after five years with prior approval from the IRDAI of India.
Initial Waiting Period 90 days
Survival Period 28 days
Waiting Period between claims 365 days Waiting Period between claims 365 days
Discounts for Higher Sum Assureds
Sum Assured 5-19 20-24 25-29 30
5,00,000 - 9,99,000 140 150 155 160
per Rs. 1,00,000 sum assured exceeding 5 lakh
10,00,000 - 24,99,000 70 73 78 83
per Rs. 1,00,000 sum assured exceeding 5 lakh
25,00,000 and above 140 145 150 160
per Rs. 1,00,000 sum assured exceeding 5 lakh

Benefit description of CritiCare+ Insurance

The product offers two options as follows:
  • Single Claim option
  • MultiClaim option
List of 17 covered Critical Illnesses are below:
Group 1
  • 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
Group 3
  • Aplastic Anaemia
  • Cancer of Specified Severity
  • Benign Brain Tumour
  • Major Organ Transplant (Bone Marrow, Liver, Lung, Pancreas)
Group 2
  • Permanent Paralysis of Limbs
  • Coma of Specified Severity
  • Major Burns
  • Total Blindness
Group 4
  • Motor Neurone Disease with Permanent Symptoms
  • Multiple Sclerosis with Persisting Symptoms


When are these Benefits payable? What are the Benefits payable? *
a) On Critical Illness (as specified in the table above) 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
b) On Death of Life Insured during the Policy Term No Benefit Payable
c) On Maturity of Policy No Benefit Payable
d) On Surrender of Policy No Benefit Payable
Free Look Period 15 days
Grace Period 30 days


*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.

Exclusions of CritiCare+ insurance

Some of the key exclusions under this plan are below…Please go through the entire list of exclusions in the terms and conditions of the policy. Thefollowing 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. (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 medicalpractitioner.
  • 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.

Brochure

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Policy wordings

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022