IFFCO Tokio Critical Illness Policy

What are the Critical Illness Covered under this Plan

1. Stroke Resulting In Permanent SymptomsAny cerebrovascular incident producing permanent neurological sequelae. This includes infarction of brain tissue, thrombosis in an intracranial vessel, haemorrhage and embolization 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 at least 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
2. Cancer of specified Severity: 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 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.
3. Kidney failure requiring regular dialysis: The 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.
4. 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). The diagnosis must be supported by a coronary angiography and the realization of surgery has to be confirmed by a specialist medical practitioner. The following are excluded:
   • Angioplasty and/or any other intra-arterial procedures.
   • Any key-hole or laser surgery.
5. Major Organ/Bone Marrow Transplant : The actual undergoing of a transplant of:
   • One of the following human organs: heart, lung, liver, kidney, pancreas, 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.
     • Where only islets of Langerhans are transplanted .
6. End Stage Liver Disease: It means an irreversible chronic alteration of the hepatic parenchyma or the biliary ductal system resulting in a life threatening liver dysfunction. The above coverage is excluded if the etiology of the disease is due to chronic alcohol consumption or any self inflicted toxic or drug consumption.
7. Major Burns : It means 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 or loss of function of the injured organ.
8. 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 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.
9. Multiple Sclerosis with Persisting Symptoms: 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 at least two clinically documented episodes at least one month apart.
   • Other causes of neurological damage such as SLE and HIV are excluded.
10. Injuries : It means accidental physical bodily harm excluding illness or disease solely and directly caused by external, violent and visible and evident means which is verified and certified by a Medical Practitioner.

IFFCO Tokio Exclusions of Critical Illness Policy Insurance

1. Pre-existing diseases. This exclusion will also apply to any complications arising from Pre- existing Disease/ Injury. Such complications will be considered as a part of the Pre-existing Disease.
2. Any critical illness as specified in the Policy, which incepts or manifest during the first 90 days of the period of insurance cover for Insured Person.
3. Any critical Illness which arises or is caused by any one of the following:
   • The ingestion of drugs other than those prescribed by Registered Medical practitioner.
   • Ingestion of Medicines whether prescribed or not for treatment of drug addiction and alcoholism and drug addiction and alcoholism.
   • Drug addiction / alcoholism, smoking of more than 30 cigarettes/cigars or equivalent intake of tobacco in a day and any complication, consequences arising there from.
   • Any attempt by the Insured Person of suicide or any injury, which is self inflicted or in any manner willfully caused by or on behalf of Insured Person.
   • Any Insured person suffering from Human T.CellLymphotropic Virus Type III (HTLV-III) or Lymphadenopathy Associated Viruses (LAV) or the Mutant derivatives or Variations Deficiency Syndrome or any Syndrome or a condition of similar kind referred to as AIDS. The onus shall always be on Insured Person to show any event was not caused by or did not arise through AIDS or HIV.
4. Any Insured Person under 5 years or aged 60 years or more.
5. Circumcision except for diseases not excluded here or Injury, vaccination or Inoculation or change of life or cosmetic or aesthetic treatment of any description.
6. Convalescence, General Debility, Run Down condition or rest cure, congenital external diseases or defects or anomalie, sterility veneral diseases.
7. Any claim if a critical Illness is caused directly or indirectly or contributed to by or arising from:
   • Ionizing Radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from combustion of nuclear fuel or nuclear weapon materials
   • War, Invasion, Act of foreign enemy, Hostilities, Civil war, Rebellion, Revolution, Insurrection, Mutiny, Military or usurped Power, Seizure, Capture, Arrest, Restraints and Detainments of all kinds, Princes of whatever nation conditions or quality so ever.
8. All non medical expenses including personal comfort and convenience items or services, such as telephone, maid/ barber or beauty services, diet charges, baby food, cosmetics, napkins, toiletry items etc, guest services and similar incidental expenses or services etc

Special Provisions of IFFCO Tokio Insurance

1. Each of the above critical illness mentioned in the Policy must be confirmed by a registered Medical Practitioner and must be supported by clinical, radiological, histological and laboratory evidence acceptable to IFFCO Tokio.
2. IFFCO Tokio will make payment to Insured Person only once in respect of treatment of any particular critical illness or injury.
3. The cover under this Policy in respect of a critical illness or injuries for any Insured Person shall cease upon the reimbursement of medical expenses incurred as inpatient /provision of Cashless hospitalization on the treatment of the critical illness or injuries.