United India Criticare insurance

Criticare health insurance review

• Benefits under Criticare insurance plan

  • The Policy covers the following critical illnesses
    1. Cancer of specified severity
    2. First heart attack - of specified severity
    3. Coronary artery surgery(CABG) Open Chest CABG
    4. Heart value replacement
    5. Coma of specified severity
    6. Kidney failure
    7. Stroke resulting in permanet symptoms
    8. Major organ or bone marrow transplant
    9. Multiple sclerosis
    10. Motor neurone disease with permanent symptoms
    11. Permanent paralysis of limbs
  • Free Look period: 15 days shall be applicable at the inception of the first policy.
  • Premium paid for self, spouse, dependent children and dependent parents are exempt from Income Tax under Section 80-D of the IT act as per rules in force.

• Clamis under Criticare insurance plan

  • All claims shall be paid in Indian Rupees only.
  • Upon happening of any event, notice of Intimation about the hospitalization or claim should be sent to the address of Insurer/TPA stated in the Policy.
  • Claim form should be collected on intimation of claim. The completed claim form along with all required/relevant hospitalization documents should be submitted to servicing TPA within 30 days from the date of discharge from the hospital. The Insured person shall submit to medical examination on behalf of and at the expenses of the Company as shall be required in connection with any claim
  List of documents to be submitted shall include –
  • Claim form
  • Treating Physician’s Certificate
  • Original/Attested copy of Discharge summary
  • Original/Attested copies of all lab/radiological/Histopathological/investigation reports
  • Original/Attested copies of Indoor case papers (if needed)
  • Original/Attested copies of all the medical bills
  • Any other document (e.g. Disability Certificate, Dialysis records, etc.) deemed necessary at the time of claim investigation for a specific Critical illness condition.

• Exclusions under Criticare insurance plan

  1. Such Critical Illness caused by or associated with directly or indirectly by any of the following:
     • Attempted suicide or intentional self-inflicted injury by the insured person.
     • Addiction to alcohol or drugs.
     • Disease in the presence of HIV/AIDS infection.
     • Smoking more than 40 cigarettes/ cigars or equivalent tobacco intake in a day
  2. Critical Illness symptom/s ( and / or the treatment ) of which were present in the insured person at any time before inception of this policy or on the date on which cover here under was granted to such insured person, or which manifests itself within a period of three calendar months from such date, whether or not the insured or the insured person has knowledge that the symptoms or treatment were related to such Critical Illness.
  3. Any claim whether directly or indirectly, occasioned by happening through or arising from any consequence of war invasion, act of foreign enemy hostilities ( whether war be declared or not or any civil war mutiny rebellion, revolution insurrection, military or usurped power.
  4. Any claim whether directly or indirectly caused by contributed to or by or arising from ionising radiation or contamination by radioactivity from any nuclear fuel or any nuclear waste from the combustion of nuclear fuel or from any nuclear weapons materials