Aapat Suraksha Bima Health Insurance

Section I - Critical Illness

Compensation to the extent of sum insured against the person, if detected/ diagnosed for the first time during the Policy period as suffering from the following Critical Illnesses:

• Paralytic Stroke: Damage of a portion of the brain due to vascular causes such as:
  • Cerebral Haemorrhage
  • Cerebral Thrombosis
  • Cerebral Embolism leading to
    • Total disability
    • Partial disability but of permanent nature
    • Disability resulting in a neurological deficit for more than six months.
• Cancer: Disease manifested by the presence of a malignant tumor characterized by the uncontrolledgrowth and spread of malignant cells and invasion of tissue. The term ‘Cancer’ also includesLeukaemia and malignant disease of the lymphatic system such as Hodgkin’s disease. Any noninvasivecancer in situ and all skin cancers except invasive malignant melanoma are excluded.
• End Stage Renal failure: The end stage renal failure as chronic irreversible failure of either of Kidneys to function, as a resultof which regular renal dialysis has to be instituted.
• Coronary Artery Disease: Narrowing or blockage of coronary arteries affecting blood circulation to cardiac muscles, which requires the Insured Person to undergo surgery by means of coronary artery bypass graft/Angioplasty. This necessity of surgery must have been proven by coronary angiography.
• Major Organ Transplant: Human to human transplant from a donor to the Insured Person of one or more of the following organs:
  • Kidney
  • Lung
  • Pancreas
  • Bone Marrow
The transplantation of all other organs, parts of organ or any other tissue transplant is excluded.The Insured Person must be required to undergo actual transplantation within 6 months of the firstdiagnoses as certified by Medical Practitioner.

Section II – Personal Accident

Bodily injury directly resulting to the death or Permanent Total disablement of Insured Person as specified in Table of Benefits as below:

TABLE OF BENEFITS	PERCENTAGE OF CAPITAL SUM INSURED
1. Death	100
2. Loss of
Loss of sight (both eyes)	100
Physical separation of or loss of ability to use both hands or both feet	100
Physical separation of or loss of ability to use one hand and/ or both feet	100
Loss of sight of one eye and physical separation of or loss of ability to use either one hand or one foot	100
3. Loss of
a. Sight of one eye	50
b. Physical separation of or use of ability to use one hand or one foot	50
4. Permanent Total and Absolute Disablement	100

Exclusions of Universal Sompo Aapat Suraksha Bima Health Insurance

• Pre-existing Diseases: Any condition ,ailment or injury or related condition(s) forwhich You had signs or symptoms and/orWere diagnosed ,and / or received medicaladvice /treatment ,within 48 months prior toYour first Policy with Us.
• Any Critical Illness, which incepts or manifestduring the first 90 days from the date ofcommencement of the Policy.
• Death within 30 days following the diagnosis ofthe Critical Illness
• Any Critical Illness which arises or is causedby any one of the following:
  • Dry addiction, alcoholism, smoking ofmore than 30 cigarettes/cigars orequivalent intake of tobacco in a day andany complication, consequences arisingthere from.
  • Any Insured person suffering from HumanT.Cell Lymphotropic Virus Type III (HTLVIII)or Lymphadinopathy AssociatedViruses (LAV) or the Mutant derivatives orVariations Deficiency Syndrome or anySyndrome or a condition of similar kindreferred to as AIDS. The onus shallalways be on Insured Person to show anyevent was not caused by or did not arisethrough AIDS or HIV.
• Any Insured Person under 5 or aged 55 yearsor more.
• Any claim if a Critical Illness is caused directlyor indirectly or contributed to by or arisingfrom:
  • Ionizing Radiation or contamination byradioactivity from any nuclear fuel orfrom any nuclear waste fromcombustion of nuclear fuel or nuclearweapon materials.
  • War, Invasion, Act of foreign enemy,Hostilities, Civil war, Rebellion,Revolution, Insurrection, Mutiny,Military or usurped Power, Seizure,Capture, Arrest, Restraints andDetainments of all kinds, Princes ofwhatever nation conditions or qualityso ever.
• Payment under Accidental Benefits arisingout of the following:
  • Committing or attempting suicide,intentional self-injury.
  • Whilst under influence of intoxicatingliquor.
  • Drug addiction or alcoholism.
  • Whilst engaged in any adventuroussports.
  • Committing any breach of law withcriminal intent.
  • War, invasion, act of foreign enemy,hostilities (whether war be declaredor not) civil war, rebellion, revolution,insurrection, mutiny military orusurped power, confiscation, seizure,capture, assault, restraint,nationalization, civil commotion orloot or pillage in connection herewith.
  • Ionizing radiation or contamination byradioactivity from any nuclear fuel orfrom any nuclear waste from thecombustion of nuclear fuel. For thepurpose of this exclusion, combustionshall include any self sustainingprocess of nuclear fission.
  • The radioactive, toxic, explosive orthe hazardous properties of anynuclear assembly or nuclearcomponent.

Disclaimer:“For the detailed list of exclusions under the policy, kindly refer to the same provided in your policy kit”