Max Life Critical Illness Rider

Key Features of Max Life Critical Illness Rider

Investment in your health is one of the best kind of investment. With that understanding, Max Life brings you a comprehensive plan that covers you against the uncertainties that life has to offer. Max Life Critical Illness and Disability Rider provides you with the following main benefits:

• Comprehensive CI cover: Option to choose Gold variant (coverage of 22 Critical Illnesses) or Platinum variant (coverage of all 64 Critical Illnesses)
• Total and Permanent Disability variant: This rider offers coverage on Total and Permanent Disability Flexible payment option: You can opt for limited pay or regular pay option as per your base plan for the rider cover
• Extended cover: You can cover yourself or your loved ones for as long as 67 years (up to age 85)
• Max Fit Program: A Wellness Benefit is available in this rider with the objective of maintaining the customer’s good health and improving it

Variants

The following benefit variants are available under the rider to choose from –

1. Gold Variant: a suite of 22 critical illnesses is covered (one minor, 21 major)
2. Gold Plus Variant: In addition to a suite of 22 critical illnesses (one minor, 21 major), TPD is also covered
3. Platinum Variant: a suite of 64 critical illnesses is covered (five minor, 59 major)
4. Platinum Plus Variant: In addition to a suite of 64 critical illnesses (five minor, 59 major), TPD is also covered
5. Total and Permanent Disability (TPD) Variant: TPD shall mean the occurrence of any of the conditions as mentioned in Annexure 2 as a result of accidental bodily injury, sickness or disease

Please note that only one variant out of the available five variants can be chosen.

List of Critical Illnesses Covered

Gold & Gold Plus Variant

1. Angioplasty (Minor)
2. Cancer of Specified Severity (Major)
3. Myocardial Infraction (First Heart Attack of Specific Severity) (Major)
4. Open Chest CABG (Major)
5. Open Heart Replacement or Repair of Heart Valves (Major)
6. Coma of Specified Severity (Major)
7. Kidney Failure Requiring Regular Dialysis (Major)
8. Stroke Resulting in Permanent Symptoms (Major)
9. Major Organ /Bone Marrow Transplant (Major)
10. Permanent Paralysis of Limbs (Major)
11. Motor Neuron Disease with Permanent Symptoms (Major)
12. Multiple Sclerosis with Persisting Symptoms (Major)
13. Benign Brain Tumor (Major)
14. Blindness (Major)
15. Deafness (Major)
16. End Stage Lung Failure (Major)
17. End Stage Liver Failure (Major)
18. Loss of Speech (Major)
19. Loss of Limbs (Major)
20. Major Head Trauma (Major)
21. Primary (Idiopathic) Pulmonary Hypertension (Major)
22. Third Degree Burns (Major)

Platinum & Platinum Plus Variant

1. Includes all 22 Critical Illnesses and Surgery Benefits from the Gold & Gold Plus Variant mentioned allowed
2. CiS / Early Stage Cancer (Minor)
3. Small Bowel Transplant (Minor)
4. Brain Aneurysm Surgery or Cerebral Shunt Insertion (Minor)
5. Severe Osteoporosis (Minor)
6. Alzheimer’s Disease (Major)
7. Parkinson’s Disease (Major)
8. Aorta Graft Surgery (Major)
9. Amputation of Feet Due to Complications from Diabetes (Major)
10. Apallic Syndrome (Major)
11. Aplastic Anaemia (Major)
12. Bacterial Meningitis (Major)
13. Brain Surgery (Major)
14. Cardiomyopathy (Major)
15. Chronic Adrenal Insufficiency (Addison’s Disease) (Major)
16. Chronic Relapsing Pancreatitis (Major)
17. Creutzfeldt-Jacob Disease (CJD) (Major)
18. Crohn’s Disease (Major)
19. Dissecting Aortic Aneurysm (Major)
20. Eisenmenger’s Syndrome (Major)
21. Elephantiasis (Major)
22. Encephalitis (Major)
23. Fulminant Viral Hepatitis (Major)
24. Hemiplegia (Major)
25. HIV due to Blood Transfusion and Occupationally Acquired HIV (Major)
26. Infective Endocarditis (Major)
27. Loss of Independent Existence (Cover up to Age 74) (Major)
28. Loss of One Limb and One Eye (Major)
29. Medullary Cystic Disease (Major)
30. Muscular Dystrophy (Major)
31. Myasthenia Gravis (Major)
32. Myelofibrosis (Major)
33. Necrotising Fasciitis (Major)
34. Other Serious Coronary Artery Disease (Major)
35. Pheochromocytoma (Major)
36. Poliomyelitis (Major)
37. Progressive Scleroderma (Major)
38. Progressive Supranuclear Palsy (Major)
39. Severe Rheumatoid Arthritis (Major)
40. Severe Ulcerative Colitis (Major)
41. Systemic Lupus Erythematosus with Lupus Nephritis (Major)
42. Terminal Illness (Major)
43. Tuberculosis Meningitis (Major)

Annexure 2

Definitions and Exclusions – Total and Permanent Disability (TPD) Benefit

TPD shall mean the occurrence of any of the following conditions as a result of accidental bodily injury, sickness or disease:

1. Permanent Disability:

Disability means the inability of the Insured Person to perform at least 3 of the 6 activities of daily living as listed below (either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons) for a continuous period of at least 6 months:
The Activities of Daily Living are:

1. 1. Washing: the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means
   2. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances
   3. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice-versa
   4. Mobility: the ability to move indoors from room to room on level surfaces
   5. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene
   6. Feeding: the ability to feed oneself once food has been prepared and made available.

2. Physical Impairment:

1. 1.  Total and irrecoverable loss of sight of both eyes. The blindness must be confirmed by an Ophthalmologist, OR
   2. Loss of use or loss by severance of two or more limbs at or above wrists or ankles; OR
   3.  The total and irrecoverable loss of sight of one eye and loss of use or loss by severance of one limb at or above wrist or ankle.

The above disability must have lasted, without interruption, for at least six consecutive months from the date of diagnosis or accident and must, in the opinion of a qualified medical practitioner appointed by the Company, be deemed permanent.

Accident means sudden, unforeseen and involuntary event caused by external, visible and violent means.

Accidental Injury means bodily injury of the insured caused solely, directly and independently of any other intervening causes from an accident {i.e. a traumatic event of violent, unexpected, external and visible nature).

The loss of use of a limb is considered as a loss of use when such loss of use involves total and permanent loss of function of the limb affected as determined by a registered medical practitioner nominated by the Company.

Exclusions of TPD:

TPD arising directly or indirectly from any of the following are specifically excluded:

We shall not be liable to make any payment under this Policy towards the TPD benefit, directly or indirectly caused by, based on, arising out of or howsoever attributable to any of the following:

1. Pre-existing Disease means any condition, aliment, injury or disease / critical illness/disability:

a. That is/are diagnosed by a physician within 48 months prior to the effective date of the policy issued by the insurer or its reinstatement; or

b. For which medical advice or treatment was recommended by, or received from, a Physician within 48 months Prior to the effective date of the policy issued by the insurer or its reinstatement

Coverage under the policy after the expiry of 48 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by the Insurer.

2. Any disability directly or indirectly caused due to treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.

3. Narcotics used by the Insured Person unless taken as prescribed by a registered Medical Practitioner.

4. Any disability directly or indirectly caused due to intentional self-injury, suicide or attempted suicide, whether the person is medically sane or insane.

5. Any disability directly or indirectly, caused by or arising from or attributable to a foreign invasion, the act of foreign enemies, hostilities, warlike operations (whether war be declared or not or while performing duties in the armed forces of any country during war or at peacetime), civil war, public defence, rebellion, revolution, insurrection, military or usurped power.

6. Service in any military, air force, naval, paramilitary or similar organization.

7. Any disability caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous form) or from any nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack.

8. Working in underground mines, tunnelling or involving electrical installations with high tension supply, or as race jockeys or circus personnel.

9. Congenital External Anomalies, inherited disorders or any complications or conditions arising therefrom including any developmental conditions of the Insured.

10. Any disability directly or indirectly caused by any treatment necessitated due to participation as a professional in hazardous or adventure sport, including but not limited to, para jumping rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding, sky diving, deep sea diving
and selfie accidents.

11. Participation by the Insured Person in any flying activity, except as a bona fide, fare-paying passenger of a recognized airline on regular routes and on a scheduled timetable.

12. Any disability directly or indirectly, caused by Medical treatment traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy.

Any disability due to miscarriages (unless due to an accident) and lawful medical termination of pregnancy during the policy period.

13. Any disability directly or indirectly, caused by any unproven/experimental treatment, service and supplies for or in connection with any treatment. Unproven / experimental treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

14. Any disability based on certification/diagnosis/treatment from persons not registered as Medical Practitioners, or from a Medical Practitioner who is practising outside the discipline that he/ she is licensed for.

15. Any disability directly or indirectly, caused due to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.

16. Any disability directly or indirectly, caused due to cosmetic or plastic surgery or any treatment to change the appearance unless for reconstruction following an Accident, Burn(s), or Cancer or as part of the medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.

17. Any disability directly or indirectly, caused due to surgical treatment of obesity that does not fulfil all the below conditions:

a. Surgery to be conducted is upon the advice of the Doctor

b. Clinical protocols should support the Surgery / Procedure conducted

c. The member has to be 18 years of age or older and

d. Body Mass Index (BMI):

• greater than or equal to 40 or

• greater than or equal to 35 in conjunction with any of the following severe co-morbidities following the failure of less invasive methods of weight loss:

i. Obesity-related cardiomyopathy

ii. Coronary heart disease

iii. Severe Sleep Apnea

iv. Uncontrolled Type 2 Diabetes despite optimal therapy

18. Any disability directly or indirectly, caused due to treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.

19. Any disability directly or indirectly, caused by treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.

20. In the event of the death of the Insured Person within the stipulated survival period as set out above.

21. Any disability directly or indirectly, caused by sterility and infertility. This includes:

a. Any type of contraception, sterilization

b. Assisted Reproductive services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI

c. Gestational Surrogacy

d. Reversal of sterilization