nrm ;, frda wdjrKh Critical Illnesss cover wdjrKh The cover rlaIs;hd Nhdkl frda.hka f,i rlaIKdjrKh hgf;a , ehsia ;=.; lrk ,o frda . ;;a;; a jhlg f.doqre õ we;s njg frda ksYaph l,fyd;a tA i|yd wdjrKh , ndfok rlaIKdjrKh nrm ;, frda wdjrKh kï fõ ' Nhdkl frda.hka f,i kï flfrkqfha • cSjk rgdjg yd oS ¾> dhqI õkaokhg ndOd flfrk • wêl õhoï iys ; meje;aula we;sflfrk • W.% iA:djr frda fYaIhkaf.ka hq ;= frda . ;; a ;ajhka fú ' critical illness cover is an insurance product in which the insurer is contracted to make a payment if the policyholder is diagnosed with one of the listed dread diseases D read disease defined as a disease with • an impact on lifestyle, longevity , • which incurs high costs for survival • And causes significant and permanent residual morbidity wdjrKfha wruqK Cover Objectives m%; s ldr úhoï iydh # frday,a .; m%; s ldr úhysho ï "Y,Hl ¾u úho ï " cSjkddOdrl $ WmlrK úho ï i|yd To support treatment Expensses : F or the costs of the operations/ hospitalizations / equipment's /appliances etc. wys ñ jQ wdodh ï mqkia:dmk iydh # wjm%udK jQ bmhSfñ mqkia:dmkh To replace any lost income : due to a decreasing ability to earn cSjk rgdf õ fjkia ùu i|yd uQ,H iydh # m%jdyK myiqlï ikSmdrlaIl úho ï i|yd To provide financial support for a change in lifestyle mYapd;a Wjegka úho ï iydh # h:dj;a lsrSfï wdOdrl " fN !; Ñls;aid fmdaIl tosfkod frda.S l,uKdlrKh úho ï i|yd To support the subsequent care Expensses : For recuperation aids, physiotherapy , Nutrition and routine medical management etc. b;sydih The History miqld,Skj ; j;a nrm ;, frda.S ;; a;ajhka 22 la fuu wdjrKhg we;=,;a flrsKs Later other 22 health conditions were keep on adding to the cover nrm ;,a frda.dndO fya ;= fjka we;sjk úYd , uQ,H ydksh $ n,mEu wdjrKh lsrSu fuys wruqK úh to cover very high financial loss/ impact of critical medical condition nr ,;, frda rlaIKh f,i ye|skajqkq fuu wdjrKh u.ska ms < sld yDohdndO uYa;sYal wd > d;h ^ iaMdr & yd lsrsgl Ouks nhsmdia Y,H l ¾u wdjrKh flrsKs Named dread disease insurance . Covered Cancer, Stroke , Heart attack and Coronary bypass surgery ffjoH fñrshia n ¾kdâ õiska 1983 Ulaf;dan¾ 06 osk wdr ïN lrk , oS Founded by Dr Marius Barnard, on 6 October 1983 in South Africa o ekg we;e ó rlaIK iud. ï ú iska fjk;a frda.S ;; a;ajhka o iajlSh wNsuh mtsos wdjrKhg we;=,;a lr we; Some insurance companies have increased the number of covered conditions including other diseases, n rm ;, frda . j ¾. Types of dared diseases ;SrKd;ul wjhjhka fyda tu wjhjhkays l%shdldrS;ajh ie,lshhq;= u Ügulg wvmK ùu significant damage to critical organs or significant functional loss of such organs i kaksfõok uOHhka fyda lsysmhla wysñùu yd iajd èk meje;au wysïùu Loss of one or more communication mean and loss of independent existence ms < sld Cancers ; SrKd;ul wjhjhka fyda tu wjhjhkays l%shdldrS;ajh ie,lshhq ;= u Ügulg wvmK ùu significant damage to critical organs or significant functional loss of such organs yDo re èr iemhqu wjysr ùï ^ lsrSgl OuKs frda .& • yDohdndO “ • nhsmdia Y,H l ¾uh" • wekacsfhdama,diaá " Disturbences for heart blood supply ( Coranary artery diseases) • Heart attacks • CABG. • Angioplasty , yDo l%shdldrSlaj h ms < sn | . eg ¿ • • yDo lmdg Y,H l¾u“ • uyd Ouks frda i|yd Y,Hl¾u • Issues of heart functions • Pulmonary Embolism/ Oulmunary Hypertension • Heart Valve Surgery , • Surgery for a Disease of the Aorta • Cardiomyopathy yDoh Heart ; SrKd;ul wjhjhka fyda tu wjhjhkays l%shdldrS;ajh ie,lshhq ;= u Ügulg wvmK ùu significant damage to critical organs or significant functional loss of such organs fud,h Brain • w> d;h ^ wxYNd.h & • wLr uYa;sYal wdndO ^ ms < sldjka fkdjk fud,fha yg.kakd f.â & • • • • Stroke, • benign brain tumor • Major Head Trauma • Parkinson's Disease – before age 65 • Encephalitis ; SrKd;ul wjhjhka fyda tu wjhjhkays l%shdldrS;ajh ie,lshhq ;= u Ügulg wvmK ùu significant damage to critical organs or significant functional loss of such organs fmky ¿ Lungs • ksoka .; fmky ¿ frda.h • Chronic lung disease wlaudj Liver • ksoka .; wlaud frda.h ^ hdlD;sl m%odyh & • *, a ñkkag,a ffjri fymghs Üia frda.h • Chronic liver deasese • Fulminant Viral Hepatitis ; SrKd;ul wjhjhka fyda tu wjhjhkays l%shdldrS;ajh ie,lshhq ;= u Ügulg wvmK ùu significant damage to critical organs or significant functional loss of such organs jl =. vq Kidneys • ksoka .; jDlal frda.h • • Chronic kidney disease • Medullary Cystic Disease Bone marrow • • Aplastic Anaemia m %Odk wjhj noaO lsrSu Major organ transplant ; SrKd;ul wjhjhka fyda tu wjhjhkays l%shdldrS;ajh ie,lshhq ;= u Ügulg wvmK ùu significant damage to critical organs or significant functional loss of such organs ùl frda Multy organ disease Systemic Lupus Erythematosus 5 ' w.akHdih " 6 ' l= vd nvje , wdka;sl frda Terminal Illness ikaksfõok uOHhka fyda lsysmhla wysñùu yd iajd èk meje;au wysïùu Loss of one or more communication mean and loss of independent existence mQ ¾K wkaONdjh Total Blindness mQ ¾K ìysrs nj Total Deftness l:kh wysó ùu loss of speech ikaksfõok uOHhka fyda lsysmhla wysñùu yd iajd èk meje;au wysïùu Loss of one or more communication mean and loss of independent existence wNskh wysñùu wxYNd.h $ mlaI > d;h , wem,sl iy,laIKh weñfhdafg%d * sla md¾Yùh cdr:Hh ^, Qa fy.ars.a frda.h & nyqúO crd:h " pd,l kshqfrdak frda.h udxY fmaYS Ldokh úYd , ms < siaiSñ úm;Hl lj,sldidokh W.% rEuefgdhsv m¾jodyh • paralysis • Multiple sclerosis, • Appalic syndrome • Amyotrophic Lateral Sclerosis • Motor neuron disease • Muscular Dystrophy • M ajor burns, • Necrotising Fasciitis • Severe Rheumatic Arthritis Loss of g esture f ldaudj Coma ikaksfõok uOHhka fyda lsysmhla wysñùu yd iajd èk meje;au wysïùu Loss of one or more communication mean and loss of independent existence wxYNd.h Paralysis iajdëk meje;au wysñõu ^ jhi wqjq 65 g fmr & Loss of Independent Existence TPD w;a md wysñùu Loss of limbs we,aIhsu¾ frda.h ^ jhi 65 g fmr & - ksrka;r wëlaIKh wjYH jk Alzheimer's disease (before age 65) ms < sld Cancers T!; sl fõ § h fidhd.ekSñ u.ska ; yjqre lrk , o • ud;aißl ffi,hkaf.a md,kh l< fkdyels j¾Okh yd • mglhka wdl%uKh lsÍu fmkakqï lrkq , nk • ish ¿ udrl w¾nqohla ^ Malignant Tumour ) fuhska woyia flf¾' úfYaIfhka neyerl , wjia:djloS yerekqfldg , shqflañhdj ^ Leukaemia & fyda ud;airsl , s ñ fmdaud yd uhf,däiama,diaàla iy,laIKh fuu ks¾jpkh hgf;aa wdjrKh fõ n rm ;, frda . ;; a jhloS úhoï Expensses during a CI m%; s ldr úhoï # frday,a .; m%; s ldr "Y,Hl ¾u " cSjkddOdrl $ WmlrK úho ï i|yd treatment Expensses : costs of operations/ hospitalizations / equipment's /appliances etc. cSjk rgdf õ fjkia ùu # m%jdyK myiqlï ikSmdrlaIl úho ï financial support for a change in lifestyle Transport Sanitory items mYapd;a Wjegka úho ï # h:dj;a lsrSfï wdOdrl " fN !; Ñls;aid fmdaIl tosfkod frda.S l,uKdlrKh subsequent care Expensses r recuperation aids, physiotherapy , Nutrition and routine medical management etc. fuysoS ksYa Ñ ; nrm ;, ;; ajhka muKla wdjrKh lsrSu Wfoid tla tla frda . ;;a;; ajh fjk fjku w ¾: olajd we;s w;r tlS ;; a ;ajhka ; yjqre lsrSug wod , ks¾Kdhlhkao fjk fjku olajd we;' ;j oqrg;a tlS w ¾: oelaõug hg;a ùhyels fjk;a nrm ;, fkdjk ;; a ;ajhka neyer lsrSñ j,g hg;a lr we; Each critical illness has got ist own definition to spacify the conditiongetting covered Each critical illness might be subject to own set of exclusion to avoid minor conditions which might be still falls under the definition Eg : Heart Attack (Myocardial Infarction): The first occurrence of heart attack or myocardial infarction, which means the death of a portion of the heart muscle as a result of inadequate blood supply to the relevant area. The diagnosis for Myocardial Infarction should be evidenced by all of the following criteria: i . A history of typical clinical symptoms consistent with the diagnosis of acute myocardial infarction (For e.g. typical chest pain) ii. New characteristic electrocardiogram changes iii. Elevation of infarction specific enzymes, Troponins or other specific biochemical markers. Excluded are : i . Other acute Coronary Syndromes ii. Any type of angina pectoris iii. A rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart disease OR following an intra - arterial cardiac procedure. iSud Limitations Wod yDohdndO ^ jys¾lka;=l bkamdlSNjkh ST elevated & yDohdndO ^ jys¾lka;=l bkamdlSNjh & uq,a j;djg we;sùu ‘ wod , m%foaYhg reêr iemhqu m%udKj;a fkdÖu fya ;= fjka yDo fmaYsfha ^jys¾lka;= lfha & fldgila ïh hdu fuhska woyia flf¾' jys¾lka;=l bkamdlSNjkh frda úksYaph my; i|yka ishΩ ¿ ks¾Kdhlhka u.ska ikd : l, hq ;= fú 1 W.% jys¾lka;=l bkamdlSNjkh frda ksYaphg wkqrEm jk o¾YSh idhksl frda . , laIKhka iys ; frda b;sydih ^ Wod # o¾YSh mmqfú fúokdj & 2 kj yDohdndOhlg , dlaIKsl úoHq;a lka ;=l f¾LK fjkialï 3 bkamdlSNjhkhlg úfYaIs ; tkaihsu by, hdu ' fg%dfmdkska fyda wfkl =;a úfYaIs ; ffcj ridhksl i <l= Kqldrl ' neyer lsrSñ # fjk;a W.% lsrSgl iskafv%dauhka ish ¿ wdldrhkays Wria iïndOhka ^ wekachskd fmlafgdarsia & wka;¾ Ouks lka ;=l l%shdj,shlg wkq.dój fyda bialsóh yDo frda.hl ;; ajhl idlaIshlska f;drj fyda bkamdlSNjhkhlg úfYaIs ; ffcj ridhksl i <l= Kqldrl by,hEu whym;a ysñlï w;aoelSï wju lsrSu Minimize Bad Claim experiences rlaIKdjrK wj,x .= ùu Policy lapsetions lS¾;s kduh wjodkug , laùu Reputation risk úYajdih ì|jeàu Lose of trust whym;a ysñlï w;aoelSï Bad Claims experiences fy,s fkdlsrSu None disclosure wê wfmalaId Over expectation ysñlï bosrsm;a lsrSfï fodaI Submission errors n rlaIKjrh ms < sn | wkjfndaOh yd oq¾u; Poor policy awareness/Wro ng preceptions whym;a ysñlï w;aoelSï wju lsrSu Minimize Bad Claim experiences rlaIKdjrKh ms < sn | wjfndaOh policy awareness mQ¾K fy,s lsrSu yd ioaNdjh disclosure and utmost good faith mQ ¾j rlaIKdjrK wkdjrKh Pre policy Disclosure • mQ ¾j frda . ;; a ;ajhka wKdjrKh • Past illnesses Disclosure • mj;sk frda . ;; a ;ajhka wKdjrKh • current illness disclosure • ixckkSh frda ;; a ;ajhka wKdjrKh • Congenital defect disclosure wdjrKh the coverage • frda . w ¾: oelaùï • Disease definitions • neyer flfrk ;; a;ajhka • Excluded conditions • wdjrK ks¾Kdhl • Cover Criteria • Fmdoq neyer lsrSï • Common exclusions • rlaIK Fldkafoais • Policy conditions wdjrKh ms < sn | iSud Coverage Limits • Wm iSud • Sublimit • fmdfrd;a ;= ld,h • Waiting period • wdjrKh wjika úu • Cover cessation • wekaacSfhdama,diaá wdjrKh • Angioplasty cover • Wmrsu rlaIs ; uqo , • Maximum cover amounts rlaIKdjrKh w;r ;=r wkdjrKh Between policy disclosure / lshdj fjkia lsrSu Change in occupation