Frequently Asked Questions

TRA/12/13-14/6541 Dec 30th 2013

Prepared by Product Management 1 For Internal Training and Circulation only

UIN:109B019V02
Birla Sun Life Insurance Critical Illness Rider – Frequently Asked Questions

Contents
BSLI Critical Illness Rider – Plan Summary ........................................................................................................................................ 3
1. What is BSLI Critical Illness (CI) Rider? ..................................................................................................................... 3
2. Am I eligible for this rider? ............................................................................................................................................ 3
3. What is the minimum / maximum sum assured under this rider?.......................................................................... 3
4. What are the rider terms available? .............................................................................................................................. 3
Premium ............................................................................................................................................................................................... 3
5. What is the minimum / maximum premium under this rider? ............................................................................... 3
6. For how many years do I need to pay my premiums? ............................................................................................... 3
7. How can I pay my premiums? ....................................................................................................................................... 3
8. Does the rider premium get invested? ......................................................................................................................... 3
Benefits ................................................................................................................................................................................................. 4
9. Is there a waiting period involved before the CI rider benefit can be claimed? .................................................. 4
10. Which are the illnesses covered under this rider? ..................................................................................................... 4
11. What do you mean by Accident, Injury, Illness, Medical Practitioner? ................................................................ 5
12. Under what circumstances (exclusions), will the CI rider benefit not be payable? ............................................ 5
13. When can this rider be added / deleted? ...................................................................................................................... 6
14. Is there any surrender benefit or paid up value or loan available on this rider? ................................................. 6
15. Are rider premium rates guaranteed throughout the term? ..................................................................................... 6
16. Can I claim for the CI benefit if I have claimed the same under Hospital Care Rider or Surgical Care
Rider? ................................................................................................................................................................................. 6
17. Can I avail of tax benefits under this plan? What are the benefits available?...................................................... 6
Termination .......................................................................................................................................................................................... 6
18. How long will my rider continue? ................................................................................................................................ 6

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UIN:109B019V02
 Birla Sun Life Insurance Critical Illness Rider – Frequently Asked Questions

No one likes to think about the possibility of suffering a critical illness like cancer, heart attack and stroke etc. It is
something that many of us assume will not happen to us. In the daily grind of activities, one ends up never being
prepared for such an eventuality.

The Critical Illness rider of Birla Sun Life Insurance is designed to help you bridge the critical gaps in your overall
protection strategy. This unique rider covers four major critical illnesses.

BSLI Critical Illness Rider – Plan Summary

1. What is BSLI Critical Illness (CI) Rider?

Critical Illness (CI) Rider is traditional rider that offers coverage towards 4 major illnesses by paying a nominal extra
premium over and above the base premium. Following are the illnesses covered under this rider -
• First Heart Attack of Specified Severity
• Cancer of Specified Severity
• Stroke Resulting In Permanent Symptoms
• Major Organ / Bone Marrow Transplant
In the unfortunate event the life insured is diagnosed to be suffering from any one of the above 4 critical illnesses, we
will pay 100% of the rider sum assured on survival of 30 days following the date of confirmed diagnosis.

2. Am I eligible for this rider?

You are eligible if you are between age 18 – 65 years.

3. What is the minimum / maximum sum assured under this rider?

The minimum sum assured is Rs. 75,000 and maximum is Rs. 50,00,000 subject to maximum of 100% sum assured of
the base plan

4. What are the rider terms available?

The term available under the plan is same as the premium paying term of the base plan or till the attained age 70 of
the life insured, whichever is earlier i.e. 5-52 years.

Premium

5. What is the minimum / maximum premium under this rider?

Premium under this rider depends on the age at entry, gender, policy term, pay term and the rider sum assured
chosen. However, the total rider premium cannot exceed 30% of the Basic SA premium.

6. For how many years do I need to pay my premiums?

Premium paying term for rider premium is same as that of the base plan or till the attained age 70 of the life insured,
whichever is earlier.

7. How can I pay my premiums?

You need to pay your rider premium in the same mode as that of base plan.

8. Does the rider premium get invested?

Rider premiums will not be invested. This rider is traditional in nature.

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UIN:109B019V02
 Birla Sun Life Insurance Critical Illness Rider – Frequently Asked Questions

Benefits

9. Is there a waiting period involved before the CI rider benefit can be claimed?
Yes, there is a waiting period of 90 days before this rider gets activated under your policy.

10. Which are the illnesses covered under this rider?

Please note that the claim under the rider is payable only if the critical illness suffered by the policyholder falls under
the scope of definitions provided. It is advisable to refer to the detailed definitions given in the sales brochure and
communicate the same to the policyholder. The following illnesses are covered under this rider:
First Heart Attack of Specified Severity
First occurrence of 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 this be evidenced by all of the following criteria:
• A history of typical clinical symptoms consistent with the diagnosis of acute myocardial Infarction (for
example typical chest pain),
• New characteristic electrocardiogram changes,
• Elevation of infarction specific enzymes, Troponins or other specific biochemical markers.

Non-ST-segment elevation myocardial infarction (NSTEMI) with elevation of Troponin I or T; other acute
Coronary Syndromes and any type of angina pectoris are specifically excluded.
Cancer of Specified Severity
A malignant tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of &
destruction of normal tissues. The diagnosis must be supported by histological evidence of malignancy & confirmed
by a pathologist. The term cancer includes leukemia, lymphoma and sarcoma. Excluded are:
• 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;
• Pailliary micro-carcinoma of the thyroid less than 1cm in diameter;
• Chronic lymphocytic leukaemia less than RAI stage 3;
• Microcarcinoma of the bladder;
• All tumours in the presence of HIV infection
Stroke Resulting In Permanent Symptoms
Any cerebrovascular incident producing neurological sequelae. This includes infarction of brain tissue, thrombosis in
an intracranial vessel, haemorrhage and embolisation 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 neurological deficit for at least 3 months has to be produced. Excluded are:
• Transient ischemic attacks (TIA)
• Traumatic injury of the brain
• Vascular disease affecting only the eye or optic nerve or vestibular functions
Major Organ / Bone Marrow Transplant
Actual undergoing of a transplant as a recipient 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 haematopoetic stem cells.

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 Birla Sun Life Insurance Critical Illness Rider – Frequently Asked Questions

• The undergoing of a transplant has to be confirmed by a specialist medical practitioner

Excluded are:
• Other stem-cell transplants
• Where only islets or langerhans are transplanted

11. What do you mean by Accident, Injury, Illness, Medical Practitioner?

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

Injury 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.

Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological
function which manifests itself during the Policy Period and requires medical treatment.

Medical Practitioner means a person who holds a valid registration from the Medical Council of any state or Medical
Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State
Government and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and
jurisdiction of his license. The medical practitioner should not be the insured or a close relative of the insured.

12. Under what circumstances (exclusions), will the CI rider benefit not be payable?
The life insured will be entitled to receive the benefit if the critical illness does not result either directly or indirectly
from any one of the following causes listed in the exceptions below:
• any pre-existing condition (disease, illness or injury) which manifested itself prior to the effective date of the rider
or its latest revival date, whichever is later;
• any condition (disease, illness or injury) manifesting itself within 90 days from the effective date of the rider or its
latest revival date, whichever is later;
• any congenital condition;
• AIDS, HIV related complications or any sexually transmitted diseases;
• attempted suicide or self-inflicted injury, irrespective of mental condition;
• participation in a criminal, unlawful or illegal activity;
• taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison,
except as prescribed by a registered medical practitioner acceptable to us;
• nuclear contamination, the radioactive, explosive or hazardous nature of nuclear fuel materials or property
contaminated by nuclear fuel materials or accident arising from such nature;
• entering, exiting, operating, servicing, or being transported by any aerial device or conveyance except when on a
commercial passenger airline on a regular scheduled passenger trip over its established passenger route;
• engaging in or taking part in professional sport(s) or any hazardous pursuits, including but not limited to, diving or
riding or any kind of race, underwater activities involving the use of breathing apparatus or not, martial arts,
hunting, mountaineering, parachuting, bungee jumping;
• war (whether declared or not), terrorism, invasion, act of foreign enemy, hostilities, civil war, martial law, rebellion,
revolution, insurrection, military or usurper power, riot or civil commotion;
• taking part in any naval, military or air force operation during peace time;
• no payment will be made by the Company for any claim directly or indirectly caused by, based on, arising out of, or
howsoever, to any Critical Illness for which care, treatment, or advice was recommended by or received from a
Physician, or which first manifested itself or was contracted before the start of the Policy Period, or for which a
claim has or could have been made under any earlier policy.
It is essential that the exclusions are conveyed to the customers clearly so that s/he is well aware of the conditions
under which the claim may be entertained.

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UIN:109B019V02
 Birla Sun Life Insurance Critical Illness Rider – Frequently Asked Questions

13. When can this rider be added / deleted?

This rider can be added only at inception. Once added, deletion of this rider is not allowed.

14. Is there any surrender benefit or paid up value or loan available on this rider?
No, there is no surrender benefit or paid up value or loan available on this rider.

15. Are rider premium rates guaranteed throughout the term?

No, rider premium rates are guaranteed for the first three years in case of in force policies. Rates may be reviewed
thereafter subject to IRDA approval.

16. Can I claim for the CI benefit if I have claimed the same under Hospital Care Rider or Surgical Care Rider?
Yes. You can claim CI benefit even if you have claimed under the Hospital Care and Surgical Care Riders.

17. Can I avail of tax benefits under this plan? What are the benefits available?
As per current tax laws you will be eligible for tax benefits under Section 80D of the Income Tax Act, 1961.
Under Section 80D, premiums up to Rs. 15,000 (Rs. 20,000 for senior citizens) are allowed as a deduction from your
taxable income each year, provided these premiums are not paid in cash.

Termination

18. How long will my rider continue?

The rider will be terminated at the earliest of:
• the coverage maturity date for this rider coverage
• the date the policy to which this rider is attached terminates; or
• the date on which a claim is paid under this rider; or the date the reinstatement period ends as per the premium
discontinuance provision of base plan. No rider benefits shall be payable during the reinstatement period of such
policies.

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UIN:109B019V02