Jeevan Shiromani - Life Insurance Policy
(Limited premium payment money
back life insurance plan)
|
LIC’s Jeevan Shiromani plan offers a combination of protection
and savings. This plan is specially designed for High Net-worth
Individuals. This plan provides financial support for the family
in case of unfortunate death of the policyholders during the
policy term. Periodic payments shall also be made on survival of
the policyholder at specified durations during the policy term
and a lump sum payment to the surviving policyholder at the time
of maturity. In addition, this plan also provides for payment of
a lumpsum amount equal to 10% of the chosen Basic Sum Assured on
diagnosis of any of the specified Critical Illnesses.
|
|
This plan also takes care of liquidity needs through loan
facility.
1. Benefits payable under an inforce policy (where all due
premiums have been paid):
Death Benefit: On death during first five years: Death Benefit
defined as sum of “Sum Assured on Death” and accrued Guaranteed
Addition shall be payable. On death after completion of five
policy years but before the date of maturity: Death Benefit
defined as sum of “Sum Assured on Death” and accrued Guaranteed
Addition and Loyalty Addition, if any, shall be payable.
Where “Sum Assured on Death” is defined as the highest of
10 times of annualised premium; or
Sum Assured on Maturity as defined in 1. c) below; or
Absolute amount assured to be paid on death, i.e. 125% of
Basic Sum Assured.
This death benefit shall not be less than 105% of all the
premiums paid as on date of death. Premiums referred above shall
not include any taxes, extra amount chargeable under the policy
due to underwriting decision and rider premium(s), if any.
Maturity Benefit:
On the life assured surviving to the end of the policy term,
provided all due premiums have been
paid, “Sum Assured on Maturity” along with accrued Guaranteed
Additions and Loyalty
Addition, if any, shall be payable.
Where “Sum Assured on Maturity” is as under:
40% of Basic Sum Assured for policy term 14 years
30% of Basic Sum Assured for policy term 16 years
20% of Basic Sum assured for policy term 18 years
10% of Basic Sum assured for policy term 20 years
Inbuilt Critical Illness Benefit:
I. Benefit:
On first diagnosis of any one of the 15 critical illnesses as
mentioned below, provided the policy
is inforce on the date of diagnosis by payment of all premiums
due under the policy, the
following benefits/ facilities shall be available:
i) Lumpsum Benefit: Inbuilt Critical Illness Benefit equal to
10% of Basic Sum Assured shall be
payable provided the claim is admissible.
ii) Option to defer the payment of premium(s): When a claim
under inbuilt Critical Illness
Benefit is admitted, life assured will have an option to defer
the payment of premiums falling
due within 2 years from the date of admission of Critical
Illness claim under the policy
(including rider premiums). The deferment of premiums shall be
allowed for a period of 2
years from the date of admission of Critical Illness claim and
subsequent premiums, if any,
shall be payable on their due dates. No interest shall be
charged from the life assured for
deferred premiums within the period of such deferment . During
this period, if any due
premium(s) are not paid, and any of the benefits payable under
the base policy and/or
rider(s) become due, the applicable benefit(s) shall be payable
as under an inforce policy
after the deduction of all the premiums due under the policy.
iii)Medical Second Opinion: The policyholder will have facility
of taking Medical Second
Opinion, through the available healthcare providers,
internationally or through reputed
hospitals in India or through specialist doctors available in
different places depending on the
arrangement in this regard by the Corporation. This facility
shall be available only once
during the policy term with no extra cost. This provision for
all or either of the options of
Medical Second Opinion is subject to availability of the
facility and arrangement made by the
Corporation and as intimated in this regard. The details of same
shall be furnished to the
policyholder along with the policy document.
II. Conditions and restrictions under Inbuilt Critical Illness
Benefit:
(A) Inbuilt Critical Illness benefit will be payable only after
the Corporation is satisfied on the
basis of available medical evidence that the specified illness
has occurred. However, in
some illnesses covered under this benefit, a specific deferment
period applies to establish
permanence of the illness covered.
3
(B) This benefit shall be payable only once during the currency
of the policy. Under a paid-up
policy proportionate benefit amount shall be payable as
mentioned in Para 9 below.
(C) The list and definitions of the 15 Critical Illness
conditions covered under this benefit:
1.CANCER OF SPECIFIED SEVERITY:
I. A malignant tumor characterized by the uncontrolled growth
and spread of malignant
cells with invasion and destruction of normal tissues. This
diagnosis must be supported
by histological evidence of malignancy. The term cancer includes
leukaemia,
lymphoma and sarcoma.
II. The following are excluded –
i. All tumors which are histologically described as carcinoma in
situ, benign, premalignant,
borderline malignant, low malignant potential, neoplasm of
unknown
behavior, or non-invasive, including but not limited to:
Carcinoma in situ of breasts,
Cervical dysplasia CIN-1, CIN -2 and CIN-3.
ii. Any non-melanoma skin carcinoma unless there is evidence of
metastases to lymph
nodes or beyond;
iii. Malignant melanoma that has not caused invasion beyond the
epidermis;
iv. All tumors of the prostate unless histologically classified
as having a Gleason score
greater than 6 or having progressed to at least clinical TNM
classification T2N0M0
v. All Thyroid cancers histologically classified as T1N0M0 (TNM
Classification) or below;
vi. Chronic lymphocytic leukaemia less than RAI stage 3
vii. Non-invasive papillary cancer of the bladder histologically
described as TaN0M0 or of
a lesser classification,
viii. All Gastro-Intestinal Stromal Tumors histologically
classified as T1N0M0 (TNM
Classification) or below and with mitotic count of less than or
equal to 5/50 HPFs;
ix. All tumors in the presence of HIV infection.
2.OPEN CHEST CABG
I. The actual undergoing of heart surgery to correct blockage or
narrowing in one or more
coronary artery(s), by coronary artery bypass grafting done via
a sternotomy (cutting
through the breast bone) or minimally invasive keyhole coronary
artery bypass
procedures. The diagnosis must be supported by a coronary
angiography and the
realization of surgery has to be confirmed by a cardiologist.
II. The following are excluded:
Angioplasty and/or any other intra-arterial procedures
3.MYOCARDIAL INFARCTION
(First Heart Attack of specific severity)
I. 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.
4
II. The following are excluded:
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.
4.KIDNEY FAILURE REQUIRING REGULAR DIALYSIS
End stage renal disease presenting as chronic irreversible
failure of both kidneys to function,
as a result of which either regular renal dialysis (haemodialysis
or peritoneal dialysis) is
instituted or renal transplantation is carried out. Diagnosis
has to be confirmed by a specialist
medical practitioner.
5.MAJOR ORGAN /BONE MARROW TRANSPLANT (as recipient)
I. The actual undergoing of a transplant of:
i. One of the following human organs: heart, lung, liver,
kidney, pancreas, that resulted
from irreversible end-stage failure of the relevant organ, or
ii. Human bone marrow using haematopoietic stem cells. The
undergoing of a transplant
has to be confirmed by a specialist medical practitioner.
II. The following are excluded:
i. Other stem-cell transplants
ii. Where only islets of langerhans are transplanted
6.STROKE RESULTING IN PERMANENT SYMPTOMS
I. Any cerebrovascular incident producing permanent 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 permanent
neurological deficit lasting for at
least 3 months has to be produced.
II. The following are excluded:
i. Transient ischemic attacks (TIA)
ii. Traumatic injury of the brain
iii. Vascular disease affecting only the eye or optic nerve or
vestibular functions.
7.PERMANENT PARALYSIS OF LIMBS
Total and irreversible loss of use of two or more limbs as a
result of injury or disease of the
brain or spinal cord. A specialist medical practitioner must be
of the opinion that the
paralysis will be permanent with no hope of recovery and must be
present for more than 3
months.
8.MULTIPLE SCLEROSIS WITH PERSISTING SYMPTOMS
I. The unequivocal diagnosis of Definite Multiple Sclerosis
confirmed and evidenced by all of
the following:
i. investigations including typical MRI findings which
unequivocally confirm the diagnosis
to be multiple sclerosis and
5
ii. there must be current clinical impairment of motor or
sensory function, which must have
persisted for a continuous period of at least 6 months.
II. Other causes of neurological damage such as SLE and HIV are
excluded.
9. AORTIC SURGERY
The actual undergoing of major surgery to repair or correct an
aneurysm, narrowing,
obstruction or dissection of the aorta through surgical opening
of the chest or abdomen. For
the purpose of this definition, aorta shall mean the thoracic
and abdominal aorta but not its
branches.
Surgery performed using only minimally invasive or
intra-arterial techniques are excluded.
10. PRIMARY (IDIOPATHIC) PULMONARY HYPERTENSION
I. An unequivocal diagnosis of Primary (Idiopathic) Pulmonary
Hypertension by a
Cardiologist or specialist in respiratory medicine with evidence
of right ventricular
enlargement and the pulmonary artery pressure above 30 mm of Hg
on Cardiac
Cauterization. There must be permanent irreversible physical
impairment to the degree of
at least Class IV of the New York Heart Association
Classification of cardiac impairment.
II. The NYHA Classification of Cardiac Impairment are as
follows:
i. Class III: Marked limitation of physical activity.
Comfortable at rest, but less than
ordinary activity causes symptoms.
ii. Class IV: Unable to engage in any physical activity without
discomfort. Symptoms may
be present even at rest.
III. Pulmonary hypertension associated with lung disease,
chronic hypoventilation, pulmonary
thromboembolic disease, drugs and toxins, diseases of the left
side of the heart, congenital
heart disease and any secondary cause are specifically excluded.
11. ALZHEIMER’S DISEASE/ DEMENTIA
Deterioration or loss of intellectual capacity as confirmed by
clinical evaluation and imaging
tests, arising from Alzheimer's Disease or irreversible organic
disorders, resulting in
significant reduction in mental and social functioning requiring
the continuous supervision
of the Life Assured for a minimum period of 6 months from date
of diagnosis. This diagnosis
must be supported by the clinical confirmation of an appropriate
Registered Medical
practitioner who is also a Neurologist and supported by the
Corporation’s appointed doctor.
The following are excluded:
i. Non-organic disease such as neurosis and psychiatric
illnesses; and
ii. Alcohol-related brain damage.
12. BLINDNESS
I. Total, permanent and irreversible loss of all vision in both
eyes as a result of illness or
accident.
II. The Blindness is evidenced by:
i. corrected visual acuity being 3/60 or less in both eyes or ;
ii. the field of vision being less than 10 degrees in both eyes.
6
III. The diagnosis of blindness must be confirmed and must not
be correctable by aids or
surgical procedure.
13. THIRD DEGREE BURNS
There must be third-degree burns with scarring that cover at
least 20% of the body’s surface
area. The diagnosis must confirm the total area involved using
standardized, clinically
accepted, body surface area charts covering 20% of the body
surface area.
14. OPEN HEART REPLACEMENT OR REPAIR OF HEART VALVES
The actual undergoing of open-heart valve surgery is to replace
or repair one or more heart
valves, as a consequence of defects in, abnormalities of, or
disease-affected cardiac valve(s).
The diagnosis of the valve abnormality must be supported by an
echocardiography and the
realization of surgery has to be confirmed by a specialist
medical practitioner. Catheter based
techniques including but not limited to, balloon valvotomy/valvuloplasty
are excluded.
15. BENIGN BRAIN TUMOR
I. Benign brain tumor is defined as a life threatening,
non-cancerous tumor in the brain,
cranial nerves or meninges within the skull. The presence of the
underlying tumor must be
confirmed by imaging studies such as CT scan or MRI.
II. This brain tumor must result in at least one of the
following and must be confirmed by the
relevant medical specialist.
i. Permanent Neurological deficit with persisting clinical
symptoms for a continuous
period of at least 90 consecutive days or
ii. Undergone surgical resection or radiation therapy to treat
the brain tumor.
III. The following conditions are excluded:
Cysts, Granulomas, malformations in the arteries or veins of the
brain, hematomas,
abscesses, pituitary tumors, tumors of skull bones and tumors of
the spinal cord.
(D) Waiting period: A waiting period of 90 days will apply from
the date of commencement of
risk or date of revival of risk cover, whichever is later, to
the first diagnosis of the Critical
Illness under consideration. This would mean that this benefit
shall terminate if any of the
contingencies mentioned in Para 1.d.II. above occurs:
(i) at any time on or after the date on which the risk under the
Policy has commenced but
before the expiry of 90 days reckoned from that date or
(ii)before the expiry of 90 days from the date of Revival.
However, waiting period will not apply to conditions arising
directly out of accident.
(E) Survival period: A survival period of 30 days is applicable
from the date of diagnosis of
Critical Illness listed above. If death occurs within the
survival period, no inbuilt critical
illness benefit shall be payable.
(F) Exclusions:
The Corporation shall not be liable to pay any of the benefits
under Inbuilt Critical Illnesses
Benefit if the critical illness has occurred directly or
indirectly as a result of any of the
following:
Any of the listed critical illness conditions where death
occurs within 30 days from the
date of diagnosis
Any sickness condition related to the critical illnesses
listed above manifesting itself
within 90 days of the commencement of risk or revival of risk
cover, whichever is later.
Intentionally self-inflicted injury or attempted suicide,
irrespective of mental condition.
Alcohol or solvent abuse, or the taking of drugs except under
the direction of a
registered medical practitioner.
War, invasion, hostilities (whether war is declared or not),
civil war, rebellion,
revolution or taking part in a riot or civil commotion.
Taking part in any act of a criminal nature.
Any Pre-existing medical condition.
HIV or AIDS
Failure to seek medical or follow medical advice (i.e. failure
to undergo tests or
treatments that a prudent person would normally undergo as
recommended by a
Medical Practitioner.
Radioactive contamination due to nuclear accident.
(G) Termination of Inbuilt Critical Illness Benefit:
The Inbuilt Critical Illness Benefit will terminate on the
earliest occurrence of any of the
following events:
The date on which the claim is paid in respect of this
benefit; or
The date of expiry of policy term; or
The date on which surrender benefit is settled under the
policy; or
On cancellation/termination of the policy for any reason; or
On cancellation/termination of the policy by the Corporation
on grounds of
misrepresentation, fraud or non-disclosure established in terms
of Section 45 of the
Insurance Act, 1938, as amended from time to time; or
On diagnosis of a Critical Illness within the waiting period
Any critical illness manifesting itself during the waiting
period is not admissible. The first
admissible critical illness which is manifested, diagnosed and
lodged after waiting period
and during the currency of policy, once admitted for, shall
preclude any further critical
illness and therefore the benefit will terminate.
2. Guaranteed Additions:
Guaranteed Additions shall accrue at the end of each policy year
during the Premium Paying Term
(PPT), provided all due premiums have been paid till date. The
rate of Guaranteed Additions shall
be as follows:
Rs. 50 per thousand Basic Sum Assured for first five years
Rs. 55 per thousand Basic Sum Assured from 6th policy year
till end of PPT
In case of a paid-up policy or on surrender of a policy the
Guaranteed Addition for the policy year
in which the last premium is received will be added on
proportionate basis in proportion to the
premium received for that year.
3. Participation in profits:
Provided the policy has completed five policy years and atleast
5 full years’ premium have been
paid, then depending upon the Corporation’s experience the
policies under this plan shall be
eligible for Loyalty Addition at the time of exit in the form of
Death during the policy term or
Maturity, at such rate and on such terms as may be declared by
the Corporation. Under a paid-up
policy, Loyalty Addition shall be payable for the completed
policy years for which the policy was
inforce.
In addition, Loyalty Addition, if any, shall also be considered
in Special Surrender Value
calculation on surrender of policy during the policy term,
provided the policy has completed five
policy years and atleast 5 full years’ premium have been paid In
case of surrender of policy,
Loyalty Addition shall be payable for the completed policy year
for which the policy was inforce.
|
