Waiting Period, Survival Period and Pre-existing Conditions

SUD Life Smart Healthcare is a fixed-benefit health insurance plan. It covers specified critical illness conditions related to cancer, heart, liver and kidney.
You choose one of three plan options at the start:

● Cancer Cover

● Heart Cover

● Heart, Cancer, Liver and Kidney Cover

Once chosen, the plan option cannot be changed during the policy term.

What you receive. On diagnosis of a covered minor¹ critical illness condition, you receive 25% of the sum insured³. On diagnosis of a covered major¹ condition of critical illness, you receive 100% of the sum insured, less any minor claims already paid².

The Company will admit only one major claim the policy term while up to two minor CI condition claims can be admitted².

The payout will be fixed regardless of what the hospital bill says. That is the whole point of a benefit plan. The money is yours — for treatment, for the income you are not earning while you recover, or for anything else you need it for.

Two things this plan does not do, stated plainly. There is no maturity benefit, so if you complete the policy term without a claim, nothing is paid and the contract ends. There is no death benefit either, and the policy ends on the death of the life assured.

● Major critical illness conditions: 90 days

● Minor critical illness conditions: 180 days

Waiting period is a period of, from the policy commencement date or policy revival date if the policy was revived, whichever is later during which no coverage will be available for the insured event.

What if you are diagnosed with major or minor condition of CI during the window? No benefit is payable.100% of the premium paid will be refunded, calculated from the date cover started or the date of revival as applicable, and the policy ends immediately.

However, there is no waiting period for a critical illness claim arising solely due to an accident.

A survival period is a period of 15 days from date of diagnosis for the covered critical illness during which the Life Assured must survive to make him eligible to submit claim under the Policy. Under this plan, it is 15 days from the date of diagnosis.
Two clarifications, because this term gets misread more than any other.

It is not a waiting period. It does not delay your cover starting. It applies at the point of claim.

The timing works in your favour. The benefit may be payable where the covered critical illness is diagnosed during the policy term, irrespective of when the 15-day survival period is completed. So a diagnosis close to the end of your policy term is not disqualified simply because the fifteenth day falls after the term ends.

Fifteen days is at the shorter end of what benefit-based plans in India typically apply. When you compare critical illness products, the survival period is one of the numbers worth putting side by side.

This is the definition to read twice.

Look carefully at what that covers. Not just a formal diagnosis, but advice or treatment as well. A doctor who told you to keep an eye on something and come back in six months has given you medical advice. That counts.

Pre-existing diseases means any condition, ailment, injury or disease,

a) That is/ are diagnosed by a physician within 36 months prior to the effective date of the Policy or its Revival; or

(b) For which medical advice or treatment was recommended by, or received from, a physician within 36 months prior to the effective date of the Policy or its Revival.

After this period, the cover for a pre-existing disease is available — but only where the condition was declared when you applied and accepted by the insurer.

That is the part people miss. Time alone does not bring an undeclared condition into cover. Declaring it does.

All of which comes back to the same point we have made before about proposal forms. Declare everything and let the underwriter decide what matters. An undeclared condition is not protected by the passing of time.

A minor CI condition claim does not use up your cover. The plan is designed for the possibility of a second one. There is a condition attached.

Where two minor critical illness condition claims are made, a cooling-off period of 180 days must fall between the date of diagnosis of the first and the date of diagnosis of the second minor CI condition claim.

That requirement does not apply where a major condition is diagnosed after a minor condition claim. If your situation worsens, you are not made to wait.

There are two further rules on repeat minor claims.

In any of the selected Plan Option, in case the first Minor CI Condition claim relates to an organ, no subsequent Minor CI Condition claim with respect to the same organ shall be entertained. For example, in case you have opted for Plan Option – Cancer Cover, then multiple minor condition claims for the same organ will not be admitted by the Company. Explanation:- For those organs with left and right component (including but not limited to breast, ear, eye, fallopian tube, kidney, lung, ovary and testicle), the left component and right component of the organ shall be considered as one and the same organ. Further, each group of the following sites will also be treated as one organ: 8 a) Basal cell and squamous skin cancer b) Corpus uteri, vagina, cervix uteri c) Colon and rectum d) Penis and testis e) Stomach and esophagus. And a benefit worth knowing about. On a valid diagnosis of first minor CI condition claim, in addition to the lump sum benefit, your premiums are waived for three policy years, or for the remaining policy term if less than three years are left. This waiver applies to the first minor claim only, not to a second.

Beyond pre-existing conditions, the plan does not pay for a covered critical illness caused by, arising out of, or made worse by a defined list. please read the sales brochure for detailed information on the exclusions applicable under the plan.

This is the consequence most people do not see coming.

The grace period. Premiums have a grace period of 15 days for monthly mode and 30 days for all other modes. You stay fully covered throughout. If you are diagnosed during the grace period, the benefit is paid after deducting the premium then due.

If the premium is still unpaid after that, the policy lapses. Cover stops and no benefits are payable under a lapsed policy.

You can revive it within five years from the due date of the first unpaid premium. You will need to provide satisfactory proof of insurability and any medical evidence required under the Board approved underwriting policy and pay the outstanding premium with interest.

Here is the catch. On revival, benefits are restored subject to completion of the waiting period. The 90-day and 180-day clocks run again from the revival date.

Which makes keeping this particular policy active more important than most. Set up an auto-debit, and check that the card or account on file is current.

● Choose your plan option carefully. Match it to your family history, because you cannot change it later.
● Declare everything. Every condition, medication and piece of medical advice from the last three years, and then some.
● Read the definitions of the specific conditions you are most concerned about. A covered condition is defined by its exact wording, not by its name.
● Note when your waiting periods end and put the dates in your calendar.
● Set up an auto-debit on day one.

None of this is meant to put you off.

A plan that pays a fixed sum on diagnosis, whatever the bill says, and waives your premiums for three years after a minor claim, is a useful thing to hold. It is far more useful when you know exactly what you have bought.

Read the brochure. Read the condition definitions. Ask the questions that occur to you while reading nobody minds. It is a much better conversation to have now than at claim stage.

For anything you want clarified, call 1800 266 8833 between 9:00 am and 7:00 pm, Monday to Saturday, or write to customercare@sudlife.in.