17 DEC 2016
Clauses and Exclusions in your policy
A life insurance policy is a legally enforceable contract between the insurer and the insured. This means that there are certain clauses and rules governing this contract. There are certain situations in which an insurer can decline the claim and there are certain clauses which decide what you can do with the policy. Here, we will understand the various clauses and exclusions that govern the policy.
1. Suicide claim
A claim for death owing to suicide is not admitted within 12 months to 2 years of the date of inception of the policy. This means that death due to suicide will not be covered for the first 1 or 2 years of the policy. Edelweiss Tokio Life – MyLife+ starts covering suicide claims after 12 months of inception of the policy. However, in case the insured commits suicide during the exclusion period, 80 % of the premiums paid are returned to the family members depending on certain conditions.
2. Grace period
If you have not paid the premium due, your policy will remain in force for 30 days from the premium due date. This is called as the grace period. If the premiums remain unpaid after the completion of the grace period, the policy shall lapse. The benefits of the policy will continue depending on deduction of the due premiums and subject to terms and conditions.
The policyholder can nominate anyone as the beneficiary to receive the benefits of the policy on his death. This nomination can be made and changed any time during the policy term. There are no restriction son the number of times this can be changed.
On a specific request by the policyholder, the rights bestowed in the policy may be assigned to another person. This is called as assignment of the policy.
Apart from the above, there are exclusion specific to a critical illness plan like Edelweiss Tokio Life – CritiCare+. These are:
1. Pre-existing diseases
Pre-existing diseases are the diseases that a policyholder suffers from at the time of talking the policy . These diseases will be covered in the case of a critical illness plan after 48 months from commencement of the policy. In other words, a claim for incidence of a complication arising out of a pre-existing diseases will not be admissible in the first two years of the policy.
2. Self-inflicted injuries
No claim arising out of self-inflicted injuries, attempted suicide, insanity, and immorality, and deliberate participation of the life insured in an illegal or criminal act will be admissible under the policy any time during the policy term. Even an illness arising out of consuming intoxicating drugs, alcohol or banned drugs will render the claim invalid.
3. War clause
Under the war clause, any critical illness arising out of war, whether declared or not, will not be admissible. The definition of war includes invasion, civil commotion like in a military coup, breach of law, rebellion, revolution, direct military action, and civil hostilities.
4. Engaging in hazardous pastimes
Incidence of critical illness due to engagement in hazardous pastimes or sports like boxing, mountaineering, underwater diving, horse racing etc will not be admissible.
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