Now, protect against 60 critical

illnesses
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HDFC Life Health Plus Rider - Non Linked
An Individual, Pure Risk Premium, Health Insurance Rider
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85

Coverage till Increasing Sum Flexibility in Premium

85 years of age Assured available *
Payout
* Under the Elite cover option 1
HDFC Life Health Plus Rider – Non Linked

Life insurance primarily ensures financial protection upon loss of life. However, adequate protection is also required to
maintain a safe and healthy life. Thus, additional protection in the form of riders is an attractive option that provides
comprehensive cover under one policy.

HDFC Life Health Plus Rider offers extensive coverage against 60 Critical Illnesses and Cancer Cover. The rider can be opted
on an individual basis.

HDFC Life Health Plus Rider offers the following benefits

• Flexibility to choose between comprehensive critical illness cover or cancer cover
• Comprehensive protection against 60 health conditions*
• Lump sum payout on diagnosis of major as well as early stages of cancer#
• Future premiums shall be waived for a period of 3 years under this rider on a valid claim of Early Stage Cancer or
Carcinoma-in-situ (CIS) diagnosis#
• Increase your Rider Sum Assured @5% p.a. with Elite Cover Option
• Option to choose premium payment term^ as Single Pay, Limited Pay or Regular Pay
*
Available under Comprehensive CI Cover Option
#
Available under Cancer Cover Option

This rider can be opted at inception or subsequently during the premium payment term of the base policy subject to limits
specified below:

Parameters Minimum Maximum

Entry Age (last birthday) 18 years 65 years
Maturity Age (last birthday) 23 years 85 years
Rider Term 5 years Outstanding Policy Term
under the base policy
Rider Premium Payment Term^ Single Pay / Regular Pay or
Limited Pay with Minimum Premium Payment Term of 5 years and
Maximum shall be Policy Term - 1 year
Minimum Rider Rs. 5,000 No Limit. Subject to Board
Sum Assured Approved Underwriting Policy

All ages are age last birthday

^
The premium paying term of this rider will be less than or equal to the outstanding premium paying term under the base
product to which this rider will be attached.
Note:
1. The Rider Sum Assured shall not exceed the Sum Assured of the base policy to which this rider is attached. This limit
shall be governed by extant regulations at the time of opting for this rider.
2. Rider will not be offered if the outstanding term under the base policy is less than minimum policy term (in months) as
specified above.
3. Rider will not be offered if the term of the rider exceeds outstanding term under the base policy.

What is the premium payable under this rider?

- The rider premium shall be collected in addition to the premium payable under the base policy.

The premiums will vary depending upon the option chosen. The minimum premium under this rider is as per the below
table:

Option Annual Rider Premium (in Rs)

A
Re. 1
B

2
- The premium payment frequency for the rider shall be same as the frequency of the base plan.

Plan Options

How does the Plan work?

The rider offers two options -

Option Option Name

Option A Comprehensive CI Cover
Option B Cancer Cover

The policyholder shall be covered for the following cases:

• Life assured is diagnosed with any of the covered critical illnesses (If Option A is selected)
• Life assured is diagnosed with Early Stage Cancer or Carcinoma-in-situ (CIS) diagnosis or Major Cancer (If Option B is
selected)

How to opt for Plan Options

The rider can be opted under the base policy on an individual basis subject to terms & conditions specified under the plan,
in the following ways:
• A Policyholder can choose any one option.
• Option A and Option B cannot be selected together.
• A Policyholder needs to opt for this rider at inception or during the premium payment term of base policy.
• The option once selected can not be changed during the rider term.
• Any rider coverage terminates as soon as the base policy terminates.

1. Option A - Comprehensive CI Cover

This option offers cover against 60 Critical Illnesses. The Rider Sum Assured shall be paid as a lumpsum on diagnosis of
any of the covered critical illnesses and the rider coverage will terminate.

2. Option B: Cancer Cover

i. Benefit on diagnosis of Cancer

This benefit is payable on diagnosis of any of the covered illness conditions listed below:

Sr. No. Name of Cancer Condition Type of Cancer Condition

1 Cancer of Specified Severity Major
2 Carcinoma-in-situ (CIS) Minor
3 Early-Stage Cancer Minor

The benefit pay-out will be as per below table :

Diagnosis of Benefit Amount as a % of Applicable Sum Assured

Minor Type of 25% of Rider Sum Assured(Increased Sum Assured in case of Elite cover option)
Cancer Condition or INR 12,50,000/- whichever is lower
Major Type of 100% of Rider Sum Assured less Early Stage Cancer
Cancer Condition or CIS claims, if any

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A maximum of two claims are payable under the minor type of cancer conditions. However, only one claim will be paid for
the same minor type of cancer condition. Once claims are made for 100% of Rider Sum Assured, the rider coverage will
terminate.
ii. Waiver of Premium Benefit:

On a valid claim of minor type of cancer condition, premiums payable under this rider will be waived for a period of three
years. In case the outstanding rider term is less than three years then premiums for the outstanding rider term would be
waived.
In case the outstanding rider term is more than three years then the premiums will be waived only for a period of three
years. The policyholder will need to resume payment of premiums thereafter.
Cover Options – Classic or Elite
Under both options, the policyholder may choose either Classic or Elite cover option.
1) Classic Cover Option – The Rider Sum Assured remains same during the rider term.
2) Elite Cover Option - The Rider Sum Assured will increase by 5% every year, subject to a maximum increase of 40% over
the rider term. The increased Rider Sum Assured shall not exceed the Base Policy Sum Assured at any point of time
The increase will stop once any claim has been made.
Benefit Payout Options –
In lieu of lump sum benefit, the policyholder may opt to receive benefit as:
a) Regular monthly income payable for 10 years, or
b)Part of benefit amount as lump sum payable immediately and the balance benefit amount as regular monthly income
for 10 years.

The choice of benefit pay-out as (a) or (b) mentioned above can be exercised on or before the claim is made.

The interest rate used to compute the instalment amount shall be equal to the annualized yield on 10 year G-Sec (over last
6 months & rounded down to nearest 25bps) less 100 basis points.

At any time during the instalment phase, the policyholder / nominee can choose to terminate the instalment payment in
exchange for a lump-sum, in which case, the lump-sum payable shall be equal to the discounted value of all the future
instalments due. The interest rate used to calculate the discounted value shall be equal to the annualized yield on 10 year
G-Sec (over last 6 months & rounded down to nearest 25bps) + 100 basis points on the date of termination.

The interest rate shall be reviewed half-yearly and any change in the interest rate shall be effective from 25th February and
25th August of each year. The interest rate shall be revised every time there is a change as per the above formula. In case of
a revision in interest rate, the same shall apply until next revision. The source of 10-year benchmark G-sec yield shall be RBI
Negotiated Dealing System-Order Matching segment (NDS-OM).

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List of Critical Illnesses covered under Option A - Comprehensive CI Cover

Sr. No. Name of CI/Surgery Sr. No. Name of CI/Surgery

1 Alzheimer’s Disease 31 Stroke resulting in permanent symptoms

2 Parkinson’s disease 32 Primary (Idiopathic) Pulmonary Hypertension

3 Aorta Graft Surgery 33 Permanent Paralysis of Limbs

4 Amputation of Feet due to Complications 34 Open Heart Replacement or Repair of Heart Valves
from Diabetes

5 Apallic Syndrome 35 Open Chest CABG

6 Aplastic Anaemia 36 Multiple Sclerosis with Persisting Symptoms

7 Bacterial Meningitis 37 Motor Neuron Disease with Permanent Symptoms

8 Brain Surgery 38 Major Organ /Bone Marrow Transplant

9 Cardiomyopathy 39 Major Head Trauma

10 Chronic Adrenal Insufficiency (Addison’s Disease) 40 Benign Brain Tumor

11 Chronic Relapsing Pancreatitis 41 Blindness

12 Severe Crohn’s Disease 42 Deafness

13 Dissecting Aortic Aneurysm 43 End Stage Lung Failure

14 Ebola 44 End Stage Liver Failure

15 Elephantiasis 45 Loss of Speech

16 Encephalitis 46 Loss of Limbs

17 Fulminant Hepatitis 47 Kidney Failure Requiring Regular Dialysis

18 Loss of Independent Existence 48 Infective Endocarditis

(cover up to Insurance Age 74)

19 Medullary Cystic Disease 49 Coma of specified Severity

20 Muscular Dystrophy 50 Cancer of Specified Severity

21 Myasthenia Gravis 51 Myocardial Infarction

(First Heart Attack of Specific Severity)

22 Other Serious Coronary Artery Disease 52 Creutzfeldt-Jacob Disease (CJD)

23 Poliomyelitis 53 Multiple System Atrophy

24 Progressive Scleroderma 54 Loss of One Limb and One Eye

25 Progressive Supranuclear Palsy 55 Necrotising Fasciitis

26 Severe Rheumatoid Arthritis 56 Hemiplegia

27 Severe Ulcerative Colitis 57 Tuberculosis Meningitis

28 Systemic Lupus Erythematosus with 58 Myelofibrosis

Lupus Nephritis

29 Pneumonectomy 59 Pheochromocytoma

30 Third Degree Burns 60 Eisenmenger’s Syndrome

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Which products can this Rider be offered with?

The rider is applicable for the following products.

Sr No Product
1. HDFC Life Sanchay Plus
2. HDFC Life Click 2 Protect Life
3. HDFC Life Click 2 Protect Super

Is there any Maturity benefit?

There is no maturity benefit available under this rider.

Is there any Death Benefit?

There is no death benefit available under this rider.

What is the grace period?

Grace Period of 30 days, where the mode of payment of Premium is annual, half-yearly, quarterly and 15 days in case of
monthly mode, is allowed for the payment of each renewal premium after the first premium. The rider is considered to be
in-force with the risk cover during the grace period without any interruption.

Can I Surrender the Benefit?

Surrender value shall be payable subject to following conditions:

o Surrender Value is acquired as follows:

Single Pay Immediately upon payment of premium

Limited Pay Upon payment of rider premiums for at least 2 years.
Regular Pay No surrender value is payable.

o Surrender Value =

50% × Total Rider Premiums Paid1 × Unexpired Rider Term

Original Rider Term
1
Total Rider Premiums Paid means total of all the rider premiums received, excluding any extra premium and taxes.

On cessation of premiums during the premium paying term the rider cover shall cease immediately and if not revived within
the applicable revival period, the rider will terminate post payment of surrender value (if any).

What are the revival conditions?

Revival period shall be the same as that of base plan. The revival shall be subject to the BAUP and payment of unpaid
premiums with interest and a revival fee of Rs 250.

What is the procedure for renewal of this rider?

As this is a rider benefit, as long as the premium due is paid along with the base premium, the rider benefit is renewed.

What is Premium Rate Guarantee in this rider?

The premium rates and Rider Sum Assured (as opted at rider inception) under this rider shall be guaranteed for a period
of 5 years from the date of risk commencement of the rider, however the premium rates may be revised thereafter at the
discretion of the Company..

After any revision, the premium rates / Rider Sum Assured remains guaranteed for 3 policy years and may be revised

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thereafter at every 3-year intervals. The guarantee / revision will be applicable in the following manner:

1. For policies where premium paying term is completed or for regular/limited pay variant policies where remaining
premium payment term is less than 5 Years:

In case of revision of the Rider Sum Assured opted by the policyholder at inception, the policyholder shall be notified with
the revised Rider Sum Assured three months prior to the next rider policy anniversary post the revision, providing the
below options to choose from:
a. Accept the revised Rider Sum Assured and continue the rider.
Revised Rider Sum Assured = Current Rider Sum Assured x {(Current Rider premium) / (Revised Rider premium)}
Note that the “Revised rider premium” will be calculated considering the same entry age, rider coverage term and rider
premium payment term as at rider inception.
b. Fully terminate the rider and take the applicable surrender value (if any).
If none of the above option is exercised by the policyholder default option (a) will be applicable and the rider will continue
with the revised Rider Sum Assured.

2. For regular pay variant policies or limited pay variant policies where remaining premium payment term is 5 years or more:

Policyholder shall be notified with the revised premium rates / revised Rider Sum Assured three months prior to the date of
revision of premium providing the below options to choose from:
a. Accept / pay the revised premium and continue the rider with same level of Rider Sum Assured
b. Continue the rider with the original premium, with revised Rider Sum Assured.
Revised Rider Sum Assured = Current Rider Sum Assured x {(Current Rider premium) / (Revised Rider premium)}
Note that the “Revised Rider premium” will be calculated considering the same entry age, rider coverage term and rider
premium payment term as at rider inception.
c. Fully terminate the rider and take the applicable surrender value (if any).

If none of the above option is exercised by the Policyholder or the revised/differential premium (as the case may be) is
not paid, default option (b) will be applicable and the rider will continue with the original premium and revised Rider Sum
Assured.

Annexure 1 – Definitions and Exclusions

Definitions
1) Option A - Comprehensive CI Cover
1.1. Definitions
1. Alzheimer’s Disease
Alzheimer’s (presenile dementia) disease is a progressive degenerative disease of the brain, characterised by diffuse
atrophy throughout the cerebral cortex with distinctive histopathological changes. It affects the brain, causing symptoms
like memory loss, confusion, communication problems, and general impairment of mental function, which gradually worsens
leading to changes in personality.
Deterioration or loss of intellectual capacity, as confirmed by clinical evaluation and imaging tests, arising from Alzheimer’s
disease, resulting in progressive significant reduction in mental and social functioning, requiring the continuous supervision
of the Life Assured. The diagnosis must be supported by the clinical confirmation of a Neurologist and supported by Our
appointed Medical Practitioner.
The disease must result in a permanent inability to perform three or more of six Activities of daily living with Loss of
Independent Living” or must require the need of supervision and permanent presence of care staff due to the disease. This
must be medically documented for a period of at least 90 days.
The following conditions are however not covered:
a) neurosis or neuropsychiatric symptoms without imaging evidence of Alzheimer’s Disease
b) alcohol related brain damage; and
c) any other type of irreversible organic disorder/dementia not associated with Alzheimer’s Disease

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The Activities of Daily Living are:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
iv. Mobility: the ability to move indoors from room to room on level surfaces;
v. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
2. Parkinson’s disease
The unequivocal diagnosis of progressive, degenerative idiopathic Parkinson’s disease by a Neurologist acceptable to us.
The diagnosis must be supported by all of the following conditions:
a. the disease cannot be controlled with medication;
b. signs of progressive impairment; and
c. inability of the Life Assured to perform at least 3 of the 6 activities of daily living as listed below (either with or without
the use of mechanical equipment, special devices or other aids and adaptations in use for disabled persons) for a
continuous period of at least 6 months:
Activities of daily living:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the shower) or wash satisfactorily
by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: The ability to move from bed to a upright chair or wheelchair and vice versa;
iv. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
v. Feeding: The ability to feed oneself once the food has prepared and made available;
vi. Mobility: The ability to move indoors from room to room on level surfaces. Parkinson’s disease secondary to drug and/
or alcohol abuse is excluded.
3. Aorta Graft Surgery
The actual undergoing of major Surgery to repair or correct aneurysm, narrowing, obstruction or dissection of the Aorta
through surgical opening of the chest or abdomen. For the purpose of this cover the definition of “Aorta” shall mean the
thoracic and abdominal aorta but not its branches.
The Life Assured understands and agrees that we will not cover:
a. Surgery performed using only minimally invasive or intra-arterial techniques.
b. Angioplasty and all other intra-arterial, catheter based techniques, “keyhole” or laser procedures.
Aorta graft surgery benefit covers Surgery to the aorta wherein part of it is removed and replaced with a graft.
4. Amputation of Feet due to Complications from Diabetes
Diabetic neuropathy and vasculitis resulting in the amputation of both feet at or above ankle as advised by a Medical
Practitioner who is a specialist as the only means to maintain life. Amputation of toe or toes, or any other causes for
amputation shall not be covered.
5. Apallic Syndrome
Apallic Syndrome or Persistent vegetative state (PVS) or unresponsive wakefulness syndrome (UWS) is a Universal necrosis
of the brain cortex with the brainstem remaining intact. The diagnosis must be confirmed by a Neurologist acceptable to
us and the patient should be documented to be in a vegetative state for a minimum of at least one month in order to be
classified as UWS, PVS, Apallic Syndrome.
6. Aplastic Anaemia
Chronic persistent bone marrow failure which results in anaemia, neutropenia and thrombocytopenia requiring treatment

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with at least one of the following:
a. Blood or Blood product transfusion;
b. Marrow stimulating agents;
c. Immunosuppressive agents; or
d. Bone marrow transplantation.
The diagnosis must be confirmed by a haematologist using relevant laboratory investigations including Bone Marrow Biopsy
resulting in bone marrow cellularity of less than 25% which is evidenced by any two of the following:
a. Absolute neutrophil count of less than 500/mm3 or less
b. Platelets count less than 20,000/mm3 or less
c. Reticulocyte count of less than 20,000/mm3 or less
Temporary or reversible Aplastic Anaemia is excluded.
7. Bacterial Meningitis
Bacterial infection resulting in severe inflammation of the membranes of the brain or spinal cord resulting in significant,
irreversible and permanent neurological deficit. The neurological deficit must persist for at least 6 weeks resulting in
permanent inability to perform three or more of six Activities of daily Living.
This diagnosis must be confirmed by:
a. The presence of bacterial infection in cerebrospinal fluid by lumbar puncture; and
b. A consultant neurologist.
The Activities of Daily Living are:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
iv. Mobility: the ability to move indoors from room to room on level surfaces;
v. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
8. Brain Surgery
The actual undergoing of surgery to the brain under general anaesthesia during which a craniotomy is performed. Keyhole
surgery is included however, minimally invasive treatment where no surgical incision is performed to expose the target,
such as irradiation by gamma knife or endovascular neuroradiological interventions such as embolizations, thrombolysis
and stereotactic biopsy are all excluded. Brain surgery as a result of an Accident is also excluded. The procedure must be
considered medically necessary by a Medical Practitioner who is a qualified specialist.
9. Cardiomyopathy
An impaired function of the heart muscle, unequivocally diagnosed as Cardiomyopathy by a Medical Practitioner who is a
cardiologist, and which results in permanent physical impairment to the degree of New York Heart Association classification
Class IV, or its equivalent, for at least six (6) months based on the following classification criteria:
NYHA Class IV - Inability to carry out any activity without discomfort. Symptoms of congestive cardiac failure are present
even at rest. With any increase in physical activity, discomfort will be experienced.
The Diagnosis of Cardiomyopathy has to be supported by echocardiographic findings of compromised ventricular
performance.
Irrespective of the above, Cardiomyopathy directly related to alcohol or drug abuse is excluded.
10. Chronic Adrenal Insufficiency (Addison’s Disease)
An autoimmune disorder causing a gradual destruction of the adrenal gland resulting in the need for life long glucocorticoid
and mineral corticoid replacement therapy. The disorder must be confirmed by a Medical Practitioner who is a specialist in
endocrinology through one of the following:
• ACTH simulation tests;

9
• insulin-induced hypoglycemia test;
• plasma ACTH level measurement;
• Plasma Renin Activity (PRA) level measurement.
Only autoimmune cause of primary adrenal insufficiency is included. All other causes of adrenal insufficiency are excluded.
11. Chronic Relapsing Pancreatitis
An unequivocal diagnosis of Chronic Relapsing Pancreatitis, made by a Medical Practitioner who is a specialist in
gastroenterology and confirmed as a continuing inflammatory disease of the pancreas characterised by irreversible
morphological change and typically causing pain and/or permanent impairment of function. The condition must be confirmed
by pancreatic function tests and radiographic and imaging evidence.
Relapsing Pancreatitis caused directly or indirectly, wholly or partly, by alcohol is excluded.
12. Severe Crohn’s Disease
Crohn’s Disease is a chronic, transmural inflammatory disorder of the bowel. To be considered as severe, there must be
evidence of continued inflammation in spite of optimal therapy, with all of the following having occurred:
• Stricture formation causing intestinal obstruction requiring admission to hospital, and
• Fistula formation between loops of bowel, and
• At least one bowel segment resection.
The diagnosis must be made by a Medical Practitioner who is a specialist Gastroenterologist and be proven histologically on
a pathology report and/or the results of sigmoidoscopy or colonoscopy.
13. Aortic Dissection
A condition where the inner lining of the aorta (intima layer) is interrupted so that blood enters the wall of the aorta and
separates its layers. For the purpose of this definition, aorta shall mean the thoracic and abdominal aorta but not its branches.
The diagnosis must be made by a Medical Practitioner who is a specialist with computed tomography (CT) scan, magnetic
resonance imaging (MRI), magnetic resonance angiograph (MRA) or angiogram. Emergency surgical repair is required.
14. Ebola
Infection with the Ebola virus where all the following conditions are met:
• presence of the Ebola virus has been confirmed by laboratory testing;
• there are ongoing complications of the infection persisting beyond thirty (30) days from the onset of symptoms; and
• the infection does not result in death.
15. Elephantiasis
Massive swelling in the tissues of the body as a result of destroyed regional lymphatic circulation by chronic filariasis infection.
The unequivocal diagnosis of elephantiasis must be confirmed by a Medical Practitioner who is a specialist physician. There
must be clinical evidence of permanent massive swelling of legs, arms, scrotum, vulva, or breasts. There must also be
laboratory confirmation of microfilariae infection.
Swelling or lymphedema caused by infection with a sexually transmitted disease, trauma, post-operative scarring, congestive
heart failure, or congenital lymphatic system abnormalities is excluded.
16. Encephalitis
Severe inflammation of brain substance (cerebral hemisphere, brainstem or cerebellum) caused by viral infection and
resulting in permanent neurological deficit. This diagnosis must be certified by a Medical Practitioner who is a consultant
neurologist and the permanent neurological deficit must be documented for at least 6 weeks. The permanent deficit should
result in permanent inability to perform three or more of six Activities for Daily Living (listed below).
Activities of daily living are:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
iv. Mobility: the ability to move indoors from room to room on level surfaces;
v. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
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vi. Feeding: the ability to feed oneself once food has been prepared and made available.
17. Fulminant Hepatitis
A sub-massive to massive necrosis of the liver by the Hepatitis virus, leading precipitously to liver failure. This diagnosis
must be supported by all of the following:
a. Rapid decreasing of liver size;
b. Necrosis involving entire lobules, leaving only a collapsed reticular framework;
c. Rapid deterioration of liver function tests;
d. Deepening jaundice; and
e. Hepatic encephalopathy.
Acute Hepatitis infection or carrier status alone does not meet the diagnostic criteria.
18. Loss of Independent Existence (cover up to Insurance Age 74)
The Life Assured is physically incapable of performing at least three (3) of the six (6) “Activities of Daily Living” as defined
below (either with or without the use of mechanical equipment, special devices or other aids or adaptations in use for
disabled persons) for a continuous period of at least six (6) months, signifying a permanent and irreversible inability to
perform the same. For the purpose of this definition, the word “permanent” shall mean beyond the hope of recovery with
current medical knowledge and technology. The Diagnosis of Loss of Independent Existence must be confirmed by a Medical
Practitioner who is a specialist.
Only Life Insured with Insurance Age between 18 and 74 on first diagnosis is eligible to receive a benefit under this illness.
Activities of daily living:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the shower) or wash satisfactorily
by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
iv. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
v. Feeding: the ability to feed oneself once food has been prepared and made available;
vi. Mobility: The ability to move indoors from room to room on level surfaces.
19. Medullary Cystic Disease
Medullary Cystic Disease where the following criteria are met:
• the presence in the kidney of multiple cysts in the renal medulla accompanied by the presence of tubular atrophy and
interstitial fibrosis;
• clinical manifestations of anaemia, polyuria, and progressive deterioration in kidney function; and
• the Diagnosis of Medullary Cystic Disease is confirmed by renal biopsy. Isolated or benign kidney cysts are specifically
excluded from this benefit.
20. Muscular Dystrophy
A group of hereditary degenerative diseases of muscle characterised by weakness and atrophy of muscle. The diagnosis of
muscular dystrophy must be unequivocal and made by a Medical Practitioner who is a consultant neurologist. The condition
must result in the inability of the Life Insured to perform (whether aided or unaided) at least 3 of the 6 “Activities of Daily
Living” for a continuous period of at least 6 months.
Activities of daily living:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the shower) or wash satisfactorily
by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
iv. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;

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v. Feeding: the ability to feed oneself once food has been prepared and made available;
vi. Mobility: The ability to move indoors from room to room on level surfaces.
21. Myasthenia Gravis
An acquired autoimmune disorder of neuromuscular transmission leading to fluctuating muscle weakness and fatigability,
where all of the following criteria are met:
• Presence of permanent muscle weakness categorized as Class IV or V according to the Myasthenia Gravis Foundation of
America Clinical Classification given below; and
• The Diagnosis of Myasthenia Gravis and categorization are confirmed by a Medical Practitioner who is a neurologist.
Myasthenia Gravis Foundation of America Clinical Classification:
•Class I: Any eye muscle weakness, possible ptosis, no other evidence of muscle weakness elsewhere.
•Class II: Eye muscle weakness of any severity, mild weakness of other muscles.
•Class III: Eye muscle weakness of any severity, moderate weakness of other muscles.
•Class IV: Eye muscle weakness of any severity, severe weakness of other muscles.
•Class V: Intubation needed to maintain airway.
22. Other Serious Coronary Artery Disease
The narrowing of the lumen of at least one coronary artery by a minimum of 75% and of two others by a minimum of 60%,
as proven by coronary angiography, regardless of whether or not any form of coronary artery intervention or surgery has
been performed. Coronary arteries herein refer to left main stem, left anterior descending, circumflex and right coronary
artery (but not including their branches).
23. Poliomyelitis
The occurrence of Poliomyelitis where all of the following conditions are met:
• Poliovirus is identified as the cause,
• Paralysis of the limb muscles or respiratory muscles must be present and persist for at least 3 months.
24. Progressive Scleroderma
A systemic collagen-vascular disease causing progressive diffuse fibrosis in the skin, blood vessels and visceral organs. This
diagnosis must be unequivocally supported by biopsy and serological evidence and the disorder must have reached systemic
proportions to involve the heart, lungs or kidneys.
The following are excluded:
•Localised scleroderma (linear scleroderma or morphea);
•Eosinophilic fasciitis; and
•CREST syndrome.
25. Progressive Supranuclear Palsy
Confirmed by a Medical Practitioner who is a specialist in neurology of a definitive diagnosis of progressive supranuclear
palsy. There must be permanent clinical impairment of motor function, eye movement disorder and postural instability.
26. Severe Rheumatoid Arthritis
Unequivocal Diagnosis of systemic immune disorder of rheumatoid arthritis where all of the following criteria are met:
•Diagnostic criteria of the American College of Rheumatology for Rheumatoid Arthritis;
•Permanent inability to perform at least three (3) of six (6) “Activities of Daily Living”;
•Widespread joint destruction and major clinical deformity of three (3) or more of the following joint areas: hands, wrists,
elbows, knees, hips, ankle, cervical spine or feet; and
•The foregoing conditions have been present for at least six (6) months.
The Activities of Daily Living are:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
12
iv. Mobility: the ability to move indoors from room to room on level surfaces;
v. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
27. Severe Ulcerative Colitis
Acute fulminant ulcerative colitis with life threatening electrolyte disturbances. All of the following criteria must be met:
• the entire colon is affected, with severe bloody diarrhoea; and
• the necessary treatment is total colectomy and ileostomy; and
• the diagnosis must be based on histopathological features and confirmed by a Medical Practitioner who is a specialist
in gastroenterology.
28. Systemic Lupus Erythematosus with Lupus Nephritis
A multi-system autoimmune disorder characterised by the development of autoantibodies directed against various
self-antigens. In respect of this Policy, systemic lupus erythematosus will be restricted to those forms of systemic lupus
erythematosus which involve the kidneys (Class III to Class V Lupus Nephritis, established by renal biopsy, and in accordance
with the WHO Classification). The final diagnosis must be confirmed by a Medical Practitioner specialising in Rheumatology
and Immunology.
The WHO Classification of Lupus Nephritis:
• Class I Minimal Change Lupus Glomerulonephritis
• Class II Mesangial Lupus Glomerulonephritis
• Class III Focal Segmental Proliferative Lupus Glomerulonephritis
• Class IV Diffuse Proliferative Lupus Glomerulonephritis
• Class V Membranous Lupus Glomerulonephritis
29. Pneumonectomy
The undergoing of surgery on the advice of an appropriate Medical Specialist to remove an entire lung for disease or traumatic
injury suffered by the life assured.
The following conditions are excluded:
a. Removal of a lobe of lungs (lobectomy)
b. Lung resection or incision
30. 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.
31. Stroke resulting in permanent symptoms
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.
The following are excluded:
a. Transient ischemic attacks (TIA)
b. Traumatic injury of the brain
c. Vascular disease affecting only the eye or optic nerve or vestibular functions.
32. Primary (Idiopathic) Pulmonary Hypertension
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.
The NYHA Classification of Cardiac Impairment are as follows:

13
a. Class III: Marked limitation of physical activity. Comfortable at rest, but less than ordinary activity causes symptoms.
b. Class IV: Unable to engage in any physical activity without discomfort. Symptoms may be present even at rest.
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.
33. 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.
34. Open Heart Replacement or Repair of Heart Valves
The actual undergoing of open-heart valve surgery 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.
35. Open Chest CABG
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.
The following are excluded:
• Angioplasty and/or any other intra-arterial procedures
36. Multiple Sclerosis with Persisting Symptoms
The unequivocal diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the following:
a. investigations including typical MRI findings which unequivocally confirm the diagnosis to be multiple sclerosis and
b. there must be current clinical impairment of motor or sensory function, which must have persisted for a continuous
period of at least 6 months.
Neurological damage due to SLE is excluded.
37. Motor Neuron Disease with Permanent Symptoms
Motor neuron disease diagnosed by a Specialist Medical Practitioner as spinal muscular atrophy, progressive bulbar palsy,
amyotrophic lateral sclerosis or primary lateral sclerosis. There must be progressive degeneration of corticospinal tracts
and anterior horn cells or bulbar efferent neurons. There must be current significant and permanent functional neurological
impairment with objective evidence of motor dysfunction that has persisted for a continuous period of at least 3 months.
38. Major Organ /Bone Marrow Transplant
The actual undergoing of a transplant of:
a. One of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from irreversible end-stage failure
of the relevant organ, or
b. Human bone marrow using haematopoietic stem cells. The undergoing of a transplant has to be confirmed by a
specialist medical practitioner.
The following are excluded:
a. Other stem-cell transplants
b. Where only Islets of Langerhans are transplanted
39. Major Head Trauma
Accidental head injury resulting in permanent Neurological deficit to be assessed no sooner than 3 months from the date
of the accident. This diagnosis must be supported by unequivocal findings on Magnetic Resonance Imaging, Computerized
Tomography, or other reliable imaging techniques. The accident must be caused solely and directly by accidental, violent,
external and visible means and independently of all other causes.
The Accidental Head injury must result in an inability to perform at least three (3) of the following Activities of Daily Living
either with or without the use of mechanical equipment, special devices or other aids and adaptations in use for disabled
persons. For the purpose of this benefit, the word “permanent” shall mean beyond the scope of recovery with current
medical knowledge and technology.

14
The Activities of Daily Living are:
i. Washing: the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash
satisfactorily by other means;
ii. Dressing: the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs
or other surgical appliances;
iii. Transferring: the ability to move from a bed to an upright chair or wheelchair and vice versa;
iv. Mobility: the ability to move indoors from room to room on level surfaces;
v. Toileting: the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a
satisfactory level of personal hygiene;
vi. Feeding: the ability to feed oneself once food has been prepared and made available.
The following is excluded:
• Spinal cord injury.
40. Benign Brain Tumor
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.
This brain tumor must result in at least one of the following and must be confirmed by the relevant medical specialist:
a. Permanent Neurological deficit with persisting clinical symptoms for a continuous period of at least 90 consecutive
days or
b. Undergone surgical resection or radiation therapy to treat the brain tumor.
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.
41. Blindness
Total, permanent and irreversible loss of all vision in both eyes as a result of illness or accident.
The Blindness is evidenced by:
a. corrected visual acuity being 3/60 or less in both eyes or;
b. the field of vision being less than 10 degrees in both eyes.
The diagnosis of blindness must be confirmed and must not be correctable by aids or surgical procedure.
42. Deafness
Total and irreversible loss of hearing in both ears as a result of illness or accident. This diagnosis must be supported by pure
tone audiogram test and certified by an Ear, Nose and Throat (ENT) specialist. Total means “the loss of hearing to the extent
that the loss is greater than 90decibels across all frequencies of hearing” in both ears.
43. End Stage Lung Failure
End stage lung disease, causing chronic respiratory failure, as confirmed and evidenced by all of the following:
a. FEV1 test results consistently less than 1 litre measured on 3 occasions 3 months apart; and
b. Requiring continuous permanent supplementary oxygen therapy for hypoxemia; and
c. Arterial blood gas analysis with partial oxygen pressures of 55mmHg or less (PaO2< 55 mmHg); and
d. Dyspnea at rest.
44. End Stage Liver Failure
Permanent and irreversible failure of liver function that has resulted in all three of the following:
a. permanent jaundice; and
b. ascites; and
c. hepatic encephalopathy.
Liver failure secondary to drug or alcohol abuse is excluded.
45. Loss of Speech
Total and irrecoverable loss of the ability to speak as a result of injury or disease to the vocal cords. The inability to speak

15
must be established for a continuous period of 12 months. This diagnosis must be supported by medical evidence furnished
by an Ear, Nose, Throat (ENT) specialist.
46. Loss of Limbs
The physical separation of two or more limbs, at or above the wrist or ankle level limbs as a result of injury or disease. This
will include medically necessary amputation necessitated by injury or disease. The separation has to be permanent without
any chance of surgical correction. Loss of Limbs resulting directly or indirectly from self- inflicted injury, alcohol or drug abuse
is excluded.
47. 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.
48. Infective Endocarditis
Inflammation of the inner lining of the heart caused by infectious organisms, where all of the following criteria are met:
• Positive result of the blood culture proving presence of the infectious organism(s);
• Presence of at least moderate heart valve incompetence (meaning regurgitant fraction of 20% or above) or moderate
heart valve stenosis (resulting in heart valve area of 30% or less of normal value) attributable to Infective Endocarditis;
and
• The Diagnosis of Infective Endocarditis and the severity of valvular impairment are confirmed by a Medical Practitioner
who is a cardiologist.
49. Coma of specified Severity
A state of unconsciousness with no reaction or response to external stimuli or internal needs. This diagnosis must be
supported by evidence of all of the following:
• No response to external stimuli continuously for at least 96 hours;
• Life support measures are necessary to sustain life; and
• Permanent neurological deficit which must be assessed at least 30 days after the onset of the coma.
The condition has to be confirmed by a specialist medical practitioner. Coma resulting from alcohol or drug abuse is excluded.
50. Cancer of Specified Severity
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 leukemia,
lymphoma and sarcoma.
The following are excluded –
a. All tumors which are histologically described as carcinoma in situ, benign, pre- malignant, 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.
b. Any non-melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
c. Malignant melanoma that has not caused invasion beyond the epidermis;
d. 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
e. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
f. Chronic lymphocytic leukaemia less than RAI stage 3
g. Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification,
h. 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;
51. Myocardial Infarction (First Heart Attack of Specific Severity)
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:
a. A history of typical clinical symptoms consistent with the diagnosis of Acute Myocardial Infarction (for e.g. typical chest
pain)

16
b. New characteristic electrocardiogram changes
c. Elevation of infarction specific enzymes, Troponins or other specific biochemical markers.
The following are excluded:
• Other acute Coronary Syndromes
• Any type of angina pectoris
• A rise in cardiac biomarkers or Troponin T or I in absence of overt ischemic heart disease OR following an intra-arterial
cardiac procedure
52. Creutzfeldt-Jacob Disease (CJD)
Creutzfeldt-Jacob disease is an incurable brain infection that causes rapidly progressive deterioration of mental function and
movement. A Medical Practitioner who is a neurologist must make a definite diagnosis of Creutzfeldt-Jacob disease based
on clinical assessment, EEG and imaging. There must be objective neurological abnormalities on exam along with severe
progressive dementia.
53. Multiple System Atrophy
A diagnosis of multiple system atrophy by a Specialist Medical Practitioner (Neurologist). There must be evidence of
permanent clinical impairment for a minimum period of 30 days of either:
a. Motor function with associated rigidity of movement; or
b. The ability to coordinate muscle movement; or
c. Loss of Bladder control and postural hypotension
54. Loss of One Limb and One Eye
Total, permanent and irrecoverable loss of sight of one eye and loss by severance of one limb at or above the elbow or knee.
The loss of sight of one eye must be clinically confirmed by a Medical Practitioner who is an eye specialist, and must not be
correctable by aides or surgical procedures.
55. Necrotising Fasciitis
Necrotizing fasciitis is a progressive, rapidly spreading, infection located in the deep fascia causing necrosis of the
subcutaneous tissues. An unequivocal diagnosis of necrotizing fasciitis must be made by a Medical Practitioner who is a
specialist and the diagnosis must be supported with laboratory evidence of the presence of a bacteria that is a known cause
of necrotising fasciitis. There must also be widespread destruction of muscle and other soft tissues that results in a total
and permanent loss or function of the affected body part.
56. Hemiplegia
The total and permanent loss of the use of one side of the body through paralysis persisting for a period of at least 6 weeks
and with no foreseeable possibility of recovery caused by illness or injury, except when such injury is self-inflicted.
57. Tuberculosis Meningitis
Meningitis caused by tubercle bacilli, resulting in permanent neurological deficit persisting for at least 180 consecutive days.
Such a diagnosis must be confirmed by a Medical Practitioner who is a specialist in neurology. Permanent neurological deficit
with persisting clinical symptoms means symptoms of dysfunction in the nervous system that are not present on clinical
examination and expected to last throughout the lifetime of life assured..
58. Myelofibrosis
A disorder which can cause fibrous tissue to replace the normal bone marrow and results in anaemia, low levels of white blood
cells and platelets and enlargement of the spleen. The condition must have progressed to the point that it is permanent and
the severity is such that the Life Insured requires a blood transfusion at least monthly. The diagnosis of myelofibrosis must
be supported by bone marrow biopsy and confirmed by a Medical Practitioner who is a specialist.
59. Pheochromocytoma
Presence of a neuroendocrine tumour of the adrenal or extra-chromaffin tissue that secretes excess catecholamines
requiring the actual undergoing of surgery to remove the tumour.
The Diagnosis of Pheochromocytoma must be confirmed by a Medical Practitioner who is an endocrinologist.
60. Eisenmenger’s Syndrome
Development of severe pulmonary hypertension and shunt reversal resulting from heart condition. The diagnosis must be
made by a Medical Practitioner who is a specialist with echocardiography and cardiac catheterisation and supported by the
following criteria:

17
• Mean pulmonary artery pressure > 40 mm Hg;
• Pulmonary vascular resistance > 3mm/L/min (Wood units); and
• Normal pulmonary wedge pressure < 15 mm Hg.
1.2. Permanent Exclusions
1. Any Illness, sickness or disease other than those specified as Critical Illnesses under this Rider;
2. Any Pre-existing Disease or any complication arising therefrom.
Pre-existing Disease means any condition, aliment, injury or disease / critical illness / disability:
a. That is/are diagnosed by a physician within 48 months prior to the Risk Commencement Date of the Rider or its
reinstatement; or
b. For which medical advice or treatment was recommended by, or received from, a Medical Practitioner within 48 months
prior to the Risk Commencement Date of the Rider or its reinstatement
Coverage under the Rider after the expiry of 48 months for any pre-existing disease is subject to the same being declared
at the time of application and accepted by us.
3. Any Critical Illness caused due to treatment for, alcoholism, drug or substance abuse or any addictive condition and
consequences thereof.
4. Narcotics used by the Life Assured unless taken as prescribed by a registered Medical Practitioner,
5. Any Critical Illness caused due to intentional self-injury, suicide or attempted suicide
6. Any Critical Illness caused by or arising from or attributable to a foreign invasion, act of foreign enemies, hostilities,
warlike operations (whether war be declared or not or while performing duties in the armed forces of any country during
war or at peace time), civil war, public defense, rebellion, revolution, insurrection, military or usurped power;
7. Any Critical Illness caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or
hazardous form) or from any nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack.
8. Congenital External Anomalies, inherited disorders or any complications or conditions arising therefrom including any
developmental conditions of the Insured;
9. Any Critical Illness caused by any treatment necessitated due to participation as a professional in hazardous or adventure
sport, including but not limited to, para jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or
scuba diving, hand gliding, sky diving, deep sea diving
10. Participation by the Life Assured in any flying activity, except as a bona fide, fare- paying passenger of a recognized
airline on regular routes and on a scheduled timetable.
11. Any Critical Illness caused by Medical treatment traceable to childbirth (including complicated deliveries and caesarean
sections incurred during hospitalization) except ectopic pregnancy. Any Critical Illness caused due to miscarriages (unless
due to an accident) and lawful medical termination of pregnancy during the policy period.
12. Any Critical Illness caused by any unproven/ experimental treatment, service and supplies for or in connection with
any treatment. Unproven/ experimental treatments are treatments, procedures or supplies that lack significant medical
documentation to support their effectiveness.
13. Any Critical Illness based on certification/diagnosis/treatment from persons not registered as Medical Practitioners or
from a Medical Practitioner who is practicing outside the discipline that he/ she is licensed for.
14. Any Critical Illness caused due to any treatment, including surgical management, to change characteristics of the body
to those of opposite sex.
15. Any Critical Illness caused due to cosmetic or plastic surgery or any treatment to change the appearance unless for
reconstruction following an Accident, Burn(s), or Cancer or as part of medically necessary treatment to remove a direct
and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
16. Any Critical Illness caused due to surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Medical Practitioner
b. The Surgery / Procedure conducted should be supported by clinical protocols
c. The member has to be 18 years of age or older and
d. Body Mass Index (BMI):
• greater than or equal to 40 or

18
• greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
i. Obesity related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type 2 Diabetes
17. Any Critical Illness caused due to treatments received in health hydros, nature cure clinics, spas or similar
establishments or private beds registered as a nursing home attached to such establishments or where admission is
arranged wholly or partly for domestic reason.
18. Any Critical Illness caused by treatment directly arising from or consequent upon any Life Assured committing or
attempting to commit a breach of law with criminal intent.
19. In the event of the death of the Life Assured within the stipulated survival period as set out above.
20. Any Critical Illness caused by sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproductive services including artificial insemination and advanced reproductive technologies such as IVF,
ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
1.3. Waiting Period
An initial waiting period of 90 days applies from the date of risk commencement or rider revival date, as the case may be.
in case the insured event happens during this period, no benefit shall be payable. However, 100% of the premium will be
refunded and the rider will terminate. No waiting period applies for critical illness claims arising solely due to an accident.
1.4. Survival Period
A 15-day survival period is applicable. This refers to the period from the diagnosis and fulfilment of the defined conditions
covered under the rider which the Life Assured must survive before the benefit will be paid.
Claim payment will be made only if confirmatory diagnosis of the conditions covered is received by the company while the
insured is alive (i.e., a claim would not be admitted if the diagnosis is made post-mortem).
2. Option B – Cancer Cover
2.1. Definitions
1. Cancer of Specified Severity
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 leukemia,
lymphoma and sarcoma.
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;
2. Carcinoma In-Situ (CiS)
Carcinoma-in-situ shall mean first ever histologically proven, localized pre-invasion lesion where cancer cells have not yet

19
penetrated the basement membrane or invaded (in the sense of infiltrating and / or actively destroying) the surrounding
tissues or stroma in any of the following covered organ groups, and subject to any classification stated:
i. Breast, where the tumor is classified as Tis according to the TNM Staging method
ii. Corpus uteri, vagina, vulva or fallopian tubes where the tumor is classified as Tis according to the TNM Staging method
or FIGO (staging method of the Federation Internationale de Gynecologie et d’Obstetrique) Stage 0
iii. Cervix uteri, classified as cervical intraepithelial neoplasia grade III (CIN III) or as Tis according to the TNM Staging
method or FIGO Stage 0
iv. Ovary –include borderline ovarian tumors with intact capsule, no tumor on the ovarian surface, classified as T1aN0M0,
T1bN0M0 (TNM Staging) or FIGO 1A, FIGO 1B
v. Colon and rectum; Penis; Testis; Lung; Liver; Stomach, Nasopharynx and oesophagus
vi. Urinary tract, for the purpose of in-situ cancers of the bladder, stage Ta of papillary Carcinoma is included.
The diagnosis of the Carcinoma in situ must always be supported by a histopathological report. Furthermore, the diagnosis
of Carcinoma In-Situ must always be positively diagnosed upon the basis of a microscopic examination of the fixed tissue,
supported by a biopsy result. Clinical diagnosis does not meet this standard.
Pre-malignant lesion and carcinoma in situ of any organ, unless listed above, are excluded.
3. Specified Early-Stage Cancers
Specified Early Cancers shall mean first ever presence of one of the following malignant conditions:
i. Prostate Cancer that is histologically described using the TNM Classification as T1N0M0 or Prostate cancers described
using another equivalent classification.
ii. Thyroid Cancer that is histologically described using the TNM Classification as T1N0M0.
iii. Tumors of the Urinary Bladder histologically classified as T1N0M0 (TNM Classification).
iv. Chronic Lymphocytic Leukaemia (CLL) RAI Stage 1 or 2. CLL RAI Stage 0 or lower is excluded.
v. Malignant melanoma that has not caused invasion beyond the epidermis.
vi. Hodgkin’s lymphoma Stage I by the Cotswold’s classification staging system.
vii. The diagnosis must be based on histopathological features and confirmed by a Pathologist.
Pre - malignant lesions and conditions, unless listed above, are excluded.
2.2. Permanent Exclusions:
We shall not be liable to make any payment under this Rider for Cancer caused by, based on, arising out of or howsoever
attributable to any of the following:
1.Any Illness, sickness or disease other than those specified as covered conditions under this Rider.
2. Pre-existing Disease means any condition, aliment, injury or disease / critical illness / disability:
a. That is/are diagnosed by a physician within 48 months prior to the Risk Commencement Date of the Rider or its
reinstatement; or
b. For which medical advice or treatment was recommended by, or received from, a Medical Practitioner within 48 months
prior to the Risk Commencement Date of the Rider or its reinstatement
In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
Coverage under the Rider after the expiry of 48 months for any pre-existing disease is subject to the same being
declared at the time of application and accepted by us.
3. Any Illness caused due to treatment for, alcoholism, drug or substance abuse or any addictive condition and
consequences thereof.
4. Narcotics used by the Life Assured unless taken as prescribed by a registered Medical Practitioner.
5. Any Illness caused due to intentional self-injury, suicide or attempted suicide, whether the person is medically sane or
insane.
6. Any Illness, caused by or arising from or attributable to a foreign invasion, act of foreign enemies, hostilities, warlike
operations (whether war be declared or not or while performing duties in the armed forces of any country during war
or at peace time), civil war, public defense, rebellion, revolution, insurrection, military or usurped power.
7. Any Illness caused by ionizing radiation or contamination by radioactivity from any nuclear fuel (explosive or hazardous
form) or from any nuclear waste from the combustion of nuclear fuel, nuclear, chemical or biological attack.

20
8. Working in underground mines, tunneling or involving electrical installations with high tension supply, or as race jockeys
or circus personnel.
9. Congenital External Anomalies, inherited disorders or any complications or conditions arising therefrom including any
developmental conditions of the Insured.
10. Any Illness directly or indirectly caused by any treatment necessitated due to participation as a professional in hazardous
or adventure sport, including but not limited to, para jumping, rock climbing, mountaineering, rafting, motor racing, horse
racing or scuba diving, hand gliding, sky diving, deep sea diving and selfie accident.
11. Participation by the Life Assured in any flying activity, except as a bona fide, fare paying passenger of a recognized
airline on regular routes and on a scheduled timetable.
12. Any Illness, caused by Medical treatment traceable to childbirth (including complicated deliveries and caesarean
sections incurred during hospitalization) except ectopic pregnancy. Any Illness directly or indirectly due to miscarriages
(unless due to an accident) and lawful medical termination of pregnancy during the policy period.
13. Any Illness, caused by any unproven/ experimental treatment, service and supplies for or in connection with any
treatment. Unproven/ experimental treatments are treatments, procedures or supplies that lack significant medical
documentation to support their effectiveness.
14. Any Illness based on certification/diagnosis/treatment from persons not registered as Medical Practitioners, or from a
Medical Practitioner who is practicing outside the discipline for which he/ she is licensed.
15. Any Illness, caused due to any treatment, including surgical management, to change characteristics of the body to
those of opposite sex.
16. Any Illness, caused due to cosmetic or plastic surgery or any treatment to change the appearance unless for
reconstruction following an Accident, Burn(s), or Cancer or as part of medically necessary treatment to remove a direct
and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the
attending Medical Practitioner.
17. Any Illness, caused due to surgical treatment of obesity that does not fulfil all the below conditions:
a. Surgery to be conducted is upon the advice of the Medical Practitioner
b. The Surgery / Procedure conducted should be supported by clinical protocols
c. The member has to be 18 years of age or older and
d. Body Mass Index (BMI):
greater than or equal to 40 or
greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive
methods of weight loss:
i. Obesity related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type 2 Diabetes despite optimal therapy
18. Any Illness, caused due to treatments received in health hydros, nature cure clinics, spas or similar establishments or
private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or
partly for domestic reason.
19. Any Illness, caused by treatment directly arising from or consequent upon any Life Assured committing or attempting
to commit a breach of law with criminal intent.
20. In the event of the death of the Life Assured within the stipulated survival period as set out above.
21. Any Illness, caused by sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproductive services including artificial insemination and advanced reproductive technologies such as IVF,
ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
2.3. Waiting Period
An initial waiting period of 180 days applies from the risk commencement date or rider revival date, as the case may be.

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In case the insured event happens during this period, no benefit shall be payable. However, 100% of the premium will be
refunded and the rider will terminate.
2.4. Survival Period
A 7-day survival period is applicable. This refers to the period from the diagnosis and fulfilment of the definition of the
conditions covered which the life assured must survive before the benefit will be paid.
Claim payment will only be made with confirmatory diagnosis of the conditions covered while the insured is alive (i.e., a claim
would not be admitted if the diagnosis is made post-mortem).

Terms & Conditions

(i) Free-look Period:
• The policyholder shall have the option of cancelling the rider, stating the reasons thereof, by returning the Rider
Document to company, within 15 days from the date of receipt of the rider in case policyholder is not agreeable to any
rider terms and conditions. The free-look period for policies purchased through Distance Marketing mode shall be 30
days.
• The rider can be cancelled in the free-look period even if the base policy to which it is attached is continued.
• The rider shall be automatically cancelled if the base policy to which it is attached is cancelled.
• If rider is cancelled along with the base policy, on receipt of letter along with original policy documents, the company
shall arrange to refund the rider premiums paid by policyholder, subject to deduction of the proportionate risk premium
for the period on cover and the expenses incurred for medical examination (if any) and stamp duty, (if any). This would
be in addition to the refund under the base policy as per applicable terms and conditions.
• If rider is cancelled independently of the base policy then the rider premium will be returned, subject to deduction of
the proportionate risk premium for the period on cover and the expenses incurred for medical examination (if any) and
stamp duty, (if any).
• A rider once cancelled shall not be revived, reinstated or restored at any point of time and a new proposal will have to be
made for a new rider.
b) Cancellation after the free look period
• The rider can be cancelled at any time during its rider term. Upon such a cancellation, the rider will lapse and the
surrender value (if any) will be payable.
• The rider shall be automatically cancelled if the base policy to which it is attached is cancelled.
(ii) Alterations: Rider term and rider sum assured cannot be altered. The premium payment frequency of the rider can be
changed if the premium payment frequency on the base product is changed. The premium payment frequency of the rider
cannot be changed independently from the base policy. The option once selected cannot be changed.
(iii) Addition/Deletion of Options:
The following Addition/Removal options are available to the policyholder subject to Board Approved Underwriting Policy
(BAUP):
a) If not opted at inception of the base policy, the policyholder may opt for the rider during the premium paying term of
base policy.
b)At any base policy anniversary, the policyholder can opt out/terminate their existing rider.
(iv) The Rider is available for purchase online via company website along with the base plan. The discount applicable on the
premium rates when the rider is purchased (Online via website) shall be same as per discount applicable in base plan. In case
the base plan offers higher benefit instead, an equivalent discount will be offered on the rider premium rates.
(v) Assignment and Transfer: This Rider cannot be assigned independently. However the Rider Policy can be assigned
along with the Base Policy as per Section 38 of the Insurance Act, 1938 as amended from time to time.
(vi) Nomination: Nomination for this Rider shall be as per the Nomination Schedule under the Main Policy as per section 39
of the Insurance Act, 1938 as amended from time to time.
(vii) Prohibition of Rebates: In accordance with Section 41 of the Insurance Act, 1938 as amended from time to
time:
No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or
continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of
the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or

22
continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses
or tables of the insurer.
Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to
ten lakh rupees.
(viii) Non-Disclosure: In accordance with Section 45 of the Insurance Act, 1938 as amended from time to time:
1. No policy of life insurance shall be called in question on any ground whatsoever after the expiry of three years from the
date of the policy, i.e., from the date of issuance of the policy or the date of commencement of risk or the date of revival
of the policy or the date of the rider to the policy, whichever is later.
2. A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy
or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever
is later, on the ground of fraud: Provided that the insurer shall have to communicate in writing to the insured or the legal
representatives or nominees or asignees of the insured the grounds and materials on which such decision is based.
3. Notwithstanding anything contained in sub-section (2), no insurer shall repudiate a life insurance policy on the ground
of fraud if the insured can prove that the mis-statement of or suppression of a material fact was true to the best of
his knowledge and belief or that there was no deliberate intention to suppress the fact or that such mis-statement of
or suppression of a material fact are within the knowledge of the insurer: Provided that in case of fraud, the onus of
disproving lies upon the beneficiaries, in case the policyholder is not alive.
4. A policy of life insurance may be called in question at any time within three years from the date of issuance of the policy
or the date of commencement of risk or the date of revival of the policy or the date of the rider to the policy, whichever
is later, on the ground that any statement of or suppression of a fact material to the expectancy of the life of the insured
was incorrectly made in the proposal or other document on the basis of which the policy was issued or revived or rider
issued:Provided that the insurer shall have to communicate in writing to the insured or the legal representatives or
nominees or assignees of the insured the grounds and materials on which such decision to repudiate the policy of life
insurance is based:Provided further that in case of repudiation of the policy on the ground of misstatement or suppression
of a material fact, and not on the ground of fraud, the premiums collected on the policy till the date of repudiation shall
be paid to the insured or the legal representatives or nominees or assignees of the insured within a period of ninety days
from the date of such repudiation.
5. Nothing in this section shall prevent the insurer from calling for proof of age at any time if he is entitled to do so, and no
policy shall be deemed to be called in question merely because the terms of the policy are adjusted on subsequent proof
that the age of the life insured was incorrectly stated in the proposal.
(ix) Taxes:
Taxes and levies as applicable will be charged. Any taxes, statutory levy becoming applicable in future may become payable
by you by any method including by levy of an additional monetary amount in addition to premium and/or charges.

Contact us today

To buy: 1800-266-9777 (Toll free)

(Available all days 10am to 7pm)

Visit us at www.hdfclife.com

HDFC Life Insurance Company Limited. (CIN: L65110MH2000PLC128245. IRDAI Registration No. 101.)
Registered Office: HDFC Life Insurance Company Ltd., Lodha Excelus, 13th Floor, Apollo Mills Compound, N.M. Joshi Marg, Mahalaxmi, Mumbai 400 011. Email: service@
hdfclife.com, Tel. No: 1860 267 9999 (Mon-Sat 10 am to 7 pm) Local charges apply.

The name/letters “HDFC” in the name/logo of HDFC Life Insurance Company Limited (HDFC Life) the company belongs to HDFC Bank Limited and is used by HDFC Life under
licence from an agreement entered into with HDFC Bank Limited.

HDFC Life Health Plus Rider – Non Linked (UIN: 101B031V01) is an Individual, Pure Risk Premium, Health Insurance Rider. This version of the rider brochure invalidates all
previous printed versions for this particular plan. This rider brochure is indicative of the terms, warranties, conditions and exclusions contained in the insurance policy. Please know
the associated risk and applicable charges from your insurance agent or the intermediary or policy document of the insurer. ARN: MC/08/23/4014.

BEWARE OF SPURIOUS PHONE CALLS AND FICTIOUS/FRADULENT OFFERS

• IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums.
• Public receiving such phone calls are requested to lodge a police complaint. 23