Health Insurance 1612 views November 3, 2020

United India Insurance Company Limited offers a critical illness cover for individuals aged between 21 and 65 years with its Criticare Insurance Policy. Your age is taken as age on the last birthday. With the United India Criticare Insurance Policy, an insured can cover self, spouse, and dependent parents with a separate sum insured. In any event, if you are being diagnosed with any one of the covered critical illnesses as defined in the policy, the company or TPA shall pay the insured person a compensation amount from the Sum Insured under the policy. Read the post and know the United India UNI Criticare Insurance Policy details.

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Covered Expenses Under United India UNI Criticare Policy

To get the claim amount, you must be diagnosed by a registered Medical Practitioner, supported by clinical radiological, histological, and laboratory evidence, and also surgical evidence (wherever it is applicable). Now, check out below the covered critical illnesses under United India Criticare Insurance Policy:-

  1. Cancer of specified severity
  2. First HEART ATTACK- of specified severity
  3. Coronary Artery Surgery (CABG) Open Chest CABG
  4. Heart Valve Replacement
  5. Coma of specified severity
  6. Kidney failure
  7. Stroke resulting in permanent symptoms
  8. Major organ and bone marrow transplant
  9. Multiple sclerosis
  10. Motor neuron disease with permanent symptoms
  11. Permanent paralysis of limbs

Here, you will also get a survival period of a minimum of 30 days from the date of the critical illness diagnosis. But the company compensates the Insured, only once in respect of any one or more of the covered diseases. If a benefit is paid in terms of this policy on behalf of an Insured Person the coverage for that person terminates under the policy and such person shall not be entitled to be covered under the policy or its renewal thereof.

Exclusions from the United India UNI Criticare Policy

The following are excluded if you buy the United India UNI Criticare Policy:-

  1. Tumors showing the malignant changes of carcinoma in situ and tumors which are histologically described as pre-malignant or non-invasive which includes but not limited to Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 and CIN-3.
  2. Any skin cancer (Except for invasive malignant melanoma)
  3. All tumors of the prostate (Unless it is histologically classified as having a Gleason score > 6 or progressed to at least clinical TNM classification T2N0M0…)
  4. Papillary Microcarcinoma of the thyroid (must be < 1 cm in diameter)
  5. Chronic lymphocytic leukemia < RAI stage 3
  6. Microcarcinoma of the bladder
  7. Tumors in presence of the HIV infection
  8. Non-ST-segment Elevation Myocardial Infarction (NSTEMI) with an elevation of Troponin I or T
  9. Acute Coronary Syndromes
  10. Any type of angina pectoris
  11. Angioplasty
  12. Any intra-arterial procedures
  13. Key-hole or laser surgery
  14. Catheter-based techniques including but not limited to, balloon valvotomy and valvuloplasty
  15. Transient Ischemic Attacks (TIA)
  16. Traumatic injury of the brain
  17. A vascular disease affecting only the eye, optic nerve, or vestibular functions
  18. Stem-cell transplants where only islets of Langerhans are transplanted
  19. Neurological damage such as SLE and HIV

Waiting Period

United India Criticare Insurance Policy has a waiting period of 90 days from the date of insurance commencement.

Claim Procedure

You must be thinking about what is to be done in the event of a claim, don’t worry just send a notice to the company or TPA in writing immediately of any covered critical illness occurrence. The notice shouldn’t be later than three days from its occurrence.

And all the certificates, information, and evidence for claims required by the company or TPA must be furnished within 30 days. You need to submit a medical examination on behalf of and at the expenses of the company as it is required in connection with any claim. The following is the list of documents you need to submit:-

  1. Duly filled Claim form
  2. Physician’s certificate (attending the insured person)
  3. Original or the Attested copy of discharge summary
  4. Original or the Attested copy of all ab, radiological, Histopathological, and investigation reports
  5. Original or the Attested copy of Indoor case papers (If needed by the company/TPA)
  6. Original or the Attested copy of all the medical bills
  7. Any other document such as disability certificate, dialysis records, which are deemed necessary at the time of claim investigation for a specific critical illness condition

United India UNI Criticare Policy Renewal Condition

The company renews United India Criticare Insurance Policy if you remit the requisite premium to the company before the expiry of your insurance period as stated in the policy schedule. Your insurer will be entitled to decline renewal if any fraud, misrepresentation, or suppression by the insured or on his behalf is found.

On renewal, the company discontinues the issuance of the policy. You will, however, have an option for renewal under any similar policy by the company provided the benefits payable in such other policies.

When you fail to remit premiums of United India Criticare Insurance Policy renewal before expiry, but within 30 days thereafter, admissibility of any claim during the period of the subsequent policy is considered in the same manner as under a renewed policy without break. However, the company isn’t liable for any claim arising out of ailments suffered in the interim period after the expiry of the earlier policy and before the date of commencement of the subsequent policy.

Note:- United India Insurance Company Limited is not bound to give you notice that the policy is due for renewal.

Condition for United India UNI Criticare Policy Cancellation

Your policy can be canceled by the insurer anytime on the grounds of misrepresentation, fraud, non-disclosure of material fact, or non-cooperation. For which, you will get a 15-day notice in writing on your registered address (as per your last known address). In such a case, the company may return to the insured a proportion of the last premium amount corresponding to an unexpired period of insurance if you haven’t made any claim under the policy.

You also have the right to cancel the policy any time by giving notice to the insurer, and in such an event, the company shall allow a refund of premium at the company’s short period rate table as given below (if no claim is being provided up to the date of cancellation).

Period on Risk Premium Rate Charged
Up to one month1/4 of the annual rate
1/4 of the annual rate1/4 of the annual rate
Up to six monthsUp to six months

If the company disclaims any liability to the insured for any claim hereunder and the insured within 12 calendar months from the date of receipt of the notice of such disclaimer will not make any claim, the subject is a matter of a suit in a court of law. Under the policy, the claim for all purposes will be deemed to be abandoned and it does not recover thereafter.

Terms and Conditions

Now, let’s take a look at the United India UNI Criticare Insurance Policy terms and conditions below before you decide to purchase it.

  1. The proposal, medical report, policy, and its schedule must be read together as one contract
  2. A claim under the policy will be paid in India in Indian National Rupee (INR) currency only
  3. It is governed by the laws of India whose courts alone shall have jurisdiction in any dispute.
  4. The policy is not assignable
  5. Compensation is payable only to the Insured person or his legal heirs (as per the case whose receipt will effectively discharge the company).
  6. In the case of misrepresentation, non-disclosure by or on behalf of the Insured or Insured person of any information material to the insurance, in respect of the Insured or such Insured Person the policy will be void.
  7. The notice should be sent to the company or TPA in writing immediately of any critical illness occurrence that gives rise to a claim under United India UNI Criticare Policy, not later than three days from its occurrence.
  8. If any claim under this policy is in any respect fraudulent or if any fraudulent means or diseases are used, to obtain any benefit under the policy, all benefits under that claim shall be forfeited.
  9. Proof of age must be submitted at the time of policy proposal, which could be the following: Passport, Birth Certificate, Driving Licence, PAN Card, Class 10th/12th Certificate, School leaving Certificate, Domicile Certificate (issued by Government), etc.
  10. The age of the insured person should be 45 years and above and must complete the medical examination report. For this, the company will reimburse 50% of the cost of such a medical examination if your proposal is accepted.
  11. The sum insured offered under United India UNI Criticare Policy is INR 1,00,000, 3,00,000, 5,00,000 and INR 10,00,000.
  12. The due payment of full premium and the observance and fulfillment of the terms provisions, conditions, and endorsements of United India policy by the insured person in so far as they relate to anything to be done or complied with by the Insured Person will be a condition precedent to any liability of the company for any payment under the policy.
  13. No waiver of any terms, provisions, conditions, and endorsements of this policy is valid unless made in writing and signed by an authorized official of the company.

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