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Critical Illness Insurance

Introduction

This policy covers ten most common critical illnesses which are life-threatening for Myanmar citizens and provides fixed amount of benefits. (this policy provide hospitalization, treatment, death and surgical) local and foreign expats residing in Myanmar.

Age LimitationThe age limitation of insured person who is eligible to this policy is from 6 years to 60 years.
(If the insured person is within 6 -18 years, the approval letter from their guardian will be needed.)
Insured PeriodThe insured period of critical illness insurance is one year.
Available UnitsThe insured can purchase critical illness insurance from minimum (1) unit to maximum (10) units.
Premium PaymentGroup Customers

• Monthly
• Quarterly
• Semi-annually
• Annually
Individual Customers

• Semi-annually
• Annually

Insurance Benefits

The insurance benefits for critical illness insurance are in the followings;

No.CoverageCauses for ClaimBenefits (Kyats)
1.Critical Illness
(1) unit
1. Heart Attack
Heart Attack means a definite diagnosis of the death of heart muscle due to obstruction of blood flow. The symptoms of heart attack can be easily seen in ECG.
Exclusion
No benefits shall be payable for Heart Attack or Heart Attack symptoms started before the starting date of policy.
Condition for Payout
The diagnosis of heart attack must be determined by a specialist and the patient must be hospitalized for a treatment.

2. Stroke
A definite diagnosis of an acute cerebrovascular event caused by intra-cranial thrombosis or hemorrhage, or embolism from an extra-cranial source. This symptom can be found suddenly or can be found by testing. If an abnormal symptom is found, must be determined with CT scan.
Exclusion
No benefits shall be payable for Stroke or stroke symptoms started before the starting date of policy.
Condition for Payout
The diagnosis of stroke must be determined by a specialist and the patient must be hospitalized for a treatment.

3. Cancer (Life-threatening)
A definite diagnosis of a tumor characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The diagnosis of cancer must be determined by a specialist.
Exclusion
No benefits shall be payable for Carcinoma in situ/ Intraepithelial Neoplasm (Malignant Tumor occurs under the Intraepithelial layer of Respiratory track, Gastrointestinal Track, Urogenital Track)
Condition for Payout
The diagnosis of cancer must be determined by a specialist, the cancer must be the first time occurrence for the patient and the patient starts getting a treatment.

4. Renal Failure
Renal failure means a definite diagnosis of chronic irreversible failure of both kidneys to function, as a result of which regular hemodialysis, peritoneal dialysis or renal transplantation is initiated.
Condition for Payout
The diagnosis of renal failure must be determined by a specialist.

5. Major Organ Transplant
Major organ transplant means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow, and transplantation must be medically necessary.
Condition for Payout
The diagnosis of major organ failure must be determined by a specialist and the patient starts getting a treatment.

6. Heart Valve Replacement or Repair
Heart valve replacement or repair means the undergoing of surgery to replace any heart valve with either a natural or mechanical valve or to repair heart defects or abnormalities.
Condition for Payout
The surgery must be determined to be medically necessary by a specialist.

7. Coronary artery bypass surgery
The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s).
Condition for Payout
The surgery must be determined to be medically necessary by a specialist.

8. Severe Burns
Severe burns mean a definite diagnosis of third-degree burns over at least 20% of the body surface.
Condition for Payout
The surgery must be determined to be medically necessary by a specialist.

9. Coma
Coma means a definite diagnosis of a state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow coma score must be 4 or less.
Condition for Payout
The diagnosis of stroke must be determined by a specialist and the patient must be hospitalized for a treatment.
Exclusion
No benefit will be payable under this condition for: a medically induced coma or, a coma which results directly from alcohol or drug use or, a diagnosis of brain death.

10. Bacterial meningitis
Bacterial meningitis means a definite of meningitis, confirmed by cerebrospinal fluid showing growth of pathogenic bacteria in culture.
Condition for Payout
The diagnosis of stroke must be determined by a specialist and the patient must be hospitalized for a treatment.
Exclusion
No benefit will be payable under this condition for viral meningitis.
1,000,000 kyats per Unit
2.Death
(1) unit
Death
(But if he had already got the claim benefit from Critical Illness shown in above, he cannot get another claim benefit from death)
1,000,000 kyats per Unit

Premium Rate

AgeIndividual CustomerGroup Customers
Semi- AnnuallyAnnuallyMonthlyQuarterlySemi- AnnuallyAnnually
6 ~ 3045,008,8008,002,2004,3008,400
31 ~ 407,80015,4001,3003,9007,40014,600
41 ~ 5012,30024,2002,1006,10011,70023,000
51 ~ 6019,00037,4003,2009,40018,10035,500

Critical Illness Policy Rules

  1. If the applicant has provided untruthful information through misrepresentation, fraud, omission, then the benefits of the policy shall be forfeited.
  2. The insurance coverage begins upon payment of insurance premium. The insurance policy shall expire at midnight (12:00 a.m.) one year from the day the coverage begins.
  3. There shall be no refund of the premium if the insurance policy is terminated by the insured. The insurer has the right to terminate the policy during the insured period and the premium shall be refunded proportionately for the remaining period.
  4. Other than annual installment plan, insurance premium must be paid within 15 days from the date of last premium payment date as per payment installment schedule, or otherwise, the insurance policy will be forfeited. If the claim happens within the insurance term, the rest of scheduled premiums for the remaining payments shall be deducted from the claim payout. There is no waiting period for the consecutive insurance policy after the first policy expires.
  5. The insured must provide additional documents as requested by the insurer within 3 months; otherwise, the insured shall lose the right to claim.
  6. For claims happened within a month from the policy starting date, the insurer shall engage experts to thoroughly review them.
  7. Exclusions;
    The policy does not cover for the following causes, symptoms and diseases:

    1. Any existing diseases that are under treatment; or for any existing symptoms,
    2. Psychosis and mental disorder,
    3. Medical check-up and examinations,
    4. Cosmetic surgery,
    5. Hearing aids,
    6. Physical defect or infirmity,
    7. Drug or alcohol abuse,
    8. Criminal commitment,
    9. AIDS/HIV,
    10. Terrorism, civil unrest, riots, hostilities or warlike operations (whether war be declared or not) civil war assuming the proportions of or amounting to popular rising, rebellion revolution, insurrection, military or usurped power or any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the government de jure or de facto or to the influencing of it by terrorism or violence or by the direct or indirect consequences of any of the said occurrences.
    11. Fraudulent claims,
    12. Suicide or Suicidal self-injury,
    13. For the treatment of Malignant Tumor cancer that occurs within 90 days from the policy starting date (in case of consecutive insurance policy, from the policy starting date before the policy renewed)
    14. Carcinoma in situ/ Intraepithelial Neoplasm (Malignant Tumor occurs under the Intraepithelial layer of Respiratory track, Gastrointestinal Track or Urogenital Track)