SBI Life - Sampoorn Cancer Suraksha_Policy Document_Form

Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Part A
WELCOME LETTER
Date: <<dd/mm/yyyy>>
To,
<<>>
<<>>
<<>>
<<>>
<<>>
Contact Details: <<>>
Father's Name: <<>>
Customer No.
:
<<>>
Policy No.
:
<<>>
Product Name
:
<SBI
Life
-
Sampoorn
Cancer Suraksha>>
UIN
Dear <<>>
<<111N109V01>>
:
We welcome you to the SBI Life family and thank you for your trust in our products.
Joining SBI Life family will give you access to the best customer service and to a wide range of products which cater to most of your life and
health insurance needs. We have enclosed the policy document& First Premium Receipt along with a copy of the proposal form signed by you
in this Policy booklet. Please check all details and make sure that it is kept safely.
Please note this is a <<Regular>> premium payment health insurance policy. <<The premium due dates are: <<dd/mm/yy>>>>
For any information/ clarification, please contact:
1. Your local SBI Life service branch:
<<SBI Life branch address>>
2. < Intermediary Name & contact nos>
3. Call us toll free at our customer service helpline 1800229090 (Timings: 9:00 a.m. to 9:00 p.m.)or email us at info@sbilife.co.in, oralso visit us
at www.sbilife.co.in. Senior citizens can also reach us on dedicated e-mail id: helpsc@sbilife.co.in
4. In case you have any complaint/grievance you may contact the following official for resolution:
<<Regional Director’s address >>
5. Register on ourCustomer Self Service websitehttp://mypolicy.sbilife.co.in to avail various online services available.
6. We request you to read the policy schedule along with the policy booklet. If you find any errors,please return your policy document for
effecting corrections.
7. All your servicing requests should be submitted to your local SBI Life service branch as mentioned above or nearest SBI Life branch only.
8. Please note that the digitally signed copy of your policy bond is available on our website www.sbilife.co.in. This can be viewed in a secure
manner through one time password. Please visit our website for details.
9. The copy of proposal form, KYC documents, benefit illustration and other important documents are also enclosed in this booklet. You may
kindly verify the documents and report discrepancy, if any.
Free Look Option
You can review the terms and conditions of the policy, within 15 days for policies sourced through any channel other than Distance Marketing
and within 30 days for policies sourced through Distance Marketing Channel, from the date of the receipt of the policy document and where you
disagree with any of those terms and conditions; you have the option to return the policy stating the reasons for your objection.
Your request for cancellation of the policy under the free look option must reach your nearest SBI Life Office within a period of 15 days or 30
days, as the case may be, as mentioned above.
We always look forward to be your preferred Life Insurance Company for all your Life Insurance needs.
Yours truly,
<signature>
<<(Name of Signatory)>>
<<(Designation of Signatory)>>
Note: The translated version of this letter in the regional language is printed overleaf for your convenience. However, should there be any
conflict between these two versions, the English version shall prevail.
Form 297
Page 1 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Welcome Letter – Regional Language
Form 297
Page 2 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
First Premium Receipt
Form 297
Page 3 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Blank Page
Form 297
Page 4 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
CUSTOMER INFORMATION SHEETfor “SBI Life– Sampoorn Cancer Suraksha”
Sr. Title
No.
Description
1
2
SBI Life – Sampoorn Cancer Suraksha
SPECIFY AS PER POLICY TERMS AND CONDITIONS
The benefit structure, once chosen at policy inception,
cannot be modified over the term of the policy.
Product Name
What am I
covered for
Policy
clause
No.
Benefit
Structure
Standard
•
Minor & Major Stage of cancer
Classic
•
Minor, Major & Advanced Stage of
cancer
Enhanced
•
Minor, Major & Advanced Stage of
cancer
Sum Assured Reset Benefit
Coverage
•
3
4
What are the
major
exclusions in
the
policy
Waiting period
•
•
•
3
Sexually Transmitted Diseases like AIDS or HIV.
Any pre-existing cancer including carcinoma in situ
Diseases arising out of Nuclear, biological or chemical
contamination (NBC)
13.5
• Initial waiting Period :180 days from the date of
commencement of risk or date of revival, whichever is later,
during which if cancer is detected, no claim will be
admissible/payable.
13.2
• Survival Period: Survival Period of 5 days is applicable ,
i.e. for a claim to be valid; the life assured should have
survived at least for a period of 5 days from the date of
diagnosis
13.3
13.5.3
.3
• Pre-existing diseases: Not covered
Form 297
Page 5 of 39
Policy Number
Part A
5
Payment basis
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Stage-wise lumpsum payout on diagnosis of cancer provided
the diagnosis is as per the definitions mentioned(provided
policy is in force)
The benefit structure, once chosen at policy inception,
cannot be modified over the term of the policy.
3.1
Standard
Contingency
Benefit
On diagnosis of Minor Lump sum benefit of 30% of the
Stage (CIS)
Sum Assured would be payable
On diagnosis of Minor Lump sum benefit of 30% of the
Stage (Early Stage cancer) Sum Assured would be payable
On diagnosis of Major Lump sum benefit which will be
Stage cancer
equal to the balance of 100% of
the Sum Assured, less claims paid
earlier, if any , would be payable.
You have the option to take 40%
of the sum assured as monthly
income benefit spread over 3
years and rest as lump sum
benefit under Major stage claim.
The monthly income benefit
would be 1.20% of the sum
assured. This is a guaranteed
benefit. Once opted, it would
continue to be paid for 36
months irrespective of the
death of the life assured or
termination of the policy
contract.
Death
No benefit is payable
Maturity
No benefit is payable
Surrender
No benefit is payable
Classic
Form 297
Page 6 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Contingency
Benefit
On diagnosis of Minor Lump sum benefit of 30% of the
Stage (CIS)
Sum Assured would be payable
On diagnosis of Minor Lump sum benefit of 30% of the
Stage (Early Stage cancer) Sum Assured would be payable
On diagnosis of Major Lump sum benefit which will be
Stage cancer
equal to the balance of 100% of
the Sum Assured, less claims paid
earlier, if any, would be payable.
You have the option to take 40%
of the sum assured as monthly
income benefit spread over 3
years and rest as lump sum
benefit under Major stage claim.
The monthly income benefit
would be 1.20% of thesum
assured. This is a guaranteed
benefit. Once opted, it would
continue to be paid for 36
months irrespective of the
death of the life assured or
termination of the policy
contract.
On diagnosis of Advanced Lump sum benefit equalto the
Stage cancer
balance of 150% of the Sum
Assured, less claims paid earlier, if
any, would be payable.
Form 297
Death
No benefit is payable
Maturity
No benefit is payable
Surrender
No benefit is payable
Page 7 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Enhanced
Contingency
Benefit
On diagnosis of Minor Lump sum benefit of 30% of
Stage claim (CIS)
the Sum Assured would be
payable
On diagnosis of Minor Lump sum benefit of 30% of
Stage claim (Early Stage the Sum Assured would be
cancer)
payable
On diagnosis of Major Lump sum benefit which will be
Stage cancer
equal to the balance of 100% of
the Sum Assured, less claims paid
earlier, if any, would be payable.
You have the option to take 40%
of the sum assured as monthly
income benefit spread over 3
years and rest as lump sum
benefit under Major stage claim.
The monthly income benefit
would be 1.20% of thesum
assured. This is a guaranteed
benefit. Once opted, it would
continue to be paid for 36
months irrespective of the
death of the life assured or
termination of the policy
contract.
On diagnosis of Advanced Lump sum benefit equal to the
Stage cancer
balance of 150% of the Sum
Assured, less claims paid earlier, if
any, would be payable.
Death
Maturity
Surrender
No benefit is payable
No benefit is payable
No benefit is payable
Sum assured reset benefit: We will restore the sum assured
after a period of 3 years from the date of last diagnosis of a
valid Minor or Major cancer claim and subject to no further
diagnosis of Minor, Major or Advanced cancer during this
Form 297
Page 8 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
period of 3 years provided the life assured had undergone
cancer surgery or radiotherapy or chemotherapy or any
medically necessary treatment for previous cancer(s).
>>
Life Assured who have been diagnosed with cancer can avail
second medical opinion any time during the policy term
provided the policy is in-force.
6
7
Loss Sharing
Renewal
Conditions
Not applicable
•
Your premiums of this policy are fixed for a block of
five policy years, that is, the premium rates of this
policy may be reviewed after each block of 5 years.
The premium may be revised based on our claim
experience under the product subject to prior IRDAI
approval. Claim experience refers to the company’s
experience on the whole and the premium revision will
not be based on your claim history alone.
The revised premiums would continue to be based on
your age at entry.
We will give a notice of three months prior to such
revision and we shall inform you the revised
installment premium.
You would have to pay the revised premium within
30 days from the due date.
If you don’t pay the premium within 30 days, then
the policy would lapse.
5
On renewal of your policy, you would continue to be covered
under the policy.
Your policy will terminate on the earliest of the following:
•
on free-look cancellation
•
the date of death of the Life Assured
•
on payment of below claim depending on the
benefit structure chosen
Standard
Payment of major
stage cancer claim
Classic
Payment of advanced
stage cancer claim
Enhanced
Payment of advanced
stage cancer claim
4
•
•
•
•
•
8
9
Renewal
Benefits
Cancellation
•
•
Form 297
on the expiry of the Revival Period if you have
not revived your Lapsed Policy during revival period;
the cover would lapse if you don’t pay the premium
within grace period.
on cancellation/ termination of the Policy
Page 9 of 39
Policy Number
10
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
•
by Us on grounds of misrepresentation, fraud or
nondisclosure established
on the date your policy term ends
10
Claims
On diagnosis of cancer, you or the life assured or nominee
should intimate the diagnosis of cancer of the life assured in
writing, stating at least the policy number and the stage of the
cancer claim.
We will require the following documents to process the claim:
•
Copy of policy document
•
Claimant’s statement and claim forms in
prescribed formats
•
Treating doctor’s certificate
•
Proof of the diagnosis of cancer to our
satisfaction, including medical reports
and
histological reports
•
Proof of the treatment undergone (cancer surgery
or radiotherapy or chemotherapy or any medically
acceptable and medically necessary treatment for
previous cancer(s) for sum assured reset benefit.
•
Any other document as the company may require
depending on the type / cause of claim
•
Proof of Occurrence of Cancer
•
Proof of occurrence of the insured event covered
by this policy must be supported by:
•
Certificate from an Appropriate Specialist Medical
Practitioners registered in India (or other country
approved by SBI Life), not being the policy owner,
Life Insured or the respective partner or spouse or
relatives
•
Confirmatory investigations including, but not
limited to, clinical, radiological, histological and
laboratory evidence
•
Any such documents which we may require.
11
Policy
Servicing/
Grievances/Co
mplaints
Your local SBI Life service branch:
<<SBI Life branch address>>
Welco
me
Letter
Toll free customer service helpline 1800229090 (Timings: &
9:00 a.m. to 9:00 p.m.)
clause
E-mail us at info@sbilife.co.in, or
13,14,
visit us at www.sbilife.co.in.
15
E-mal id (health insurance
<helpsc@sbilife.co.in>
related
claims
for
senior
citizens):
If you are not satisfied with our decision or have not received
Form 297
9
Page 10 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
any response within 10 business days, you may write to us at:
Head – Client Relationship,
SBI Life Insurance Company Limited
7th Level (D Wing) & 8th Level, Seawoods Grand Central,
Tower 2, Plot No. R-1, Sector 40, Seawoods,
Nerul Node, Navi Mumbai - 400 706
Dist. Thane, Maharashtra
Telephone No.:
+91 - 22 – 6645 6241
Fax No.: +91 - 22 – 6645 6655
E-mail Id: info@sbilife.co.in
E-mal id : helpsc@sbilife.co.in
Insurance Ombudsman address is available on the website of
IRDAI, http://www.irda.gov.in
and in our website
http://www.
sbilife.co.in
or
http://www.sbilife.co.in/sbilife/content/13_2943
In case the complaint is not fully attended by us within 15 days
of lodging the complaint through our Grievance Redressal
Mechanism; you may escalate the complaint to IRDAI through
the Integrated Grievance Management System (IGMS)
website: http://www.igms.irda.gov.in or contact IRDAI
Grievance Call Centre on toll-free number : 155255 / 1800
4254 732
12
Insured’s
Rights
Grace Period:
•
30 days from the due dates for premium
frequencies of yearly, half-yearly and quarterly
•
15 days for monthly frequency.
In case of revision of premium, you would have 30 days of
grace period irrespective of premium frequency mode.
Free Look:
6
13.1
15 days for policies sourced through any channel other than
Distance Marketing
30 days for policies sourced through Distance Marketing
Channel
13
Insured’s
Obligations
Please provide correct information in the proposal form and
disclose all pre-existing disease/s or condition/s before buying
a policy.
13.9
Non-disclosure may result in claim not being paid.
Form 297
Page 11 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Note: Customer Information Sheet contains brief information about the key features of the Product. The same shall not be
construed as terms and conditions of the Policy or part thereof. For detailed terms and conditions governing the Policy,
please read all parts of the Policy document. In case of any conflict between the information given in the Customer
Information Sheet and the terms and conditions of the policy, the terms and conditions of the Policy shall prevail.
Form 297
Page 12 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Blank Page
Form 297
Page 13 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
SBI Life Insurance Company Limited
Registration Number: 111
POLICY
DOCUMENT
Regulated by IRDAI
SBI LIFE –SAMPOORN CANCER
SURAKSHA
UIN:<<111N109V01>>
(A NON-LINKED, NON-PARTICIPATING, HEALTH INSURANCE PLAN)
Registered & Corporate Office: SBI Life Insurance Co. Ltd, “Natraj”, M.V. Road & Western Express
Highway Junction, Andheri (East), Mumbai - 400 069.
Website: www.sbilife.co.in| Email: info@sbilife.co.in | CIN: L99999MH2000PLC129113
Toll Free: 1800 22 9090 (Between 9.00 am & 9.00 pm)
Form 297
Page 14 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Policy Preamble
Welcome to your SBI Life –– Sampoorn Cancer Surakshapolicy and thank you for preferring
SBI Life Insurance Company Limited to provide you with insurance solutions. The UIN
allotted by IRDAI for this product is 111N109V01.
The information you have given in your proposal form, personal statement together with any
reports or other documents and declarations form part of this contract of insurance with us.
Your policy document, comprising this policy schedule along with the policy booklet and any
endorsements, is evidence of the contract. You should read these carefully to make sure you
are satisfied. Please keep these in a safe place.
We request you to read this policy schedule along with the policy booklet. If you find any
errors, please return your policy document for effecting corrections.
SBI Life –Sampoorn Cancer Surakshapolicyis an individual, non-participating, non-linked
health insurance product.
In return for your premiums we will provide benefits as described in Part C and D of the policy
document. The benefits available under this policy are subject to the payment of premiums as
and when due.
The benefits will be paid to the person(s) entitled as set out in the policy document, on proof to
our satisfaction, of such benefits having become payable and of the title of the persons
claiming the payments.
Please communicate any change in your mailing address or any other communication details
as soon as possible.
If you require further information, please contact us or the Agent/ facilitator mentioned below.
You may also contact the Third Party Administrator (TPA) mentioned below for any assistance
regarding medical examination, claim servicing etc scheduled by the Company, if any. The
complete list of TPAs engaged by the Company is available on the website www.sbilife.co.in.
<<Insurance Advisor/Facilitator>> Details: <<name>><<code>>
<< mobile number or landline number if mobile not available>>.
<<License number>><<Validity>>>>
<<TPA name>><<TPA address>><<TPA contact number>>
Form 297
Page 15 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Policy Schedule
Identification
1. Policy Number
<< as allotted by system >>
2. Proposal No.
<< from the proposal form >>
3. Proposal Date
<< dd/mm/yyyy >>
4. Customer ID
<<as allotted by system >>
Personal information
5. Name of the Life Assured
<< Title / First Name / Surname of the life assured>>
6. Name of Proposer / Policyholder
<< Title / First Name / Surname of the policyholder>>
Life Assured
<< dd/mm/yyyy >>
Life Assured
7. Date of Birth
8. Age at entry
9. Gender
10. Mailing Address
Policyholder
<< dd/mm/yyyy >>
Policyholder
Life Assured
Policyholder
<< Male / Female >>
<< Male / Female >>
<< Address for communication >>
11. Telephone Number with STD
Code
12. Mobile Number
13. E-Mail ID of the policyholder
Form 297
<< E-Mail ID of the policyholder>>
Page 16 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Nomination
14. Name of the Nominee(s)
Relationship with the life
assured
Date of Birth
15. Name of the Appointee(s)
Relationship with nominee
Date of Birth
Important dates
16. Date of commencement of policy
17. Date of commencement of risk
18. Policy anniversary date
19. Premium Review date
20. Premium due dates
21. Due Date of Last Premium
22. Cover End Date
Gender
Gender
<< dd/mm/yyyy >>
<< dd/mm/yyyy >>
<< dd/mm>>
<< dd/mm/yyyy>>& after every 5 years thereafter
<<>>
<< dd/mm/yyyy >>
<< dd/mm/yyyy >>
Basic policy information
23. Benefit Structure
<< Standard/Classic/Enhanced >>
24. Sum Assured (Rs.)
<<>>
25. Premium frequency
<< Yearly / Half-Yearly / Quarterly / Monthly >>
26. Policy Term
27. Premium Payment Term
28. Premium waiver Benefit Period
<< 5 years / Outstanding policy term >>
29. Total Installment Premium, excluding
Taxes
30. ApplicableTaxes*
31.
32.
33. Applicable rate of Tax*
34. Total Installment Premium, including
taxes
Form 297
Page 17 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
*includes Service Tax, Cess, GST and/ or any other statutory levy/ duty/ surcharge, as notified by
the Central and/or State Government from time to time as per the provisions of the prevalent tax
laws.
<< To be printed only when the policyholder is staff member/online sales>>
We have provided the following discount to you on your premium
Premium
Policy Year
Discount applicable on the tabular
premium
Throughout the premium paymentterm
<<5 % >>
Signed for and on behalf of SBI Life Insurance Company Limited,
Authorised Signatory
Name
Designation
Date
Place
The stamp duty of Rs. <<….>> (Rupees……only) paid by pay order, vide receipt no. <<……>>
dated <<>>. Government notification Revenue and Forest Department No.
Mudrank <<…………………>> dated <<…….>>
<< Digital Signature >>
(Signature)
Proper Officer
***************************************** End of Policy Schedule **************************************
Form 297
Page 18 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
Policy Booklet
Table of Contents
Part B
21
1. Definitions
21
2. Abbreviations
25
Part C
26
3. Base Policy Benefits
26
3.3.
Maturity Benefit
28
3.4.
Medical Second Opinion
28
4. Premiums
28
5. Reviewability
29
6. Grace Period
29
Part D
30
7. Non-forfeiture Benefits
30
7.2.
30
Surrender Value
8. Revival
30
9. Claims
30
9.1.
Death Claim
30
9.2.
Claim on diagnosis of cancer including CIS
30
9.3.
Maturity Claim
31
9.4.
Surrender
31
10. Termination
31
11. Withdrawal
33
Part E
34
12. Charges
34
Part F
35
13. General Terms
35
13.1.
Free Look Period
35
13.2.
Waiting Period
35
13.3.
Survival Period
35
13.4.
Suicide Exclusion
35
13.5.
Other Exclusions
35
13.6.
Policy Loan
35
Form 297
Page 19 of 39
Policy Number
Part A
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
13.7.
Nomination
35
13.8.
Assignment
36
13.9.
Non – disclosure
36
13.10.
Misstatement of age
36
13.11.
Taxation
36
13.12.
Date formats
36
13.13.
Electronic transactions
36
13.14.
Communications
36
Part G
38
14. Complaints
38
15. Relevant Statutes
38
15.1.
Governing laws and jurisdiction
38
15.2.
Section 41 of the Insurance Act 1938, as amended from time to time
38
15.3.
Provision 12 (1) of Redressal of Public Grievances Rules, 1998
39
15.4.
Provision 13 of Redressal of Public Grievances Rules, 1998
39
Form 297
Page 20 of 39
Policy Number
Part B
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
Part B
This is your policy booklet containing the various terms and conditions governing your policy. This policy booklet
should be read in conjunction with the policy schedule and other related documents of your policy.
1. Definitions
These definitions apply throughout your policy document.
The definitions are listed alphabetically. Items marked with † alongside are mentioned in your policy schedule
Expressions
1.
Advanced Stage Cancer
2.
Age
3.
Age at entry †
4.
Annualised Premium
5.
Appointee †
6.
Assignment
7.
Base Policy
8.
Beneficiary
9.
Benefit Structure †
10.
Birthday
11.
Carcinoma in-situ (CIS)
12. Cover End Date †
13. Date of commencement
of policy †
14. Date of commencement
of risk †
15. Date of revival
Form 297
Meanings
Means all Stage IV malignant tumour with the presence of distant metastasisThe diagnosis of
malignancy must be confirmed by histological evidence. .
A spread to lymph nodes only is not covered under this definition.
All tumour in the presence of HIV infection are excluded.
is the age last birthday; i.e., the age in completed years.
is the age last birthday on the date of commencement of your policy.
means the premium payable in a policy year, excluding the underwriting extra premiums and
loadings for modal premiums, if any. Please note that the premiums are guaranteed for only five
years.
is the person who is so named in the proposal form or subsequently changed by an endorsement,
who is authorised to give a valid discharge to the policy monies in case of the death of the life
assured during the term of the policy while the nominee is a minor.
is the transfer of rights and benefits of an insurance policy under section 38 of the Insurance Act,
1938.
is that part of your policywhich covers benefit structures as explained under this policy
document.
the persons nominated by the policy owner to receive the insurance benefits under the provisions
of your policy. The Beneficiary may be you, or the nominee or the legal heirs as the case may be.
The beneficiary may be stated in the policy schedule or may be changed or added subsequently.
is a variant to be opted at the inception .
is the conventional Birthday. If it is on 29th February, it will be considered as falling on the last
day of February.
Carcinoma in-situ is characterized by the presence of cancer cells that remain within the cell
group from which they arose, where cancer cells do not penetrate the basement membrane nor
invade the surrounding tissues. The cancer must be classified as “Tis” according to the AJCC 7th
Edition TNM staging method.
The following are specifically excluded:
• Carcinoma in-situ of skin, Melanoma in-situ
• Cervical Intraepithelial Neoplasia (CIN I, CIN 2, and CIN 3) without carcinoma insitu
is the date on which the benefit terminates on expiry of the policyterm.
is the start date of your policy.
is the date from which the insurance cover under the policy commences.
is the date on which the policy benefits are restored at the conclusion of the revival process
Page 21 of 39
Policy Number
Part B
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
is the amount payable on death of the life assured.There is no death benefit applicable under this
policy.
The policy shall be void and all premium paid thereon shall be forfeited to the Company in the
event of misrepresentation, mis-description or non-disclosure of any material fact.
16.
Death Benefit
17.
Disclosure to
information norm
18.
Diagnosis
shall mean a process of determining by examination of the causes of illness. It is an investigative
analysis made by a physician based upon various medical tests including but not limited to
radiological, clinical, and histological or laboratory tests acceptable to the Company.
19.
Early Stage Cancer
Early Stage Cancer shall mean the presence of one of the following malignant conditions:
(i) Prostate tumour histologically described as TNM Classification T1a or T1b or T1c or of
another equivalent or lesser classification.
(ii) Chronic lymphocytic leukaemia classified as RAI Stage I or II;
(iii) Hodgkin’s lymphoma Stage I
(iv) Papillary carcinoma of the thyroid histologically classified as T1aN0M0/T1bN0M0
according to the TNM classification. The benefit will be paid only when total thyroidectomy is
performed to treat this condition.
The Diagnosis must be established by histopathological evidence and confirmed by a
Pathologist. Premalignant lesions and conditions, unless listed above, are excluded.
All tumours in the presence of HIV infection are excluded.
20.
Endorsement
A change in any of the terms of the policy, agreed to or issued by Us, in writing
21.
Free-look period
22.
Grace period
23.
In-force
24.
Installment premium †
25.
Lapse
26.
Life assured †
27.
Legal Heir
28.
Major Stage Cancer
is the period during which you have the option to return the policy and cancel the contract.
is the period from the premium due date during which you can pay the premium without any late
fees, interest & other requirements and the policy is considered to be in-force. In case of
premium revision, the grace period is 30 days.
is the status of the policy when all the premiums due up to date have been paid.
is the contractual amount payable by you on each Premium Due Date in order to keep the
insurance cover in force under the provisions of your policy. Applicable service tax and cess or
any other taxes and levies if any, is payable in addition.
is the status of the policy when a due premium is not paid before the expiry of grace period.In
case of premium revision, the grace period is 30 days.
is the person in relation to whom insurance and other benefits are granted.
means the person(s) certified to be the legal heirs of the policyholder by a court of competent
jurisdiction.
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, 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.
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,
Form 297
Page 22 of 39
Policy Number
Part B
29.
Maturity Benefit
30.
Medical Advice
31.
Medically Necessary
Treatment
32.
Medical Second
Opinion (MSO)
33.
Minor
34.
Minor Stage Cancer
35.
Monthly income benefit
36.
Nominee †
37.
Non-participating
38.
Notification of Claim
39. Physician / Medical
Practitioner
40.
Policy anniversary†
41.
Policy document
42.
Policy Schedule
43. Policyholder or Policy
Owner †
44.
Policy month
Form 297
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
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;
i) All tumors in the presence of HIV infection.
is the benefit payable on maturity. There is no maturity benefit available under this policy.
Medical Advice means any consultation or advice from a Medical Practitioner including the
issuance of any prescription or follow-up prescription
Medically necessary treatment means any treatment, tests, medication, or stay in hospital or
part of a stay in hospital which:
i) is required for the medical management of the illness or injury suffered by the insured;
ii) must not exceed the level of care necessary to provide safe, adequate and appropriate
medical care in scope, duration, or intensity;
iii) must have been prescribed by a medical practitioner;
iv) must conform to the professional standards widely accepted in international medical
practice or by the medical community in India.
Medical second opinion is a service which enables life assured who has been diagnosed with
cancers to get an opinion ontheir diagnoses and their treatment plans, evaluated by another
doctor. This service is provided by Mediguide India.
is a person who has not completed 18 years of age
under this stage, carcinoma in-situ and early stage cancers are covered.
means the option available to you to take 40% of the sum assured as a monthly income
benefit over the next 3 years and rest as lump sum benefit under Major stage claim, starting
from the one month after the date of diagnosis. The monthly income would be 1.20% of sum
assured. This is a guaranteed benefit. Once opted, it would continue to be paid for 36 months
irrespective of the death of the life assured or termination of the policy contract.
is the person who is named as the nominee in the proposal form or changed by an endorsement
subsequently, as per section 39 of the Insurance Act, 1938, and who is authorised to give a valid
discharge and to receivethe policy monies in case of the death of the life assured.
means that the policy does not have a share in our profits..
Notification of claim means the process of intimating a claim to Us or TPA through any of
the recognized modes of communication.
A Medical practitioner is a person who holds a valid registration from the medical council of any
state of India or Medical Council of India or Council for Indian Medicine or for Homepathy set
up by the Government of India or a State Government and is thereby entitled to practice
medicine within its jurisdiction; and is acting within the scope and jurisdiction of his license.And
who is neither the life insured himself nor related to the life insured by blood or marriage. The
term Medical Practitioner will include surgeons, anaesthetists, consultants, pathologists,
radiologists, radiation oncologists and specialists.
is the same date and month each year during the policy term as the date of commencement.
If the date of commencement is on 29th of February, the policy anniversary will be the last date
of February.
means the policy schedule, policy booklet, endorsements (if any), Any subsequent written
agreements (if any) mutually agreed by you and us during the term of the policy also forms a part
of the Policy document.
is the document that sets out the details of your policy.
is the owner of the policy and is referred to as the proposer in the proposal form. The policy
owner need not necessarily be the same person as the life assured.In case of policies issued to
minor life assured, the policy will vest in the name of life assured once the life assured attains
majority.
is the period from the date of commencement, to the date one day prior to the corresponding date
in the following calendar month or similar periods thereafter beginning from the dates in any
Page 23 of 39
Policy Number
Part B
45.
Policy year
46.
Policy Term †
47.
Premium frequency †
48.
49.
Premium paying term †
Premium
WaiverBenefit
50.
Pre-Existing Disease
51.
Reviewability
52.
Revival
53.
Revival period
54.
Sum Assured †
55.
Sum Assured Reset
Benefit (SA Reset
Benefit)
56.
Survival Period
57.
Surrender
58.
Surrender Value
59.
Underwriting
60.
We, Us, Our
61.
Waiting Period
62.
You, Your †
Form 297
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
calendar month corresponding to the date of commencement of policy.
If the said corresponding date is not available in a calendar month, then the last day of the
calendar month will be considered for this purpose.
is the period between two consecutive policy anniversaries; by convention, this period includes
the first day of the policy anniversary and excludes the next policy anniversary day.
is the period, in years, during which the contractual benefits are payable.
is the period between two consecutive premium due dates for regular premium policy; the
premium frequency can be either Yearly, Half-yearly, Quarterly or Monthly;
is the period, in years, over which premiums are payable.
means waiver of the policyholder's obligation to pay any further premiums on occurrence of
certain conditions,as specified in this document, for a specified duration of time.
Pre-Existing Disease means any condition, ailment or injury or related condition(s) for which
there were signs or symptoms, and / or were diagnosed, and / or for which medical advice /
treatment was received within 48 months prior to the first policy issued by the insurer and
renewed continuously thereafter.
means that the premium may be revised after each block of five years. The revised
premiums would be based on our claim experience under the product subject to prior IRDAI
approval. Claim experience refers to the company’s experience under this product.
is the process of restoring the benefits under the policy which are otherwise not available due to
lapsation of the policy on account of non-payment of premiums on due dates
is a 2-year period from the due date of first unpaid premium.
is the sum assured as on the date of commencement of policy.
After a period of 3 years from the date of valid Minor or Major Cancer claim, and if there is no
further/subsequent diagnosis of Minor, Major or Advanced stage Cancer during the same period,
the full Sum Assured will be restored provided the life assured had undergone cancer surgery or
radiotherapy or chemotherapy or any medically acceptable and recognized treatment for previous
cancer(s) subject to our satisfaction. .
This reset benefit will be payable irrespective of whether the nature of cancer diagnosed
after 3 claims free years is the same as the earlier one for which claim has been settled or is an
entirely different type of cancer.
shall mean the period of 5 days from the date of diagnosis of cancer during which the life
assured must survive for the claim to be admitted – i.e. if cancer is detected, the life assured will
have to survive the period specified as the Survival Period for the claim to be accepted as a valid
claim.
No Benefit is payable if the life assured dies within 5 days from the date of diagnosis.
is the voluntary termination of the policy before the expiry of the policy term. There is no
surrender value available under this policy.
is the amount to be refunded, if any, to the Policyholderupon early and voluntary termination of
the Policy.There is no surrender value available under this policy
is the process of classification of lives into appropriate homogeneous groups based on the
underlying risks.
Based on underwriting, a decision on acceptance or rejection of cover is taken.
SBI Life Insurance Company Limited or its successors.
We are regulated by the Insurance Regulatory and Development Authority (IRDAI). The
registration number allotted by the IRDAI is 111.
is the initial period of 180 days from the Date of Commencement of Risk or from the date on
which the cover is restored/revived after the completion of revival process, whichever is later,
during which if cancer occurs, no benefit will be payable. Claim during the Waiting Period (as
defined under this policy) is excluded under the policy and will not be covered.
is the person named as the policyholder.
Page 24 of 39
Policy Number
Part B
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
The above definitions are provided only for the purpose of proper comprehension of the terms and phrases used in the
policy document. The actual benefits under the policy are payable strictly as per the terms and conditions of the policy
only.
2. Abbreviations
Abbreviation
IRDAI
Rs.
UIN
PPT
PWB
CIS
Stands for
Insurance Regulatory and Development Authority of India
Indian Rupees
Unique Identification Number (allotted by IRDAI for this product)
Premium Paying Term
Premium Waiver Benefit
Carcinoma In Situ
These abbreviations bear the meanings assigned to them elsewhere in the policy booklet.
Form 297
Page 25 of 39
Policy Number
Part C
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
Part C
3.
Base Policy Benefits
3.1. Cancer Benefits:
3.1.1. We shall pay cancer benefit on the diagnosis of cancer including carcinoma in situ (CIS) as per the
definitions mentioned in this document and as per benefit structurechosen by you.
3.1.2. The benefit(s) is based on the stage of cancer diagnosed – Minor, Major and Advanced.
3.1.3. Throughout the policy document, while carcinoma in-situ, cancer and its various stages are being referred
to, you may refer to the ‘Definitions’ section for further understanding.
3.1.4. If you have chosen “Standard benefit structure” and provided the policy is in-force, then
3.1.4.1.
On the diagnosis of a minor stage cancer i.e. CIS or early stage cancer
3.1.4.1.1.We will pay a lump sum benefit of 30% of the sum assured
3.1.4.1.2.You can claim for one CIS and one early stage cancer during the term of the policy.
3.1.4.1.3.We will waive five annual renewalpremiumsin case of first valid minor stage cancer claim.
3.1.4.1.4.In case the outstanding policy term is less than five years, then premiums till the end of the
policy term would be waived.
3.1.4.1.5.In case the outstanding policy term is more than five years, you will have to continue to
pay the renewal premiums after the “5-year renewal premium waiver” period is over.
3.1.4.1.6.The premium waiver will be effective from the next premium due date after the date of
diagnosis of minor stage cancer.
3.1.4.1.7.There is no premium waiver benefit on second minor stage claim.
3.1.4.2.
On the diagnosis of a major stage cancer
3.1.4.2.1.We will pay lump sum benefit which will be equal to the of 100% of the sum assured less
any claim(s) paid earlier
3.1.4.2.2.You have the option to take 40% of the sum assured as a monthly income benefit over the
next 3 years and rest as lump sum benefit.
3.1.4.2.2.1. The monthly income would be 1.20% of thesum assured.
3.1.4.2.2.2. The first monthly income benefit would start fromone month after the date of diagnosis.
3.1.4.2.2.3. We will pay all the monthly income benefits due, but not paid, from date of diagnosis to
date of acceptance of claim in a lump sum without any interest thereon.
3.1.4.2.2.4. Once you opt for the monthly income benefit, the monthly benefit would continue to be
paid for 36 months irrespective of the death of the life assured or termination of the
policy contract.
3.1.4.2.3.There is no further benefit after payment of major stage claim.
3.1.5. If you have chosen “Classic benefit structure”and provided the policy is in-force, then
3.1.5.1.
On the diagnosis of a minor stage cancer i.e. CIS or early stage cancer
3.1.5.1.1.We will pay a lump sum benefit of 30% of the sum assured
3.1.5.1.2.You can claim for once CIS and one early stage cancer during the term of the policy.
3.1.5.1.3.We will waive all futurepremiums till the end of the policy term in case of first valid minor
stage claim.
3.1.5.1.4.The premium waiver will be effective from the next premium due date after the date of
diagnosisof minor stage cancer.
Form 297
Page 26 of 39
Policy Number
Part B
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
3.1.5.2.
On the diagnosis of a major stage cancer
3.1.5.2.1.We will pay lump sum benefit which will be equal to the balance of 100% of the sum
assured less any claim(s) paid earlier.
3.1.5.2.2.You have the option to take 40% of the sum assured as a monthly income benefit over the
next 3 years and rest as lump sum benefit.
3.1.5.2.2.1. The monthly income would be 1.20% of the sum assured.
3.1.5.2.2.2. The first monthly income benefit would start fromone month after the date of diagnosis.
3.1.5.2.2.3. We will pay all the monthly income benefits due, but not paid, from date of diagnosis to
date of acceptance of claim in a lump sum without any interest thereon.
3.1.5.2.2.4. Once you opt for the monthly income benefit, the monthly benefit would continue to be
paid for 36 months irrespective of the death of the life assured or termination of the
policy contract.
3.1.5.2.3.We will waive all futurepremiums till the end of the policy term, if any
3.1.5.2.4.The premium waiver will be effective from the next premium due date after the date of
diagnosis of major stage cancer.
3.1.5.3.
On the diagnosis of an advanced stage cancer
3.1.5.3.1.We will pay a lump sum benefit which will be equal to balance of 150% of the sum
assured less any claim(s) paid earlier
3.1.5.3.2.There is no further benefit after payment of advanced stage claim.
3.1.6. If you have chosen “Enhanced benefit structure”and provided the policy is in-force, then
3.1.6.1.
On the diagnosis of a minor stage cancer i.e. CIS or early stage cancer
3.1.6.1.1.We will pay a lump sum benefit of 30% of the sum assured
3.1.6.1.2.You can claim for once CIS and one early stage cancer during the term of the policy.
3.1.6.1.3.We will waive all future premiums till the end of the policy termin case of first valid minor
stage claim.
3.1.6.1.4.The premium waiver will be effective from the next premium due date after the date of
diagnosisof minor stage cancer.
3.1.6.2.
On the diagnosis of a major stage cancer
3.1.6.2.1.We will pay lump sum benefit which will be equal to the balance of 100% of the sum
assured less any claim earlier paid.
3.1.6.2.2.You have the option to take 40% of the sum assured as a monthly income benefit over the
next 3 years and rest as lump sum benefit.
3.1.6.2.2.1. The monthly income would be 1.20% of the sum assured.
3.1.6.2.2.2. The first monthly income benefit would start fromone month after the date of diagnosis.
3.1.6.2.2.3. We will pay all the monthly income benefits due, but not paid, from date of diagnosis to
date of acceptance of claim in a lump sum without any interest thereon.
3.1.6.2.2.4. Once you opt for the monthly income benefit, the monthly benefit would continue to be
paid for 36 months irrespective of the death of the life assured or termination of the
policy contract.
3.1.6.2.3.We will waive all future premiums till the end of the policy term, if any
3.1.6.2.4.The premium waiver will be effective from the next premium due date after the date of
diagnosis of major stage cancer.
3.1.6.3.
On the diagnosis of an advanced stage cancer
3.1.6.3.1.We will pay a lump sum benefit which will be equal to balance of 150% of the sum
assured less any claim(s) paid earlier
3.1.6.3.2.There is no further benefit after payment of advance stage claim.
Form 297
Page 27 of 39
Policy Number
Part C
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
3.1.6.4.
3.1.6.5.
3.1.6.6.
We will restore the sum assured after a period of 3 years from the date of last diagnosis of
a valid Minor or Major cancer claim and subject to no further diagnosis of Minor, Major or
Advanced cancer during this periodof 3 years provided the life assured had undergone
cancer surgery or radiotherapy or chemotherapy or any medically necessary treatment for
previous cancer(s).
This reset benefit will be payable irrespective of whether the cancer diagnosed after
3 claims free years is the same cancer for which claim benefits have been paid under the
policy or an entirely different type of cancer.
The sum assured reset benefit is available only once during the policy term.
3.2. Death Benefit
3.2.1. There is no death benefit under the product.
3.3. Maturity Benefit
3.3.1. There is no maturity benefit under your policy.
3.4. Medical Second Opinion
3.4.1. You have the option to avail the service of medical second opinion from M/s Mediguide India, provided
the policy is in-force and the life assured has been diagnosed with any of the covered cancer.
3.4.2. This service is provided by Mediguide India, an independent Company not affiliated to us.
3.4.3. The medical Second Opinions are not independent treatment or diagnosis and should not be solely relied
upon as such.
3.4.4. The Physicians who provide the medical services contemplated by this Agreement do not have the benefit
of information that would be obtained by examining the Member in person and observing his or her
physical condition. Therefore, the Physician may not be aware of facts or information that would affect his
or her opinion of the diagnosis or treatment alternatives or options.
3.4.5. To avail the medical second opinion option, you simply need to call on 0008000401647.
3.4.6. The Mediguide representative would contact you to facilitate the medical second opinion.
3.4.7. You will have to give consent to the release of your medical records and details for availing the service of
obtaining medical second opinion.
3.4.8. We will not have access to your medical records and details shared by you with Mediguide India.
3.4.9. We will not have access to the second medical opinion unless you give consent for sharing the second
medical opinion.
3.4.10.
We shall not in any event be responsible for any actual or alleged errors or opinion made by the
Medical Second Opinion or for any consequence of actions taken or not taken on the second opinion.
3.4.11.
We do not provide any warranty or guarantee concerning any particular result or cure of the disease,
medical condition, or incapacity.
3.4.12.
In future, we may engage any other service provider to provide medical second opinion. In that
case, we would notify you the same along with the procedure of obtaining the second opinion.
4.
Premiums
4.1. You have to pay the premiums on or before the premium due dates or within the grace period.
4.2. You have to pay the premiums even if you do not receive renewal premium notice. We are not liable to send you
any premium notices, whatsoever.
4.3. You are liable to pay the Service Tax/Cess/GST and/or any otherstatutory levy/duty/ surcharge, at the rate
notified by the State Government or Central Government of India from time to time, as per the applicable tax
laws on premium.
4.4. The premium should always be paid in advance for full policy year. However, for your convenience, we may
allow you other modes of payment of premium.
4.5. The premium frequency can be changed only on a policy anniversary by sending a written request at least one
month in advance.
Form 297
Page 28 of 39
Policy Number
Part C
SBI Life – Sampoorn Cancer Suraksha PolicyDocument
(UIN:111N109V01)
4.6. Change in premium frequency is subject to:
4.6.1. Minimum premium requirement for the requested premium frequency
4.6.2. Availability of the requested premium frequency on the day of change in premium frequency
4.6.3. Payment of extra loading associated with changes in the mode of payment of premium from lower
frequency to higher frequency, if any
4.6.4. The then applicable Premium rates. If the request is received when the premiums are due for revision
(once every five years), then the revised premium rates shall be applicable
4.7. If we receive any amount in excess of the required premium, we will refund the excess. We will not pay any
interest on this excess amount.
4.8. If we receive any amount less than the installmentpremium, we will not adjust the said amount towards premium
till you pay the balance of premium. Further no interest will be payable on suchunadjusted amounts
5.
Reviewability
5.1. Your premiums under this policy are fixed for eachblock of five policy years, that is, the premium rates under
this policy willbe reviewed by us after each block of five policyyears.
5.2. The premium may be revised based on our claim experience under the product subject to prior IRDAI approval.
5.3. Claim experience refers to the company’s experience on the whole and the premium revision is not based on
your claim history alone.
5.4. The revised premiums would continue to be based on your age at entry.
5.5. We will give a notice of three months prior to such revision and we shall inform you the revised installment
premium.
5.6. You will have to pay the revised premium within 30 days from the due date.
5.7. If you don’t pay the premium within 30 daysfrom the due date in case of revision in premium, then the policy
would lapse.
6.
6.1.
6.2.
6.3.
6.4.
6.5.
6.6.
Form 297
Grace Period
You can pay your premiums within a grace period of 30 days from the due dates for premium frequencies of
yearly, half-yearly and quarterly.
You have a grace period of 15 days for monthly frequency.
In case, the premium is due for revision then you have 30 days from the due dates to pay the revised premium
irrespective of premium frequency mode chosen by you.
Your policy will be treated as in-force during the grace period. However, in case of claims during the grace
period and if the claim is found admissible, the outstanding premium shall be recovered from the claim amount.
If you do not pay your due premiums before the end of grace period, your policy lapses.
No benefits are payable under a lapsed policy.
Page 29 of 39
Policy Number
Part D
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
Part D
7.
7.1.
Non-forfeiture Benefits
Paid-up Value
7.1.1. No Paid – up value is available under your policy.
7.2. Surrender Value
7.2.1. No Surrender Value is available under your policy.
8.
8.1.
8.2.
8.3.
8.4.
8.5.
8.6.
8.7.
8.8.
8.9.
Revival
You can revive your policywithin 2 years from the date of the First Unpaid Premiumand before 6 months
prior to the date of expiry of policy term, whichever is earlier, while the life assuredis still alive.
You should write to us during the revival period requesting revival.
You have to submit Good Health Declaration and satisfy other underwriting requirements, if any.
We may accept or reject your revival request. We will inform you about the same.
Revival will be subject to underwritingafresh by us based on our Board approved underwriting policy.
You have to pay all due premiums, not paid during the revival period, along with interest. The due premiums
would include the applicable installment premium(inclusive of premium revision,if any). The Premium may be
increased at the time of revival.
The interest rate will be charged at a rate declared by us from time to time.
You cannot revive your policy after the expiry of the revival period or within 6 months prior to the date of
expiry of the policy term whichever is earlier.
Revival shall not be effective unless we accept the revival and intimate you the same in writing.
9.
Claims
9.1. Death Claim
9.1.1. There is no death claim payable under the policy.
9.2. Claim ondiagnosisofcancerincluding CIS
9.2.1. On diagnosis of cancer,the life assuredorthe policyholderornominee should intimate the diagnosis of
cancer of the life assured in writing, stating at least the policy number and the stage ofthe cancer claim.
9.2.2. We will require the following documents to process the claim:
9.2.2.1.
Copy of policy document
9.2.2.2.
Claimant’s statement and claim forms in prescribed formats
9.2.2.3.
Treating doctor’s certificate
9.2.2.4.
Proof of the diagnosis of cancer or CIS, satisfactory to our company including medical and
histological reports, if any, called for
9.2.2.5.
Proof of the treatment undergone (cancer surgery or radiotherapy or chemotherapy or any
medically necessary treatment) for previous cancer(s) in case of claim under sum assured reset benefit as
defined under “Sum Assured Reset Benefit definition”.
9.2.2.6.
Any other document as the company may require depending on type / cause of claim
9.2.3. Proof of Occurrence of Cancer
9.2.3.1.
Proof of occurrence of theinsured event covered by this policy must be supported by:
9.2.3.1.1. Appropriate Specialist Medical Practitioners registered in India (or other
country approved by SBI Life), not being the policy owner, Life Insured
or the respective partner or spouse or relatives
9.2.3.2. Confirmatory investigations including, but not limited to, clinical, radiological, histological and laboratory
evidence,
9.2.4. The Company reserves the right to call for such medical examinations as it may require and for this
purpose and may require the Life Assured to undergo further medical examinations by a Specialist
Form 297
Page 30 of 39
Policy Number
Part D
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
appointed by the Company for this purpose or to undergo any diagnostic tests at any of the diagnostic
centers authorisedby ourCompany. We would bear the cost of such medical examinations. Any failure to
provide the required proof or to submit to such medical examinations will result in rejection of the claim.
In that event the Company shall not be liable to refund any premiums paid under this Policy.
9.2.5. However, in case the life assured is not in a position to undergo the required medical examination or
diagnostic test at the diagnostic centres and he/she submits a genuine reason for the same, we would try to
arrange for the diagnostic tests at his place of stay/residence to the extent possible or we may waive this
requirement.
9.2.6. Claim under the policy may be filed with us within90 days of date of diagnosis of cancer, as per the opted
benefit structure.
9.2.7. However, without prejudice, in case of delay in intimation or submission of claim documents beyond the
stipulated period in the policy document or in the Statutes, We, at our sole discretion, may condone such
delay and examine the admissibility or otherwise of the claim, if such delay is proved to be for reasons
beyond the control of the nominee/claimant.
9.2.8. We will pay the claim, if found admissible as per the benefits listed in Part C of this document.
9.2.9. We will not pay claim under this policyif the covered illness is diagnosed or any claim arises within the
first 180 days from the date of commencement of risk or from the date of revival of policy, whichever is
later. The policy shall terminate and no benefit shall be payable under the policy if the diagnosis is made
or signs or symptoms (related to the diagnosed cancer) are first observed during the waiting period.
9.2.10. We will not pay any claim under this policyif the life assured does not survive for 5 days from the date of
diagnosis.
9.2.11. We will not pay any claim under the policy in respect of any Minor stage cancer including CIS, Major
stage cancer or Advanced stage Cancer resulting directly or indirectly from or caused or contributed
by (in whole or in part) any exclusions as mentioned in this policy document.
9.2.12. In case you are the life assured, we will pay the claim to you. Incase you are not in a position to receive
the benefit , we will pay the benefit
9.2.12.1.
To your nominee or
9.2.12.2.
To your legal heir, if nomination is not valid
9.2.13. In case you are not the life assured, we will pay the claim to you. In case you are not in a position to
receive the benefit , we will pay the benefit
9.2.13.1.
To the life assured
9.2.13.2.
To the nomineeor
9.2.13.3.
To the legal heir of the life assured, if nomination is not valid
9.2.14. If there is any dispute onthe title under the policy, the benefits shall be paid only to the person as certified
by a court of competentjurisdiction.
9.2.15.
We shall settle or reject a claim, as may be the case, within thirty days of the receipt of the last
required document.
9.2.16. In the event of any delay on Our part in processing the claim, for a reason other than non-receipt of
requisite documents or if the non-payment of claim is due to non-establishment of proper identification of
the Claimant, then, We shall be liable to pay interest at a rate which is 2% (two percent) above the bank
rate prevalent at the beginning of the financial year in which the claim is admittedby Us or such other
interest rate as may be prescribed by IRDAI from time to time.
9.3. Maturity Claim
9.3.1. There is no maturity claim payable under the policy.
9.4. Surrender
9.4.1. There is no surrender value payable under the policy.
10.
Termination
10.1. Your policy will terminate on the earliest of the following:
10.1.1. on free-look cancellation
10.1.2. the date of death of the Life Assured
Form 297
Page 31 of 39
Policy Number
Part D
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
10.1.3. on payment of below claim depending on the benefit structure chosen
Standard
Payment of major stage cancer claim
Classic
Payment of advanced stage cancer claim
Enhanced
Payment of advanced stage cancer claim
10.1.4. on the expiry of the Revival Period if you have not revived your Lapsed Policy during revival period.
However, the cover under this policy will terminate automatically if you fail to pay any renewal premium
before the expiry of the grace period.
10.1.5. on cancellation/ termination of the Policy by Us on grounds of misrepresentation, fraud or
nondisclosure established
10.1.6. on the date your policy term ends
Form 297
Page 32 of 39
Policy Number
Part D
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
11.
Withdrawal
11.1. We may withdraw this product.
11.2. However, your policy would continue as per terms and conditioned mentioned in this document.
Form 297
Page 33 of 39
Policy Number
Part E
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
Part E
12.
Charges
12.1. Charges
12.1.1. Being a non-linked product, there are no explicit charges under this policy
Form 297
Page 34 of 39
Policy Number
Part F
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
Part F
13.
General Terms
13.1. Free Look Period
13.1.1. If you have purchased the policy through distance marketing channel, you have 30 days from the date of
receipt of this policy document to review its terms and conditions. If you are not satisfied, you can return
the policy stating the reasons for objection.
13.1.2. If you have purchased the policy through a channel other than distance marketing, you have 15 days from
the date of receipt of this policy document to review its term and conditions. If you are not satisfied, you
can return the policy stating the reasons for objections.
13.1.3. We will then refund the premium paid after deducting the stamp duty and the proportionate risk premium
with taxes as applicable for the period on cover.
13.1.4. You cannot revive, reinstate or restore your policy once you have returned your policy.
13.2. Waiting Period
13.2.1. Initial waiting period of 180 days is applicable i.e. No claims would be admitted within the initial waiting
period of 180 days from the date of commencement of risk or date of revival whichever is later.
13.3. Survival Period
13.3.1. Survival Period of 5 days is applicable, i.e. for a claim to be valid, that is, the life assured should have
survived for a period of at least 5 days from the date of diagnosis.
13.4. Suicide Exclusion
13.4.1. This exclusion is not applicable.
13.5. Other Exclusions
13.5.1. The following exclusions are applicable to the benefits provided under the Policy:
13.5.2. The policy shall terminate and no benefit shall be payable under the policy if the diagnosis or signs or
symptoms (related to the diagnosed cancer) arefirst occurred during the waiting period.
13.5.3. No benefit shall be payable under the policy in respect of any Minor stage cancer including CIS, Major
stage cancer or Advanced stage Cancer resulting directly or indirectly from or caused or contributed
by (in whole or in part):
13.5.3.1.
Sexually Transmitted Diseases AIDS or HIV.
13.5.3.2.
Any pre-existing cancer including carcinoma in situ..
13.5.3.3.
Nuclear, biological or chemical contamination (NBC),
13.6. PolicyLoan
13.6.1. You are not entitled to any loan under this policy.
13.7. Nomination
13.7.1. Nomination would be as per provisions of Section 39 of the Insurance Act, 1938, as amended from time
to time.
13.7.2. If you are the life assured then you have to make thenomination
13.7.3. If you are not the life assured, then the life assured can make the nomination
13.7.4. If the nominee is a minor, you may appoint a person, competent to contract, as an appointee in the manner
laid down by us, to receive the money secured by the policy in the event of death of the life assured
during the minority of the nominee.
13.7.5. You may cancel or change the existing nomination.
13.7.6. Your nomination should be registered in our records so as to make it binding on us.
13.7.7. For complete details about the nomination, please refer to Section 39 of the Insurance Act, 1938, as
amended from time to time.
[A Leaflet containing the simplified version of the provisions of Section 39 is enclosed as Annexure – (I) for reference]
Form 297
Page 35 of 39
Policy Number
Part F
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
13.8. Assignment
13.8.1 Assignment would be as per provisions of Section 38 of the Insurance Act 1938, as amended from time to
time.
13.9. Non – disclosure
13.9.1. We have issued your policy based on the statements in your proposal form, personal statementand
declaration.
13.9.2. If we find that any of this information is inaccurate or false or you have withheld any material information, we
shall declare your policy null and voidbut subject to section 45 of the Insurance Act, 1938, as amended from time
to time.
13.9.3. We will pay the amount payable as per section 45 of the Insurance Act, 1938, as amended from time to time, if
any, as on the date of repudiation of your claim.
[A Leaflet containing the simplified version of the provisions of Section 45 is enclosed in Annexure – (II) for reference]
13.10. Misstatement of age
13.10.1.
If we find that the actual age of the life assured is different from that mentioned in the proposal
form, we will check his/her eligibility for the insurance cover as on the date of commencement.
13.10.2.
If eligible,
13.10.2.1.
If the actual age is found to be higher, you have to pay the difference in premiums along
with interest.
13.10.2.2.
We will terminate your policy if you do not pay the difference in premiums and applicable
interest.
13.10.2.3.
If the correct age is found to be lower, we will refund the difference in premiums without
any interest.
13.10.3.
If the life assured is not eligible for the policy as per his/her actual age,
13.10.3.1.
We will terminate your policy.
13.11. Taxation
13.11.1.
You are liable to pay the Service Tax/Cess/GST and/or any other statutory levy/duty/ surcharge, at
the rate notified by the State Government or Central Government of India from time to time, as per the
applicable tax laws on basic premium.
13.11.2.
You are eligible for Income Tax benefits/exemptions as per the applicable income tax laws in India,
which are subject to change from time to time. You may visit our website for further details:
http://www.sbilife.co.in/sbilife/content/21_3672#5. Please consult your tax advisor for details.
13.12. Date formats
13.12.1.
Unless otherwise stated, all dates described and used in the policy schedule are in dd/mm/yyyy
formats.
13.13. Electronic transactions
13.13.1.
We shall accept premiums and pay benefits through any approved modes including electronic
transfers.
13.14. Communications
13.14.1. We will communicate to you in writing and deliver the correspondence by hand, post, facsimile, e-mail
or any other approved mode.
13.14.2. We will send correspondence to the mailing address you have provided in the proposal form or to the
address subsequently changed and registered by you with us.
13.14.3. You should also communicate in writing and deliver the correspondence by hand, post, facsimile, e-mail
or any other approved mode.
13.14.4. Your correspondence can be addressed to any of SBI Life branch offices or to its Central Processing
Centre at the address below:
7th Level (D Wing) & 8th Level, Seawoods Grand Central,
Tower 2, Plot No. R-1, Sector 40, Seawoods,
Nerul Node, Navi Mumbai - 400 706
Form 297
Page 36 of 39
Policy Number
Part F
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
Dist. Thane, Maharashtra
Telephone No.: + 91 - 22 - 6645 6241
FAX No.:
+ 91 - 22- 6645 6655
E-mail: info@sbilife.co.in
13.14.5.
It is important that you keep us informed of your change in address and any other communication
details.
Form 297
Page 37 of 39
Policy Number
Part G
(UIN:111N109V01)
SBI Life – Sampoorn Cancer Suraksha Policy Document
Part G
Complaints
14.
14.1. Grievance redressal procedure
14.1.1. If you have any query, complaint or grievance, you may approach any of our offices.
14.1.2. You can also call us on our toll-free number: 1800 22 9090 (9 am to 9 pm).
14.1.3. If you are not satisfied with our decision or have not received any response within 10 business days, you
may write to us at:
Head – Client Relationship,
SBI Life Insurance Company Limited
7th Level (D Wing) & 8th Level, Seawoods Grand Central,
Tower 2, Plot No. R-1, Sector 40, Seawoods,
Nerul Node, Navi Mumbai - 400 706
Dist. Thane, Maharashtra
Telephone No.: +91 - 22 – 6645 6241
Fax No.:
+91 - 22 – 6645 6655
E-mail Id:
info@sbilife.co.in
E-mail id (health insurance related claims for senior citizens): <helpsc@sbilife.co.in>
14.1.4. In case you are not satisfied with our decision and the issue pertains to provision 12 (1) of the Redressal
of Public Grievances Rules, 1998, you may approach the Insurance Ombudsman, as per rules. You can
make the complaint to the Ombudsman as per provision 13 of the said rules. The relevant provisions
have been mentioned in the section “Relevant Statutes”.
14.1.5. The address of the Insurance Ombudsman and the Redressal of Public Grievances Rules, 1998, are,
available on the website of IRDAI, http://www.irda.gov.in and in our website http://www. sbilife.co.in.
The address of the ombudsman at Mumbai is:
Office of the Insurance Ombudsman (Maharashtra and Goa)
3rd Floor, Jeevan Seva Annexe,
S.V. Road, Santa Cruz (W),
Mumbai – 400 054.
Telephone No.: +91 – 22 – 2610 6928
Fax No. :
+91 – 22 – 2610 6052
E-mail:
ombudsmanmumbai@gmail.com
14.1.6. We have also enclosed a list of addresses of insurance ombudsmen.
14.1.7. In case the complaint is not fully attended by us within 15 days of lodging the complaint through our
Grievance Redressal Mechanism; you may escalate the complaint to IRDAI through the Integrated
Grievance Management System (IGMS) website: http://www.igms.irda.gov.in or contact IRDAI
Grievance Call Centre on toll-free number : 155255 / 1800 4254 732
15.
Relevant Statutes
15.1. Governing laws and jurisdiction
15.1.1. This is subject to prevailing Indian Laws. Any dispute that may arise in connection with this shall be
subject to the jurisdiction of the competent Courts of Mumbai.
15.2. Section 41 of the Insurance Act 1938, as amended from time to time
Form 297
Page 38 of 39
Policy Number
Part G
SBI Life – Sampoorn Cancer Suraksha Policy Document
(UIN:111N109V01)
(1) No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take 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 continuing a policy accept any rebate, except such rebate as may be allowed
in accordance with the published prospectuses or tables of the insurer:
Provided that acceptance by an insurance agent of commission in connection with a policy of life insurance
taken out by himself on his own life shall not be deemed to be acceptance of a rebate of premium within the
meaning of this sub-section if at the time of such acceptance the insurance agent satisfies the prescribed
conditions establishing that he is a bona fide insurance agent employed by the insurer.
(2)Any person making default in complying with the provisions of this section shall be liable for penalty which may
extend to ten lakh rupees.
15.3. Section 45 of the Insurance Act 1938, as amended from time to time
[A Leaflet containing the simplified version of the provisions of Section 45 is enclosed in Annexure – (III) for reference]
15.4. Provision 12 (1) of Redressal of Public Grievances Rules, 1998
The Ombudsman may receive and consider
(a) Complaints under Rule 13
(b) Any partial or total repudiation of claims by an insurer
(c) Any dispute in regard to premium paid or payable in terms of the policy
(d) Any dispute on the legal construction of the policy, insofar as such disputes relate to claims
(e) Delay in setlement of claims
(f) Non-issue of any insurance document to customers after receipt of premium
15.5. Provision 13 of Redressal of Public Grievances Rules, 1998
(1) Any person who has a grievance against an insurer, may himself or through his legal heirs make a complaint in
writing to the Ombudsman within whose jurisdiction the branch or office of the insurer complained against is
located.
(2) the complaint shall be in writing duly signed by the complainant or through his legal heirs and shall state clearly
the name and address of the complainant, the name of the branch or office of the insurer against which the
complaint is made, the fact giving rise to complaint supported by documents, if any, relied on by the complainant,
the nature and extent of the loss caused to the complainant and the relief sought from the Ombudsman.
(3) no complaint to the Ombudsman shall lie unless –
(a) the complainants had before making a complaint to the Ombudsman made a written representation to the
insurer named in the complaint and either insurer had rejected the complaint or the complainant had not
received any reply within a period of one month after the insurer concerned received his representation
or the complainant is not satisfied with the reply given to him by the insurer.
(b) the complaint is made not later than one year after the insurer had rejected the representation or sent his
final reply on the representation of the complainant, and
(c) the complaint is not on the same subject matter, for which any proceedings before any Court, or
Consumer Forum or Arbitrator is pending or were so earlier
Ombudsman as on
07 Nov. 2012.docx
Form 297
Page 39 of 39
Policy Number
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