HDFC Life Group Health Shield

The choice of benefit options can be exercised by both the master policyholder as well as the member. This choice shall be governed by the provisions of scheme rules.

The choice of various benefit options shall be subject to conditions stated in the “Limitations on Choice” column of the above table.

Where multiple benefit options are chosen, the benefits payable under each benefit option shall be independent of benefits payable under other benefit options.

This benefit is paid in case of hospitalization due to any injury, sickness or disease

The benefit shall be payable after the completion of each medically necessary continuous hospitalization for more than 24 hours as a result of injury, sickness or disease

In case of Hospitalization, the Member shall receive 2.5% of DHCB Sum Insured per day in case admitted in a Non ICU room or 5% of DHCB Sum Insured per day in case admitted in an ICU room for each day of hospitalisation beginning from the second day

Benefit payable towards any claim shall not exceed Unclaimed DHCB Sum Insured.
Unclaimed Benefit Sum Insured shall mean the Benefit Option Sum Insured as reduced by any claims already made for the Benefit Option since the date of Commencement of Risk or the date of renewal of coverage, whichever is later.

The coverage for the Member shall cease for the remaining Member Cover Term in case 100% of DHCB Sum Insured is exhausted against claims.

However, coverage under other benefit options (if any) shall continue to be in force till the end of Member Cover Term

Renewal of this benefit shall be as per Board Approved Underwriting Policy (BAUP)

Surgical Benefit shall be payable, if the Member has undergone any medically necessary surgery out of the 138 covered surgeries (specified in Brochure), during the Member Cover Term and the surgery has been performed:

• by a qualified surgeon for a surgical operation
• at a hospital due to injury or sickness for covered surgical procedures advised by medical practitioner (defined in Brochure)

In case the Member has undergone any of the specified surgeries, a fixed percentage of SB Sum Insured shall be payable on the basis of the category of the surgery as shown below:

** Surgeries are listed in Brochure    

If more than one Surgery is performed on the Member, through the same incision or by making different incisions, during the same surgical session, the claim shall be payable for one surgery only 

The Member shall not be allowed to claim for the same surgery more than once. However, multiple claims from the same category can be made

The Member shall be entitled to make multiple claims up to a maximum of 100% of SB Sum Insured during the Member Cover Term

Coverage for the Member shall cease for the remaining Member Cover Term in case 100% of SB Sum Insured is exhausted

However, coverage under other benefit Options(if any) shall continue to be in force till the end of Member Cover Term

Benefit payable towards any claim shall not exceed the Unclaimed SB Sum Insured. Unclaimed Benefit Sum Insured shall mean the Benefit Option Sum Insured as reduced by any claims already made for the Benefit Option since the date of Commencement of Risk or the date of renewal of coverage, whichever is later.

Renewal of this benefit shall be as per BAUP

In case a Member is diagnosed on first occurrence of any of the covered Critical Illnesses or undergoing any of the surgeries specified below during the Member Cover Term, 100% of the CI Benefit Sum Insured shall be payable, provided the illness/ condition has occurred for the first time

All covered critical illnesses and surgeries shall be collectively referred as Covered critical illnesses

Benefit shall be payable provided the member survives for a period of 30 days following the date of occurrence of Critical Illness

You have the option to choose any one from the 4 Critical Illness Benefit Options available under the plan as mentioned below:

• Critical Illness Benefit (Option C): Includes 29 CIs specified across Category A, B and C
• Critical Illness excluding Cancer Benefit (Option D):Includes 28 CIs specified across Category A and C
• Critical Illness excluding Cardiac Benefit (Option E): Includes 27 CIs specified across Category B and C
• Critical Illness excluding Cancer and Cardiac Benefit (Option F): Includes 26 CIs specified in Category C

Please refer to Brochure for definitions of Covered Critical Illnesses

The insured Member must survive for a period of 30 days following the date of occurrence of the covered critical illness

This Benefit shall be payable only once to the Member. Once the Critical Illness Benefit is paid, the benefit shall cease for the Member.

However, other benefits if opted for shall continue for the remaining Member Cover Term

If the diagnosis of the covered critical illness is made within the Member Cover Term and the Survival Period crosses the end of Member Cover Term, a valid claim arising as a result of such diagnosis shall not be denied

Cancer Cover offers lump sum payout on diagnosis of Early Stage Cancer, Carcinoma-in-situ or Major Stages of Cancer, during the Member Cover Term, provided the Member survives for a period of 7 days from the date of diagnosis of the condition. The benefit payable is as follows:

Multiple claims can be made for diagnosis of Early Stage Cancer or Carcinoma-in-situ (CIS):

• occurring in a different body organ, part or system and
• not being classified as Secondary Cancer or Metastasis

Claim for recurrence of Early Stage Cancer or Carcinoma-in-situ (CIS) in the same body organ, body part or system shall not be payable.

If the diagnosis is made within the Member Cover Term and the survival period crosses the end point of Member Cover Term, a valid claim arising as a result of such a diagnosis shall not be denied

Benefit payable towards any claim shall not exceed the Unclaimed Cancer Cover Sum Insured. Unclaimed Benefit Sum Insured shall mean Benefit Option Sum Insured as reduced by any claims already made for the Benefit since the date of Commencement of Risk.

Member coverage under this benefit shall terminate once 100% of the Cancer Cover Sum Insured has been paid against all valid claims during the Member Cover Term.

However, coverage under other Benefit Options (if any) shall continue for the remaining Member Cover Term.

In the event of the first occurrence/diagnosis/undergoing and subsequent recurrences of covered conditions/surgeries during the Member Cover Term while the coverage is in force, a lump sum payout (as a % of Cardiac Cover Sum Insured) shall be payable to the Member. The percentage of benefit payable shall be as specified in the table below:

Disclaimer:

1. If a claim is made for this condition, in addition to satisfying the definitions and exclusion criteria, the procedure or surgery must be determined to be medically necessary by a Consultant Cardiologist / Surgeon and must be supported by relevant imaging findings & evidenced by established diagnostic reports.

The claim under this benefit option shall be paid only if the Member survives for a period of 30 days from the date of occurrence of covered conditions

Multiple claims can be made for condition/s falling under the Group B and C

In an event where more than one covered condition occurs simultaneously the claim shall be payable for only one covered condition

Cooling off periods applicable after occurrence of covered condition resulting into valid claim and corresponding benefit amount are given below:

The aforesaid cooling off period shall apply afresh on each valid claim.

For a given claim due to one of the 17 conditions covered under Cardiac Cover, the other 16 conditions are referred to as “other covered condition”.

Member coverage under this benefit shall terminate once 100% of the Cardiac Cover Sum Insured has been paid against all valid claims during the Member Cover Term.

Benefit payable under each claim shall not exceed the Unclaimed Cardiac Cover Sum Insured. Unclaimed Benefit Sum Insured shall mean Benefit Option Sum Insured as reduced by any claims already made for the Benefit since the date of Commencement of Risk.

However, coverage under other Benefit Options (if any) shall continue for the remaining Member Cover Term

 In case the Member has opted for this Benefit Option, the Benefit shall be paid out on the following events:

• Accidental Death,
• Accidental  Total Permanent Disability(ATPD) and/or
• Accidental Partial Permanent Disability(APPD)

The Benefit shall be payable to the Member or his/her Nominee

In the event of Accidental Death of a Member, during the Member Cover Term, 100% of the PAC Sum Insured shall be payable to the Nominee

Accidental Death means death by or due to a bodily injury caused by an Accident, independent of all other causes of death. The Accident means sudden, unforeseen and involuntary event caused by external, visible and violent means.

Accidental Death must be caused within 180 days of any bodily injury. If the bodily injury occurred within the coverage period and the Accidental Death happens after the end of coverage period but within 180 days of bodily injury, a valid claim arising as a result of such Accidental Death shall not be denied.

In lieu of lumpsum benefit amount for Accidental Death, the nominee may receive benefit as:

            a. Regular monthly Income equal to 1% of PAC Sum Insured payable for 10 years, or Part of Benefit amount as lump sum immediately on Accidental Death and regular monthly income @ 1% of balance benefit amount (i.e.,100% of PAC Sum Insured as reduced by part lump sum already paid) for 10 years depending upon the payout option chosen.

            b. The choice of benefit payout as lumpsum or income or combination thereof can be exercised on or before the claim is made.

In the event of Accidental Total Permanent Disability(ATPD) of a member during the Member Cover Term, a regular monthly Income equal to 1% of PAC Sum Insured shall  be payable for 10 years

ATPD means when the insured Member is totally, continuously and permanently disabled and meets either of the two definitions below:

Part 1: Unable to work:

Disability as a result of injury or accident and  is thereby rendered totally incapable of being engaged in any work or any occupation or employment for any compensation, remuneration or profit and he/she is unlikely to ever be able to do so.

Part 2: Physical Impairments:

1. The Member suffers an injury/accident due to which there is total and irrecoverable loss of:
2. the use of two limbs; or
3. the sight of both eyes; or
4. the use of one limb and the sight of one eye; or
5. loss by severance of two or more limbs at or above wrists or ankles; or
6. sight of one eye and loss by severance of one limb at or above wrist or ankle
   • The disabilities as stated above in Part 1 and Part 2 must have lasted, without interruption, for at least 6 consecutive months and must, in the opinion of a Medical Practitioner, be deemed permanent
   • This benefit shall commence upon the completion of this uninterrupted period of 6 months. However, for the disabilities mentioned in (d) and (e) under Part 2, such 6 months period would not be applicable and the benefit shall commence immediately
   • Injury means accidental physical bodily harm excluding illness and disease. It must be solely and directly caused by external, violent, visible and evident means which is verified and certified by a Medical Practitioner.
   • Once the maximum benefit is claimed, the coverage under PAC benefit option shall terminate

Under Accidental Partial Permanent Disability (APPD),in case any Insured Member sustains any bodily injury during the Member Cover Term, resulting solely and directly from accident:

• 50% of the PAC Sum Insured shall be payable, if such injury shall, within 12 months of its occurrence be the sole and direct cause of the total and irrecoverable loss by physical separation of one entire hand or of one entire foot.
• If such injury shall, within 12 months of its occurrence be the sole and direct cause of the Total and /or Partial and irrecoverable loss of use or of the actual loss by physical separation of the following, then the percentage of the Personal Accident Cover Sum Insured as indicated below shall be payable:

The disabilities as stated above must have lasted, without interruption, for at least 6 consecutive months and must, in the opinion of a Medical practitioner, be deemed permanent. However, for the disabilities mentioned in (a) above, such 6 months period would not be applicable and the benefit shall payable immediately.

Once the PAC Sum Insured has been paid, the coverage under this benefit option shall terminate for the Member for the remaining Member Cover Term

If ATPD occurs after APPD, then 1% of the remaining amount (100% of PAC Sum Insured – APPD Claims paid) shall be paid as a regular monthly income for 10 years.

In case Accidental Death happens after APPD, then the remaining amount (100% of PAC Sum Insured – APPD Claims paid) shall be paid as a lump sum to the Nominee

In lieu of lumpsum benefit amount for APPD, the Life Assured may receive benefit as:

• Regular monthly Income equal to 1% of Benefit amount payable for 10 years, or  Part of Benefit amount as lump sum and a regular monthly income @ 1% of balance benefit amount (i.e.100% of APPD claim entitlement as reduced by part lump sum already paid) for 10 years depending upon the payout option chosen
• The choice of benefit payout as lumpsum or income or combination thereof can be exercised on or before the claim is made.

During the income period future income payments or part thereof can be surrendered in exchange for a lump sum. This lump sum shall be the discounted value of the future income payments at the prevailing revival interest rate charged by the company.