Birla Sun Life Insurance Critical Illnes Woman Rider

Primary Illnesses

Heart Attack
The death of a portion of the heart muscle as a result of inadequate blood supply and being evidenced by all three of the following:
A history of typical prolonged chest pain; and
New electrocardiograph (ECG) changes; and
Significant elevation of cardiac enzymes above accepted laboratory levels of normal.
Confirmation by a specialist approved by us may be required. Diagnosis of heart attack based solely on an ECG or solely on a blood test is excluded. We will not pay for other causes of severe non-cardiac chest pain, heart failure or angina.
Stroke
Stroke is a cerebrovascular accident or incident producing permanent neurological deficits lasting more than 30 days, as verified by a consulting neurologist or specialist approved by the Birla Sun Life Insurance. This includes infarction of brain tissue as a result of thrombosis or Zaemorrhage or embolisation from an extracranial source.
Cancer
A malignant tumour characterized by the uncontrolled growth and spread of malignant cells and the invasion of tissue. The term cancer includes leukaemia, lymphoma and Hodgkin's Disease. The cancer must require treatment by surgery, radiotherapy, chemotherapy, biological response modifiers, or any other major interventionist treatment. Carcinoma in-situ of the breast is also covered if it results directly in the removal of the entire breast specifically to arrest the spread of malignancy. Cancers that are completely untreatable where only palliative therapy is initiated are also covered in this definition. The diagnosis must be confirmed with a valid pathology report and a report from a specialist approved by us.
Specifically Excluded Are:
- All tumours which are histologically described as benign, pre-malignant or non-invasive;
- Any lesion described as Carcinoma in-situ; Carcinoma insitu of the breast is covered if it results directly in the removal of the entire breast specifically to arrest the spread of malignancy;
- Cervical dysplasia or intra-epithelial neoplasia (CIN-1, CIN- 2 or CIN-3);
- Prostatic Intra-epithelial neoplasia (PIN);Early prostate cancers that are histologically described as TNM Classification T1, or American Urological Association's (AUA) stage A, or of equivalent stage with any other classification system;
- Any forms of cancer in the presence of Human Immunodeficiency Virus infection, including lymphoma or Kaposi's sarcoma;
- Thin melanomas with pathology report showing Clarke's Level less than III or Breslow thickness less than 1.5 mm;
- All non-melanoma skin cancers; All cancers that are a recurrence or metastasis of a tumor that first occurred within 90 days from the Coverage Date of this Rider Coverage or the effective date of reinstatement of this policy, whichever is later.
Surgery to Coronary Arteries
The undergoing of open-heart surgery or keyhole surgery on the advice of a consultant cardiologist, to correct narrowing or blockage of one or more coronary arteries with insertion of bypass graft(s). Balloon angioplasty (PTCA), heart catheterization, laser relief, rotablade, stenting and all other cardiac procedures are excluded.
Kidney Failure (End Stage Renal Disease)
The total and chronic irreversible failure of both kidneys necessitating continuous renal dialysis at least for 180 days in the opinion of a specialist approved by the BSLI. Acute reversible kidney failure that only needs temporary renal dialysis and single kidney failure is not covered.
Major Organ Transplantation
The actual undergoing, as a recipient of a transplant of a heart, lung, pancreas (excluding the transplant of Langerhans cells alone), liver or kidney. The transplantation must have been necessary to treat irreversible end-stage failure of the relevant organ and the Life Insured must be accepted in a transplant program satisfactory to Birla Sun Life Insurance. Bone marrow transplant is also covered if the Life Insured has undergone the transplant and a specialist acceptable to us confirms that the bone marrow transplant was medically necessary. Other stem cell transplants are excluded.
Aorta Graft Surgery
Undergoing of surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches. Surgery to treat peripheral vascular disease of the aortic branches is excluded even if a portion of the aorta is removed during the operative procedures. Surgery performed using only minimally invasive or intra-arterial techniques such as percutaneous endovascular aneurysm with insertion of a stent graft are excluded.
Heart Valve Surgery
The undergoing of open-heart valve surgery, performed to replace or repair one or more heart valves, as a consequence of defects in, abnormalities of, or disease-affected cardiac valve(s). The surgery must be considered medically necessary by a consulting cardiologist and supported by investigations. Repair via valvotomy, catherter, keyhole or similar techniques are excluded.
Paraplegia
Total and irreversible loss of use of two or more limbs through paralysis as a result of injury or disease of the spinal cord. These conditions must be permanent, supported by appropriate neurological evidence and have to be medically documented for at least 90 days.
Blindness
Total, permanent and irreversible loss of all vision in both eyes as a result of illness or accident. The diagnosis must be clinically confirmed by an ophthalmology specialist. The blindness must not be correctable by aides or surgical procedures. Cataract is not covered under this definition of blindness. Also blindness due to cataracts or due to surgery for cataracts is specifically excluded and not covered under this policy.
Benign Brain Tumour
A benign brain tumour means a tumour that is in the brain or meninges excluding the skull, spinal cord. Cysts, abscesses, malformations in the arteries or veins of the brain, haematomas are excluded. Pituitary microadenomas less than 10 mm. in diameter are also excluded. The diagnosis must be confirmed neuro-radiologically by a specialist trained in the interpretation of these investigations and acceptable to us. Motor Neurone Disease Motor neurone disease diagnosed by a consultant neurologist acceptable by the BSLI, as spinal muscular atrophy, progressive bulbar palsy, amyotrophic lateral sclerosis or primary lateral sclerosis. There must be progressive degeneration of the corticospinal tracts and anterior horn cells or bulbar efferent neurons. There must be significant, progressive, irreversible, and functional neurological impairment with objective evidence of motor or sensory dysfunction, which must have persisted for a continuous period of at least 90 days.
Multiple Sclerosis
A definite diagnosis by a consultant neurologist holding an appointment as such in a major hospital, which satisfies the two criteria.
1. There must be current, significant and permanent functional neurological impairment with objective evidence of motor or sensory dysfunction persisting for a continuous period of at least 180 days; and
2. The diagnosis must be based on confirmatory neurological investigations of lumbar puncture, evoked visual responses, evoked auditory responses, CT or MRI evidence of lesions of the central nervous system. Diseases of the central nervous system due to other causes are unequivocally excluded.
Coma
A state of unconsciousness with no reaction or response to external stimuli or internal needs persisting continuously and requiring intubation and mechanical ventilation to sustain life for a period of at least 96 hours. There must be current significant and permanent functional neurological impairment with objective evidence of motor or sensory dysfunction. Coma resulting directly from alcohol or drug abuse is excluded.
End Stage Liver Disease
End stage liver failure as evidenced by all of the following:
- permanent jaundice
- ascites and
- hepatic encephalopathy
Liver disease secondary to alcohol or drug misuse is excluded.
End-stage Lung Disease
End stage lung disease including interstitial lung disease causing chronic respiratory failure and evidenced by following :
- FEV 1 test results consistently less than 1 litre with use of bronchial dilator; and
- Requiring extensive and permanent supplementary oxygen therapy.
The diagnosis must be confirmed by a respiratory physician acceptable by BSIL.
Aplastic Anaemia
Bone Aplastic anemia is defined as total permanent bone marrow failure which results in granulocytes less than 500 cells per microlitre, anaemia with corrected reticulocyte count less than 1 %, platelet count less than 20000 cells per microlitre and markedly hypoplastic bone marrow with depletion of hematopoietic cells with <20% cellularity. There must also be continuous treatment for a period of at least 180 days with at least one of the following:
Repeated blood transfusions.
Marrow stimulating agents.
Immunosuppressive agents.
Bone marrow transplant.
Temporary or reversible aplastic anemia is excluded and not covered in this policy.

Specific Illnesses

Severe Rheumatold Arthritis
The unequivocal diagnonis of Rheumatoid Arthritis must be made by a certified medical consultant. There must be atleast a 6 week history of this arthritis and it must involve 3 or more of the following joint areas: proximal interphalangeal joints in the hands, metacarpophalangeal joints in the hands, metatarsophalangeal joints in the foot, wrist, elbow, knee or ankle. A physician must witness simultaneous bilateral and symmetrical j o i n t soft tissue swelling or fluid (not bony overgrowth alone). There must also be evidence of typical rheumatoid joint deformity with bone erosions seen on imaging.

The diagnosis must also be supported by at least 2 of the following criteria:
Morning stiffness
Rheumatoid nodules
Positive rheumatoid factor
Degenerative osteoarthritis and all other arthritides are excluded.
Severe Systemic Lupus Erthematosis
The unequivocal diagnosis by a consultant physician of systemic lupus erythematosis (SLE) with evidence of malar rash, discoid rash, photosensitivity, multi-articular arthritis, and serositis.

There must also be hematological and immunological abnormalities consistent with diagnosis of SLE, a positive antinuclear antibody test and evidence of central nervous system or renal impainment with either:
1. Renal Involvement defined as either persistent protelnurla greater than 0.5gm per day or a spot urine showing 3+ or greater proteinuria; or
2. Central nervous system involvement with permanent functional neurological dysfunction as evidence with objective motor or sensory neurological abnormal signs on physical examination by a neurologist and present for at least 3 months Selzures, headaches, cognitive and psychlatric abnormalities are specifically excluded. Discoid lupus and medication induced lupus are excluded.

Pregnancy Complications
Specifically Excluded Are:

Ectopic Pregnancy Surgery
Pregnancy, in which the fertilized ovum implants in the falloplan tube. The ectopic pregnancy must have required the immedicate surgical removal of the ovum and falloplan tube. The diagnosis must be confirmed with a pathology report.
Hydatiform Mole
Complete Hydatiform Mole is a form of trophoblastics disease characterized by clusters of hydropic vIII and trophoblastic elements and atypia. The Hydatiform Mole must have been diagnosed by a specialist approved by BSIL, and confirmed with a pathology report. The condition must require a hysterectomy and the same must have been performed.
Uterine Rupture
Rupture of the uterus during pregnancy requiring a hysterectomy and emergency delivery of the baby by caesarean section. Hysterectomy must have been perfomed.

Congenital Anomalies in Newborn Child:

Down's Syndrome
Live birth of a baby with Down's Syndrome(trisomy 21) - as diagnosed by a specialist physician and proven on chromsomal analysis.
Spina Bifida
This is a neural tube defect where there is failure of the spine to close properly during pregnancy. There must be a resultant meningomycele or meningocele. The spina bifida must also have required corrective surgery and there must be objective evidence of permanent paralysis as verified by a neurologist.
Oesophagal Atresia and Tracheoesophagal Fistula
Absence of oesophagus with or wihtout fistula requiring correction by surgery.
Anal Atresia (imperforate anus)
Absence of anus requiring correction by surgery.
Cleft Palate
Congential fissure of the roof of the month requiring corrective surgical procedures produced by failure of the two maxillae to unite during embryonic development with or without cleft llp.
Club Feet
Congenital clubbed foot requiring corrective surgical procedures. Metatarsus varus or abductus are excluded.
Tetralogy of Fallot
A congenital abnormality of the heart characterised by pulmonary stenosis, an opening in the Interventricular septum, malposition of the aorta over both ventricles, and hypertrophy of the right ventricle. Open-heart surgery must have taken place to correct the congenital defect.