Salient features for the plan

Plan at a Glance - Eligibility Criteria to buy the product

Vital Care Benefit

Under this Benefit Option, the Life Assured is covered for Minor and Major critical illness conditions mentioned in Table 1 and Table 2 below. On diagnosis of any of the Major or Minor Conditions during the Coverage Term whilst the policy is in-force, the percentage of Vital Care Sum Assured as mentioned in the Table 1 and Table 2 will be paid to the Claimant. In order for a Minor or a Major Condition to be valid it should satisfy the terms and conditions of the Critical Illnesses as referred under Annexure 1.

i. Minor Conditions: Table 1 shows the list of Minor Conditions covered under Vital Care Benefit

Table 1: Minor Conditions covered under Vital Care Benefit:

1. In the event Life Assured is diagnosed with any of the above listed Minor Conditions during the Coverage Term, whilst the policy is in-force, then the percentage of Vital Care Sum Assured as mentioned in above Table 1 will be paid to the Claimant.
2. Upon acceptance of a Minor Condition claim by the Company, the Vital Care Sum Assured shall be reduced to the extent of the claim(s) paid under Minor Condition.
3. The Company shall process claims for other Minor Conditions so long as the Vital Care Sum Assured is completely exhausted, and the claims being raised are for unique Minor Conditions.
4. Upon complete exhaustion of the Vital Care Sum Assured then Vital Care Benefit shall terminate with all rights and benefits thereunder.
5. Once a claim has been paid for a specific Minor Condition, no further claims shall be honoured by the Company for the same Minor Condition.
6. Upon termination of the Vital Care Benefit, the Policy shall continue only for the Surgical Procedures mentioned under Clause 1.2 (b) for a period of 365 days (within the Coverage Term) commencing from the date of diagnosis of the Minor Condition which led to exhaustion of the Vital Care Sum Assured.
7. This cover will only pay one claim per qualifying “surgical procedure” with reference to Minor Conditions Urinary Incontinence requiring Surgical Repair, Uterine Prolapse and Pelvic floor dysfunction treated with Hysterectomy. If a hysterectomy has been carried out under any of these conditions, regardless of the need for the procedure, no other benefits which require a hysterectomy are eligible to be claimed.
8. A Cooling-off Period will be applicable in case of diagnosis of consecutive Minor Conditions. A Cooling-Off Period shall not be applicable in the case of diagnosis of any claim for a Major Condition following a Minor Condition claim. In case of diagnosis of a Minor Condition during Cooling off period, the claim will not be admissible.

ii. Major Conditions: Table 2 shows the list of Major Conditions covered under Vital Care Benefit

Table 2: Major Conditions covered under Vital Care Benefit:

1. In the event, the Life Assured is diagnosed with the any of the Major Conditions listed above in Table 2 during the Coverage Term, whilst the Policy is In-Force, then the Vital Care Sum Assured as may be applicable at the time of diagnosis will be paid to the Claimant. Thereafter, Vital Care Benefit will be terminated with all rights and benefits thereunder.
2. Upon exhaustion of the 100% of Sum Assured under Vital Care Benefit, the Policy shall continue only for the Surgical Procedures mentioned under Clause 1.2 (b) for a period of 365 days (within the Coverage Term) commencing from the date of diagnosis of the Major Condition which led to exhaustion of the Vital Care Sum Assured.
3. There can only be one claim for any of the Major Conditions covered under the Vital Care Benefit.

Surgical Care Benefit

1.2 Surgical Care Benefit: Under this Benefit, the Life Assured is covered only for the Surgical Procedures mentioned under Table 3.

Table 3: Surgical procedures covered under the plan

^*The major burns referred in Serial No 2 above is required to occur during Coverage Term to make it an eligible claim.

1. Under this benefit only one claim for the surgical procedures covered can be made. The percentage of Surgical Care Sum Assured payable against each surgery is provided in the Table 3 above.
2. In the event the Life Assured undergoes with any of the surgeries listed from Serial number 1 – 5 in Table 3, then the Surgical Care Benefit shall terminate upon payment of the 100% of Surgical Care Sum Assured. And in the event the Life Assured undergoes with any of the surgeries listed from Serial number 6 – 9 in Table 3, then the Surgical Care Benefit shall terminate upon payment of the 40% of Surgical Care Sum Assured.
3. If Surgical Care Benefit claim is made before 100% of the Vital Care Sum Assured is exhausted: In the event, the Life Assured undergoes any of the covered Surgical Procedures during the Coverage Term, whilst the policy is in-force, the percentage of Surgical Care Sum Assured applicable for the Surgical Procedures as shown in Table 3 will be paid. Upon payment of the respective Surgical Care Sum Assured, the Surgical Benefit shall terminate with all rights and benefits thereunder.
4. If Surgical Care Benefit claim is made after 100% of the Vital Care Sum Assured is exhausted: You can claim the Surgical Care Benefit if you undergo surgery for any of the following conditions within 365 days from the date of diagnosis of the latest Minor or Major Condition (which led to exhausting the Vital Care Sum Assured), provided that the 365-day period falls within the Coverage Term:
   - Only Surgeries under Surgical Care Benefit listed in Table 3, linked to Minor or Major condition that lead to the exhaustion of the Vital Care Benefit
   - Skin grafting due to major burns^*; or
   - Complicated repair of a Vaginal Fistula
   ^*The major burns referred in the above condition is required to occur during Coverage Term to make it an eligible claim.
5. The Surgical Care Benefit shall terminate on the earlier of: • On payment of the applicable claim amount in case of a claim under Surgical Care Benefit; or • On the expiry of 365 days from the date of diagnosis of the latest Minor or Major Condition which has resulted in the termination of the Vital Care Benefit.
6. In the event, Life Assured undergoes any listed Surgical Procedures on the Date of Maturity then the Surgical Benefit Sum Assured shall not be payable and the Surgical Care Benefit shall terminate with all rights and benefits thereunder.
7. In case the Surgical Care Benefit terminates before Vital Care Benefit, the Vital Care Benefit will continue with the total instalment premium reduced to the extent of the instalment premium for Surgical benefit.
8. The payouts made under Vital Care Benefit will not affect the Sum Assured of Surgical Care Benefit.

Maternity Care Benefit

1. Under Maternity Care Benefit, upon diagnosis of any of the covered Critical Illnesses /procedures shown in Table 4 below, during the applicable Coverage Term while the Policy is In-force, the Maternity Care Sum Assured will be payable to the Claimant, thereafter the Maternity Care Benefit shall terminate with all rights and benefits thereunder.
2. Only one claim for one condition for Maternity Care Benefit can be made post which the Maternity Care Benefit shall terminate.
   

   Table 4: Maternity complications and Congenital Illnesses covered under the plan

   Benefit	Critical illness / surgical procedure	Benefits as a % of Maternity Care Sum Assured
   Pregnancy complications	1 Uterine rupture	100% of Maternity Care Sum Assured
   	2 Ectopic pregnancy
   	3 Eclampsia
   	4 Molar pregnancy
   	5 Disseminated Intravascular Coagulation
   	6 Postpartum Haemorrhoge requiring Hysterectomy
   	7 Placenta Increta / Percreta
   	8 HELLP syndrome
   	8 HELLP syndrome
   Congenital illness or Newborn Complications	10 Down's syndrome	100% of Maternity and Child Care cover
   	11 Spina bifida
   	12 Oesophageal atresia and tracheoesophageal fistula
   	13 Anal atresia
   	14 Cleft palate
   	15 Club feet
   	16 Tetralogy Of Fallot
   	17 Transposition of great vessels
   	18 Patent ductus Orteriosus
   	19 Total anomalous pulmonary Venous return (TAPVR)
   	20 Tricuspid atresia
   	21 Atrial Septal Defect
   	22 Ventricular Septal Defect

3. The payouts made under Surgical Care Benefit and Vital Care Benefit will not affect the Sum Assured of Maternity Care Benefit.
4. Upon termination of the Vital Care Benefit (i.e., upon exhaustion of 100% of Vital Care Sum Assured) no claim for a Maternity Care Benefit shall be admissible and the Maternity Care Benefit shall terminate. This is applicable even if no claims have been made under the Maternity Care Benefit.
5. In case the Maternity Care Benefit terminates before Vital Care Benefit, the Policy shall continue with Vital Care Benefit and Surgical Care Benefit (if not exhausted earlier) for the remaining applicable Coverage Term. The Total Instalment Premium payable for the Policy thereafter will reduce to the extent of the premium applicable for Maternity Care Benefit.
6. In the event of diagnosis of any of the covered Critical Illnesses on the Date of Maturity (applicable for Maternity Care Benefit), then the Maternity Care Sum Assured shall not be payable and the Benefit shall terminate with all rights and benefits thereunder.

No Benefit will be payable on death of Life Assured or the Newborn child (if case Health Care Plus Option is chosen) under this Policy

Premium Sabbatical

This product provides you with the flexibility to stop paying your premiums for one policy year anytime during the premium payment term by opting for Premium Sabbatical. Policy will be considered as In-force during Premium Sabbatical Year. This option can be availed only once during the entire Premium Payment Term.

The following terms and conditions are applicable for Premium Sabbatical:

Surrender Benefit

You can Surrender the policy any time after payment of at least one full year’s Premiums. Prior to receipt of one full year’s premium, no surrender value is payable.

On Policy Surrender, Surrender Value equal to Unexpired Risk Premium Value will be payable to the Claimant provided no claims have been paid out in the Policy.

Limited Pay

1. For Vital Care Benefit and Surgical Care Benefit:
   If one full year’s premium is not paid, Unexpired risk premium value = 0
   Unexpired risk premium value = 25% X [Number of months for which premiums are paid / (PPTVTL X 12)] X [1 – (Policy Month of surrender – 1) / (CTVTL X 12)] X Total Premiums Paid for Vital Care benefit and Surgical Care benefit.
2. For Maternity Care Benefit:
   If one full year’s Premium is not paid, Unexpired Risk Premium Value = 0.
   Unexpired risk premium value = 25% X [Number of months for which premiums are paid / (PPTMT X 12)] X [1 – (Policy Month of surrender– 1)/ (CTMT X 12)] X Total Premiums Paid for Maternity Care benefit
   In Health Care Plus Option, you do not have the option to surrender only Maternity Care Benefit and to continue with Vital Care and Surgical Care Benefit.
   Surrender Value payable under Health Care Plus will be a Sum of Surrender Value calculated for Vital Care Benefit and Surgical Care Benefit and Maternity Care Benefit as mentioned above.
   Where,
   PPT= Premium Payment Term | CT = Coverage Term | MT= Maternity Care | VTL= Vital Care

Regular Pay

There will be no Surrender Value applicable for Regular Pay policies. On payment of the Surrender Value, the policy will terminate and all rights, benefits and interests under the policy will stand extinguished.

Revival

A Policy which has lapsed for nonpayment of premium, within the grace period, may be revived subject to underwriting and the following conditions:

1. The application for revival is made within five years from the due date of the first unpaid premium and before the Date of Maturity of the respective Benefit Option. Revival will be based on the prevailing Board approved underwriting policy.
2. Policyholder has to furnish, at their own expense, satisfactory evidence of the Life Assured’s health as required by the Company.
3. The arrears of Premiums together with interest at such rate as the Company may charge for late payment of premiums are paid.
4. Revival interest rates will be set monthly based on the prevailing yield on 10-year Government Securities and is equal to 150 basis points over the yield. The yield on 10 year Government Securities will be sourced from www.bloomberg.com. The revival interest rate for November 2024 is 8.36% p.a. compounded half-yearly.
5. The revival interest rate will be reviewed on the 15th day of every month by the company based on the 10-year G-Sec yield of one day prior to such review.
6. The revival of the Policy may be on terms different from those applicable to the Policy before premiums were discontinued; for example, extra mortality premiums or charges may be applicable. The Company reserves the right to refuse to revive the Policy. The revival will take effect only if it is specifically communicated by the Company to the Policyholder.
7. Any change in revival conditions will be subject to prior approval from IRDAI and will be disclosed to policyholders.

Policy may be revived for the lower of the Sum Assured as applicable on the date of premium discontinuance or the reduced Sum Assured as approved during the Revival.

Other Terms & Conditions

1. No Benefit will be payable on death of Life Assured or the New Born child (if case Health Care Plus Option is chosen) under this Policy.
2. Suicide clause: Not Applicable
3. Loan: Not Applicable
4. Waiting Period is defined as the period commencing from Date of Commencement of Risk or date of revival whichever is later.
   No Benefit will be payable if the Life Assured is diagnosed with any of the Critical Illnesses or any signs or symptoms related to any Critical Illness which arises within the Waiting Period. The Waiting Period for the respective Benefit Options are mentioned below:

   Name of Cover or Plan or Option	Waiting Period
   Vital Care	90 Days
   Surgical Care	90 Days
   Maternity Care Benefit	365 Days

5. Cooling off period: A cooling-off period will apply in case of diagnosis of consecutive Minor Conditions. Cooling off period means a consecutive period of 180 days commencing from the date of diagnosis of one Minor Condition to the date of diagnosis of a subsequent Minor Condition. In case of diagnosis of a Minor Condition during Cooling off period, the claim will not be admissible.
6. Survival Period: The Survival Period is defined as a period of 14 days commencing from the date of first diagnosis of covered Critical Illness Condition that the Life Assured or the newborn child under the Maternity Care Benefit has to survive to be eligible for receiving the benefit amount covered under this Policy. No benefit will be payable if Life Assured or the new born child under the Maternity Care Benefit does not survive during this period.
7. Free look period: On receipt of the policy document, whether received electronically or otherwise, You have an option to review the policy terms and conditions. If You are not satisfied or have any disagreement with the terms and conditions of the Policy or otherwise and have not made any claim, the Policy Document needs to be returned to the Company with reasons for cancellation within 30 days from the date of receipt of the Policy Document. We will refund the premium paid after deduction of Stamp duty, proportionate risk premium for the period of cover and the expenses borne by Us on medical tests, if any. The Policy shall terminate on payment of this amount and all rights, benefits and interests under this Policy will stand extinguished.
8. Exclusions: The Life Assured will not be entitled for any benefit if the covered conditions fall within the exclusions mentioned below.These exclusions apply in addition to the exclusions specified in the definitions mentioned in Annexure 1.
   
   1. Pre-existing Disease means any condition, ailment, injury or disease:
      1. That is/are diagnosed by a physician not more than 36 months prior to the date of commencement of the risk of the policy issued by Us or its reinstatement or,
      2. For which medical advice or treatment was recommended by, or received from, a physician not more than 36 months prior to the Date of Commencement of the risk of the Policy issued by Us or its reinstatement.
   2. For any medical condition or medical procedure resulting directly or indirectly from self-inflicted injuries, attempted suicide.
   3. Any external congenital anomaly: Congenital anomaly which is in the visible and accessible parts of the body. Congenital Anomaly means a condition which is present since birth, and which is abnormal with reference to form, structure or position.
   4. For any medical condition or any medical procedure arising from the donation of any of the life assured’s organs.
   5. Alcohol or Solvent abuse or taking of Drugs, narcotics or psychotropic substances unless taken in accordance with the lawful directions and prescription of a registered medical practitioner.
   6. For any medical condition or any medical procedure arising from nuclear contamination; the radioactive, explosive or hazardous nature of nuclear fuel materials or property contaminated by nuclear fuel materials or accident arising from such nature.
   7. Treatment for injury or illness caused by avocations or activities such as hunting, mountaineering, steeple chasing, professional sports, racing of any kind, scuba diving, aerial sports, activities such as hand-gliding, ballooning, deliberate exposure to exceptional danger.
   8. Participation by the life assured in a criminal or unlawful act.
   9. Taking part in any naval, military or air force operation during peace time.
   10. War, invasion, act of foreign enemy, hostilities (whether war be declared or not), armed or unarmed truce, civil war, mutiny, rebellion, revolution, insurrection, military or usurped power, riot or civil commotion, strikes.
   11. Participation by the life assured in any flying activity, except as a bona fide, fare-paying passenger, pilot, air crew of a recognized airline on regular routes and on a scheduled timetable.
   12. Service in the armed forces, or any police organization, of any country at war or service in any force of an international body
   13. No benefit shall be paid for any pregnancy complications and any congenital anomalies covered under the Maternity Care benefits if the pregnancy results from fertility treatment such as assisted reproduction services including artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI and Gestational surrogacy.
9. Tax benefits: Premiums and the benefits under the policy, will be subject to the taxes and other statutory levies as may be applicable from time to time.
   The Policyholder will be required to pay goods and services tax, cess or any other form of taxes or charges or levies as per the prevailing laws, regulations and other financial enactments as may exist from time to time, wherever applicable.
   All benefits payable under the policy are subject to the tax laws and other financial enactments as they exist from time to time.
   All provisions stated in this Policy are subject to the current guidelines issued by the Regulator as on date. All future guidelines that may be issued by the Regulator from time to time may also be applicable to this Policy.
10. Grace period: If you are unable to pay an instalment premium by the due date, you will be given a Grace Period of 15 days for payment of due instalment premium if You have chosen monthly frequency, and 30 days for payment of due instalment premium if You have chosen any other frequency, commencing from the Premium due date. The applicable cover continues during the Grace Period. In case of diagnosis of any of the covered conditions/ undergoing any covered surgery of Life Assured during the Grace Period, We will pay the applicable Benefit.
11. Lapsation: If any premium instalment is not paid within the grace period, then the policy shall lapse, and the cover will cease. If the policy is not revived within the revival period, then the surrender value (if applicable, computed as on date of premium discontinuance), if any, shall become payable on the earliest of the following events:
    • Event of death of the Life Assured within the revival period,
    • End of the revival period, and
    • Date of Maturity.

    Post payment of such surrender value (if any), then the policy shall foreclose and all rights and benefits under the policy shall stand extinguished.

12. Renewal Premium in Advance: Collection of renewal premium in advance shall be allowed within the same financial year for the premium due in that financial year,. However, where the renewal premium due in one financial year is being collected in advance in earlier financial year, Company may collect the same for a maximum period of three months in advance of the due date of the premium. The renewal premium so collected in advance shall only be adjusted on the due date of the premium.
13. Change of frequency of premium payment: You have the flexibility to change the frequency of premium payment on policy anniversary.
14. Modal loadings: Loadings for various modes of premium payment are given below

    Premium paying frequency	Modal Loading (as a % of Annualized Premium)
    Yearly	0%
    Half-yearly	1.25%
    Monthly	2.50%

15. Nomination: Nomination in the Policy will be governed by Section 39 of the Insurance Act, 1938 as amended from time to time. For more details on this section, please refer to our website.
16. Section 41 of the Insurance Act, 1938 as amended from time to time: In accordance to the Section 41 of the Insurance Act, 1938 as amended from time to time, 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.
    Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to ten lakh rupees.
17. Policies where Policyholder and Life Assured are different individuals: If the Policyholder and the Life Assured are different, then in the event of death of the Policyholder and upon subsequent intimation of the death with the Company, the policy shall vest on the Life Assured. Thereafter, the Life Assured shall become the Policyholder and will be entitled to all benefits and subject to all liabilities as per the terms and conditions of the policy. The Life Assured cum Policyholder can register due nomination as per Section 39 of the Insurance Act, 1938 as amended from time to time.
    We hereby agree to pay the appropriate benefits under the Policy subject to:
    a) Our satisfaction of the benefits having become payable on the happening of an event as per the Policy terms and conditions,
    b) The title of the said person or persons claiming payment,
    
18. The product is also available for sale through online mode.
19. Policy Servicing and Grievance Handling Mechanism: For any clarification or assistance, You may contact Our advisor or call Our customer service representative (between 10.00 a.m. to 7.00 p.m, Monday to Saturday; excluding national holidays) on the numbers mentioned on the reverse of the Policy folder or on Our website: www.iciciprulife.com. For updated contact details, We request You to regularly check Our website. If You do not receive any resolution from Us or if You are not satisfied with Our resolution, You may get in touch with Our designated grievance redressal officer (GRO) at gro@iciciprulife.com or 1800-2660.

Disclaimers

^*16,18,196 are the in-force number of policies issued to women (Individual business) since inception as on 31st March 2024. The number is as per Annual Audited Statistics submitted to IRDAI

^%Lives covered across our individuals and group customers as per ICICI Prudential Annual Report 2023-24. Please refer to Public Disclosure section on ICICI Prudential website for more details.

^{^}1 Day is a working day, counted from the date of receipt of all relevant documents from the claimant, additional information sought by the Company and any clarification received from the claimant. The Company will be calling the claimants for verification of information submitted by the Claimant which will also be considered as part of relevant documents. Working day will be counted as Monday to Friday and excluding National holidays /Bank holidays/Public holidays. Interest shall be at the bank rate that is prevalent at the beginning of the financial year in which death claim has been received. In case of breach in regulatory turnaround time, interest will be paid as per IRDAI regulations. Mandatory documents to be submitted at Branch Office- Claimant statement form, Copy of death certificate issued by local authority, AML KYC documents- Nominee’s recent photograph ,Copy of Nominee’s pan card, Nominee’s current address proof, photo identity proof, Cancelled cheque/ Copy of bank passbook, Copy of medico legal cause of death, Medical records (Admission notes, Discharge / Death summary, Test reports, etc.), For accidental death - Copy of FIR, Panchnama, Inquest report, Postmortem report, Driving license. All due premiums in the policy have been paid and the policy has been active for 3 consecutive years preceding life assured’s death

^`As per ICICI Prudential Annual Report 2023-24: Financial Statements (Schedule 4- Benefits paid (Gross))of the company, benefits paid since inception up to March 31, 2024.

^#Source: https://www.iciciprulfe.com/content/dam/icicipruaboutus/BusinessPresentations/fy2025/SEBl_Results_June_ 2024pdf

Address: ICICI Prudential Life Insurance Company Limited, Ground Floor & Upper Basement, Unit No. 1A & 2A, Raheja Tipco Plaza Rani Sati Marg, Malad (East) Mumbai-400097.

The concerns of senior citizens will be resolved on priority ensuring there is a speedy disposal of the grievances.

For more details, please refer to the “Grievance Redressal” section on www.iciciprulife.com. If You do not receive any resolution or if You are not satisfied with the resolution provided by the GRO, You may escalate the matter to Our internal grievance redressal committee at the address mentioned below:

ICICI Prudential Life Insurance Co. Ltd. Ground Floor & Upper Basement Unit No. 1A & 2A, Raheja Tipco Plaza, Rani Sati Marg, Malad (East), Mumbai- 40009, Maharashtra.

If you are not satisfied with the response or do not receive a response from us within 15 days, you may approach Policyholders’ Protection and Grievance Redressal Department, the Grievance Cell of the Insurance Regulatory and Development Authority of India (IRDAI) on the following contact details: IRDAI Grievance Call Centre (BIMA BHAROSA SHIKAYAT NIVARAN KENDRA) 155255 (or) 1800 4254 732

Email ID: complaints@irdai.gov.in

Address for communication for complaints by fax/paper:

Policyholders’ Protection and Grievance Redressal Department – Grievance Redressal Cell Insurance Regulatory and Development Authority of India, Survey No. 115/1, Financial District, Nanakramguda, Gachibowli, Hyderabad, Telangana State – 500032

You can also register your complaint online at bimabharosa.irdai.gov.in.

This is subject to change from time to time.

Refer https://www.iciciprulife.com/services/grievance-redre ssal.html for more details.