TATA AIA LIFE NIRVANA PLUS

Transcription

1 TATA AIA LIFE NIRVANA PLUS In this Policy: BASIC DEFINITIONS You or Your means the Policyholder of this Policy as shown in the Policy Information Page. We, Us, Our or Company refers to the Tata AIA Life Insurance Company Limited. Issue Date or Commencement Date is the date when coverage under this Policy or its relevant Supplementary Contract or Rider takes effect. The Issue Date is shown on the Policy Information Page and the Commencement Date is the date of issue of any endorsement indicated in the relevant endorsement if the original terms and coverage of the Policy are changed subsequently. Commencement Date is also the approval date of reinstatement of the Policy and/or its Supplementary Contract or Rider in case of any reinstatement. Policy Date as shown in the Policy Information Page is the date from which Policy Anniversaries, Policy Years, Policy Months and Premium Due Dates are determined. Policy Anniversary refers to the same date each year as the Policy Date. Maturity Date and Expiry Date of the Basic Policy are shown in the Policy Information Page. Unless otherwise specified, the Expiry Date for a Supplementary Contract or Rider falls on the Policy Anniversary equal to the number of years for which premiums for the relevant Supplementary Contract are payable as shown in the Schedule of Coverages, Benefits and Premiums of the Policy Information Page. Maturity Date and Expiry Date are also the Vesting Date when referred to in this contract. Vesting Date is shown under the Maturity/Expiry Date in the Policy Information Page. Face Amount means the initial sum assured of the Basic Policy when the Policy is issued and is shown in the Policy Information Page. If the Face Amount is subsequently altered according to the terms and conditions of the Policy, the adjusted amount after such alteration will become the Face Amount. "Accident" refers to a sudden, unforeseen and involuntary event caused by external, violent and visible means which occurs while the Policy is in force and during the lifetime of the Insured. "Bodily Injury" means an abnormal bodily condition of the Insured which occurs while the Policy is in force and within 90 days of Accident, and caused directly and solely by Accident independent of any other cause and not therefore due to illness or disease. Such Bodily Injury must be evidenced by external signs such as contusion, bruise and wound except in cases of drowning and internal injury. Physician or Registered Medical Practitioner means only a person holding a degrees of bachelor of medicine and bachelor of surgery (MBBS.) or equivalent degrees and is registered and legally authorised by the Medical Council of India or the relevant authority in the geographical area of his practice to render medical or surgical services; but excluding a Physician who is the Insured himself or an agent of the Insured, an insurance agent, business partner(s) or employer/employee of the Insured or a member of the Insured's immediate family. Critical Illnesses mean illnesses the signs or symptoms of which first commence more than 180 days following the Issue Date or Commencement Date or the date of any reinstatement of the Policy, whichever is the latest, and shall include either the first diagnosis of any of the following illnesses or first performance of any of the covered surgeries stated below: 1. Cancer The first occurrence of a histologically confirmed invasive malignant tumour exhibiting invasion of adjacent tissues. The following are excluded: Tumours treated by endoscopic procedures alone; (iii) Tumours classified as carcinoma in situ and prostate tumours classified as T 1 and papillary carcinoma of the thyroid less than 1cm in diameter classified as T1N0M 0 (TNM Classification system); Malignant melanomas less than 1.5 mm in depth; Indebtedness means any unpaid policy loans including automatic premium loan and accrued interest, unpaid premiums, deductibles and any other amounts owed to the Company. Cash Value means the gross amount, before any deduction, that is to be refunded to the Policyholder upon the termination of the Policy while it is in force. Any Indebtedness will be deducted from the Cash Value of the Policy before payment. The Cash Value of the Policy, before any deductions, is subject to the Guaranteed Surrender Value. (iv) (v) (vi) Other cancers of the skin; Tumours that are a recurrence or metastasis of a tumour that first occurred prior to 180 days following the later of the issue Date, the Commencement Date or last reinstatement date. Kaposi's Sarcoma and other tumours associated with HIV infection; and Guaranteed Surrender Value refers to the minimum guaranteed amount of Cash Value of the Policy, provided that the premiums of the Policy have been paid for at least three consecutive years. The Guaranteed Surrender Value, when allowable under the Policy, is equal to the percent as shown in the Policy Information Page, of the total amount of the premiums of the Basic Policy paid excluding the premiums for the first Policy Year and all extra premiums of the Basic Policy. Nominee'' is the person(s) nominated by the Policyholder to receive the insurance benefits payable on the death of the Insured. "Accidental Death" means the death of the Insured which results directly, solely and independently of any other causes from Bodily Injury AND occurs within 90 days of the date of Accident. (vii) Tumours which pose no threat to life and for which no treatment is required. 2. Stroke The first occurrence of an acute neurological event caused by a cerebral or intracranial haemorrhage, cerebral embolism or cerebral thrombosis where the following conditions are met: There is an acute onset of objective and ongoing neurological signs that are expected to be permanent; and Findings on Magnetic Resonance Imaging, Computerised Tomography, or other reliable imaging techniques, demonstrate a lesion consistent with the acute haemorrhage, embolism or thrombosis.

2 3. Heart Attack Brain damage due to an accident, infection, vasculities or an inflammatory disease are excluded. The first occurrence of an acute myocardial infarction where the following conditions are met: The occurrence of typical chest pain, The occurrence of typical new acute infarction changes on the electrocardiograph progressing to the development of new pathological Q waves; and (iii) Elevation of cardiac Troponin to at least 3 times the upper limit of the normal reference range or an elevation in CK MB to at least 200% of the upper limit of the normal reference range. 4. Coronary Artery Bypass Graft Surgery The actual undergoing for the first time of open chest coronary artery bypass grafting surgery to one or more coronary arteries due to disease of those arteries. Angioplasty, stent insertion, laser or other intra-arterial procedures are excluded. 5. Kidney Failure Chronic irreversible failure of both kidneys requiring either permanent renal dialysis or kidney transplantation. 6. Major Organ Transplant The receipt by the Insured of a transplant of: Human bone marrow using haematopoietic stem cells preceded by total bone marrow ablation, or One of the following whole human organs: heart, lung, liver, kidney or pancreas, as a result of irreversible end stage failure of the relevant organ. 3. Death Benefit - We will pay the Face Amount to the Nominee if the Insured dies while the Policy is in force and before the Maturity Date. The Death Benefit payable (adjusted for any Guaranteed Addition, vested Reversionary Bonuses and Terminal Bonuses if any, and Indebtedness), or a part of it, may be elected to be paid in lumpsum or in the form of a single premium to purchase an immediate annuity issued by us or other institutions in the market. 4. Accidental Death Benefit - In the event of Accidental Death of the Insured while the Policy is in force and before the Maturity Date and provided that the Death Benefit in (3) above is payable, we will pay the Face Amount to the Nominee. No Accidental Death Benefit shall be payable for any losses caused directly or indirectly, wholly or partly, by any one of the following occurrences: (c) (d) (e) (f) (g) assault or murder; riot and civil commotion, industrial action or terrorist activity; war, declared or undeclared, or revolution; service in the armed forces in time of declared or undeclared war or while under orders for warlike operations or restoration of public order; self-destruction or any attempted self-destruction or selfinflicted injury while sane or insane; participation in any fight or affray; racing of any kind other than on foot; Other stem cell transplants and transplants of part of an organ are excluded. Whenever the context requires, masculine form shall apply to feminine and singular term shall include the plural. (h) participation in scuba diving; Accident occurring while or because the Insured is under the influence of alcohol or any non-prescribed drug; INDIVIDUAL PENSION PLUS(PAR) ENDORSEMENT Your Basic Policy is a deferred participating Endowment Policy, also known as Tata AIA Life Nirvana Plus, which matures and vests on the date indicated on the Policy Information Page. Your Basic Policy provides benefits subject to the following terms and conditions: 1. Guaranteed Addition - If the Policy is in force on the fifth (5th) Policy Anniversary and during the lifetime of the Insured, we will add a term insurance of an amount equal to 10% of the Face Amount, without additional premium, to the Basic Policy on the fifth (5th) such Policy Anniversary and a similar amount on similar conditions every five years thereafter. Such insurance amount will be payable on the Maturity Date or in the event of death of the Insured while the Policy is in force. Such Guaranteed Addition will cease upon conversion of the Policy into a Reduced Paid-Up Insurance. 2. Vested Benefit - We will pay you the Face Amount if the Insured is then alive on the Vesting Date (which is the Maturity Date in the Policy Information Page). The Vested Benefit, together with any Guaranteed Addition and vested Reversionary Bonuses and Terminal Bonuses if any, and after deduction for any Indebtedness, shall be paid in the form of a single premium to purchase an immediate annuity issued by us or other institutions in the market. You may elect to receive in a lumpsum of up to 50% of the Vested Benefit payable (adjusted for any Guaranteed Addition, vested Reversionary Bonuses and Terminal Bonuses if any, and Indebtedness) and apply the remainder to purchase an immediate annuity as above. (j) (k) (l) food poisoning or bacterial infection (except pyogenic infection which shall occur with and through an accidental cut or wound); entering, exiting, operating, servicing, or being transported by any aerial device or conveyance except when the Insured is on a commercial passenger airline on a regular scheduled passenger trip over its established passenger route; physical handicap or mental infirmity existing at the time of insurance application or reinstatement of the Basic Policy ; (m) any kind of sickness, disease or congenital anomalies; (n) (o) complications of surgical procedures or accidents occurring during surgical or therapeutic procedures; hunting, mountaineering or climbing requiring the use of ropes or guides; (p) ionising radiation or contamination by radioactivity from any nuclear fuel or nuclear waste; (q) radioactive, toxic, explosive or other dangerous properties of any nuclear equipment or any part of the equipment; (r) (s) any underwater or subterranean operation or activity; deliberate act(s) of the Policyholder, Nominee or Insured;

3 (t) violation or attempted violation of the law or resistance to arrest. 5. Critical Illness Benefit - In the event of the Insured's survival for a period of at least thirty days following a first diagnosis of Critical Illness or first performance of any of the covered surgeries as hereinafter defined while this Policy is in force and before the third (3rd) Policy Anniversary, we shall, subject to the provisions herein contained, pay Rupee one lakh (100,000) in one lump sum (the LumpSum Payment ). as shown on the Policy Information Page. In all circumstances, no more than one LumpSum Payment shall be granted under this Benefit. This Critical Illlness Benefit shall terminate on the earlier of payment of a LumpSum Payment; or the third (3rd) Policy Anniversary. Subject to our acceptance and provided no claim for the Critical Illness Benefit has been made, you may apply for similar critical illness insurance plan then available covering the Insured after termination of this Critical Illness Benefit. Such application is subject to our then usual full underwriting and health requirements as well as other rules for new issues; and such application shall reach us in writing no later than six months before the termination date of this Critical Illness Benefit. Where a Critical Illness or covered surgery, or a claim for it, arises after such application has reached us and before our acceptance, and provided this Critical Illness Benefit is still in force then, we shall consider any such claim under this Critical Illness Benefit. In all circumstances, any such claim, if payable, shall not be paid under both this Critical Illness Benefit of this Policy or the new critical illness insurance plan applied for. No Critical Illness Benefit shall be payable for any Critical Illness or covered surgery related to or caused directly or indirectly, wholly or partly, by any of the following occurrences: (c) (d) (e) (f) Any illness other than the occurrence of Critical Illness as defined herein; Any Critical Illness the signs or symptoms of which first occurred prior to 180 days following the later of the Issue Date or Commencement Date or last reinstatement of this Policy; Any congenital defect or abnormalities that has manifested or was diagnosed before the Insured attains 17 years of age; Self destruction or attempted self-destruction or selfinflicted injuries while sane or insane; Performance of any covered surgery which is not medically necessary or is not the usual treatment consistent in accordance with standards of good medical practice, or which is not performed by a Registered Medical Practitioner as defined herein; violation or attempted violation of the law or resistance to arrest. 6. In the event that any Supplementary Contracts or Riders providing any form of Accelerated or Advance payment, whether in lump sum or installments, of the Face Amount is attached to the Basic Policy such as, but not limited to, the supplementary total and permanent disability contract and supplementary critical illness contract (hereinafter called the Accelerated Benefit Payment Rider(s) ), the following provisions shall apply: Once a claim has been admitted under the Accelerated Benefit Payment Rider(s): Any benefit set out in Clause (1), & (2), (3) & (4) above will be based on the said Face Amount after deducting all Accelerated or Advance Payments made or payable under the Accelerated Benefit Payment Rider(s). The Death Benefit under the Basic Policy will be based on the Face Amount of the Basic Policy after deducting all Accelerated or Advance payments made under the Accelerated Benefit Rider(s). 1 Any Indebtedness of the Policy at the time of any payment herein shall be deducted from the amount otherwise payable. 2 The terms and conditions of the Endorsement supersede any conflicting provisions of the Policy to which this Endorsement is attached and forms part of. THE POLICY CONTRACT GENERAL PROVISIONS This Contract is made in consideration of your application and payment of the required premium. The Policy, application for it and any attached endorsements, constitute the entire contract. The terms and conditions of this Policy cannot be changed or waived except by endorsement or rider duly signed by our duly authorized officer. Your Policy consists of the basic insurance plan (the Basic Policy ) and the Supplementary Contracts which may be attached to it. The plan name of the Basic Policy and the product and/or code name and form number of the Supplementary Contract, if attached to this Policy, are shown under the Schedule of Coverages, Benefits and Premiums of the Policy Information Page. INCONTESTABILITY Except for fraud or non-payment of premiums and subject to the Misstatement of Age and Sex clause, this Policy but not any attached Supplementary Contract granting accident, hospitalization or other disability benefits, shall be incontestable after it has been in force during the lifetime of the Insured for two years from the Issue Date, or Commencement Date, whichever is later. SUICIDE If the Insured, whether sane or insane, commits suicide within one year from the Issue Date or Commencement Date, whichever is later, our liability shall be limited to the refund of premiums paid less any Indebtedness without interest. In the case of reinstatement, such refund of premium shall be calculated from the Commencement Date. MISSTATEMENT OF AGE AND SEX This Policy is issued at the age and sex shown on the Policy Information Page which is the Insured's declared age at last birthday and declared sex in the Application. If the age and/or sex is misstated and higher premium should have been charged, the benefit payable under this Policy will be what the premiums paid would have purchased at the correct age of the Insured. If the Insured's age/sex is misstated and lower premium should have been charged, the Company will refund any excess premiums paid without interest. If at the correct age/sex the Insured is not insurable under this Policy or any of its Supplementary Contracts pursuant to our Underwriting rules, the Policy or the relevant Supplementary Contract shall be void and the Company will refund the premiums paid without interest after deducting all payments made under the Policy or the relevant Supplementary Contract. CURRENCY AND PLACE OF PAYMENT All amounts payable either to or by us will be paid in the Currency shown on the Policy Information Page. Such amounts will be paid by a negotiable bank draft or checks drawn on a bank in the country in which the Currency of this Policy is denominated. All amounts due from us will be payable at our office shown on the Policy Information Page. FREEDOM FROM RESTRICTIONS Unless otherwise specified, this Policy is free from any restrictions upon the Insured as to travel, residence or occupation.

4 FREE LOOK PERIOD You have the right to cancel the Policy by giving written notice to the Company and receive the premiums paid aftera) deducting for any expenses (such as medical examination costs and stamp duty) which have been incurred for issuing the Policy; and b) deducting for all payments made under the Policy or the relevant Optional Benefit or Supplementary Contract; and c) deducting for market value changes for underlying investment losses as deemed necessary by the Company. Such notice must be signed by you and received directly by the Company within 15 days after you receive the Policy. CLAIM PROCEDURES Notice of Claim All cases of death must be notified immediately to us in writing. Other claims must be submitted in writing not later than 20 days after the date the insured event happens. Filing Proof of Claim Affirmative proof of loss and any appropriate forms as required by us must be completed and furnished to us, at the claimant's expenses, within 90 days after the date the insured event happens, unless specified otherwise. A list of primary claim documents listing the normally required documents is attached to the Policy. Submission of the listed documents, forms or other proof, however, shall not be construed as an admission of liabilities by the Company. We reserve the right to require any additional proof and documents in support of the claim. Medical Examination We reserve the right to request medical examination of the Insured. In case of death, we may require, if appropriate and legally allowable, an autopsy. Proof of Continuing Loss In the case of disability or other losses as we deem appropriate, we will require, at reasonable intervals, proof of continuing disability or loss. If such proof is not submitted as required, or such disability or loss ceases, claims for such disability or loss will not be considered. TAXES AND DUTIES Service Tax is payable on Life Insurance premium as per section 65(105)(zx) of Finance Bill (No.2), 2004 at the applicable rates as per circular number 80/10/2004-S.T dated September 17, 2004 issued by the Government of India, Ministry of Finance and subsequent directions issued by the authorities from time to time. The service tax component payable by the policyholder at applicable rates will be stated in the premium notice and the premium receipt for the information of the policyholder. The current rates are subject to amendment made by Government from time to time. No separate notification will be sent for change in rates of service tax. Applicable amount of service tax at applicable rate will be stated in the premium notice sent to the policyholder. PROOF OF CRITICAL ILLNESS The occurrence of a Critical Illness or performance of a covered surgery must be proven to our satisfaction. Such proof must be supported by the following: 1) Evidence provided by appropriate Physician(s) who is/are properly registered with the local authority; and, 2) Appropriate medical investigations and/or reports including, but not limited to, clinical, radiological, histological and laboratory evidence; and 3) If the insured event requires a surgical procedure to be performed, the procedure must be the usual treatment for the condition and be medically necessary. In the event of any dispute or disagreement regarding the appropriateness or correctness of the diagnosis, the Company shall have the right to call for an examination, of the Insured and the evidence used in arriving at such diagnosis, by such persons as the company requires. Medical terms used in this contract, unless herein specified, will have the technical meaning as generally understood and used by medical specialists in the relevant field. THE POLICYHOLDER OWNERSHIP PROVISIONS You are the Policyholder and beneficiary of this Policy as shown on the Policy Information Page until changed. Only the Policyholder can, during the Insured's lifetime, exercise all rights, privileges and options provided under this Policy subject to any Nominee's vested interest or Assignee's rights. NOMINEE The Nominee is named in the application unless subsequently changed. If a Nominee dies before the Insured, the payable benefits will be made to the surviving Nominee(s). If no nomination has been made, or all Nominees die before the Insured, the payable benefits will be made to the legal heir or legal representative of the Policyholder. In the event of death of the Insured whilst the Nominee is a minor, the money secured by the Policy shall be received by the Appointee as named in the application unless subsequently changed. C H A N G E O F O W N E R S H I P, N O M I N E E A N D ASSIGNMENT While this Policy is in force, you may change the Nominee/Appointee by filing a written notice to us. Such change is valid only if recorded by us during the lifetime of the Insured and endorsed on this Policy. We assume no responsibility for the validity or sufficiency of the nomination of the Nominee or appointment of the Appointee. No change of ownership or assignment, except assigning to us, is allowed under this Policy. PAYMENT PREMIUM PROVISIONS All premiums are payable on or before their due dates to us either at our issuing office or to our authorized Officer or Cashier. The premium shall be paid in the policy currency stated in the Policy Information Page. CHANGE You may change the frequency of premium payments by written request. Subject to our minimum premium requirements, premiums may be paid on an annual, semi-annual, quarterly or monthly mode at the premium rates applicable on the Issue Date. Premiums payable monthly shall be paid by auto-deduction through a bank, unless we agree otherwise in writing. If such arrangement ceases for whatever reason, the Company will stop accepting monthly interval of premium payment and the policy will be automatically converted to quarterly mode. Any outstanding balance of the quarterly premium will become due immediately for payment. DEFAULT After payment of the first premium, failure to pay a subsequent premium on or before its due date will constitute a default in premium payment. GRACE PERIOD A Grace Period of thirty-one days from the due date will be allowed for payment of each subsequent premium. The Policy will remain in force during the period. If any premium remains unpaid at the end of its Grace Period, the Policy shall lapse and have no further value except as may be provided under the NON-FORFEITURE PROVISIONS.

5 DEDUCTION OF PREMIUM AT DEATH If this Policy becomes a claim by death of the Insured, any balance of the premiums due for the full policy year in which death occurs shall be deducted from the proceeds payable under the Policy. REINSTATEMENT If a premium is in default beyond the Grace Period and subject to the Policy not having been surrendered, it may be reinstated, at our absolute discretion, within five years after the due date of the premium in default subject to: your written application for reinstatement; production of Insured's current health certificate and other evidence of insurability satisfactory to us; (iii) payment of all overdue premiums with interest; and (iv) repayment or reinstatement of any Indebtedness outstanding at the due date of the premium in default plus interest. Interest on premiums and Indebtedness will be compounded at an annual rate which we shall determine. We will require evidence of insurability before reinstating any Supplementary Contract. Any reinstatement shall only cover loss or insured event which occurs after the reinstatement or Commencement Date. REVERSIONARY BONUS PROVISIONS REVERSIONARY BONUS This is a deferred participating Policy from the sixth (6th) Policy Anniversary onwards and its share of divisible surplus will be determined annually by the Company and credited as a Reversionary Bonus on the Policy Anniversary. A Reversionary Bonus is an insurance amount in addition to the Face Amount and whenever vested in the Policy is payable: Option 2 - Reduced Paid-Up Insurance - To continue this Policy in force as a non-participating paid-up insurance for a reduced Face Amount. The reduced Face Amount shall be such a sum as shall bear the same ratio to the full Face Amount as the number of premiums actually paid shall bear to the total number originally payable as stipulated for in the Policy. AUTOMATIC NON-FORFEITURE PROVISIONS If premium is not paid within the Grace period, and no non-forfeiture option has been elected, we will advance the premium due as an automatic loan so long as the Cash Value is equal to or greater than the premium in default plus any Indebtedness. We will continue to extend an automatic premium loan at subsequent due dates provided the Cash Value is sufficient. AUTOMATIC LOAN PROVISIONS Where an automatic loan has been made against the Cash Value, such loan will be subject to such terms and conditions as the Company may fix from time to time. Your Policy must be assigned to us. LOAN INTEREST Daily interest shall accrue on policy loan at a rate which we shall determine. Interest shall be payable on each Policy Anniversary after the loan date and until the loan is repaid. Any unpaid interest shall be added to the principal loan and bear interest at the same rate. At anytime while this Policy is in force, you may repay the principal and accrued interest, or any part of the loan. When the loan with accrued interest together with any Indebtedness exceeds the Cash Value, the policy will become void. DEDUCTION FROM PROCEEDS The unpaid loan or any Indebtedness on this Policy will be deducted from any payment or proceeds under this Policy at the time of settlement. Our claim for any Indebtedness will have priority over the claim of any creditor, assignee or any other interested party. 1 Together with the Face Amount in case of Insured's death before Maturity Date or Expiry Date of the Policy; or 2 On Maturity Date or Expiry Date; or 3 In advance in the same proportion as the Accelerated or Advance Payment bears to the Face Amount whenever any payment under any Accelerated or Advance Benefit Rider becomes due and payable, as the case may be. The Policy will cease to be participating upon conversion into a Reduced Paid-Up Insurance. TERMINAL BONUS TERMINAL BONUS PROVISIONS The Company may, at its absolute discretion, determine if a Terminal Bonus is payable and its amount if payable in the event that this Policy terminates by maturity or death. NON- FORFEITURE PROVISIONS ELECTIVE NON- FORFEITURE PROVISIONS If you fail to pay the premium within the Grace Period after this Policy has acquired a Cash Value, you may elect one of the following non-forfeiture options by writing to us within 90 days after the due date of the premium in default:- Option 1 - Cash Value - To surrender this Policy for its Cash Value. Such Cash Value is equal to the surrender value of the Basic Policy plus the surrender values of any Paid- Up Additions and vested Reversionary Bonus, and the amount of any Dividend Accumulations, less any Indebtedness.