Critical-Illness Insurace

Critical illness Insurance

Objective

Critical illness treatment insurance covers hospitalization for conditions that are close to being life-threatening, a common occurrence in Myanmar. This type of insurance provides financial for hospitalization, surgical treatments, and in the event of death.

Age Limitation

Age (6) to (60) years

(If the insured person is within 6 -18 years, the approval letter from their guardian will be needed.)

Policy Term

1 year

Premium Payment

Group Customers

Monthly

Quarterly

Semi-annually

Annually (lump sum)

Individual Customers

Semi-annually

Annually (lump sum)

Available Units

The insured can purchase critical illness insurance from a minimum (1) unit to a maximum (10) units.

Critical Illness Insurance Benefits

The insurance benefits for Critical Illness Insurance are in the following:

No	Coverage	Causes for Claim	Benefits (Kyats)
1.	Critical Illness(1) unit
		Heart Attack Heart Attack means a definite diagnosis of the death of heart muscle due to obstruction of blood flow. The symptoms of heart attack can be easily seen in ECG. Exclusion No benefits shall be payable for pre-existing or symptoms started before the starting date of the policy. Condition for Payout The diagnosis of a heart attack must be determined by a specialist and the patient must be hospitalized for treatment.	‌MMK 1,000,000
		Stroke A stroke is caused by a brain aneurysm or blood clot. It can occur suddenly and is detectable through diagnostic tests. If abnormal symptoms are identified, confirmation through a CT scan is recommended. However, less severe strokes may not require testing. Exclusion No benefits shall be payable for stroke or pre-existing stroke symptoms started before the starting date of the policy. Condition for Payout The diagnosis of stroke must be determined by a specialist and the patient must be hospitalized for treatment.
		Cancer (Life-threatening) Tumors, or rapid tumor cell proliferation that spreads to other parts of the body, are classified as life-threatening cancers. Specialist approval is required. Exclusion No benefits shall be payable for Carcinoma in situ/ Intraepithelial Neoplasm (Malignant Tumor occurs under the Intraepithelial layer of Respiratory track, Gastrointestinal Track, Urogenital Track). Condition for Payout The diagnosis of cancer must be determined by a specialist, the cancer must be the first occurrence for the patient and the patient starts getting treatment.
		Renal Failure Renal failure means a definite diagnosis of chronic irreversible failure of both kidneys to function, as a result of which regular hemodialysis, peritoneal dialysis, or renal transplantation is initiated. Condition for Payout The diagnosis of renal failure must be determined by a specialist.
		Major Organ Transplant Major organ transplant means a definite diagnosis of the irreversible failure of the heart, both lungs, liver, both kidneys or bone marrow. Condition for Payout The diagnosis of major organ failure must be determined by a specialist and the patient starts getting treatment.
		Heart Valve Replacement or Repair Heart valve replacement or repair refers to surgery for replacing or repairing damaged or abnormal heart valves. It is performed in cases of heart damage or abnormalities. Condition for Payout The surgery must be determined to be medically necessary by a specialist.
		Coronary artery bypass surgery The undergoing of heart surgery to correct narrowing or blockage of one or more coronary arteries with bypass graft(s). Condition for Payout The surgery must be determined to be medically necessary by a specialist.
		Severe Burns Severe burns mean a definite diagnosis of third-degree burns over at least 20% of the body surface. Condition for Payout The surgery must be determined to be medically necessary by a specialist.
		Coma Coma means a definite diagnosis of a state of unconsciousness with no reaction to external stimuli or response to internal needs for a continuous period of at least 96 hours, and for which period the Glasgow coma score must be 4 or less. Exclusion No benefit will be payable under this condition for a medically induced coma, brain death diagnosis, or coma resulting directly from alcohol or drug use. Condition for Payout The diagnosis of stroke must be determined by a specialist and the patient must be hospitalized for treatment.
		Bacterial meningitis Bacterial meningitis means a definite meningitis, confirmed by cerebrospinal fluid showing growth of pathogenic bacteria in culture. Exclusion No benefit will be payable under this condition for viral meningitis. Condition for Payout The diagnosis of stroke must be determined by a specialist and the patient must be hospitalized for treatment.
2.	Death(1) unit
2.	Death(1) unit	Death, (however, if the above-mentioned critical illness benefit has already been paid, the policy will lapse and no death benefit will be paid).	MMK 1,000,000

Premium Rate

The premium rates for critical illness insurance are outlined in the table below.

	Coverage	Age	Semi- Annually	Annually
Individual Customer	1 unit of critical illness insurance coverage
		6 ~ 30	45,00	8,800
		31 ~ 40	7,800	15,400
		41 ~ 50	12,300	24,200
		51 ~ 60	19,000	37,400
Group Customers	1 unit of critical illness insurance coverage
		6 ~ 30	4,300	8,400
		31 ~ 40	7,400	14,600
		41 ~ 50	11,700	23,000
		51 ~ 60	18,100	35,500

If the applicant has provided untruthful information through misrepresentation, fraud, omission, then the benefits of the policy shall be forfeited.

The insurance coverage begins upon payment of the insurance premium. The insurance policy shall expire at midnight (12:00 a.m.) one year from the day the coverage begins.

There is no premium refund if the insured terminates the insurance policy. In case of policy termination initiated by the insured, the premium will be refunded at the rate calculated for the remaining period.

After the initial premium payment, subsequent premiums must be paid within 15 days from the day after the deadline, as per the premium payment system. In case of a benefit claim, any unpaid premiums during the waiting period will be deducted from the benefit amount. If the premium remains unpaid beyond the grace period, the insurance contract will be void starting from the day after the grace period ends. There is no grace period for premium payment during the renewal period for extended insurance policies.

The insured must provide additional documents as requested by the insurer within 3 months.Otherwise, the insured shall lose the right to claim.

For claims that happened within a month from the policy starting date, the insurer shall engage experts to thoroughly review them.

Benefits will not be paid for the following causes, symptoms, and diseases, whether directly or indirectly:

Undergoing medical treatment, obtaining a doctor's approval, or having pre-existing symptoms,

Psychosis and mental disorder,

Hospitalization for Medical check-ups and rest,

Cosmetic surgery,

Hearing aids,

Physical defect or infirmity,

Drugs or controlled substances,

Criminal commitment,

AIDS/HIV,

Terrorism, civil unrest, riots, hostilities or warlike operations (whether war be declared or not) civil war assuming the proportions of or amounting to popular rising, rebellion revolution, insurrection, military or usurped power or any act of any person acting on behalf of or in connection with any organization with activities directed towards the overthrow by force of the government de jure or de facto or to the influencing of it by terrorism or violence or by the direct or indirect consequences of any of the said occurrences.

Fraudulent claims,

Suicide or Suicidal self-injury,

For the treatment of Malignant Tumor cancer that occurs within 90 days from the policy starting date (in case of consecutive insurance policy, from the policy starting date before the policy is renewed)

Carcinoma in situ/ Intraepithelial Neoplasm (Malignant Tumor occurs under the Intraepithelial layer of Respiratory track, Gastrointestinal Track or Urogenital Track)