Cancer Insurance Policy
- The Insured specified in the Schedule has declared and represented in the proposal
form that the Insured is in good health and the health statement to the said effect
in the format specified by Raheja QBE has been submitted along with the proposal
- On the basis of the said declarations and representations contained in the proposal
form (which are to form part of the contract of insurance) Raheja QBE has agreed
to issue this Policy.
This Policy is being issued to record the said terms and conditions mentioned hereinafter.
2. Nature of Cover:
- Subject to the terms, conditions and exclusions contained hereinafter, if the Insured
during the Period of Insurance specified in the Schedule, is diagnosed with Cancer
and if this requires diagnostic investigation or treatment by a duly qualified medical
practitioner or surgeon, Raheja QBE shall pay to the Insured:
- the lesser of 50% of the Sum Insured specified in the Schedule and Rs. 250,000.00
as a lump sum benefit amount on the acceptance of a claim under the Policy; and
Reasonable and necessary medical expenses actually incurred by the Insured in the
diagnostic investigation or medical treatment of Cancer, in excess of 75% of the
benefit amount paid in accordance with Clause 2.1.1, as indemnities.
- The total liability of Raheja QBE under this Policy for any and all claims made
in respect of the Insured is restricted to the Sum Insured mentioned in the Schedule.
- Reimbursement of medical expenses will be based on submission of original bills
only, unless the Insured has already submitted a claim and the original bills under
any insurance policy with any other Indian insurance company in which case Raheja
QBE will accept certified true copies of the bills from the Insured provided that
written documentation from the Indian insurance company is provided confirming its
quantum of liability under its insurance policy issued to the Insured for that claim
and that it has received the original bills from the Insured.
- If an Insured is diagnosed as suffering from Cancer and reports the claim during
the Period of Insurance, he/she can continue to receive benefits under the Policy
up to the Sum Insured limit even after the expiry of the Policy for up to 5 yrs
from the inception of the Policy.
- The Insured for the purposes of this Policy shall mean the Insured specified in
the Schedule only.
- This Policy is ordinarily renewable unless the Insured or anyone acting on behalf
of an Insured has acted in an improper, dishonest or fraudulent manner or there
has been any misrepresentation under or in relation to this Policy or the renewal
of the Policy poses a moral hazard.
- The renewal premium under the Policy is payable by the due date specified in the
Schedule or at the altered rate notified by Raheja QBE 15 days before the due date.
Raheja QBE will allow a grace period of 30 days from the due date of the renewal
premium for payment of the premium due to Raheja QBE. If the Policy is not renewed
within the grace period, then Raheja QBE may agree to issue a fresh policy subject
to Raheja QBE’s underwriting criteria and, in such cases, no continuing benefits
shall be available from the expired Policy.
4. Scope of Cover
- The Policy is valid for a period of one year from the date of commencement specified
in the Schedule unless the Policy is renewed for subsequent periods of one year
in accordance with the terms of Clause 3.
- No claim, however, shall be payable on any account whatsoever, if the Insured is
diagnosed with Cancer within a period of thirty days from the commencement of the
initial Period of Insurance specified in the Schedule, provided that this period
of thirty days does not apply to renewals of the Policy.
- If after the said period of thirty days and thereafter during the currency of the
Policy, or subsequent renewals, if the Insured, contracts cancer or is suspected
of having contracted cancer and makes an initial claim under the Policy, the Policy
shall be deemed to have been invoked and the liability of Raheja QBE shall continue
to the extent of the Sum Insured
- CUMULATIVE BONUS: If no claims have been made for a Period of Insurance and the
Policy is subsequently renewed in accordance with the terms of the Policy, Raheja
QBE will increase the Sum Insured by 5% for the immediately following Period of
Insurance provided that the cumulative bonus over all Periods of Insurance shall
not exceed 25%
- The earned Cumulative Bonus will not be lost if the policy is renewed within the
30 day grace period specified in Clause 3.
- The premium rates charged are subject to review every 5 years.
- Notice of Claims: A notice of claim shall be served upon Raheja QBE within a period
of 30 days of the happening of any event which gives rise to a claim under the Policy
with full particulars.
- Proof of Claims: The claim shall be substantiated in full with all supporting documents
including but not limited to the following as a condition precedent to the consideration
of the claim by Raheja QBE:
- Raheja QBE’s claim form which shall be duly completed;
- All original diagnostic, investigative and treatment reports;
- All original of bills and receipts of tests carried out and treatment taken;
In respect of Clauses 5.2.2 and 5.2.3 above, if the Insured has already submitted
a claim and the original reports, bills or receipts under any insurance policy with
any other Indian insurance company in which case Raheja QBE will accept certified
true copies of the reports, bills and receipts from the Insured provided that written
documentation from the Indian insurance company is provided confirming its quantum
of liability under its insurance policy issued to the Insured for that claim and
that it has received the original reports, bills and receipts from the Insured.
- All original/certified copies of prescriptions of doctors
- Hospital case records and Discharge Ticket, if treatment taken there.
- any other information or documentation sought by Raheja QBE.
- The claim and the requisite information, particulars and documents in respect of
and pertaining to a claim shall be submitted within 15 days of notification of the
- Payment of Claims: Claims shall be paid by Raheja QBE in Indian currency to the
Insured or his/her legal heir in respect of whom the claim has been made for claims
pertaining to diagnosis, investigation and medical/surgical treatment for Cancer
taken entirely within India only
- Claim for reimbursement of medical expenses incurred may be submitted by the Insured
to Raheja QBE on a quarterly basis along with the information and documentation
specified in Clause 5.2 above.
6. Conditions, Warranties, Exclusions
- Raheja QBE shall not be liable for making any payment under the Policy by reason
of any injury, disease or illness directly or indirectly caused or contributed by
nuclear weapons, or by reason of the contact of the Insured with radiation or radioactivity
from any source whatsoever from non diagnostic or therapeutic source.
- Raheja QBE shall not be liable for making any payment under the Policy for any cancer
or cancer related condition(s) for which the Insured had signs or symptoms and was
diagnosed and received medical advice/treatment, within 48 months prior to his/her
first policy with Raheja QBE.
- All Insureds above the age of 50 years to whom cover under this insurance is extended
by Raheja QBE after medical examination and confirmation of no pre-existing cancer
in the proposal form and are later on detected with cancer in advanced stages will
not be denied cover on the basis of the disease being a pre-existing one.
- No claim shall be payable under or in respect of this Policy if any claim or any
aspect thereof or if any of the representations on the basis whereof this Policy
is issued shall be discovered to be in any manner fraudulent or incorrect or if
any fraudulent means or devices are adopted by the insured person or anyone acting
on his/her behalf at any time in making or preferring any claim under or in respect
of this Policy.
- This Policy will not be renewed for an Insured once a claim in is admitted under
- No claim shall be payable under this Policy unless the diagnostic investigation
reveals positive existence or presence of Cancer.
- Cancellation: Raheja QBE may cancel the Policy on grounds of misrepresentation,
fraud, nondisclosure of material facts or non-cooperation by any Insured or anyone
acting for or on behalf of an Insured by sending 30 days notice in writing to the
Insured at the last known address and refunding premium pro-rata for the unexpired
term of the Policy. The Insured may cancel the Policy at any time, by giving written
notice to Raheja QBE. Provided that no claim has arisen under the Policy prior to
the receipt of such notice by Raheja QBE, the Insured would be entitled to a return
of premium at Raheja QBE’s short period scales as mentioned in the table below,
for the period the Policy had been in force.
For a period not
Full Annual Premium
85% of the Annual Premium
80% of the Annual Premium
75% of the Annual Premium40
70% of the Annual Premium
60% of the Annual Premium
50% of the Annual Premium
40% of the Annual Premium
30% of the Annual Premium
15% of the Annual Premium
For a period exceeding
10% of the Annual Premium specified in the
Schedule (Annual Premium)
7. Disputes Settlement
- If any difference shall arise as to the claim or quantum thereof, such difference
shall be referred to the Grievance Committee constituted by Raheja QBE comprising
of the Chief Underwriting Officer, Head of Claims and Compliance Officer of Raheja
QBE, for settling disputes.
- Grievance Redressal
In case the Insured is aggrieved in any way, he/she may contact Raheja QBE at the
specified address, during normal business hours for the following grievances:
Any partial or total repudiation of claims by Raheja QBE.
Any dispute regard to premium paid or payable in terms of the Policy.
Any dispute on the legal construction of the policies in so far as such disputes
relate to claims. Delay in settlement of claims.
Non-issue of any insurance document to customer after receipt of the premium.
Raheja QBE will take all steps to settle the Insured’s claim in accordance with
policy terms and conditions. However, since the Policy does not cover all eventualities,
there may be disagreement on settlement of the claim.
For resolution disputes Raheja QBE has an elaborate Grievance Redressal mechanism.
At your request, the claim/grievance will be considered by the Grievance Committee
of Raheja QBE. If the Insured is not satisfied with the decision of the Grievance
Committee he/she is entitled to refer his/her case to the Insurance Ombudsman as
enlisted in “Annexure A “
8. Other Insurance
- If at the time when any claim for reimbursement of medical expenses arises in accordance
with Clause 2.1.2 of this Policy, there is in existence any other Policy where the
Insured is covered and the claim is totally or partially covered under the same,
Raheja QBE shall pay only the rateable proportion of the claim
9. Definition of Cancer
- CANCER means a disease manifested by the presence of a malignant tumor characterized
by the uncontrolled growth and spread of malignant cells with invasion and destruction
of normal tissue. CANCER also includes leukemia and malignant diseases of the lymphatic
system such as Hodgkin's disease.
Cancer does not include Kaposi's Sarcoma or any other malignant tumor in the presence
of any Human Immuno-deficiency virus;
- POLICY means these terms and conditions, the Proposal Form, the Schedule and any
endorsements issued by Raheja QBE.
- REASONABLE AND NECESSARY MEDICAL EXPENSES mean the charges for services or supplies,
which are the standard charges for the specific provider and consistent with the
prevailing charges in the geographical area for identical or similar services among
comparable providers, taking into account the nature of the illness involved.