Aviva Heart Care Plan

Aviva Heart Care Plan is a health insurance plan which is specially designed to cover cardiac related ailments and complications. The plan provides an exhaustive coverage by covering almost all heart-related problems. Furthermore, the plan comes with an option of covering the spouse under the same plan.

Key features of the plan

• This is a health insurance plan which covers 19 heart related illnesses and ailments.
• The ailments are categorized in three heads of mild, moderate and severe and the payout depends on the severity of the ailment suffered.
• There are four coverage options under the plan. These options allow coverage for self and spouse in one plan and also provide the option of Sum Assured restoration for severe ailments if the coverage is exhausted in any policy year.
• Premium discounts are available for choosing a high Sum Assured level.

How does the plan work?

Step 1 – the policyholder chooses the Sum Assured and the coverage option. There are four coverage options which are as follows:

• ME which covers a single life
• ME + which covers a single life and also allows restoration of the Sum Assured for covering severe ailments in case 100% of the Sum Assured is exhausted in settling earlier claims for mild or moderate ailments. Once the restoration benefit is activated, future premiums are waived off and claims are made only for severe ailments.
• WE which covers the life insured and the spouse in one plan independently. Both lives have 100% Sum Assured cover. If 100% of the Sum Assured of any life is exhausted, the premiums are waived off and the plan terminates for that life but continues for the second life.
• WE + which covers the life insured and the spouse and also allows restoration of the Sum Assured. Restoration is allowed once for each life insured. Moreover, restoration is available for treating severe ailments only. Once the restoration benefit is activated, future premiums are waived off.

Step 2 – The policyholder also chooses the plan tenure and the premium paying frequency. Premiums are payable throughout the plan term.

Step 3- Heart-related ailments are categorized under three categories. If the life insured suffers any ailment, the payout would be made depending on the category of the ailment. Moreover, there is also a limit to the number of claims which can be made during the plan tenure. This limit also depends on the category of the ailment suffered.

Step 4 – If the plan matures and the life insured does not suffer any ailment, no maturity benefit is paid.

Example

Rahul, a non-smoking male aged 30 years, buys Heart Care plan for a term of 20 years. The Sum Assured he chooses is Rs.10 lakhs.

Option 1 – Rahul chooses the ME option. He undergoes Pericardectomy which is categorized as a ‘Mild’ ailment. Thus, he gets Rs.2.5 lakhs payout. If he suffers a heart attack later in the policy tenure, it would be classified as ‘Severe’ ailment and he would get the remaining Sum Assured which is Rs.7.5 lakhs.

Option 2 – Rahul chooses ME+ option. He takes two ‘Moderate’ category treatments which pay his 50% of the Sum Assured in each instance. When his Sum Assured is exhausted, it is restored back to Rs.10 lakhs which would be available if he suffers any ‘Severe’ ailment.

Option 3 – Rahul takes WE option covering his wife too. Both the lives can claim the plan benefits. If Rahul suffers heart attack which is a ‘Severe’ condition, 100% of the Sum Assured is paid thus exhausting his cover amount. His policy would be terminated but his wife’s policy would continue and premiums would be waived off.

Option 4 – Rahul chooses WE+ option with restoration benefit. He takes two ‘Moderate’ category treatments which pay his 50% of the Sum Assured in each instance. When his Sum Assured is exhausted, it is restored back to Rs.10 lakhs. His wife’s Sum Assured can also be restored if it gets exhausted in treating any ‘Mild’ or ‘Moderate’ ailment. The restored Sum Assured would be applicable for ‘Severe’ ailments for both lives and the future premiums would be waived off.

Plan benefits

• Illness benefit – if the life insured (s) suffer from any heart-related ailments covered by the plan, the Sum Assured is paid in a proportion depending on the severity of the ailment suffered. Though multiple claims can be made in a policy period, there is a limit on the maximum number of claims which can be made. This limit also depends on the severity of the illness. The categories, limit on claims and the payout proportion are as follows:

Eligibility Criteria

Moreover, in case of ME+ and WE+ plan variants, the premiums are waived off if the restoration benefit is activated and the Sum Assured is replenished.

Maturity Benefit – when the chosen tenure expires and the plan matures, no benefit is paid if the life insured does not suffer from any heart ailments.