27.5.2022<\/p>\n\n\n\n
To
All Insurers<\/p>\n\n\n\n
1. Reference is invited to the Chapter II of Section 1 of Master Circular on Standardization of Health Insurance Products Ref : IRDAI\/HLT\/REG\/CIR\/193\/07\/2020 dated 22.07.2020 prescribing nomenclature and procedure for 22 critical illnesses that may form part of health insurance policies. Insurers were mandated to use the definitions without exception wherever the products cover any of the Critical Illnesses specified in the guidelines.<\/p>\n\n\n\n
2. In partial modification of clause 1, 11 & 18 aforementioned circular, the definitions specified hereunder are substituted :<\/p>\n\n\n\n 3. These modifications shall come into force with immediate effect.<\/p>\n\n\n\n 4. All other terms and conditions referred in the within referred master circular dated 22.07.2020 shall remain unchanged.<\/p>\n\n\n\n This has the approval of the competent authority.<\/p>\n\n\n\n (DVS Ramesh)S.NO<\/strong><\/td> Critical
Illness<\/strong><\/td>Modified Definition<\/strong><\/td><\/tr> 1<\/td> CANCER OF
SPECIFIED
SEVERITY<\/td>CANCER OF SPECIFIED SEVERITY
<\/strong>I. A malignant tumor characterized by the
uncontrolled growth and spread of malignant cells
with invasion and destruction of normal tissues. This
diagnosis must be supported by histological evidence
of malignancy. The term cancer includes leukemia,
lymphoma and sarcoma.
II. The following are excluded \u2013
i.All tumors which are histologically described as
carcinoma in situ, benign, pre-malignant, borderline
malignant, low malignant potential, neoplasm of
unknown behavior, or non-invasive, including but
not limited to: Carcinoma in situ of breasts, Cervical
dysplasia CIN-1, CIN – 2 and CIN-3.
ii. Any non-melanoma skin carcinoma unless there is
evidence of metastases to lymph nodes or beyond;
iii.Malignant melanoma that has not caused invasion
beyond the epidermis;
iv. All tumors of the prostate unless histologically
classified as having a Gleason score greater than 6
or having progressed to at least clinical TNM
classification T2N0M0
v. All Thyroid cancers histologically classified as
T1N0M0 (TNM Classification) or below;
vi. Chronic lymphocytic leukaemia less than RAI stage
3
vii. Non-invasive papillary cancer of the bladder
histologically described as TaN0M0 or of a lesser
classification,
viii.All Gastro-Intestinal Stromal Tumors
histologically classified as T1N0M0 (TNM
Classification) or below and with mitotic count of
less than or equal to 5\/50 HPFs;<\/td><\/tr>2<\/td> MULTIPLE
SCLEROSIS
WITH
PERSISTIN
G
SYMPTOMS<\/td>MULTIPLE SCLEROSIS WITH PERSISTING
SYMPTOMS<\/strong>
I. The unequivocal diagnosis of Definite Multiple
Sclerosis confirmed and evidenced by all of the
following:
i. investigations including typical MRI findings
which unequivocally confirm the diagnosis to be
multiple sclerosis and
ii. there must be current clinical impairment of
motor or sensory function, which must have
persisted for a continuous period of at least 6
months.
II. Neurological damage due to SLE is excluded.<\/td><\/tr>3<\/td> LOSS OF
SPEECH<\/td>LOSS OF SPEECH<\/strong>
I.Total and irrecoverable loss of the ability to speak
as a result of injury or disease to the vocal cords.
The inability to speak must be established for a
continuous period of 12 months. This diagnosis
must be supported by medical evidence furnished
by an Ear, Nose, Throat (ENT) specialist.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n
Chief General Manager (Health)’<\/p>\n\n\n\n