Rules & Terms for Critical Illness Insurance (BV-NR21/2025)
The BV-NR21/2025 Critical Illness Insurance product provides financial protection against specified severe diseases, including cancer (early and late stages), stroke, and myocardial infarction. Benefits are paid out based on the stage of the illness, with total payouts capped at 100% of the Sum Assured. Policyholders must adhere to strict claim submission deadlines and disclosure requirements to maintain policy validity and ensure timely claim resolution.
Key Takeaways
Coverage includes early and late-stage cancer, stroke, and heart attack.
Early-stage cancer pays 25% of the Sum Assured, maintaining policy effect.
Total payout for all claims cannot exceed 100% of the Sum Assured.
Claims must be filed within one year of the insured event occurrence.
Policyholders have a 21-day free-look period to cancel the contract.
What are the core insurance benefits provided by the policy?
The core benefits of this critical illness policy focus on providing essential financial support upon the diagnosis of specified severe diseases, primarily cancer, stroke, and myocardial infarction. For early-stage cancer, the policy pays 25% of the Sum Assured, up to 500 million VND, and importantly, the policy remains in effect. For late-stage cancer, stroke, or myocardial infarction, 100% of the Sum Assured is paid, minus any previous early-stage cancer payout, after which the policy terminates. All diagnoses must be confirmed by a specialist and meet the specific conditions outlined in Appendix 2, ensuring the total cumulative payout never exceeds 100% of the Sum Assured.
- Early-stage cancer: 25% Sum Assured payout; policy remains active.
- Late-stage cancer, stroke, or heart attack: 100% Sum Assured payout; policy terminates.
- Diagnosis must be confirmed by a specialist and satisfy Appendix 2 conditions.
- Total cumulative payment is strictly limited to 100% of the Sum Assured.
- No payment is made if the diagnosis occurs during the Waiting Period.
How should policyholders submit and resolve insurance claims?
Policyholders must adhere to strict timelines when submitting claims to ensure prompt resolution and validity. Risk events must be reported to the insurer within 30 days of the policyholder becoming aware of the event. The complete claim file must then be submitted within one year from the date the insured event occurred. Once all valid and complete documents are received, the insurer has 30 days to process the claim. If the case involves a legal matter, the resolution period extends to 30 days after the final court judgment or decision takes effect. The insurer is liable to pay interest if payment is delayed due to the insurer's fault.
- Notify the insurer of the risk event within 30 days of awareness.
- Submit the complete claim file within one year of the event date.
- Required documents include the claim request form, certified medical records, and identification papers.
- The policyholder is responsible for covering the costs of collecting necessary documentation.
What rights and options do policyholders have regarding policy management?
Policyholders possess several key rights, including the ability to review and cancel the contract shortly after issuance. They are granted a 21-day “free-look” period starting from the date they receive the contract, during which they can choose to reject participation. If canceled during this period, the premium is refunded, excluding any medical examination fees. Policyholders also have the right to terminate the product prematurely, with the refund amount depending on the policy year. Furthermore, policies can be reinstated within 24 months of termination, provided outstanding premiums and health check requirements are met, subject to insurer approval.
- 21-day consideration period to reject the contract and receive a premium refund (minus health check fees).
- Early termination refund rate is 0% in years 1 and 2, and 100% from year 3 onward.
- Policy reinstatement is possible within 24 months of termination, subject to insurer approval.
- Policyholders can request a reduction in the Sum Assured, adjusting premiums and benefits accordingly.
How are the insurance term and premium payments structured?
The insurance term is structured annually, lasting one year from the effective date or the renewal date of the product. Premiums are calculated based on several factors, including the Sum Assured, payment frequency, age, gender, and risk assessment. The duration for premium payment is equal to the insurance term. It is crucial that policyholders only make payments against legitimate payment slips or invoices issued by the insurer, as the insurer is only responsible for premiums paid through these authorized means. A grace period of 60 days is provided if the premium is not paid on time, after which the policy terminates if payment remains incomplete.
- The insurance term is one year, starting from the effective date or renewal date.
- Premiums are calculated based on Sum Assured, age, gender, and risk assessment.
- The premium payment period matches the one-year insurance term.
- A 60-day grace period is allowed for late premium payments, after which the policy terminates.
What are the general obligations and conditions for policy effectiveness and termination?
General provisions govern the policy's initiation, renewal, and termination conditions. To initiate the policy, the applicant must complete the required application documents and pay the provisional premium. The policy becomes effective either concurrently with the main product (upon submission of documents and provisional payment) or later (upon issuance of the Certificate of Insurance and provisional payment). Policyholders have an ongoing obligation to provide full and truthful information; failure to do so may lead to cancellation, adjustment, or denial of claims. The policy can terminate due to several reasons, including the death of the insured, maximum benefit payout, or failure to pay renewal premiums.
- Policy initiation requires completing the application and paying the provisional premium.
- The insurer reviews the policy annually for renewal, subject to age limits and premium payment.
- The insurer must notify the policyholder of renewal or rejection at least 7 days prior to expiration.
- Policyholders must truthfully declare information and notify the insurer of changes (residence, occupation) within 30 days.
- Termination occurs upon death, maximum claim payout, policyholder request, or non-payment of renewal fees.
Who is covered and what key terms define the policy's scope?
Appendix 1 establishes crucial definitions regarding eligibility and policy mechanics. A Policyholder must be an individual or organization aged 18 or older residing in Vietnam. The Insured Person must be an individual residing in Vietnam, aged 0 to 65 when the policy becomes effective. Renewal is possible up to age 74 if participation has been continuous for at least five years. The Waiting Period is defined as 90 days from the policy's effective date or the most recent reinstatement date, during which no claims for critical illness will be paid. Pre-existing conditions are defined as illnesses or symptoms that arose within 36 months before the policy's effective date or reinstatement.
- Policyholders must be 18+ and reside in Vietnam.
- Insured persons must be 0-65 years old at the effective date, renewable up to age 74.
- The Waiting Period is 90 days from the policy's effective date or reinstatement.
- Pre-existing conditions are those arising 36 months prior to the effective date.
- Activities of Daily Living (ADLs) include eating, bathing, dressing, transferring, mobility, and sanitation.
Which specific critical illnesses are covered and what are the diagnostic requirements?
Appendix 2 details the specific criteria required for the three major covered critical illnesses: Cancer, Stroke, and Myocardial Infarction. For cancer, coverage distinguishes between early stages (I/II) and late stages (III/IV, metastasis, or Grade 3/4 brain tumors), with specific exclusions for certain low-grade cancers like thyroid, skin, and prostate cancer in the early stage. Stroke diagnosis requires evidence of brain damage confirmed by MRI or CT scan, lasting at least 90 days, and resulting in permanent neurological deficits. Myocardial Infarction (heart attack) requires satisfying at least three out of four conditions, including symptoms, ECG changes, angiography results, and elevated cardiac enzyme levels (CK-MB/Troponin).
- Cancer coverage differentiates between early (I/II) and late (III/IV) stages.
- Early-stage cancer exclusions include low-grade thyroid, skin, and prostate cancers.
- Stroke diagnosis requires MRI/CT confirmation of brain damage lasting over 90 days.
- Myocardial Infarction requires meeting specific criteria related to symptoms, ECG, and enzyme levels.
Frequently Asked Questions
Does the policy terminate after an early-stage cancer claim is paid?
No. The policy pays 25% of the Sum Assured for early-stage cancer, up to 500 million VND, and remains in effect. Termination only occurs after a 100% payout for late-stage critical illnesses, such as late-stage cancer, stroke, or heart attack.
What is the deadline for submitting a complete claim file?
The complete claim file must be submitted within one year from the date the insured event occurred. However, you must first notify the insurer of the risk event within 30 days of becoming aware of the event to initiate the claim process.
Can I get a refund if I cancel the policy early?
Yes, but the refund depends on the policy year. If you terminate early, the refund rate is 0% in the first two years. From the third year onward, the refund rate is 100% of the determined surrender value, minus any outstanding debts.
How long is the Waiting Period for critical illness coverage?
The Waiting Period is 90 days. This period starts from the policy's effective date or the most recent date the policy was reinstated. No claims for covered critical illnesses will be paid if the diagnosis occurs during this time.
What happens if I fail to pay the premium on time?
If the premium is not paid by the due date, the insurer grants a 60-day grace period. If the full premium remains unpaid by the end of this 60-day period, the insurance policy will automatically terminate its effectiveness.
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