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Presentation on ACCIDENT CARE

Presentation on ACCIDENT CARE. ACCIDENT. ?. Accident Means. Not only Road/Rail or Travel accidents but also includes Accidental Fall Electric Shock Snake Bite Drowning in Water. Covers. Accidental Death Disablement. Age Limits.

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Presentation on ACCIDENT CARE

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  1. Presentation on ACCIDENT CARE

  2. ACCIDENT ?

  3. Accident Means Not only Road/Rail or Travel accidents but also includes • Accidental Fall • Electric Shock • Snake Bite • Drowning in Water

  4. Covers • Accidental Death • Disablement

  5. Age Limits • Available for Persons aged between 18 years and 70 years. • Children from 3 years can be covered under family package when atleast any one of the parents are covered.

  6. Table of Benefits

  7. Table I : Accidental Death • Covers Death of the Insured Person • Death occurring within 12 Months from the date of Accident • Compensation payable is 100% of Capital Sum Insured

  8. Table II : Accidental Death + PTD + PPD • Death Cover - As per Table I • Disablement cover • The disablement should occur within 12 Calendar months from the date of the Accident • The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement

  9. Table II : Percentage of Compensation Payable

  10. Table II : Percentage of Compensation Payable (contd.)

  11. Table II : Percentage of Compensation Payable (contd.)

  12. Table II : Percentage of Compensation Payable (contd.)

  13. Table IIIAccidental Death+PTD+PPD+TTD • Death Cover - As per Table I • Death+PTD+PPD Cover- As per Table II • TTD Cover • Weekly compensation @ 1% of the Sum Insured not exceeding Rs. 5000 per week

  14. Capital Sum Insured Maximum Limit • TABLE I - 75 Times of monthly income • TABLE II - 60 Times of monthly income • TABLE III - 24 Times of monthly income (Table III cover can be given only with the approval of Corporate Office)

  15. Risk Groups

  16. Premium Rating Note: Rate provided is “Per Mille” i.e., Per Thousand

  17. Additional Benefits • Educational Grant – Rs.5000 per Child below 18 years maximum Rs.10000 • Transportation of Mortal Remains – Rs.3000 if Accident outside the place of Residence • Travel Expenses for Relative – Actual TravelExpenses, maximum of Rs.1000 (Relative means spouse, children, parents, siblings or in-laws)

  18. Group Discount Group Discount Applicable to Accident Care (Group) Policies

  19. Medical Expenses Extension • ADDITIONAL PREMIUM - 10% • COVERAGE 25% of valid claim under P.A. or the Actual Medical Expenses incurred because of Accident, which ever is less subject to a maximum of 10% of Capital Sum Insured.

  20. Restricted Cover • On-duty cover : @75% of Applicable Premium • Off-duty Cover : @50% of Applicable Premium

  21. Cumulative Bonus • Applicable for Death and PTD cover only. • 5 % increase in Capital Sum Insured for every claim free year. • Maximum 50 %.

  22. Transfer of Policy Documents required for granting Cumulative Bonus (a) Renewal Notice with Cumulative Bonus details • Cumulative Bonus as shown in the Renewal Notice is given (b) No Renewal Notice or Renewal Notice without Cumulative Bonus details • Cumulative Bonus as shown in the Previous Policy is given • If a declaration stating No Claim under the expiring policy is obtained from the insured, eligible Cumulative Bonus will be given Note: To obtain the above mentioned benefits there should be a continuous renewal without break.

  23. Major Exclusions Any Claim, • In Respect of Pre Existing Conditions. • If the Insured acts against the advice of the Physician. • Whilst under the influence of intoxicating liquor or drugs. • Arising out of mental diseases, suicide or attempted suicide, self inflicted injuries or sexually transmitted conditions, anxiety, etc. • Due to participation in hazardous sport / activities. • By persons who are physically and mentally challenged unless specifically agreed and endorsed in the policy. Note: For a detailed list kindly refer the policy conditions.

  24. Claims Procedure Document to be submitted in case of Death Claims • Completed Claim form • Death certificate, Panchanama • FIR, wherever applicable • Postmortem report • In the absence of assignment, Legal Heir ship Certificate/Succession Certificate / Will duly probated • Original Policy, if issued for Individual • Coroner’s Report/Police Inquest Report

  25. Claims Procedure (Contd.) Document to be submitted in case of Disablement Claims • Original Policy • Disability Certificate from the attending Doctor confirming the %age of disability. • Photo of the person indicating the disability. • Completed claim form • FIR, Wherever applicable • Employer’s Certificate for the period of absence from duty (for TTD Claims)

  26. Thank You

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