Accident Trauma Care

Star Health and Allied Insurance Co. Ltd.

Presentation on Accident Trauma Care

Presentation On

Accident Trauma Care



Accident Means

Not only Road/Rail or Travel accidents but also includes

Accidental Fall

Electric Shock

Snake Bite

Drowning in Water

Any thing other than Natural Death or Death due to Disease.



Family

Family shall mean

• Insured Person

• Spouse

• Dependent Children upto 18 years of age

• Dependent Parents.



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.



Section I



Covers

Accidental Death

Permanent Total Disablement

The coverage is applicable only in respect of loss occurring within India.



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



Permanent Total Disablement

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



Section II



Covers

• Covers hospitalisation expenses incurred for grevious injury following an accident, other than work-place accidents and incurred as inpatient for treatment in any nursing home / hospital in India.



Add On Covers

• Work-place accidents



Allowable Expenses• Room, Boarding Expenses as provided by the Hospital /

Nursing Home not exceeding 2% of the Sum Insured

• Nursing expenses

• Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees

• Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, diagnostic imaging modalities, cost of Pacemaker and similar expenses



Common features to Section I and II



Risk Groups that can be covered

Risk Group I Persons engaged primarily in administrative functions

Risk Group II Persons engaged in manual work other than what is specifically provided under Group III

Note: Risk Group III cannot be covered under this policy.



Sum Insured

Section I :

Sum Insured in Multiples of Rs. 5,000/- upto a maximum of Rs. 1,00,000/-.

Section II* :

Sum Insured in Multiples of Rs. 5,000/- upto a maximum of Rs. 1,00,000/-.

* Sum Insured under Section II can be equal to or less than Sum Insured under Section I.



Premium Rating

Section Coverage Rate

I PA Re. 1 per mille

II (a) Basic cover i.e., Hospitalisation for Grevious Injuries

Rs. 2 per mille

II (b) Additional coverage for workplace accidents

Re. 1 per mille

Note: Rate provided is “Per Mille” i.e., Per Thousand Minimum Premium: Rs. 100/-



Group DiscountGroup Discount Applicable to Accident Trauma Care (Group) Policies

Number of persons Discount on the final premium

101-1000 5%1001-10000 7.5%10001-50000 10%50001-100000 12.5%100001- 200000 15%200001-500000 20%500001-1000000 25%Above 1000000 30%



Major ExclusionsAny 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.Cost of spectacles, contact lens, hearing aids, walkers, crutches, wheel chairs, artificial limbs and such other aids.

Note: For a detailed list kindly refer the policy conditions.



Claims Procedure - Accident Claims

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



Claims Procedure - Accident Claims (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



Immediate intimation to the Call Centre (1800 425 2255)

Claim form will be sent to the Insured.

Based on the intimation a field visit will be done by the Star Doctor

Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents

• Original Discharge Summary• Main Hospital Bill with Break Up• Investigation Reports with X-Ray Film• Medical Bills with Prescriptions

Cashless facility will be provided on a case to case basis if treatment is taken in a Network Hospital.

Claim Procedure – Medical Claims



Thank You

Accident Trauma Care

Health & Medicine

Transcript of Accident Trauma Care