Star Health and Allied Insurance Co. Ltd. Presentation on Accident Care Presentation on ACCIDENT...

Star Health and Allied Insurance Co. Ltd.

Presentation on Accident Care

Presentation on

ACCIDENT CARE



ACCIDENTACCIDENT

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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

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.



Table of BenefitsTable I Death Cover Only

Table II Death

+

Permanent Total Disablement (PTD)

+

Permanent Partial Disablement (PPD)

Table III Death

+

Permanent Total Disablement (PTD)

+

Permanent Partial Disablement (PPD)

+

Temporary Total Disablement (TTD)



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



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



Table II : Percentage of Compensation Payable

Benefits Benefits Percentage of Sum Insured

1. Death

2. Permanent Total Disablement

Total and irrevocable loss of

a. Sight of both eyes

b. Physical separation of two entire hands

c. Physical separation of two entire foot

d. One entire hand and one entire foot

e. Sight of one eye and loss of one hand

f. Sight of one eye and loss of one entire foot

100%

100%

100%

100%

100%

100%

100%

100%



Table II : Percentage of Compensation Payable (contd.)Benefits Benefits Percentage of Sum Insured

g. Use of two hands

h. Use of two foot

i. Use of one hand and one foot

j. Sight of one eye and use of one hand

k. Sight of one eye and use of one foot

l. Sight of one eye

m. Physical separation of one entire hand

n. Physical separation of one entire foot

o. Use of one hand without physical separation

p. Use of one foot without physical separation

100%

100%

100%

100%

100%

50%

50%

50%

50%

50%



Table II : Percentage of Compensation Payable (contd.)

BENEFITS Percentage of Sum Insured

Loss of toes – all

Great - both phalanges

Great - one phalanx

Other than Great, if more than

One toe lost – for each toe

Loss of hearing - both ears

Loss of hearing - one ear

Loss of four fingers and thumbs of One hand

Loss of four fingers

Loss of thumb - both phalanges

- One phalanx

Loss of index finger - three phalanges

- Two phalanges

- One Phalanx

20

5

2

1

75

30

40

35

25

10

10

8

4



Table II : Percentage of Compensation Payable (contd.)BENEFITS Percentage of Sum

Insured

Loss of middle finger - Three phalanges

- Two phalanges

- One phalanx

Loss of ring finger - Three phalanges

- Two phalange

- One phalanx

Loss of little finger - three phalanges

- Two phalanges

- One phalanx

Loss of metacarpals - first or second (Additional)

Third, fourth or Fifth (Additional)

Any other permanent partial disablement

6

4

2

5

4

2

4

3

2

3

2

Percentage as assessed by the panel Doctor of the Company



Table III Accidental 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



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)



Risk GroupsRisk 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

Risk Group III Persons working in explosives industry, mine and / or magazine workers, high tension supply, horse racing including jockeys, athletes and occupations of similar hazard.



Premium RatingCOVERAGE / RISK GROUP

GROUP 1 GROUP 2 GROUP 3

Table I 0.45 0.60 0.80

Table II 0.80 1.30 1.75

Table III 1.25 1.75 2.00

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



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 Travel Expenses, maximum of Rs.1000 (Relative means spouse, children, parents, siblings or in-laws)



Group Discount

Group Size Discount on Premium

2 – 100 5%

101 – 1000 10%

1001 – 5000 12.5%

5001 – 10000 15%

Above 10000 20%

Group Discount Applicable to Accident Care (Group) Policies



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.



Restricted Cover

On-duty cover : @75% of Applicable Premium

Off-duty Cover : @50% of Applicable Premium



Cumulative Bonus

Applicable for Death and PTD cover only.

5 % increase in Capital Sum Insured for every claim free year.

Maximum 50 %.



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.



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.

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



Claims ProcedureDocument 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 (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)



Thank You

Star Health and Allied Insurance Co. Ltd. Presentation on Accident Care Presentation on ACCIDENT...

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