Accident/Health Policies:






  • Personal Accident Policy
  • Group Personal Accident Policy
  • Mediclaim Policy
  • Group Mediclaim Policy
  • Nagarik Suraksha Policy
  • Overseas Mediclaim Policy








PERSONAL ACCIDENT POLICY:


APPLICABILITY OF INSURANCE:
The purpose of this insurance is to pay fixed compensation for death or disablement resulting from accidental bodily injury.

CLASSIFICATION OF RISKS: NORMAL/HEAVY
NORMAL RISKS: Accountants/Doctors/Lawyers/Architects/Teachers/Bankers, person engaged in administrative functions, Builders, Drivers and persons engaged in occupations of similar hazards and not engaged in manual labor.

HEAVY RISKS: Persons working in mines, explosives, magazines, electrical installations with high tension supply, jockeys, circus personnel, persons engaged in activities like racing, hunting, mountaineering winter sports, skiing, ice-hockey, ballooning and similar hazards.

BENEFITS OFFERED UNDER THE POLICY:
Benefit is paid if during the period of insurance the insured shall sustain and bodily injury solely and directly form accident caused by external violent and visible means as follows:

TABLEBENEFITSINDEMNITY
% age if sum insured
I1. Death cover100% of S.I.
II2. Death Cover.Loss of 2 limbs or 2
eyes or 1 eye and 1 limb.
3. Loss of 1 limb or 1 eye.
4. Permanent total Disablement.
5. Permanent Partial Disablement.		100% of S.I.

50% of S.I.
100% of S.I.
10% of S.I.
III6. In addition to % benefits offered
under table II+Temporary Total
Disablement.		1% of S.I. per week.







GROUP PERSONAL ACCIDENT POLICY:



APPLICABILITY OF INSURANCE:
Group policies can be issued where there is some common relationship among the persons to be insured and a central point for the administration of insurance scheme.

TYPE A:
Covering employees of a firm/ company/ association/ club (employer-employee relationship)- on named and unnamed basis.

TYPE B:
Covering members of an institution/ society association/ club(no employer-employee relationship)- on named and unnamed basis.
  • No cumulative bonus and educational fund
  • On duty cover 75% of premium
  • Off duty cover 50% of premium

GROUP DISCOUNT:

NO. OF PERSONSDISCOUNT (%)
101-10005.0
1001-100007.5
10001-5000010.0
50001-10000012.5
100001-20000015.0
200001-50000020.0
500001-100000025.0
Above 100000130.0






MEDICLAIM POLICY:



APPLICABILITY OF INSURANCE:
The policy covers reimbursement of hospitalization/domiciliary hospitalization expenses for illness / diseases or injury sustained.

INDEMNIFICATION UNDER THE POLICY:
In the event of any claim becoming admissible under this scheme, the amount of such expenses reasonably and necessarily incurred under the heads given here below are payable. However, this should not exceed the sum insured in any one period of insurance.
  • Room, Boarding expenses in the hospital / nursing home.
  • Nursing expenses.
  • Surgeon, anesthetist, medical practitioner, consultants, specialists’ fee appliances, medicines and drugs, diagnostic materials and x-rays, dialysis, chemotherapy, radio therapy, cost of pace-maker, artificial limbs and cost of organs and similar expenses.


N.B.: All claims admitted during the period of insurance shall not exceed the sum-insured person mentioned in the policy schedule.

ADDITIONAL BENEFITS:
This scheme also provides the following benefits:
  • Family package discount in premium.
  • Cumulative bonus.
  • Cost of health check-up.


ESSENTIAL REQUIREMEMTS FOR HOSPITAL/NURSING HOME:
  • It should have atleast 15 in-patient beds.
  • Fully qualified nursing staff under its employment round the clock.
  • Fully qualified doctors should be in charge round the clock.
  • Availability of fully equipped operation theater.


DOMICILIARY HOSPITALIZATION BENEFIT:
This means medical treatment for a period exceeding 3 days for such illness / disease / injury which in the normal course will require care and treatment at a hospital / nursing home but actually taken whilst confined at home in India under any of the following situations:
  • The condition of the patient is such that he/she cannot be removed to the hospital/ nursing home or
  • The patient cannot be removed to hospital / nursing home for lack of accommodation therein.


EXCLUSIONS UNDER DOMICILIARY HOSPITALIZATION BENEFITS:
  • Any treatment not exceeding 3 days.
  • Expenses incurred for pre & post hospitalization treatment.
  • Expenses incurred for treatment of any of the following diseases.
    • Asthma
    • Bronchitis
    • Chronic Nephritis
    • Diarrhea and all type of Dysenteries including Gastro enteritis.
    • Diabetes Mellitus and Insipidus.
    • Epilepsy
    • Hypertension
    • Influenza, Cough and cold
    • All psychiatric or Psychosomatic Disorders
    • Pyrexia of unknown origin for less than 10 days
    • Tonsillitis and upper respiratory Tract Infection including Laryngitis.
    • Arthritis, Gout and Rheumatism.


EXCLUSIONS UNDER THE POLICY:

PRE-EXISTING ILLNESS:
All diseases / injuries which are preexisting when the cover incept for the first time are excluded.

FIRST 30 DAYS EXCLUSIONS:
Any disease other then “diseases coming under First year exclusions” contracted by the insured person during the first 30 days from the commencement of the insurance are excluded.

FIRST YEAR EXCLUSIONS:
During the first year of operation of the cover, the expenses incurred on treatment such as Cataract, Benign Prostatic Hypertrophy, Hysterectomy Menorrhagia or Fibromyoma, Hernia, Hydrocele. Congenital Internal Diseases. Fistula in anus, piles. Sinusitis and related disorders are not payable.

GENERAL EXCLUSIONS APPLICABLE IN ALL SITUATIONS:
  • War or warlike operations
  • Circumcision unless it is necessary for a treatment of a disease not excluded under the scheme or necessitated due to an accident.
  • Cost of spectacles and contact lenses, hearing aids.
  • Dental treatment or surgery of any kind unless warranting hospitalization.
  • Convalescence, general debility, “Run-down” condition or rest cure, congenital external disease or defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs / alcohol.
  • Charges incurred at the hospital primarily for diagnostic, x-ray or laboratory examinations not connected with the positive existence of any ailment is excluded.
  • Expenses on vitamins and tonics unless forms part of treatment.
  • Nuclear weapons, materials.
  • Treatment pertaining to pregnancy (including voluntary termination of pregnancy), child birth including ceasarian operation.
  • Naturopathy treatment.


AGE-LIMIT:
  • 5 TO 75 YEARS
  • Children between the age group of 3 months and 5 years of age can also be covered so long as one or both parents and covered.


FAMILY DISCOUNT:
A discount of 10% in the total premium will be allowed comprising the insured and any one or more of the following:
  • Spouse.
  • Dependent Children i.e., Legitimate or legally adopted children.
  • Dependent parents/ parents-in.law.






GROUP MEDICLAIM SCHEME:


  • GROUP MEDICLAIM SCHEME is available for named persons only.
  • GROUP MEDICLAIM SCHEME applicable as per the following table
    No. of personsDiscounts %
    101-5002.5
    501-10005.0
    1001-20007.5
    2001-1000010.0
    10001-1500012.5
    15001-2500015.0
    25001-5000020.0
    Above 50000 persons30.0

  • MATERNITY BENEFIT EXTENSION is available with 10% loading on Total Basic premium. Maximum benefit allowable is Rs. 50,000/- or sum insured which ever is lower.
  • COST OF HEALTH CHECK-UP is not payable under Group Mediclaim policy.
  • CUMULATIVE BONUS is not available under Group Mediclaim policy
  • Group Mediclaim policy is subject to BONUS CLAUSE i.e., Low Claims Ratio discount or High Claims Ratio loading will be applicable on the premium at renewal depending on the incurred claims ratio for the entire group insured.





NAGRIK SURAKSHA POLICY:



COVERAGE:
Personal accident cover (Death, Loss of Limbs, PTD and PPD more than 40%) upto a maximum of 80% of the Total Sum Insured opted and reimbursement of accidental hospitalization expenses upto 20% of the opted Sum insured.

TYPES:
Individual / Family Package and Group Policy.

SUM INSURED:
  • Minimum Rs. 1 Lac.
  • Increase in multiples of Rs. 25,000/-
  • Six times the annual salary of the proposer
  • Maximum Rs. 5 Lacs.


POLICY PERIOD:
Individual - 1 to 4 years
Group - 1 year.

ELIGIBILITY:
Indian citizens 5 to 70 years in case of family cover. 18 to 70 years for group/ individual cover.

GEOGRAPHICAL SCOPE: Worldwide.

Payment of claims: Indian Currency only.

Hospital/ Nursing Home means:
Medical establishments with:
  • Inpatient bed facilities
  • Fully equipped operation theatre
  • Fully qualified nursing staff on duty round the clock
  • Full-fledged modern X-ray facilities
  • Fully qualified Registered Medical Practitioners in-charge round the clock.


SUM INSURED LIMITATION:

Individual: Maximum 6 times annual income.

Family Cover: Maximum 6 times annual income of proposer for non-earning members also.

ALTERATION OF SUM INSURED:
It is not permissible to alter the sum insured during the currency of policy.

FAMILY PACKAGE DISCOUNT:
10% for one or more additional members.

OTHER BENEFITS (Only for Individual Nagrik Suraksha Policy)

Cumulative Bonus:
5% for each completed claim free year for PA section. Maximum 20% if renewed within 30 days of expiry.

Carriage of Dead Body and Funeral Charges (Available for Group Policy also)
@2% of the Sum Insured under P.A. section or Rs. 2,500/- whichever is less.

Education Fund:
In the event of death or PTD by accident to the Insured, 10% Sum Insured under PA subject to maximum of Rs. 5,000/- in cases of one dependent child below the age of 23 years or Rs. 10,000 in case of more than one dependent child below the age of 23 years.

Loss of Employment:
In case of loss of employment of the insured due to PTD, 1% of Sum Insured under PA Section is payable in addition to the Sum Insured The following points are to be applied strictly whilst issuing a Nagrik Suraksha Policy.
  • The policy is available only to Indian Citizens.
  • No short period policy will be issued.
  • No alteration in sum insured during the currency of the policy is allowed.
  • No income tax benefit is available under this policy.
  • No reimbursement of expenses towards pre and post hospitalization under section II of the policy is available.
  • No third party cheque should be accepted against premium under the policy.


GROUP POLICY:
  • Group of persons comprising of more than 100 persons.
  • It is not permissible to issue unnamed group policy.
  • Add-on benefits viz., Education Fund, cumulative bonus, family discount, loss of employment are not available under group policy.






OVERSEAS MEDICLAIM POLICY:



This policy provides indemnity for expenses incurred for medical treatment for illness, diseases contracted or injury sustained during overseas travel which is primarily in the nature of an emergency and without which insured would not be able to leave the overseas country. It also provides travelers with in flight Personal Accident, Loss of passport, Loss of checked baggage, Delay of checked baggage, Personal liability benefits.

This policy is not designed to provide any indemnity in respect of medical services, the need for which arises out of pre-existing conditions.

PERIOD OF COVER:
  • Under plans A-1, A-2, B-1 and B-2 policy can be issued for upto 180 days any one trip. However, cover can be considered for extension beyond 180 days subject to prior approval form Regional Office by issuing fresh policy and exclusion of treatment for any illness/ accident declared or not occurring during the previous policy period or before inception of this policy.
  • Under plans E-1 and E-2 annual policies can be issued to corporate Frequent Travelers with a maximum limit of 60 days per trip but unlimited number of trips per year. It subject to the total days outside India during the policy period is limited to 180 days.
  • For CFT policies, medical reports are required to be submitted for persons above 60 years of age to have full cover for illness.


AGE LIMIT:
FOR PLANS ‘B’ AND ‘H’:
  • Proposers between 5 years to 70 years of age.
  • Accompanying child between 6 months and 5 years of age can also be covered under B and H cover subject to exclusion of childhood diseases
  • Children under 6 months of age are not insurable at all.
  • Proposals received from persons over 70 years (completed years 71 and above) have to be referred to for approval.
  • For proposals received from persons over 84 years of age reference should be made to Head Office at least 15 days prior to date of departure along with all medical reports, completed proposal forms including the doctor’s report and a general health certificate from the usual physician which is a must.
  • CFT cover would be available for persons in the age group of 18 to 70 years only.


AGE BAND:
To determine the applicable age band only consider the proposer’s age in “Completed years”. For example for a proposer who has completed 40 years, the age band ‘5 to 40’ would apply. When the proposer’s declared age is 41 and above the age band of ’41 to 60’ should be applied.

ISSUANCE OF OVERSEAS MEDICLAIN POLICY BEYOND 70 YEARS:
Loading:
AGE IN COMPLETED YEARSLOADING
71 and 72 years25%
73 and 74 years50%
75 to 79 years100%
80 to 84 years150%


Note:
Proposals for 80 Years of age and above should be accommodated under Plan A-1/ B-1 only. It is reiterated that Plan A-2/ B-2 should not be granted such persons.

IMPORTANT REQUIREMENTS ALONG WITH PROPOSAL FORMS:
  • Passport details such as citizenship and its validity.
  • Visa details and its validity.
  • Country of visits.
  • Name and address of the Indian Sponsor along with certificate showing details of employment/ study and its duration.
  • Period of Insurance required.
  • Medical examination as per medical procedure prescribed in the guidelines(ECG, Blood Test, Sugar Test, BP reading)
  • Income Certificate of sponsor(in case of student)