Health Insurance Plans

Accident means any sudden, unintended and fortuitous external and visible event, which might cause bodily injury or which leads to a physical disability or death.

Yes you can include your family. There are various packaged plans, which we have and hence the inclusion of your family will depend on the plan that you will opt for.

Mediclaim policy is designed to cover the hospitalization expenses arising out of illness, sickness & accident. PA policy on the other hand is a benefit policy & the benefits are paid to the insured on the prescribed scale on happening of an accident leading to admissible claim under the policy. PA policy can be extended to cover the reimbursement of the medical expenses on payment of extra premium.

Loss of, or loss of use of, specified members of the body resulting from accidental bodily injury is called dismemberment.

Doctor certified total and continuous loss or impairment of a body part or sensory organ specified

Doctor certified disablement which entirely prevents You from engaging in your usual occupation or employment or any other occupation or employment for which You are suited by reason of education, training, experience or skill or if not employed, from engaging in any and every occupation for the remainder of Your life

Doctor certified inability to engage in your usual occupation or employment

No, personal accident policy does not cover natural death. Only deaths due to accident will be covered.

Benefits under the Accident Policy are as mentioned.

Death 100 % of Sum Insured

Permanent Total Disablement 100 % of Sum Insured

Loss of two limbs / Two eyes or one limb and one eye 100 % of Sum Insured

Loss of one limb or one eye 50 % of Sum Insured

Permanent Partial Disablement Varies from 1% to 75% of Sum Insured depending on the disablement

Temporary Total Disablement 1 % of Sum Insured per week subject to a maximum of Rs 5000 per week for a maximum period of 100 weeks

Details are mentioned in policy certificate provided by us.

The standard exclusions under the policy are as under:

Any claim in the same period of insurance exceeding the Sum Insured

Suicide, attempt thereat, VD, criminal breach of law, influence of liquor / drugs

Pregnancy related claim

War and nuclear perils

For details of exclusions refer the policy documents.

The coverage offered under the policy is on worldwide basis. So the policy covers any accident happened even abroad. However policies are also issued which are locations or time basis. Please check the policy document for the confirmation.

Hospital Cash allowance pays a fixed daily benefit to an insured person for being admitted in a hospital because of an accident. The benefit amount and the number of days for which the payment will be made are based on the cover taken by you. The Amount paid is compensation and is not restricted to actual expenses that one incurs in the Hospital.

Note: Hospital cash allowance is an additional cover under accident policy on payment of additional premium.

Amateur sports will be covered. While you are covered for most of the normal, non- hazardous sports, Professional sport and any racing are not covered.

The following activities and sports are not covered by the policy: Whilst working in underground mines, explosives, magazines, workers involved in electrical installation with high tension supply, jockeys, circus personnel, Engaged in activities like racing on wheels or horseback, big game hunting, mountaineering, winter sports, rock climbing, pot holing, bungee jumping, skiing, ice hockey, ballooning, hand gliding, river rafting, polo and persons engaged in occupation / activities of similar hazard.

Yes you will be covered only if travel in the Plane as a passenger and if the death is due to physical injury caused by the hijackers or if such hijacked plane meets with an accident

NO - Only people traveling as a passenger on a registered standard airline are covered.

The following is the indicative list of documents required for processing a claim.

Documents required for death claims include:

Claim form

Attending doctor’s report

Original death certificate

Original / attested post mortem / coroner’s report

Attested copy of FIR / Panchnama

Police Inquest Report, where applicable

Documents required for disablement claims include:

Claim form

Attending doctor’s report

Original disability certificate from the doctor

Investigation / laboratory reports and other medical case papers

Original discharge summary if hospitalized

Police Inquest report, where applicable

In case of permanent total disability, disability certificate from competent authority.

Documents required for weekly benefit claims include:

Claim form

Attending doctors report

Original disability certificate from the doctor

Investigation / laboratory reports and other medical case papers

Employee leave certificate with grade / designation

The claim can be intimated by either writing to us at the address mentioned in the policy or just give a call at the toll free number, mentioning the policy number / certificate number and name of insured and we shall take the claim process forward.

MLC Copy, a Medico – Legal certificate is the certificate signed by the policeman and issued by the hospital for medico legal cases (cases where police need to be kept informed). On admission to the hospital, hospital medical staff will identify the cause or nature of illness / disease / accident and if required will inform the police about the case. Policeman will visit the hospital to enquire the cause and sign the MLC Copy.