Transcript Presentation

Presentation on Accident Care
Presentation on
ACCIDENT CARE
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
ACCIDENT
?
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Accident Means
•
•
•
•
Not only Road/Rail or Travel accidents but
also includes
Accidental Fall
Electric Shock
Snake Bite
Drowning in Water
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Covers
Accidental Death
Disablement
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Table of Benefits
Table 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)
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Table II : Percentage of Compensation Payable
Benefits
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
Benefits Percentage of Sum Insured
100%
100%
100%
100%
100%
100%
100%
100%
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Table II : Percentage of Compensation Payable (contd.)
Benefits
g.
h.
i.
j.
k.
l.
m.
n.
o.
p.
Use of two hands
Use of two foot
Use of one hand and one foot
Sight of one eye and use of one
hand
Sight of one eye and use of one
foot
Sight of one eye
Physical separation of one entire
hand
Physical separation of one entire
foot
Use of one hand without physical
separation
Use of one foot without physical
separation
Benefits Percentage of Sum Insured
100%
100%
100%
100%
100%
50%
50%
50%
50%
50%
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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)
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Risk Groups
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
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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Premium Rating
COVERAGE /
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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)
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Group Discount
Group Discount Applicable to Accident Care (Group) Policies
Group Size
Discount on Premium
2 – 100
5%
101 – 1000
10%
1001 – 5000
12.5%
5001 – 10000
15%
Above 10000
20%
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Presentation on Accident Care
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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Restricted Cover
On-duty cover : @75% of Applicable Premium
Off-duty Cover : @50% of Applicable Premium
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Cumulative Bonus
Applicable for Death and PTD cover only.
5 % increase in Capital Sum Insured for
every claim free year.
Maximum 50 %.
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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.
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
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)
Star Health and Allied Insurance Co. Ltd.
Presentation on Accident Care
Thank You
Star Health and Allied Insurance Co. Ltd.