INDIVIDUAL PERSONAL
ACCIDENT POLICY
Definition of an Accident
EXTERNAL
VIOLENT
RESULTING TO –
 Death
CAUSE –
 PTD
 PPD
 TTD
VISIBLE
COMPENSATION PAYABLE
1
DEATH
100% of Capital Sum Insured
2
Loss of two limb
100% of Capital Sum Insured
3
Loss of one limb or one eye
50% of Capital Sum Insured
4
Permanent Total Disablement
100% of Capital Sum Insured
5
Permanent Partial Disablement
Depending on disablement % as
specified by treating doctor
6
Temporary Total Disablement
1% of Capital Sum Insured (Subject to
a max. of Rs 10,000 per week)
ADDITIONAL BENEFITS (INBUILT
COVERS)
CUMULATIVE
CHILDREN EDUCATION FUND
EXPENSES FOR CARRIAGE OF DEAD
BODY
Ambulance Charges
Loss of Employment
Damage to
Clothes
Additional Benefits
CUMULATIVE BONUS
•
•
•
•
•
Compensation for individual policies and family package covers (ONLY) under 1 to
4 of Table of Benefits.
The Benefits shall be increased by 5% of Capital Sum Insured in respect of each
completed year subject to following:
Maximum accumulation: …
…
50%.
Bonus is permissible on renewals of other insurers only when the policy is renewed
within 90 days from the date of expiry.
In case Capital Sum Insured is increased at the time of renewal, the bonus will be
allowed only on the previous years CSI at the above rate. Cumulative Bonus on the
additional sum insured will be allowed next year at 5% and such percentage that the
insured has earned on the CSI of previous year policy. The bonus will accordingly be
increased in subsequent years.
CHILDREN EDUCATION FUND:
• In the event of death or permanent total disablement of the insured person
due to an accident and provided the claim under the policy is admissible,
compensation towards Education Fund for the dependant children shall be
paid as under:
• If the Insured person has one dependent child, below the age of 23 years,
amount payable is equal to 10% of C.S.I subject to a maximum of Rs.5,000/-.
• If the insured person has more than one dependent child below the age of 23
years, amount payable is equal to 10% of the CSI subject to a maximum of
Rs.10,000/• The payment as above will be made along with the CSI to the same person/s
who is/are entitled to receive the CSI.
• The benefit under this extension will be available on the basis of the Original
CSI only and not on the Cumulative Bonus.
• The age of 23 years shall apply on the date of accident only.
EXPENSES FOR CARRIAGE OF DEAD BODY
•
The policy covers reimbursement of actual expenses, including funeral charges
incurred for transportation of the dead body of the insured to the place of his
residence in the event of death claim being admissible under the Policy. Limit will be
Rs.2,500/-
AMBULANCE CHARGES
•
Ambulance charges for transportation of Insured person to Hospital following
accident, which results in liability having been admitted by the Company as per 1 to 6
of the Table of Benefits is payable upto Rs. 1,000 or actual expenses whichever is
lower in addition to CSI
DAMAGE TO CLOTHES
The cost of clothing damaged in accident as described under the Table of
Benefits is payable at Rs. 1000 per insured person any one accident or actual
expenses whichever is lower in addition to CSI. However, in the event of
death, this amount is payable on basis of declaration by the claimant.
LOSS OF EMPLOYMENT
• In the event of, permanent total disablement i.e. 2,3, 4 of Table of Benefits of
insured person, leading to loss of employment of Insured Person, the
Company will pay 1% of the CSI subject to a maximum of Rs. 15,000 in
addition to CSI
Fixing of Sum Insured
Maximum Limits
Table “A”
…
10 times the annual income
Table “B”
…
05 times the annual income
Table “C”
…
05 times the annual income
Premium rates
Sr.
No.
Table & Benefits
Normal
Risk
Heavy Very Heavy Risk
Risk
(Per Mille)
1.
Rate of premium(per mille)
“A” Benefit
(a)
0.40
0.60
0.75
2.
“B1” Benefits (a) to (d)
0.70
1.00
1.25
3.
“B” Benefits (a) to (e)
0.85
1.25
1.60
4.
“C” Benefits (a) to (f)
1.40
2.00
2.50
Family Package
This cover can be granted if the family members are also to be covered--
) Husband, wife &/or
parents (2 persons)
10.00%
ii) Husband, wife,
parents &/or one
child(3 persons)
12.50%
iii) Husband, wife,
parents &/or more than
one child (more than 3
persons) 15.00%
DISCOUNTS
- attractive family package discount
ranging from `0-15% on the premium ,
It varies with number of family members
covered
UNDERWRITING
GUIDELINES
•
•
•
•
•
Preferably to be done on accommodation for existing clients
Capital sum insured to be as per limits specified
Person should be above 5 years and not older than 70 years of age
The person should be free from any disability
Housewives should be covered only under Table B with CSI limited to
50% of husband’s CSI or Rs 2 lacs which ever is less
• Children and dependent parents should be covered only for Table B but for
CSI limited to 25% of Parent’s CSI or Rs 1 lac which ever is less
Medical Expenses Extension
(a) If loaded by 10%
Actual expenses incurred, or
10% of the C.S.I. or
25% of the admissible P.A. claims
be less.
c) If loaded by 50%
Actual Expenses or
35% of capital sum insured or
75% of the admissible PA claim
whichever shall be less.
b) If loaded by 25%
Actual expenses incurred, or
20% of the C.S.I. or
50% of the admissible P.A. claim amount, whichever shall
Whichever shall be less.
d) If loaded by 100%
Actual Expenses or
50% of capital sum insured or
100% of the admissible PA claim amount
whichever shall be less.
EXCLUSIONS
•
•
•
•
•
Intentional self injury, suicide or attempted suicide, Venereal Disease or Insanity
The insured being under the influence of intoxicating liquor or drugs
Death or disablement resulting from pregnancy or child birth. (in case of female
insured)
The Insured committing any breach of law with criminal intent
Engaging in Aviation or Balloning or Whilst mounting into or dismounting from or
travelling in any a ballon or aircraft other than as passenger (fare paying or
otherwise) in any duly licensed standard type of aircraft
•
•
•
•
Contracting any illness directly or indirectly arising from or attributable to HIV or
any HIV related illness including AIDS and/or any mutant derivative or variation of
HIV or AIDS.
War and allied perils
Nuclear perils
On duty with any armed forces.
DOCUMENTS REQUIRED
IN EVENT OF A CLAIM
•
INTIMATION
F.I.R.
CLAIM FORM
POST
MORTEM
REPORT
X-RAY FILMS
MEDICAL
CERTIFICATE
FOR
DISABILITY
MEDICAL
BILLS
A RECAP
•
•
•
•
•
Loyalty Discount-Not available
Stamp DutyGPA(0.05%o on the CSI of Top 20 Lives)
IPA(0.05%o on the Total SI)
Cumulative Bonus-5% to 50%
Short period rates
On Duty and Off Duty discount
On Duty Discount-25%
Off Duty Discount-50%
Group Discount Table-GPA
•
•
•
•
•
•
•
•
•
•
•
•
Total no of persons
50-100
Between 101 and 2500 persons
Between 2501 and 5000 persons
Between 5001 and 10000 persons
Between 10001 and 25000 persons
Between 25001 and 50000 persons
Between 50001 and 100000 persons
Between 100001 and 200000 persons
Between 200001 and 500000 persons
Between 500001 and 1000000 persons
Between 1000001 and above persons
Group Discount
2.5% on total premium
5% on total premium
7.5%on total premium
10% on total premium
12.5% on total premium
15% on total premium
17.5% on total premium
20% on total premium
25% on total premium
30% on total premium
35% on total premium