Accident comes uninvited and they can unsettle your life and those of your loved ones. A little planning in this regard goes a long way for financial protection.
Presenting Accident Care Individual Insurance from Star Health and Allied Insurance Co Ltd.- a policy that offers protection to you and your loved ones in case you meet with an accident because whatever happens, life must go on
Family Discount: 10% discount on total premium if family is covered.
Exclusions:
1.Any payment, in case of more than one claim under the Policy, during any one period of insurance by which the maximum liability of the Company in that period would exceed the capital sum insured payable under this Policy except in case of Permanent Total Disability claim, in which case the amount payable is 150% of the sum insured. This exclusion will not apply to payments made under Medical Expenses Extension, Hospital Cash, Home Convalescence, Educational Grant, Ambulance Charges/Transportation of mortal remains, Travel expenses of one Relative, Expenses for Vehicle and /or Residence Modification, Purchase of Blood and Transportation of Imported Medicine
2.Any claim relating to events occurring before the commencement of the cover or otherwise outside the Period of Insurance
3. Any injuries/conditions which are Pre-existing.
4. Any claim for Death or Disablement of the Insured Person from (a) intentional self-injury / suicide or attempted suicide or (b) whilst under the influence of intoxicating liquor or drugs or (c) self-endangerment unless in self-defense or to save life.
5.Any claim arising out of mental disorder, suicide or attempted suicide, self inflicted injuries, or sexually transmitted conditions, anxiety, stress, depression, venereal disease or any loss directly or indirectly attributable to HIV (Human Immunodeficiency Virus) and / or any HIV related illness including AIDS (Acquired Immunodeficiency Syndrome), insanity and / or any mutant derivative or variations thereof howsoever caused.
6.Insured Person engaging in Air Travel unless he/she flies as a fare-paying passenger on an aircraft properly licensed to carry passengers. For the purpose of this exclusion Air Travel means being in or on or boarding an aircraft for the purpose of flying therein or alighting there from.
7. Accidents that are results of war and warlike occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power, seizure capture arrest restraints detainments of all kings princes and people of whatever nation, condition or quality whatsoever
8. Participation in riots, confiscation or nationalization or requisition of or destruction of or damage to property by or under the order of any government or local authority
9. Any claim resulting or arising from or any consequential loss directly or indirectly caused by or contributed to or arising from:
a) Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion (including any self sustaining process of nuclear fission) of nuclear fuel.
b) Nuclear weapons materia
c) The radioactive, toxic, explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof
d) Nuclear, chemical and biological terrorism
10. Any claim arising out of sporting activities in so far as they involve the training or participation in competitions of professional or semi-professional sports persons.
11. Participation in Hazardous Sport / Hazardous Activities
12. Persons who are physically and mentally challenged, unless specifically agreed and endorsed in the policy.
13. Any loss arising out of the Insured Person's actual or attempted commission of or willful participation in an illegal act or any violation or attempted violation of the law.
The above mentioned amounts are payable in addition to the sum insured.
Note: Wherever the word “Death / Disability” occurs it means “Death/Disability” arising out of Accidents.
Additional Benefits (No Extra Premium)
Note : These benefits apply only when there is an admissible claim under the policy.
Who Can Take This Insurance?
A free look period of 15 days from the date of receipt of the policy is available to the insured to review the terms and conditions of the policy. In case the insured is not satisfied with the terms and conditions, the insured may seek cancellation of the policy and in such an event the Company shall allow refund of premium paid after adjusting the stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation.
Free look Period is not applicable at the time of renewal of the policy.
Special Conditions
1.If the Accident affects any physical or mental function, which was already impaired prior to the accident, a deduction as certified by a Government Doctor will be made in respect of this prior disablement
2.If the accident impairs a number of physical or mental functions, the degree of disablement given in the Table of Benefits will be added together, but liability in any case shall not exceed 100% of the Sum Insured (150% in case of Permanent Total Disablement)
3.In case of Permanent Partial Disablement claim the Sum Insured under the policy will be reduced by the amount of admissible claim under the policy in respect of the Insured Person to whom such sum shall become payable.
4.In the event of Permanent Disablement, the Insured Person will be under obligation:
a) To have himself/herself examined by doctors appointed by the Company / and the Company will pay the costs involved thereof.
b) To authorize doctors providing treatments or giving expert opinion and any other authority to supply the Company any information that may be required. If the obligations are not met with due to whatsoever reason, the Company may be relieved of its liability to pay. Provided however the insured shall be deemed to have discharged his duties/obligations if he authorizes / gives consent to the treating doctor/s or the experts who gave opinion. Any subsequent failure on the part of the treating doctor/experts who gave opinion / hospital will not be held up against the insured.
5.Where a claim for 100% of the Capital Sum Insured (150% for Permanent Total Disablement) is admitted / admissible, the coverage under the policy ceases and the policy cannot be renewed for such relevant person
6.Where a claim for less than 100% of the Sum Insured is admitted / admissible, the coverage under the policy will continue until expiry for the balance sum insured and Company would exclude such disability on renewal in respect of such relevant person
Renewal: The policy will be renewed except on grounds of misrepresentation / fraud committed.
A grace period of 30 days from the date of expiry of the policy is available for renewal. If renewal is made within this 30 days period the continuity of benefits will be allowed. However the actual period of cover will start only from the date of payment of premium. In other words no protection is available between the policy expiry date and the date of payment of premium for renewal.
Every renewal premium (which shall be paid and accepted in respect of this policy) shall be so paid and accepted upon the distinct understanding that no alteration has taken place in the facts contained in the proposal or declaration herein before mentioned and that nothing is known to the Insured that may result to enhance the risk of the Company under the insurer. Where a claim for 100% of the Capital Sum Insured is admitted / admissible, the policy cannot be renewed for such relevant person.
Where a claim for less than 100% of the Sum Insured is admitted / admissible, the Company would exclude such disability on renewal in respect of such relevant person
In the event of this policy being withdrawn / modified with revised terms and/or premium with the prior approval of the Competent Authority, the insured will be intimated three months in advance and accommodated in any other equivalent insurance policy offered by the Company, if requested for by the Insured Person, at the relevant point of time
Renewal premium is subject to change with prior approval from the Regulator. Change of options/plans within same product are permissible only at the time of renewal.
Table A | Accidental Death | 100% of Sum Insured + Bonus (if any) | |
a. Accidental Death | 100% of Sum Insured + Bonus (if any) | ||
Table B | b. Permanent Total Disablemen | 150% of Sum Insured + Bonus (if any) | |
c. Permanent Partial Disablement | Specified percentage depending on the disability | ||
a. Accidental Death | 100% of Sum Insured + Bonus (if any) | ||
Table C | b. Permanent Total Disablement | 150% of Sum Insured + Bonus (if any) | |
c. Permanent Partial Disablement | Specified percentage depending on the disability | ||
d. Temporary Total Disablement |
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The benefit under this table is payable during the period of Temporary Total Disablement of the person covered due to an accident and resulting in hospitalization. The compensation payable is at the rate of 1% of the sum insured, subject to a maximum of Rs.15,000/- , per completed week, upto 100 weeks. |
Risk Group I- Persons engaged primarily in administrative functions.For purpose of rating, persons proposed for insurance are classified under three risk groups
Premium for One Year Policy
Coverage / | Premium ( Rs.) per mille sum insured | ||
Risk Group | Risk Group I | Risk Group II | Risk Group III |
Table A | 0.43 | 0.60 | 0.80 |
Table B | 0.70 | 1.30 | 1.75 |
Table C | 1.25 | 1.75 | 2.00 |
Premium for Two Year Policy
Coverage / | Premium ( Rs.) per mille sum insured | ||
Risk Group | Risk Group I | Risk Group II | Risk Group III |
Table A | 0.83 | 1.16 | 1.54 |
Table B | 1.35 | 2.51 | 3.38 |
Table C | 2.41 | 3.38 | 3.86 |
Premium for Three Year Policy
Coverage / | Coverage / Premium ( Rs.) per mille sum insured | ||
Risk Group | Risk Group I | Risk Group II | Risk Group III |
Table A | 1.20 | 1.68 | 2.24 |
Table B | 1.96 | 3.63 | 4.89 |
Table C | 3.49 | 4.89 | 5.59 |
Premium for Optional Benefits
Medical Expenses Extension | 10% of the final premium per year per person |
Winter Sports & Rallies | 100% of the policy premium per person. |
Hospital Cash | Rs.40/- per year per person |
Home Convalescence | Rs.15/- per year per person |
Final Premium means: Basic premium + premium for other extensions, if any
Policy Premium means: Basic premium + premium of opted optional benefits
For Policy Term of one year
Period on Risk | Rate of premium to be retained |
For a period not exceeding 15 days | 10% of the Annual Premium |
For a period not exceeding 1 month | 15% of the Annual Premium |
For a period not exceeding 2 months | For a period not exceeding 2 months 3 |
For a period not exceeding 3 months | 40% of the Annual Premium |
For a period not exceeding 4 months | 50% of the Annual Premium |
For a period not exceeding 5 months | 60% of the Annual Premium |
For a period not exceeding 6 months | 70% of the Annual Premium |
For a period not exceeding 7 months | 75% of the Annual Premium |
For a period not exceeding 8 months | 80% of the Annual Premium |
Exceeding 8 months | Full Annual Premium |
Period on Risk | Rate of premium to be retained | |
Up to 1 year | 65% of the premium | |
Up to 2 years |
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For Policy Term of three years
Period on Risk | Rate of premium to be retained | |
Up to 1 year | 45% of the premium | |
Up to 2 years | 85% of the premium | |
Up to 3 years |
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In Case of a Claim
The Company : Star Health and Allied Insurance Company Ltd commenced its operations in 2006 with the business interests in Health Insurance, Travel and Personal Accident. As an exclusive Health Insurance Company and the first of its kind in India, the Company is committed to setting international benchmarks in service and personal caring.
Cashless hospitalization: Section 41 of Insurance Act 1938 : No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectuses or tables of the insurer
Any person making default in complying with the provisions of this section shall be liable for a penalty which may extend to ten lakh rupees.
Illustration:
Premium per person without optional benefits in Rs. Including of Tax @18%
Coverage / Risk Group | Table A | Table B | Table C | |
Sum Insured Rs. 5,00,000 | Group I | 254 | 413 | 738 |
Group II | 354 | 767 | 1033 | |
Group III | 472 | 1033 | 1180 | |
Sum Insured Rs. 10,00,000 | Group I | 507 | 826 | 1475 |
Group II | 708 | 1534 | 2065 | |
Group III | 944 | 2065 | 2360 | |
Sum Insured Rs. 15,00,000 | Group I | 761 | 1239 | 2213 |
Group II | 1062 | 2301 | 3098 | |
Group III | 1416 | 3098 | 3540 |
Premium per person with optional benefits in Rs. (Excluding Winter Sports) Including Tax @ 18%
Coverage / Risk Group | Table A | Table B | Table C | |
Sum Insured Rs. 5,00,000 | Group I | 350 | 526 | 883 |
Group II | 461 | 915 | 1207 | |
Group III | 591 | 1207 | 1369 | |
Sum Insured Rs. 10,00,000 | Group I | 630 | 980 | 1694 |
Group II | 850 | 1759 | 2343 | |
Group III | 1110 | 2343 | 2667 | |
Sum Insured Rs. 15,00,000 | Group I | 909 | 1434 | 2505 |
Group II | 1240 | 2602 | 3479 | |
Group III | 1629 | 3479 | 3965 |
Premium for winter sports and rallies : 100% of the policy premium per person