Accident trauma care nandagopal-9994910202

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARING

S.V.NANDAGOPAL SENIOR SALES MANAGER STAR HEALTH & ALLIED INSURANCE CO.LTD

THANKS FOR OPPORTUNITY TO SERVE

WE ARE ONE OF THE LEADING INSURANCE & INVESTMENT

CONSULTANT IN COIMBATORE SINCE 2000MOBILE

99949 10202, 94431 86864,83000 20102Email [email protected],[email protected]

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Accident Trauma Care


Accident Means Not only Road/Rail or Travel accidents but also includes

Accidental FallElectric ShockSnake BiteDrowning in WaterAny thing other than Natural Death or Death due to Disease.

FamilyFamily shall mean Insured PersonSpouseDependent Children up to 18 years of ageDependent Parents.

Age LimitsAvailable 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.


Section ICovers

Accidental DeathPermanent Total Disablement

The coverage is applicable only in respect of loss occurring within India.

Accidental DeathCovers Death of the Insured PersonDeath occurring within 12 Months from the date of AccidentCompensation payable is 100% of Capital Sum Insured

Permanent Total Disablement

Disablement coverThe 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


Section IICovers

Covers hospitalisation expenses incurred for grevious injury following an accident, other than work-place accidents and incurred as inpatient for treatment in any nursing home / hospital in India.

Add On CoversWork-place accidents

Allowable ExpensesRoom, Boarding Expenses as provided by the Hospital / Nursing Home not exceeding 2% of the Sum Insured

Nursing expenses

Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist FeesAnaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, diagnostic imaging modalities, cost of Pacemaker and similar expenses


Common features to Section I and II

Risk Groups that can be covered

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

Note: Risk Group III cannot be covered under this policy.

Sum InsuredSection I :

Sum Insured in Multiples of Rs. 5,000/- up to a maximum of Rs. 1,00,000/-.Section II* :

Sum Insured in Multiples of Rs. 5,000/- up to a maximum of Rs. 1,00,000/-.

* Sum Insured under Section II can be equal to or less than Sum Insured under Section I.


Premium RatingSection Coverage Rate

I PA Re. 1 per mille

II (a) Basic cover i.e., Hospitalisation for Grevious

Injuries

Rs. 2 per mille

II (b) Additional coverage for workplace accidents

Re. 1 per mille

Note: Rate provided is “Per Mille” i.e., Per Thousand Minimum Premium: Rs. 100/-Group Discount

Group Discount Applicable to Accident Trauma Care (Group) PoliciesNumber of persons Discount on the final premium101-1000 5%1001-10000 7.5%10001-50000 10%50001-100000 12.5%100001- 200000 15%200001-500000 20%500001-1000000 25%Above 1000000 30%


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.Cost of spectacles, contact lens, hearing aids, walkers, crutches, wheel chairs, artificial limbs and such other aids.

Note: For a detailed list kindly refer the policy conditions.


Claims Procedure - Accident ClaimsDocument to be submitted in case of Death Claims

Completed Claim formDeath certificate, PanchanamaFIR, wherever applicable Postmortem report In the absence of assignment, Legal Heir ship Certificate/Succession Certificate / Will duly probatedOriginal Policy, if issued for Individual Coroner’s Report/Police Inquest Report

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


Claim Procedure – Medical Claims

Immediate intimation to the Call Centre (1800 425 2255)Claim form will be sent to the Insured.Based on the intimation a field visit will be done by the Star DoctorBills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents

• Original Discharge Summary• Main Hospital Bill with Break Up• Investigation Reports with X-Ray Film• Medical Bills with Prescriptions

Cashless facility will be provided on a case to case basis if treatment is taken in a Network Hospital.

STAR HEALTH AND ALLIED INSURANCE COMPANY LIMITEDPERSONAL & CARINGFHO-rev2014/cpu/ver1.4/16 Oct 2014 11

• ALSO WE PROVIDE • LIFE INSURANCE• HEALTH INSURANCE• CHILD FUTURE PLANS• TAX SAVING & PLANNING• PAN CARD & PASSPORT • MOTOR VEHICLE INSURANCE• IMPORT & EXPORT INSURANCE• INDIVIDUAL,FAMILY,GROUP &

CORPORATE INSURANCE NEEDS


Healthcare

Accident trauma care nandagopal-9994910202