Individual Personal Accident

Entry Age

The insured person must live in India may be insured irrespective of nationality.This policy can be issued to an individual and/or a family.The family includes spouse, dependent children and dependent parents. Maximum 8 members of a family can be covered; consists of 1 Policy Holder, 3 Adult dependents ( Spouse, Mother, Father) and 4 Dependent Children

SelfMinimum 18 years and Maximum 69 years ( last birthday)

Cover Ceasing Age 70 years

Who Can be Insured

Family DiscountA discount of 10% on Gross Premium is available if two or more members are covered under this policy

Duration The policy will be issued for a 1 year periodGeography This policy compensates for injuries sustained anywhere in the world.The benefit in respect of Accidental medical expenses shall be paid only for medical expenses incurred in India, irrespective of the place where the injury was sustained / accident occurred.

Adult dependents Minimum 18 years and Maximum 69 years

Child Dependents Minimum 5 years and Maximum 21 yearsChildren below 5 years can be covered from 91st day onwards only if both the parents are covered

Occupation Class

Occupation Class I - Persons engaged in White collar non-hazardous occupations in office, showroom only e.g. Lawyers, Doctors, Dentists, Office Executives, Clerks, Salesmen, Superintending/ Consulting Engineers, Teachers, Bureaucrats, Accountants, Architects, Bankers, Persons engaged in administration functions, Persons primarily engaged in occupations of similar hazard. Occupation Class I includes Housewife and Students

Occupation Class II - Persons engaged in Semi-hazardous occupations with duties in a supervisory capacity, and not a machine operator of any type, or doing manual work e.g. Builders, Contractors, On-site engineers, Personal Car Drivers, Mechanics, Veterinary Doctors and persons engaged in occupation of similar hazards

Rating Factor

Occupation Class III - Persons engaged in manual labour, Skilled or semi-skilled workers using light / heavy machinery i.e. Filing Station Attendants, Taxi Drivers, Heavy Vehicle Drivers, Industrial Workers Or Unskilled Labourers, Construction Workers, Electricians, Farmers, Labourers and Persons engaged in occupations of similar hazards.

Occupation Class IV – Any occupation not falling into any category above will be declined risk.

Occupation Class List_2008-04-28.xls

Rating Factor

Individual Personal Accident Product

Standard Premium

Sum Insured- Eligibility

Benefit Annual Income

Accidental DeathUp to 10 times of annual

income (Salaried individuals)

Temporary Total Disablement

Up to 2 times of annual income subject to a max. of

5.00 L for Standard and 15.00L for Premium

Sum Insured Standard Premium

AD Sum Insured options ( Rupees in lacs)

1, 2, 3, 5, 7.5, 10, 25, 50

5,10, 15, 25, 50, 100,200, 500

Sum Insured for Adult Dependents

50% of Proposer SI;Max Rs 25,00,000

50% of Proposer SI;Max Rs 50,00,000

Sum Insured for Children Dependents

25% of Proposer SI;Max Rs 10,00,000

25% of Proposer SI;Max Rs 10,00,000

Sum Insured

Standard

S. No.

Benefits

1.Accidental Death [AD] (Rupee in Lakhs)

2. Transportation of Mortal Remain

3.Permanent Total Disablement [PTD]

4.Permanent Partial Disablement [PPD]

5.Temporary Total Disablement [TTD]

6. Emergency Ambulance Charges7. Education Fund8. Family Transportation9. Accidental Medical Expenses

Benefit Grid

1. Accidental Death[AD] If an Insured Person suffers an Accident during the Policy Period and

this is the sole and direct cause of his death within 365 days from the date of the Accident, then We will pay the lump sum Sum Insured

Benefit Total Annual Income

Accidental Death Up to 10 times of total annual income

2. Transportation of Mortal remains

2 % of AD Sum Insured; max up to Rs .10,000 is payable for expenses incurred on transporting the mortal remains of the Insured Person from the place of the Accident or the Hospital to his residence or Hospital or to a cremation or burial ground, Provided we have accepted a claim for Accidental Death

Standard

3. Permanent Total Disablement [PTD]If an Insured Person suffers an Accident during the Policy Period and within 365 days from the date of the Accident this is the sole and direct cause of his Permanent Total Disablement, then We will pay the percentage of the Sum Insured shown below:

Benefits % of AD Sum Insured

Loss of 2 Limbs (both hands or both feet or one hand and one foot)

100%

Loss of a Limb and an eye 100%

Complete and irrecoverable loss of sight of both eyes 100%

Complete and irrecoverable loss of speech & hearing of both ears

100%

Loss of a Limb 50%

Complete and irrecoverable loss of sight of an eye 50%

Standard

4. Permanent Partial Disablement[PPD] If an Insured Person suffers an Accident during the Policy Period and

within 365 days from the date of the Accident this is the sole and direct cause of his permanent partial disablement in one of the ways detailed in the table below, then We will pay the percentage of the Sum Insured

 Loss of: % of

AD Sum

Insured

Each arm at the shoulder joint

70%

Each arm to a point above elbow joint

65%

Each arm below elbow joint 60%Each hand at the wrist 55%Each thumb 20%Each index finger 10%Each other finger 5%Each leg above center of the femur

70%

Each leg up to a point below the femur

65%

Loss of: % of AD Sum

InsuredEach leg to a point below the knee

50%

Each leg up to the center of tibia

45%

Each foot at the ankle. 40%Each big toe 5%Each other toe 2%Each eye 50%Hearing in each ear 30%Sense of smell 10%Sense of taste 5%

Standard

5. Temporary Total DisablementIf an Insured Person suffers an Accident during the Policy Period which is the sole and direct cause of a temporary disability which completely prevents him from performing each and every duty pertaining to his employment or occupation, then we will pay the weekly benefit. Provided that

The temporary total disablement is certified by a Doctor We will pay 1% of the Sum Insured for each week for a period not

exceeding 100 weeks from the date of the Accident If the Insured Person is disabled for a part of a week, then only a

proportionate part of the weekly benefit will be payable  We will not pay any amount in excess of the Insured Person’s base

weekly income excluding overtime, bonuses, tips, commissions, or any other special compensation.Benefit Total Annual Income

TTD Up to 2 times of total annual income but max. 5.00 L for Standard and 15.00L for Premium

Standard

6. Emergency AmbulanceActual Expenses incurred; maximum upto Rs. 2000 on an ambulance used to transfer the Insured Person to the nearest Hospital by the shortest route following an emergency caused due to an Accident. Using ambulance offered by a healthcare or ambulance service provider.

7. Education Fund 10% of the AD Sum Insured ; max Rs. 20000

Provided We have accepted a claim under [AD] or [PTD] ,Dependent Child is pursuing an educational course as a full

time student in an educational institution50% of Education Fund will be payable per Dependent Child (up to maximum of two children),

Standard

8. Family Transportation1% of AD Sum Insured ; max Rs. 1,00,000 will be reimbursed for expenses incurred in transporting one Immediate Family Member to the Hospital where the Insured Person is admitted following an Accident, Provided:

We have accepted the claim under [AD] or [PTD], Such Hospital is located at least 200 km from the Insured Person’s

residence.

9. Accidental Medical Expenses If We have accepted a valid claim under the Section [AD], [PTD], [PPD] or [TTD], We will reimburse the Medical Expenses incurred by the Insured Person for use of Hospital facilities for medical treatment following an Accident. We will pay the lowest of the following: Actual expenses 40% of admitted claim under [AD], [PTD], [PPD] or [TTD] 10% of AD Sum Insured Rs. 50000

Standard

Individual Personal AccidentPremium

Premium S.

No.Benefits

1. Accidental Death [AD] (Rupee in Lakhs)

2. Permanent Total Disablement [PTD]

3. Permanent Partial Disablement[PPD]

4. Emergency Ambulance Charges

5. Family Transportation

6. Transportation of Mortal Remains

7. Education Fund

8. Temporary Total Disablement [TTD]

9. Accidental Inpatient Hospitalization

10. Transportation of Imported Medicine

11. Purchase of Blood

12. Modification of Residence/Vehicle

13. Broken Bones

9. Accidental Inpatient Hospitalization If any Insured Person suffers an Accident during the Policy Period

that requires that Insured Person’s Hospitalization as an inpatient, We will reimburse the Medical Expenses up to Rs. 1,00,000 incurred for the in-patient treatment of such Insured Person in a Hospital for medical treatment following the Accident, provided that the Hospitalization commences within the same Policy Period.

Hospitalisation or Hospitalised means the Insured Person’s admission into a Hospital for medically necessary treatment as an inpatient for a continuous period of at least 24 hours following an Accident occurring during the Policy Period.

Premium

Premium

10.Transportation of Imported Medicine5% of AD Sum Insured ; max Rs. 20,000 will be reimbursed for expenses incurred on freight charges for importing medicines to India provided

We have accepted a valid claim under [AD], [PTD], [PPD] or [TTD], Such medicines, formulations or their alternatives are not available

in India,   Such medicines are necessary for the medical or surgical treatment

of the Insured Person in a Hospital following the Accident. Such medicines shall not include any drugs under clinical trial or

medicines, formulations or molecules of unproven efficacy.

11.Purchase of Blood 5% of AD Sum Insured ; max Rs. 10,000

Will be reimbursed for expenses incurred in purchasing blood through a Hospital or lawful blood bank for the required medical or surgical treatment of the Insured Person following an Accident Provided that we have accepted a valid claim under [AD], [PTD], [PPD] or [TTD],

Premium

12. Modification of Residence/Vehicle 10% of AD Sum Insured ; max. Rs. 1,00,000

If We have accepted a claim under [PTD], We will reimburse the reasonable expenses incurred to modify the Insured Person’s residential accommodation or the Insured Person’s vehicle as long as the modifications have been carried out in India and certified by a Doctor to be necessary and directly required as a result of the Accident for which We accepted the claim.

Premium

13.Broken Bone20 % of AD Sum Insured; max. Rs. 1,00,000 will be payable ( Lump Sum), if an

Accident causes an Insured Person to suffer a fracture (a break in the continuity of a bone, confirmed by imaging investigations such as by X-rayWe will pay max 100% of broken bones SI , irrespective of the number of fractures that the Insured Person suffers caused by the same Accident. If a claim in respect of any fracture of a whole bone also encompasses some or all of its parts, Our liability to make payment will be limited to the whole bone only and not any of its parts.

Benefits % of BB SI

Benefits % of BB SI

Injury to vertebral body resulting in spinal cord damage

100% Wrist (collies or similar fractures)

10%

Pelvis 100% Ankle (Potts or similar fracture)

10%

Skull (excluding nose and teeth) 30% Coccyx 5%Chest (all ribs and breast bone) 50% Hand 3%Shoulder (collar bone and shoulder blade) 30% Finger 3%Arm 25% Foot 3%Leg 25% Toe 3%Vertebra – vertebral arch (excluding coccyx) 30% Nasal bone 3%

Cumulative Bonus

The policy carries a cumulative bonus of 5% per claim free year up to a maximum of 50% of the Accidental Death Sum insured.

If a cumulative bonus has been applied and a claim is made, then in the subsequent Policy Year the cumulative bonus will

automatically reduce to zero in that following Policy Year. The cumulative bonus will be applicable for AD, PTD, & PPD

Sum Insured only. No transfer of Cumulative Bonus from other insurers

The policy will not compensate for any claim due to Intentional self injury, suicide or attempted suicide, while sane or insane. HIV/AIDS, Sexually transmitted diseases, Insured persons participation or involvement in naval, military or air force

operations, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing, any breach of law with criminal intent.

Abuse of intoxicants or hallucinogens including drugs & alcohol, War or any act of war, invasion, act of foreign enemy, war like operations,

civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, chemical, radioactive or nuclear contamination,

Pregnancy childbirth & it’s complications, congenital internal & external disease,

Pre-existing conditions & their complications, Any non allopathic treatment

General Exclusions:

Applicable for Standard and Premium Plan

Acceptable Income Proofs

Salaried BusinessmenAgricultural Income

Income from agency

commission Last FY/AY

Form 16 Last FY/AY

ITR Last 3

months’ salary slips

ITR

audited P&L account of the company along with Article of Association providing the details of shareholding pattern (in partnership firms) OR the most recent partnership deed

ITR Form

J(7/12) / CA certificate /Mandi receipt

Form 16A

If the proposed SI for an Individual is ≥ Rs 25.00L a proof of income for the immediately preceding financial year(s) shall be required.

Thank You!