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Accident Trauma Care
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Accident Trauma Care

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  • 1. Presentation On Accident Trauma Care
  • 2. Accident Means
    • Not only Road/Rail or Travel accidents but also includes
    • Accidental Fall
    • Electric Shock
    • Snake Bite
    • Drowning in Water
    • Any thing other than Natural Death or Death due to Disease.
  • 3. Family
    • Family shall mean
    • Insured Person
    • Spouse
    • Dependent Children upto 18 years of age
    • Dependent Parents.
  • 4. 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.
  • 5.
    • Section I
  • 6. Covers
    • Accidental Death
    • Permanent Total Disablement
    • The coverage is applicable only in respect of loss occurring within India.
  • 7. 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
  • 8. Permanent Total Disablement
    • 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
  • 9.
    • Section II
  • 10. Covers
    • 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.
  • 11. Add On Covers
    • Work-place accidents
  • 12. Allowable Expenses
    • Room, Boarding Expenses as provided by the Hospital / Nursing Home not exceeding 2% of the Sum Insured
    • Nursing expenses
    • Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees
    • Anaesthesia, Blood, Oxygen, Operation Theatre charges, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, diagnostic imaging modalities, cost of Pacemaker and similar expenses
  • 13.
    • Common features to Section I and II
  • 14. 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.
  • 15. Sum Insured
    • Section I :
    • Sum Insured in Multiples of Rs. 5,000/- upto a maximum of Rs. 1,00,000/-.
    • Section II* :
    • Sum Insured in Multiples of Rs. 5,000/- upto a maximum of Rs. 1,00,000/-.
    • * Sum Insured under Section II can be equal to or less than Sum Insured under Section I.
  • 16. Premium Rating Note: Rate provided is “Per Mille” i.e., Per Thousand Minimum Premium: Rs. 100/- Section 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
  • 17. Group Discount Group Discount Applicable to Accident Trauma Care (Group) Policies Number of persons Discount on the final premium 101-1000 5% 1001-10000 7.5% 10001-50000 10% 50001-100000 12.5% 100001- 200000 15% 200001-500000 20% 500001-1000000 25% Above 1000000 30%
  • 18. 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.
  • 19. Claims Procedure - Accident Claims
    • 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
  • 20. Claims Procedure - Accident Claims (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
  • 21.
    • 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 Doctor
    • Bills 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.
    Claim Procedure – Medical Claims
  • 22. Thank You