Apollo accidental care presentation new

1. Individual Personal Accident
AMHI/PR/H/0026/0003/102010

2. What all can happen?
AccidentAccident
DeathDeath DisabilityDisability
TemporaryTemporaryPermanentPermanent
TotalTotal PartialPartial

3. Maximum 8 members of a family can be covered
under 1 policy
Self
3 Adult dependents ( Spouse, Mother, Father)
4 Dependent Children
Who Can be Insured
Individual Family
Note: IPA policy does not include Earning Parent
as Adult Dependent.

4. Entry Age
Member Minimum age
(Last Birthday)
Maximum age
(Last Birthday)
Self 18 years 69 years
Dependent
Adult
18 years 69 years
Dependent
Child*
5 years
(Children below 5 years can
be covered from 91st
day
onwards only if both the
parents are covered)
21 years
A discount of 10% is available if two or more members are covered
under a single policy.
*Dependent Child or Dependent Children means the Proposer’s children aged
between 91 days and 21 yrs at the commencement of the policy period if they
are unmarried, still financially dependent and have not established their own
independent households.

5. Occupation Class I
Few examples: Teacher, Bank employee, CA, Accounts –Clerk,
Executive - Facilities & Administration, Local Government Officer,
Doctor - General Practitioner, Lawyer , Air Traffic Controller, Architect,
Beautician, Barber, Dietician, Diplomat etc.
Occupation Class II
Few examples: Alcohol Production–Chemist, Contractor, Mechanics,
Bus Conductors, Veterinary Doctor, Embroiderer, Personal Car Drivers
etc.
Occupation Class III
Few examples: Driver, Electricians, Farmers, Laborers, Pottery, Ship
Building – Worker, Welder, Fire Brigade, Heavy Vehicle Driver etc.
Occupation Class IV (Declined Risk)
Few examples: Armed Forces, Circus Worker, Divers, Coal & Mining
Industry worker, Ship Crew, Sports related etc.
Occupation Class V
Few examples: Student, Retired, Housewife etc.
Rating Factor- Occupation Class
Please refer to Occupation class list for
complete details
Microsoft Excel
Worksheet

6. Individual Personal Accident- Product Variants

7. Sum Insured- Eligibility
Benefit Sum Insured
Accidental Death
Salaried individual: Up to 10 times of annual
income
Businessmen/Self employed: Up to 20 times of
annual income subject to a maximum of Rs. 50 lakh
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
Note: The maximum sum insured available above 70 years of age is restricted up
to Rs 5,00,000

8. IPA Coverage

9. 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 sum insured.
Standard
Standard (Rupee in Lakhs) Premium (Rupee in Lakhs)
1, 2, 3, 5, 7.5, 10, 25, 50 5, 10, 15, 25, 50, 100, 200, 500

10. 2. Transportation of Mortal
remains
Standard
If we have accepted a claim under [AD], then we will in addition
reimburse the expenses incurred in 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 .
Standard Premium
2% of AD Sum Insured; maximum Rs. 10,000 Rs. 10,000

11. 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 in one of the
ways detailed in the table below, 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

12. 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 shown in the table below.
Loss of:
% of AD
SI
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
SI
Each 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

13. 5. Temporary Total Disablement
If 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, and
Our liability to make payment will be limited to 1% of sum insured for each week
during the period of TTD for a period not exceeding 100 weeks from the date of
accident, and
If the insured person is disabled for a part of a week, then only a proportionate part
of the weekly benefit will be payable, and
We will not pay any amount in excess of he insured person’s base weekly income
excluding overtime, bonuses, tips, commissions, or any other special
compensation.
Benefit Sum Insured
TTD Up to 2 times of total annual income but max.
Rs. 5.00 Lakh for Standard and Rs. 15.00 Lakh
for Premium
Standard

14. Standard
6. Emergency Ambulance
If we have accepted a claim
under IPA and following the
accident it is necessary to
immediately transfer the
insured person to the nearest
hospital by ambulance
offered by a healthcare or an
ambulance service provider ,
then we will in addition
reimburse the actual
expenses of the transfer
using the shortest route.
Standard Premium
Rs. 2000 Rs. 2000

15. Standard
7. Education Fund
If we have accepted a
claim under AD or PTD, then we
will in addition pay 50% of the
sum insured per dependent child
up to a maximum of 2 dependent
children provided that such
dependent child is pursuing an
educational course as a full time
student in an educational
institution.
Standard Premium
10% of AD Sum Insured; maximum
Rs. 20,000
Rs. 20,000

16. 8. Family Transportation
If we have accepted a claim under [AD] or [PTD], then we
will in addition reimburse the actual expenses incurred in
transporting one immediate family member to the hospital
where the insured person is admitted following an accident,
provided that such hospital is located at least 200 kms from
the insured person’s residence.
Standard
Standard Premium
1% of AD Sum Insured;
maximum Rs. 50,000
1% of AD Sum Insured;
maximum Rs. 1,00,000
Note: In this benefit, immediate family member means the insured person’s
legal spouse, children, parents, parents-in-law, legal guardian, ward, step
child, or adopted child.

17. 9. Accident Medical Expenses (Available in Standard variant
only)
If We have accepted a valid claim under [AD], [PTD], [PPD] or [TTD],
we will in addition reimburse the medical expenses incurred by the
insured person at a hospital, provided that our maximum liability under
this benefit shall be limited to the lowest of:
a) Actual expenses
b) 40% of admitted claim under [AD], [PTD], [PPD] or [TTD]
c) 10% of AD Sum Insured
d) Rs. 50000
Standard

18. 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

19. 9. Accident Hospitalization (Inpatient)
If any Insured Person suffers an Accident during the Policy
Period that requires that Insured Person’s Hospitalization as
an inpatient, then we will in addition reimburse the Medical
Expenses up to Rs. 1,00,000 incurred for the in-patient
treatment of such Insured Person, provided that such
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
Standard Premium
- Rs. 1,00,000

20. Premium
10. Transportation of Imported Medicine
If we have accepted a claim under [AD], [PTD],
[PPD] or [TTD], then we will in addition
reimburse the actual expenses incurred on
freight charges for importing medicines to
India, provided that:
Such medicines, formulations or their
alternatives are not available in India, and
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.
Standard Premium
- 5% of AD Sum Insured; maximum up to
Rs. 20,000

21. Premium
11. Purchase of Blood
If we have accepted a claim
under [AD], [PTD], [PPD] or
[TTD], then we will in addition
reimburse the actual expenses
incurred in purchasing blood
through a hospital or lawful blood
bank for the purpose of the
insured person’s medical or
surgical treatment provided that
such treatment is necessitated by
the accident.
Standard Premium
- 5% of AD Sum Insured; maximum up
to Rs. 10,000

22. Premium
12. Modification of Residence/Vehicle
If We have accepted a claim under [PTD],
We will in addition reimburse the
reasonable expenses incurred to modify
the Insured Person’s residential
accommodation and/or 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.
Standard Premium
- 10% of AD Sum Insured; maximum
up to Rs. 1,00,000

23. Premium
13. Broken Bone
If an accident causes an insured person to suffer a fracture (a break in
the continuity of a bone) and this is certified by a Doctor and also
confirmed by imaging investigations such as by X-ray, then we will pay
the percentage of the sum insured specified in the table.
Benefits % of
SI
Benefits % of
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%
Standard Premium
- 20% of AD Sum Insured; maximum up to Rs. 1,00,000

24. Benefit Grid ( Standard and 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 Medical Expenses*
10. Accidental Inpatient Hospitalization
11. Transportation of Imported Medicine
12. Purchase of Blood
13. Modification of Residence/Vehicle
14. Broken Bones
*Only in Standard Plan

25. 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 by 5%
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

26. Premium Chart

27. Acceptable Income Proofs
Salaried Businessmen
Agricultural
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 more than Rs 25 Lakh, a proof of
income for the immediately preceding financial year(s) shall be required.

28. Important Points
Proposal forms will be accepted and logged in even if last year
ITR is enclosed (in case of businessmen) and the latest salary
slip(for salaried). Additional documents can be called for
wherever required.
In event of availability of only 1 year’s income evidence, it must
be ascertained that the same is of the most recent financial year.
In case of Sum Insured more than Rs. 50 Lakh, ‘Financial
Questionnaire’ will be required to be submitted.
Financial
Questionnaire

29. Key Product Differentiators
• Optional benefit is offered with high sum insured level to support
customers’ loss of income due to temporary disablement.
Temporary
Total
Disablement

30. Thank You!