Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Accident Trauma Care


Published on

Published in: Economy & Finance, Business
  • Be the first to comment

  • Be the first to like this

Accident Trauma Care

  1. 1. Presentation On Accident Trauma Care
  2. 2. Accident Means <ul><li>Not only Road/Rail or Travel accidents but also includes </li></ul><ul><li>Accidental Fall </li></ul><ul><li>Electric Shock </li></ul><ul><li>Snake Bite </li></ul><ul><li>Drowning in Water </li></ul><ul><li>Any thing other than Natural Death or Death due to Disease. </li></ul>
  3. 3. Family <ul><li>Family shall mean </li></ul><ul><li>Insured Person </li></ul><ul><li>Spouse </li></ul><ul><li>Dependent Children upto 18 years of age </li></ul><ul><li>Dependent Parents. </li></ul>
  4. 4. Age Limits <ul><li>Available for Persons aged between 18 years and 70 years. </li></ul><ul><li>Children from 3 years can be covered under family package when atleast any one of the parents are covered. </li></ul>
  5. 5. <ul><li>Section I </li></ul>
  6. 6. Covers <ul><li>Accidental Death </li></ul><ul><li>Permanent Total Disablement </li></ul><ul><li>The coverage is applicable only in respect of loss occurring within India. </li></ul>
  7. 7. Accidental Death <ul><li>Covers Death of the Insured Person </li></ul><ul><li>Death occurring within 12 Months from the date of Accident </li></ul><ul><li>Compensation payable is 100% of Capital Sum Insured </li></ul>
  8. 8. Permanent Total Disablement <ul><li>Disablement cover </li></ul><ul><li>The disablement should occur within 12 Calendar months from the date of the Accident </li></ul><ul><li>The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement </li></ul>
  9. 9. <ul><li>Section II </li></ul>
  10. 10. Covers <ul><li>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. </li></ul>
  11. 11. Add On Covers <ul><li>Work-place accidents </li></ul>
  12. 12. Allowable Expenses <ul><li>Room, Boarding Expenses as provided by the Hospital / Nursing Home not exceeding 2% of the Sum Insured </li></ul><ul><li>Nursing expenses </li></ul><ul><li>Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialist Fees </li></ul><ul><li>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 </li></ul>
  13. 13. <ul><li>Common features to Section I and II </li></ul>
  14. 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. 15. Sum Insured <ul><li>Section I : </li></ul><ul><li>Sum Insured in Multiples of Rs. 5,000/- upto a maximum of Rs. 1,00,000/-. </li></ul><ul><li>Section II* : </li></ul><ul><li>Sum Insured in Multiples of Rs. 5,000/- upto a maximum of Rs. 1,00,000/-. </li></ul><ul><li>* Sum Insured under Section II can be equal to or less than Sum Insured under Section I. </li></ul>
  16. 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. 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. 18. Major Exclusions <ul><li>Any Claim, </li></ul><ul><li>In Respect of Pre Existing Conditions. </li></ul><ul><li>If the Insured acts against the advice of the Physician. </li></ul><ul><li>Whilst under the influence of intoxicating liquor or drugs. </li></ul><ul><li>Arising out of mental diseases, suicide or attempted suicide, self inflicted injuries or sexually transmitted conditions, anxiety, etc. </li></ul><ul><li>Due to participation in hazardous sport / activities. </li></ul><ul><li>By persons who are physically and mentally challenged unless specifically agreed and endorsed in the policy. </li></ul><ul><li>Cost of spectacles, contact lens, hearing aids, walkers, crutches, wheel chairs, artificial limbs and such other aids. </li></ul><ul><li>Note: For a detailed list kindly refer the policy conditions. </li></ul>
  19. 19. Claims Procedure - Accident Claims <ul><li>Document to be submitted in case of Death Claims </li></ul><ul><li>Completed Claim form </li></ul><ul><li>Death certificate, Panchanama </li></ul><ul><li>FIR, wherever applicable </li></ul><ul><li>Postmortem report </li></ul><ul><li>In the absence of assignment, Legal Heir ship Certificate/Succession Certificate / Will duly probated </li></ul><ul><li>Original Policy, if issued for Individual </li></ul><ul><li>Coroner’s Report/Police Inquest Report </li></ul>
  20. 20. Claims Procedure - Accident Claims (Contd.) <ul><li>Document to be submitted in case of Disablement Claims </li></ul><ul><li>Original Policy </li></ul><ul><li>Disability Certificate from the attending Doctor confirming the %age of disability. </li></ul><ul><li>Photo of the person indicating the disability. </li></ul><ul><li>Completed claim form </li></ul><ul><li>FIR, Wherever applicable </li></ul>
  21. 21. <ul><li>Immediate intimation to the Call Centre (1800 425 2255) </li></ul><ul><li>Claim form will be sent to the Insured. </li></ul><ul><li>Based on the intimation a field visit will be done by the Star Doctor </li></ul><ul><li>Bills has to be settled by the Insured and will be reimbursed by Star on submitting the following documents </li></ul><ul><li>Original Discharge Summary </li></ul><ul><li>Main Hospital Bill with Break Up </li></ul><ul><li>Investigation Reports with X-Ray Film </li></ul><ul><li>Medical Bills with Prescriptions </li></ul><ul><li>Cashless facility will be provided on a case to case basis if treatment is taken in a Network Hospital. </li></ul>Claim Procedure – Medical Claims
  22. 22. Thank You