The document outlines coverage details for a personal accident insurance policy available to individuals and families in India, including eligibility, maximum member limits, and age requirements. It specifies various benefits such as accidental death compensation, temporary total disablement, and accidental medical expenses, along with exclusions and premium rates. Additionally, it provides information regarding occupation classes that influence premium rates and the policy's geography of coverage.

1. Individual Personal Accident

2. Who Can be Insured
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
Entry Age
Self
Minimum 18 years and Maximum 69 years
( last birthday)
Cover Ceasing Age
 70 years

3. Adult dependents
 Minimum 18 years and Maximum 69 years
Child Dependents
 Minimum 5 years and Maximum 21 years
Children below 5 years can be covered from 91st day onwards only if both the
parents are covered
Family Discount
A 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 period
Geography
 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.

4. Rating Factor
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

5.  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

6. Individual Personal Accident Product
Standard Premium

7. Sum Insured- Eligibility
Benefit Annual Income
Accidental Death
Up 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

8. 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

9. Standard
Benefit Grid
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 Charges
7. Education Fund
8. Family Transportation
9. Accidental Medical Expenses

10. Standard
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

11. 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%

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
Loss of: % of
AD
Sum
Insured
Each arm at the shoulder joint 70%
Each arm to a point above elbow
65%
joint
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
65%
femur
Loss of: % of AD
Sum
Insured
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
 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

14. Standard
6. Emergency Ambulance
Actual 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 institution
50% of Education Fund will be payable per Dependent Child (up to
maximum of two children),

15. Standard
8. Family Transportation
1% 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

16. Individual Personal Accident
Premium

17. 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

18. Premium
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.

19. Premium
10. Transportation of Imported Medicine
5% 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],

20. 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.

21. Premium
13. Broken Bone
20 % 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-ray
We 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%

22. 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

23. General Exclusions:
Applicable for Standard and Premium Plan
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

24. Acceptable Income Proofs
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.
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

25. Thank You!