Health Assurance - AccidentCare | ||
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Baseline Cover Benefits under AccidentCare | ||
Age at Entry | For adults 18 to 65 years and for dependent children 2 years to 21 years (Maximum 2 children covered) | |
Policy Tenure | 1 year, 2 years or 3 years | |
Sum Insured (SI) in lacs | 5 to 25 Lacs (In multiples of 5 lacs) | 30/35/40/45/50/60/75/100/125/150/175/200/225/ 250/275/ 300/350/400/450/500 lacs |
Accident Death | For Individual Option : 100% of Sum Insured For Family Option : Coverage for Self - 100% of Sum Insured; Coverage for Spouse - 50% of Sum Insured or Rs 10 lacs (whichever is lower); Coverage for Children - 20% of Sum Insured or Rs 5 lacs (whichever is lower |
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Accident Permanent Total Disability | 125% of Sum Insured | |
Accident Permanent Partial Disability | As per the Company grid | |
Child Education Benefit | Minimum of 5% of Sum Insured or Rs 50,000 per child | Minimum of 5% of Sum Insured or Rs 500,000 per child |
Funeral Expenses | Rs 5,000 | Rs 50,000 |
Sum Insured Multiple | Sum Insured not to exceed 12/15 times of annual income for salaried/self-employed respectively | |
Health Assurance - AccidentCare - Optional Benefits | ||
Accident Temporary Total Disability (TTD) | TTD Sum Insured - 1lac to 20 lacs (in multiple of 50,000) TTD benefit - 1% of TTD Sum Insured payable per week. Such weekly payout shall be made for a maximum of 100 weeks | |
TTD Sum Insured Multiple | TTD Sum Insured not to exceed Lower of (2 times of Annual Income or AccidentCare Sum Insured) | |
Accident Hospitalization limit (confined to Indian territory only) | Up to 2% of AccidentCare Sum Insured | |
Surgical Operations | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Nursing Care, drugs and Surgical Dressing | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Medical Practitioner's / Surgeon's Fee | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Room Rent | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Operation Theater Charges | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Anesthetics fees (including administration), x-ray examinations or treatments, including CT | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Diagnostic Procedures and therapies | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Prosthetic Implants | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Emergency Ambulance as a part of overall Sum Insured | Covered up to the Accident Hospitalization limit. Claim settlement on reimbursement basis only and coverage limited to India only. | |
Physiotherapy as a part of overall Sum Insured | Limited to 10% of Accidental Hospitalization limit. | |
Risk Classification for AccidentCare | ||
Risk | Class / Occupancy | |
1 | Persons engaged in white collar, non-hazardous occupations in office, administrative/managerial work and similar functions For eg: senior management staff, administration manager, clerk, auditor, accountant, lawyer, banker, teacher, doctor, architect, owner of small businesses which do not deal in hazardous goods or involve manual labour and similar occupations. | |
2 | Persons engaged in semi-hazardous occupations, engaged in superintending activities with duties in a supervisory capacity and not an operator of light / heavy machinery or doing manual work. For e.g.: agriculture engineer, air traffic controller, auto engineer; builder, contractor & engineer engaged in superintending functions only and persons engaged in occupations of similar hazard. | |
3 | Persons engaged in hazardous occupations like working in underground mines, explosives, magazines, electrical installation with high tension supply, circus performers and big game hunters, manual labors, skilled/semi skilled workers using light/heavy machinery, persons engaged in adventurous sports and activities such as racing on wheels or on horseback, big game hunting, mountaineering, winter sports, skiing, river rafting; cash-carrying employees, garage and motor mechanics, machine operators, drivers of trucks and lorries and other heavy vehicles, professional athletes and sportsmen, wood-working machinists; or those engaged in occupations/activities of similar hazard. |
Claim Section / Benefit | Documents to be Submitted |
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Accident Death |
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Accident Permanent Total Disability |
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Accident Permanent Partial Disability |
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Temporary Total Disability |
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Accident Hospitalization |
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Review Niva BupaHealth Assurance Personal Accident brochure to understand coverage details.
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