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Overview

Why should you take this plan?

 

  • to provide health benefits to your quality employees and/or your loyal customers.

 

How will this Plan fulfill the requirements?

 

The Master Policyholder can:

  • use this as a tool to attract and retain your loyal customers and/or quality employees.
  • possibly lend higher amounts (subject to customer’s eligibility) because of the assurance of having no repayment in case of an unfortunate contingency.

The Customer:

  • has a Health and Accidental Insurance protection at a very economical cost.
  • has a sense of security.
  • gets Tax benefits under section 80D of the Income Tax Act, 1961.

 

 

Coverage Options

 

Option I: Accidental Death Cover

  • Under this option, on occurrence of death due to an accident, a lump sum benefit equal to Accidental Death Sum Insured will be payable and the cover will cease.

 

Option II: Critical Illness Cover

  • Under this option, a fixed lump sum benefit equal to 100% of the Critical Illness Sum Insured will be payable on diagnosis with any of the 21 critical illnesses as mentioned below, provided that the insured member has survived the survival period following such diagnosis. The cover will cease thereafter.

 

Option III: Accidental Death plus Accidental Permanent, Total or Partial Disability Cover

  • Under this option, on occurrence of ATPD, a lump sum benefit (% of ATPD Sum Insured) will be payable as per the ATPD benefit defined below.

  • The Sum Insured for the ADB cover will be reduced by the ATPD benefit already paid. Hence, on occurrence of death due to an accident, a lump sum benefit equal to Sum Insured less ATPD benefit already paid will be payable and the cover will cease.

 

Option-IV: Accidental Death plus Critical Illness Cover

  • Under this option, a fixed lump sum benefit equal to 100% of the Critical Illness Sum Insured will be payable on diagnosis with any of the 21 critical illnesses, provided that the insured member has survived the survival period following such diagnosis.

  • In addition, on occurrence of death due to an accident, a lump sum benefit equal to Accidental Death Sum Insured will be payable in addition to the CI benefit already paid and the cover will cease.

 

Option-V: Accidental Death plus Accidental Permanent, Total or Partial Disability plus Critical Illness Cover

  • Under this option, on occurrence of ATPD, a lump sum benefit (% of ATPD Sum Insured) will be payable as per the ATPD benefit defined below.

  • An additional fixed lump sum benefit equal to 100% of the Critical Illness Sum Insured will be payable on diagnosis with any of the 21 critical illnesses as mentioned above (in Option-ll), provided that the insured member has survived the survival period following such diagnosis.

  • Further, on occurrence of death due to an accident, a lump sum benefit equal to Sum Insured less ATPD benefit already paid will be payable and the cover will cease.

  • Under Option III & V, the ADB & ATPD Sum Insured shall always be equal only at the inception of the Policy. Subsequently, the benefits payable under ATPD for the different insured events can be at 25%, 50%, etc. of the chosen ATPD Sum Insured at policy inception

  • Under Option II, IV & V, the CI cover will terminate upon payment of the first CI benefit for any of the mentioned 21 critical illnesses

  • Please refer to next section for details on these Coverage Options

 

Eligibility

 

Minimum

Maximum

Member’s Age at Entry (last birthday)

14 years for education loan

18 years for all other cases

65 years

Coverage Expiry Age (last birthday)

One Year Renewable Cover: 66 years

Single Pay: 70 years

Policy Term

1 years

5 Years

Premium Payment Term

One Year Renewable and Single Premium in case of Policy Term 2 to 5 Years

Premium Payment Mode

For 1 Year Policy Term: Annual, Semi-annual, Quarterly and Monthly modes are applicable

For Policy Term from 2 to 5 Years: Single Premium

Sum Insured

Rs.1000 per life

Accidental Benefits: Rs.3 Crore per life

Critical Illness Benefit: Rs.50 Lakhs per life

For all benefits combined together, maximum sum insured shall be restricted to Rs.3 Crore per life, subject to board approved underwriting policy.

Group Size

7 members

No limit

 

Modal Factors

Premium Mode

Annual

Semi-Annual

Quarterly

Monthly

Modal Factor

1

0.52

0.265

0.09

 

Features

  1. Accidental Death Benefit (ADB)

 

On occurrence of death due to an accident, a lump sum benefit equal to Accidental Death Sum Insured will be payable subject to the following and the cover will cease thereafter.

a) The member has sustained any bodily injury directly and solely from the accident, which has been caused by external, violent and visible means and the injury is independent of all other causes.

b) The death must occur within 180 days of the date of accident due to such injury as stated above solely, directly and independently of all other causes of death.

c) The accident which eventually leads to death has occurred during the term of the policy, even if the death occurs after policy term but within 180 days of accident.

 

  1. Accidental Permanent, Total or Partial Disability (ATPD)

 

On occurrence of ATPD, a lump sum benefit as per the following will be payable. There can be multiple claims upon occurrence of ATPD; however the total lump sum benefit paid shall be subject to a maximum of 100% of ATPD Sum Insured chosen at policy inception:

Events

% of Sum Insured

Events

% of Sum Insured

Permanent Loss of use of both hands

100%

Permanent Loss of speech and hearing in both ears

50%

Permanent Loss of use of both feet

100%

Permanent Loss of hearing in both ears

25%

Permanent Loss of use of both eyes

100%

Permanent Loss of speech

25%

Permanent Loss of use of one hand and one foot

100%

Permanent Loss of use of one hand

25%

Permanent Loss of use of one hand and one eye

100%

Permanent Loss of use of one foot

25%

Permanent Loss of use of one foot and one eye

100%

Permanent Loss of use of one eye

25%

 

Accidental Permanent, Total or Partial Disability shall mean the occurrence of any of the following conditions as a result of accidental bodily injury within 180 days of such accident:

a) Physical severance at or above wrists or permanent loss of use of both the hands

b) Physical severance at or above ankles or permanent loss of use of both the feet

c) Total and irrecoverable loss of sight of both eyes

d) Physical severance at or above wrist or permanent loss of use of one hand and physical severance at or above ankle or loss of use of one foot

e) Physical severance at or above wrist or permanent loss of use of one hand total and irrecoverable loss of sight of one eye

f) Physical severance at or above ankle or permanent loss of use of one foot and total and irrecoverable loss of sight of one eye

g) Total and irrecoverable loss of speech and hearing in both ears

h) Total and irrecoverable loss of hearing in both the ears

i) Total and irrecoverable loss of speech

j) Physical severance at or above ankle or permanent loss of use of one foot

k) Physical severance at or above wrists or permanent loss of use of one hand

l) Total and irrecoverable loss of sight of one eye

 

For accidental total and permanent disability benefit to be payable, such disability must have persisted for at least 180 days and must, in the opinion of a registered independent medical practitioner, be deemed permanent. Except for physical severance where the benefit would be payable immediately.

 

  1. Critical Illness (CI)

A fixed lump sum benefit equal to 100% of the Critical Illness Sum Insured will be payable on diagnosis with any of the following 21 critical illnesses, provided that the insured member has survived for a period of at least 14 days following such diagnosis.

 

The product will cover the insured member against the following 21 critical illnesses:

S No

Critical Illnesses

S No

Critical Illnesses

1

Benign Brain Tumor

12

Loss of Speech

2

Blindness

13

Major Organ /Bone Marrow Transplant

3

Brain Surgery

14

Motor Neuron Disease With Permanent Symptoms

4

Cancer of Specified Severity

15

Multiple Sclerosis With Persisting Symptoms

5

Coma of Specified Severity

16

Open Chest CABG

6

Deafness

17

Open Heart Replacement Or Repair of Heart Valves

7

End Stage Liver disease

18

Permanent Paralysis of Limbs

8

End Stage Lung disease

19

Stroke Resulting In Permanent Symptoms

9

First Heart Attack of Specified Severity

20

Surgery of Aorta

10

Kidney Failure Requiring Regular Dialysis

21

Third Degree Burns

11

Loss of Limbs

All the policy benefits are subject to policy being in force.