Star Health Accident Individual Insurance Policy

A health cover for accident death, permanent disability, and temporary disablement, the Star Accident Individual Insurance Policy is for any person between the age of 18 and 70 years, where dependent children (minimum 5 months) and each person under the family will be covered. In this accident health insurance, you will get compensation for Permanent Total Disablement, and an enhanced weekly compensation up to INR.15,000 (for a maximum of 100 weeks). To know more about Star Accident Individual Insurance Policy, read this page below.

Star Health Accident Individual Insurance Policy Coverage

After having a brief intro of the Star Accident Individual Insurance Policy, let’s take a look at its risk coverage. Check out the table below to know when these benefits will be payable to the insured, nominee, or beneficiary.

1. If the accident affects any physical or mental dysfunction, which is already existing before the accident, a deduction will be made, as certified by a Government Doctor in respect of the prior disability.
2. If the accident causes impairment to several physical or mental functions, the degree of disablement as per the above table will be added together, but the liability, in any case, may not exceed 100% of the Sum Insured, subject to a maximum of 150% in the case of Permanent Total Disablement.
3. For the Permanent Partial Disablement claim, the Sum Insured will be reduced by the amount of admissible claim in respect of the Insured Person to whom such amount is payable.
4. In case of a Permanent Disablement, you need to get yourself examined by doctors appointed by the company, which will pay the cost of that. To authorize a doctor providing treatments or giving expert opinion and any other authority which supplies the company any information that may be required. If these obligations aren’t met due to whatsoever reason, the company may be relieved of its liability to pay, provided you shall be deemed to have been discharged your duties or obligations if you authorize or give consent to the treating doctor/s or the experts who gave their opinion to the company.

The hospital will not be held responsible if any subsequent failure happens on the part of the treating doctor or experts who give an opinion.

1. Wherever a claim for 100% of the Capital Sum Insured is admitted or admissible, the coverage under the policy ceases and it cannot be renewed.
2. Where a claim for less than 100% of the Sum Insured is admitted or admissible, the coverage under the policy will continue until the expiry of the balance sum insured. And the company would exclude such disability on renewal in such cases.

Additional Benefits of Star Health Accident Individual Insurance Policy (On No Extra Premium)

Along with the above-mentioned coverage, you will get the following expenses covered in this accident individual insurance –

1. Educational funding to the children: one child – INR.10,000/-, two or more children – INR. 20,000/-
2. Ambulance and transportation expenses of mortal remains are covered up to INR. 5,000/-
3. Travel expenses of the insured relative from home to the hospital are covered for upto 1% of the total sum insured or actuals, subject to a maximum of INR. 50,000/-
4. Vehicle and residence modification expenses are covered up to 10% of the sum assured for Permanent Total Disablement and Permanent Partial Disablement. And it is subject to a maximum of INR. 50,000 for Temporary Total Disablement.
5. Purchase of blood cost are covered up to 5% of the sum insured, subject to a maximum of INR.10,000/-
6. Transportation expenses of imported medicines are up to 5% of the total sum insured, subject to a maximum of INR. 20,000

Note: These additional benefits will apply only when there is an admissible claim under the policy.

Cumulative Bonus of Star Health Accident Individual Insurance Policy

A cumulative bonus of 5% will occur for each completed year, subject to a maximum of 50% of the sum insured. This cumulative bonus applies to that part of the sum insured which is renewed continuously without break. Your bonus will not be lost if the policy is renewed within 30 days before the expiry.

Note: Cumulative bonus does not apply to additional or optional benefits

Optional Benefits for Star Health Accident Individual Insurance Policy (on additional premium payment)

If you need some optional coverage on your Star Accident Individual Insurance policy, you can do so by paying an additional premium amount. Check out the optional cover that you can get from the insurer if you pay the additional premium.

1. Medical Expenses Extension: A 25% of your valid claim or 10% of the sum insured or actuals (whichever is less), subject to an overall limit of INR. 5,00,000 per policy period. This will be payable to the insured/beneficiary in addition to the sum insured.
2. Coverage for Winter Sports: The policy extension is granted for the period where the insured person proposes to participate in a winter sport as specified in the policy schedule.
3. Hospital Cash: The insurer will pay a cash benefit of INR 1,000/- (per day) for each completed hospitalization provided such hospitalization happens within 30 days from the date of the accident. This benefit is payable for a maximum of 15 days per occurrence and 60 days per policy period. If the policy term is more than one year, this benefit is applicable for each year.

Note: Hospital cash benefit cannot be cumulated or carried forward to the next year. The valid amount is payable in addition to the sum insured. Your days of admission and discharge will not be taken into account for hospital cash.

1. Home Convalescence: The insurer pays INR 500/- for each completed day, subject to a maximum of 15 days per occurrence and 60 days per policy period if there is an engaging attendant at the residence of the insured, immediately after he/she gets discharged from the hospital (if recommended by the attending physician). If the policy term is for more than one year, this benefit is applicable for each year. This benefit cannot be accumulated or carried forward to the next year same as hospital cash.
2. Family Discount: The insured will get a 10% discount on the total premium if the family is covered under the policy.

Exclusions from Star Health Accident Individual Insurance Policy

After knowing the Star Accident Individual Insurance Policy coverage, let’s check out the policy exclusions below –

1. More than one claim under the policy, during any one period of insurance where the maximum liability of the company in that period would exceed the capital sum insured payable (except in case of Permanent Total Disability claim where the payable amount is 150% of the sum insured). It does not apply to the payments made under optional benefits.
2. Any claim occurring before the commencement of the cover
3. Any claim occurring outside the period of insurance
4. Any pre-existing injuries/conditions
5. Any claim for Death or Disablement where intentional self-injury, suicide, or attempted suicide is proved
6. Any claim for Death or Disablement where the insured is under the influence of intoxicating liquor or drugs
7. Self-endangerment unless it is for self-defense or to save the life
8. Any claim due to mental disorder, self-inflicted injuries, sexually transmitted conditions, anxiety, stress, depression, venereal disease, loss directly or indirectly attributable to HIV (Human Immunodeficiency Virus) or any HIV related illness including AIDS (Acquired Immunodeficiency Syndrome), insanity, and any mutant derivative or variations.
9. If you engage in Air Travel unless you fly as a fare-paying passenger on an aircraft properly licensed to carry passengers. Here, Air Travel means being in or on or boarding an aircraft for flying.
10. Accidents due to war and warlike occurrence, or invasion. Acts of foreign enemies, hostilities, civil war, rebellion, insurrection, civil commotion, military or usurped power, seizure capture, arrest, restraints, detainments of people of whatever nation will be excluded from this policy.
11. Your participation in riots, confiscation or nationalization or requisition of or destruction of or damage to property under the order of any government or local authority.
12. Any claim arising from ionizing radiation or contamination by radioactivity from any nuclear fuel or any nuclear waste.
13. Accident due to nuclear weapons material and the radioactive, toxic, explosive, or other hazardous properties of any explosive nuclear assembly or nuclear component, including nuclear, chemical, and biological terrorism
14. Any claim arising out of training or participation in competitions of professional or semi-professional sports
15. Any claim due to participation in Hazardous Sport or Hazardous Activities
16. Physically and mentally challenged person, unless specifically agreed and endorsed in the policy.
17. Any loss due to willful participation in an illegal act, any violation, or attempted violation of the law.

Claim Procedure for Star Health Accident Individual Insurance Policy

To know the Star claim procedure for this policy, follow the steps below and claim your sum insured –

1. Contact the 24X7 Star Toll-Free help-line
2. Submit your policy number for reference

Star Advantages

1. No Third Party Administrator (TPA)
2. Direct in-house claims settlement
3. Faster and hassle-free settlement
4. Cashless hospitalization, if you admit to the network hospital

Prohibition of Rebates: Under Section 41 of the Insurance Act 1938, no person will allow or offer to allow, directly or indirectly, as an inducement to any person to take out, renew, or continue this policy in respect of any kind of risk relating to lives or property in India. Any rebate of the payable whole or part of the commission or any premium rebate as shown on the policy, shall not acceptable to any person taking out, renewing, or continuing a policy for any rebate, except such rebate is allowed by the published prospectuses or tables of the insurer: Any person who deviates and does not comply with the provisions of this section is liable for a maximum penalty of ten lakh rupees.

Star Health Accident Individual Insurance Policy Free Look

You will get a free look period of 15 days from the date of receipt of the policy from the insurer. At this time, you need to review the terms and conditions of the policy. In case you are not satisfied with the terms and conditions, you can request to cancel the policy. In such an event, the company shall allow a refund of paid premium after adjusting the cost of pre-acceptance medical screening, stamp duty charges, and proportionate risk premium for the period on cover, provided no claim has been made until the cancellation. No free look period is applicable at the time of policy renewal.

Renewal of Star Health Accident Individual Insurance Policy

A grace period of 30 days from the date of expiry is available to you for renewal. If you renew the policy within these 30 days, the continuity of benefits will be allowed. However, the actual period of cover starts from the date of renewal premium payment. No protection is available between the policy expiry date and the date of renewal premium payment. The Renewal Premium is subject to change. Change of options or plans within the policy is permissible only at the time of renewal.

Each renewal premium is paid and accepted upon the distinct understanding that no alteration will take place in the facts contained in the proposal or declaration herein before. Where a claim for 100% of the Capital Sum Insured is admitted or admissible, Star accident individual insurance policy cannot be renewed for such relevant insured persons. If the claim is less than 100% of the Sum Insured, the company would exclude such disability on renewal in respect of such insured people.

In case the policy is withdrawn or modified with revised terms and premium before approval of the Competent Authority, the insured will be intimated 3-months in advance and accommodated in any other equivalent insurance policy by the company.

Star Health Accident Individual Insurance Policy Cancellation

The company can cancel this policy on the grounds of misrepresentation, fraud, moral hazard, non-disclosure of material fact, or non-co-operation of the insured by giving him/her a 30-day notice. You also hold the rights to cancel the policy at any time, and in such a case, the company shall allow a refund after retaining the premium at the company’s short period rate, if no claim is made up to the date of cancellation.