Insurance Plans November 12, 2020

Star Group Accident Insurance Policy

Star Health and Allied Insurance Company Limited pays the insured person or his nominees/legal heir a sum assured for any loss during the insurance period if you purchase the  Group Accident Insurance Policy from the company. This policy covers risks such as Accidental Death, Permanent disablement, Temporary total disablement arising out of an accident as described under the policy schedule. Read this post to know the policy coverage, exclusion, and terms & conditions applicable to Star Group Accident Insurance Policy.

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Star Group Accident Insurance Policy Coverage

The policy is for a group of people, which means if the following risk occurs to any of the group individuals, the sum assured will be used. Look at the below-covered risks for which you are purchasing this accident insurance policy from Star.

  1. Accidental Death – If any time during the coverage period, any of the group members sustain any bodily injury from an accident caused by any external, violent, and visible means and this causes the death of the insured person within 12-months from the date of the accident, the company will pay a compensation of 100% of the Capital Sum Insured.
  2. Accidental Death & Permanent Disablement – If an insured meets an accident, which causes disablement or subsequent death, the company will provide insurance coverage to the Insured in the following manner as per the policy schedule:

Accidental Death: If an accident causes death within 12-months from the date of the accident, the company will pay a compensation amount equivalent to 100% of the Capital Sum Insured.

Permanent Disablement: If an accident causes permanent impairment either mental or physical, the company will pay the benefits as provided below –

  1. If the disablement occurs within 12 months from the date of the accident
  2. The disablement is confirmed and claimed before the expiry of 60 days from the time of disablement.

Where a covered accident results in Permanent Disablement whether it falls under Permanent Total Disablement or Permanent Partial Disablement, the higher percentage of the sum insured will be paid.

  • Accidental Death, Permanent Disablement & Temporary Total Disablement (Weekly Compensation) – If any of the following members of the group meet an accident that causes the death of the Insured Person within 12 months from the date of the accident, the company will pay a compensation equivalent to 100% of the Capital Sum Insured. If that accident causes permanent impairment of the Insured’s mental or physical capabilities, the company will pay the benefits of Permanent Total Disablement or Permanent Partial Disablement if the disablement occurs within 12 months from the date of the accident. And the disablement is confirmed and claimed before the expiry of 60 days since the occurrence of the disablement.

If during the period of insurance, any insured person sustains a grievous injury arising solely and directly from an accident and resulting in hospitalization, the insured person will be paid an amount of about 1% of the sum insured per completed week of hospitalization (not exceeding INR.15,000). If such injury causes Temporary Total Disablement, this benefit is subject to a maximum period of 100 weeks from the date of such Temporary Total Disablement. In no case, the compensation will exceed the sum insured. The payment of the benefit is made only after the termination of such disablement.

Special Conditions for Star Group Accident Insurance Policy

For the following expenses, certain conditions apply to the policy claim.

  1. If an accident affects any physical or mental function, which was already impaired before, a deduction as certified by a Government Doctor will be made for this prior disablement.
  2. If several physical or mental functions are affected by an accident, the degree of disablement as per the table of benefits mentioned in the coverage exception will be added together. In any case, the claim will not exceed 100% of the Sum Insured (only 150% in case of Permanent Total Disablement)
  3. For a Permanent Partial Disablement claim, the Sum Insured under the policy will be reduced by the amount of admissible claim concerning whom such sum becomes payable.
  4. In the event of Permanent Disablement, the Insured Person must get himself/herself examined by the company-appointed doctors. The cost for the same will be borne by the company.

Star Group Accident Insurance Policy Additional Features

Now that you know the Star Group Accident Insurance Policy coverage conditions, let’s learn about the additional features –

Ambulance Fee & Transportation Expenses for the Mortal Remains: A claim will be admissible under this Star group policy if the cause of injury or death is an accident outside the insured’s residence. The company pays the claim amount during the policy period either for an ambulance charge for emergency treatment or the transportation of the mortal remains of the insured person to the residence of the insured, including the cost of embalming and coffin charges. The company’s liability towards either the ambulance charges or transportation of mortal remains is INR.5,000 only. And this lump sum is payable in addition to the sum insured which is applicable for each person covered under this star group policy.

Insured Person Relatives Travel Expense: If a claim is made for the death of the Insured Person due to an accident, outside his/her residence, the company will pay an amount up to 1% of the total sum insured for the transport of one relative of the Insured Person, subject to a maximum of INR. 50,000. This claim amount will be payable in addition to the sum insured and applicable to each person covered under the policy.

Vehicle or Residence Modification: You can get a policy claim up to 10% of the sum insured, subject to a maximum of INR. 50,000 to modify the residential accommodation or vehicle as long as it is carried out in India and certified by your attending doctor as a necessity and directly related to an accident for which there is an admissible claim made under the Permanent Total Disablement. This benefit is admissible for Permanent Total Disablement, and the claim amount is payable in addition to the sum insured which is applicable for each person covered under the policy.

Purchase of Blood: Claim up to 5% of the sum insured under the policy, subject to a maximum of INR.10,000 towards the expenses incurred in purchasing blood from a Hospital or Government-approved blood bank for medical or surgical treatment for an admissible claim. The amount for the purchase of blood is payable in addition to the sum insured and applicable for each person covered under the group policy.

Transportation Expenses of Imported Medicines: Get up to 5% of the total sum insured in addition to the sum insured and applicable for each person covered under the policy. This is subject to a maximum amount of INR. 20,000 for the expenses incurred on freight charges for importing medicines to India.

Because the imported medicines, formulations, or alternatives are not available in India, and it is necessary for the medical/surgical treatment following the accident. The imported medicines should be permissible under Government Regulation and they shall not include any drugs under clinical trial, medicines, formulations, or molecules of unproven efficacy.

Star Group Accident Insurance Policy Optional Benefits

If the insured person pays an additional premium under the policy, the following benefits will be available to him/her:

Medical Expenses: Payment of the medical expenses that are necessary and reasonably incurred for the treatment of injuries and where the insured is admitted as an in-patient or as an out-patient. This is for an admissible claim only, and under this, you can get up to 25% of the valid claim or 10% of the sum insured or actual, whichever is less, subject to an overall limit of INR 5,00,000 per person. It is an optional benefit of the policy and will be effective only when the additional premium is paid and specifically shown in the policy schedule.

Hospital Cash Benefit: When you are hospitalized due to an injury caused by an accident as an in-patient, the company will pay a Cash Benefit of INR 1000 for each completed hospitalization day. For this benefit, such hospitalization must happen within 30 days from the date of the accident. The benefit is payable to the insured for a maximum of 15 days per occurrence and 60 days per policy period. The days of admission and discharge will not be considered for hospital cash. And the amount is payable in addition to the sum insured. It is applicable if specifically opted by paying an additional premium.

Home Convalescence: The company will pay INR 500/- for each completed day, subject to a maximum of 15 days from its occurrence and 60 days each policy period. This involves the fees of an engaging attendant at the home residence from the hospital if the same is recommended by the attending physician. For this, the payable amount was in addition to the sum insured and applicable for each person covered under the policy.

Exclusions from the Star Group Accident Insurance Policy

Some expenses won’t be covered under this Star group health insurance. Check those expenses below.

  1. Any payment for more than one claim under the policy during the insurance period, where the maximum liability of the company has exceeded the amount specified in the schedule.
  2. Any other claim that becomes payable for Death or Permanent Total Disablement after a claim has been admitted by the company. This would not cover the payment under education grant, ambulance charges, transportation of mortal remains, travel expenses of relatives, residence modification, purchase of blood, and the transportation of imported medicines.
  3. Any claim that may have arisen due to an accident related to pregnancy, childbirth, infirmity (directly or indirectly)

General Exclusions

The company is not liable to make payments in respect of the following:

  1. The company will not do the payment, in case of more than one claim, during any period where the maximum liability has exceeded the capital sum insured, except in case of Permanent Total Disability claim, where the payable amount is 150% of the sum insured. This exclusion will not affect the Medical Expenses Extension, Hospital cash, Home Convalescence, Ambulance Charges, Transportation of mortal remains, vehicle or residence modification, travel expenses of the relative, purchase of blood, and transportation of imported medicines.
  2. The company will not pay for any claim relating to events occurring before the commencement of the cover or outside the insurance period.
  3. Pre-existing conditions
  4. Payment of Death or Disablement arising due to intentional self-injury, suicide, attempted suicide, the influence of intoxicating liquor/drugs, or self-endangerment act unless it is for self-defense or to save someone’s life.
  5. Mental disorder
  6. Suicide or attempted suicide
  7. Self-inflicted injuries
  8. Sexually transmitted conditions
  9. Anxiety, stress, depression, venereal disease, or any loss due to HIV (Human Immunodeficiency Virus) or any HIV related illness including AIDS (Acquired Immunodeficiency Syndrome), insanity, and any mutant derivative, or variations.
  10. If the insured person engages himself in Air Travel unless he/she flies as a fare-paying passenger of an aircraft properly licensed to carry passengers.
  11. Accidents from war and war-like occurrence, invasion, acts of foreign enemies, hostilities, civil war, rebellion, insurrection, civil commotion, military or usurped power, seizure capture, arrest, restraints, detainments, etc.
  12. If the insured person participates in riots, confiscation, nationalization or requisition of or destruction of or damage to property by or under the order of any government or the local authority.
  13. Claims resulting from or arising from or any consequential loss that is directly or indirectly caused by the following as mentioned in the table below:
    Cause of Accident
    Ionizing radiation or contamination by radioactivity from any nuclear fuel, nuclear waste combustion (including any of the self-sustaining process of nuclear fission)
    Nuclear weapons material
    Radioactive, toxic, explosive and other hazardous properties of any explosive nuclear assembly or nuclear component
    Nuclear, Chemical and Biological terrorism
  14. If the insured person is involved in the training or participation in professional or semi-professional sports.
  15. Insured Person’s participation in hazardous Sports/Activities
  16. Physically and mentally challenged insured persons, unless the conditions were specifically agreed and endorsed in the policy.
  17. If the insured person attempts commission of or do willful participation in an illegal act or engage in any violation of the law, the cover won’t apply

Star Group Accident Insurance Policy Claim Procedure

Before you purchase any type of health insurance, you must have a better understanding of its claim procedure, so you don’t have any problems in the future. And for the same reason, in the below steps, you will find how to claim the Star Group Accident Insurance policy. The conditions mentioned below will apply throughout the insurance period. And any failure to comply with the conditions may be prejudicial to a claim:

  1. An intimation about the accident that gives rise to a claim must be given within 30 days of its happening.
  2. A claim for the insurance benefits must be submitted to the company not later than 1 month after the completion of treatment or after transportation of the insured person’s mortal remains/burial (in case of a death).
  3. However, the company first examines and relaxes the time limit for the claim, as per the condition depending upon the merits of the case.
  4. The company receives a claim intimation by the call center or its corporate office, including details of the coverage that is collected.

After that, the following Claim Documentation will be required during the claim process –

  • A duly completed claim form

Death Claim Document:-

  1. Death Certificate
  2. Post-mortem Certificate (if conducted as per the case)
  3. FIR (wherever it is necessary or required by the company)
  4. Police Investigation report or panchanama (wherever it is necessary or required by the company)
  5. Viscera Sample Report or a Chemical analysis report (wherever it is necessary or required by the company)
  6. Forensic Science Laboratory report (wherever it is necessary or required by the company)
  7. Legal Heir Certificate
  8. Succession Certificate (wherever it is necessary or required by the company)

Disability Claim Documents:

  1. Certificate from the Government doctor (who is not below the rank of Civil Surgeon and can confirm the disability & its percentage). The company-authorized doctor may examine the insured if required for further investigation.
  2. Certificate from the employer for a confirmed leave of absence

Travel Expenses for One Relative

  1. Original proof of expenses incurred

Vehicle or Residence Modification

  1. Certificate from the attending doctor confirming the disability and the requirement of modification
  2. Cost estimate from a workshop
  3. Cash receipt for the modification
  4. An estimated fee of the civil engineer
  5. Cash receipt for the work modification completion

Purchase of Blood

  1. Original receipt for purchase of blood (wherever it is necessary or required by the company)

Imported Medicines

  1. A prescription from the treating doctor
  2. Confirmation regarding the non-availability of medicines in India
  3. Original receipt for the freight incurred towards import
  4. A copy of the invoice

Ambulance Fee / Transportation Expenses of Mortal Remains

  1. Death Certificate
  2. Proof of hospitalization
  3. Proof of utilized services (Ambulance or Mortuary Van)

Optional Benefits Claim Documents:

  1. Medical expenses
  2. Original Discharge Summary (wherever it is necessary or required by the company)
  3. Original Medical Reports
  4. Original Invoices and Bills
  5. Original Payment Receipts

Hospital Cash and Home Convalescence

  1. Discharge Summary (wherever it is necessary or required by the company)
  2. Recommendation by the treating doctor
  3. Cash receipt of the payment made to the attendant

Note: The company has the right to call for additional documents wherever it is necessary or required.

Star Group Accident Insurance Policy Claim Settlement

The Star group policy benefits are payable within 7 days from the receipt of all documents. In case of delay in claim payment under the policy terms and conditions, beyond the stipulated period as prescribed under IRDA (Protection of Policyholders Regulation), 2002, the company is liable to pay an interest, which is 2% above the bank rate as per the financial year in which the claim is approved by the company.

For this clause, ‘bank rate’ means the existing rate as notified by the Reserve Bank of India (RBI), unless the extent of regulation requires payment at some other prescribed interest rate. The company is released from any obligation to pay insurance benefits if any of the terms and conditions are breached during the policy period. The Star Group Accident Insurance Policy cover applies worldwide.

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