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Insurance Plans 167 views November 12, 2020
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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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.
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 –
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.
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.
For the following expenses, certain conditions apply to the policy claim.
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.
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.
Some expenses won’t be covered under this Star group health insurance. Check those expenses below.
The company is not liable to make payments in respect of the following:
|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|
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:
After that, the following Claim Documentation will be required during the claim process –
Death Claim Document:-
Disability Claim Documents:
Travel Expenses for One Relative
Vehicle or Residence Modification
Purchase of Blood
Ambulance Fee / Transportation Expenses of Mortal Remains
Optional Benefits Claim Documents:
Hospital Cash and Home Convalescence
Note: The company has the right to call for additional documents wherever it is necessary or required.
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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