Star Health Personal Accident Insurance

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Star Health Personal Accident Insurance

Star Health and Allied Insurance Co Limited, founded in 2006 is a joint collaboration between leading Indian businessmen, M/S ICICI Ventures Funds Management, M/S Sequoia Capital, M/s Tata Capital Growth Fund, M/s Alpha TC holdings, Singapore and M/s Oman Insurance Company UAE. The company is known for its customized, tailor made and diverse plans which are there to meet the insurance needs of the individuals, families, students, senior citizens, travelers and rural customers.

Why one should choose Star Health Insurance Plans

  • Cashless hospitalization plans and Reimbursement facility in more than 7000 network hospitals in India.
  • 90% of all cashless claims almost under all plans are approved just within one hour.
  • Pan India presence with more than 290 Branch Offices.
  • Hassle Free and user friendly direct claim settlement process without any TPA.
  • The company has been awarded with many prestigious awards in the past. And in recent times, the company has been awarded as the “Health Insurance Company of the Year 2015” by Indian Insurance Awards, 2015.
  • The company is rated as the Best Claim Settlement Insurer.
  • Personal doctor visit for all customers getting hospitalized.
  • Wide range of insurance plans which caters to the insurance requirements of all individuals.

Accident Care is one of the insurance plans provided by Star health which provides coverage against accidental death, permanent disability and temporary total disablement.

Lets have an overview of Star Health Accident Plan.

Features and Benefits of Accident care Plan

  • Coverage Benefit under the plan includes
    • Accidental Death Plan: In case of Death within 12 months from the occurrence of the accidental bodily injury which is caused due to Accident solely and directly caused by external, violent and visible means, the sum assured is paid which is specified in the Schedule of Insurance Certificate.
    • Permanent or Partial Disability Plan due to an accident: If the insured person meets with an accident resulting to unfortunate death and disablement, the company will provide the insurance coverage under the plan as follows:
      • Death of the Insured person: If death occurs within 12 months from the date of the accident, then the company will pay the maximum Sum Insured.
      • Permanent Disablement : If an accident causes permanent impairment  or injury to the insured physical and mental capabilities, then the company will compensate from any one as mentioned above provided
  • The disablement occurs within 12 calender months from the date of Accident.
  • The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since the occurrence of the disablement.
  • Temporary Total Disablement Plan: During the plan period, if the Insured Person sustains any bodily injury resulting solely and directly from an accident, then the insured person is eligible for a weekly benefit at 1% of Capital Sum Assured subject to a maximum of Rs 5000/- per week for a 100 weeks. This benefit is payable for only one occurrence during the entire plan tenure. The compensation never increases the sum insured under the plan. Also the payment is made only after the termination of such disablement.
  • Free Benefits under the plan: This includes the following coverages:
    • Educational funding: Under this plan, in case the insured person is met with Permanent Total Disability or unfortunate death, educational funding is provided to children below 18 years of age at Rs 5000/- for one dependent child and Rs 10000/-for two  dependent  children below 18 years of age (maximum 2 children).
    • Travel expenses of one relative: Under this plan, if the death of the Insured Person occurs outside the place of his/her residence, the company will pay for the transport expense upto a maximum of Rs 1000/- to the place of accident.
    • Transportation expenses of the mortal remains upto a maximum of Rs 3000/-.
  • Cumulative Bonus: Cumulative Bonus of 5% of the sum insured is allowed for every claim free    year subject to a maximum of 50%.
  • Upon payment of additional premium, the plan can be extended to cover the medical expenses as well.

Risks are classified into three categories for the purpose of rating under all the plans:

  • Risk Group I: Individuals who are engaged mainly in Administrative Departments.
  • Risk Group II: Individuals who are engaged in manual work other than mentioned in Risk Group III.
  • Risk Group III: Individuals who are engaged in explosive industry, mines and /or magazine workers, high tension electric supply, horse racing( including jockey), atheletes and those in occupation with similar hazards.

Policy Premium

Coverage/Risk Group

Group I

Group II

Group III

Per mile=Per Thousand

 

 

 

Table I

0.45 per mile

0.60 per mile

0.80 per mile

Table II

0.80 per mile

1.30 per mile

1.75 per mile

Table III

1.25 per mile

1.75 per mile

2.00 per mile

 

Group Policy

Group Plans are eligible for discounts which are as follows:

Group Size

Discount on Premium

2-100

5%

101-1000

10%

1001-5000

12.5%

5001-10000

15%

>10000

20%

 

Eligibility

  • This plan can be availed by both individuals as well as Groups.
  • Family package under the plan includes children from 3 years along with parents.

Exclusions:

There are certain exclusions under the plan under which the claim will not be admissible. The following are the exclusions:

  • If any expenses has been incurred before the policy inception or otherwise outside the period of insurance plan.
  • Claims which arises due to not following the Doctor’s Advise.
  • Pre-existing condition under the plans.
  • Any claim under the plan which the insured person has caused deliberately or any crime committed due to intoxication or drug addiction.
  • Sports activities which are hazardous.
  • Mental Disorder, suicide or attempted suicide, self injected injuries, or sexually transmitted conditions, anxiety etc.
  • Individuals who are mentally challenged unless agreed and mentioned in the plan.
  • Nuclear, chemical and Biological Terrorism.

Renewal

The plan can be renewed unless there has been any misrepresentation of facts or frauds involved in the plan or the policy. A  Grace Period of 30 days is available from the expiry date of the plan for renewal.

Cancellation

The Company has the right to cancel the insurance plans in the following cases:

  • Misrepresentation of facts.
  • Frauds.
  • Moral hazard.
  • Non Disclosure of material fact.
  • Non cooperation by the Insured person.

Also the Insured may cancel the plan at any time, however the company will refund the premium after retaining the premium at company’s short period rate as below:         

Period of Risk under the plan

Rate of premium to be retained by the company

For a period not exceeding 15 days

10% of the Annual premium

For a period not exceeding 1 month

15% of the Annual premium

For a period not exceeding 2 months

30% of the Annual premium

For a period not exceeding 3 months

40% of the Annual premium

For a period not exceeding 4 months

50% of the Annual premium

For a period not exceeding 5 months

60% of the Annual premium

For a period not exceeding 6 months

70% of the Annual premium

For a period not exceeding 7 months

75% of the Annual premium

For a period not exceeding 8 months

80% of the Annual premium

Exceeding 8 months

Full Annual premium

 

Free look Period for all the plans

In case the Insured wants to cancel the plan due to dissatisfaction in the terms and conditions, a free look period of 15 days from the receipt of the policy document is allowed for cancellation. The company will refund the premium after adjusting the cost of medical check ups done before the processing of the plan, the stamp duty charges and proportionate risk premium for the period provided no claim has been made till such cancellation.

Ways to avail the plans

Various types of Accident Care Plans which are as follows:

  • Accident Care Insurance Plans
  • Student Care- School and College Plan- This plan covers the accidental death, permanent total disability, hospitalization benefits, and education grants.
  • Accident Trauma Care Plan : This covers accidental death, permanent total disability, hospitalization benefits.
  • Pravasi Bhima Yojna Plan: Under this plan, accidental death, permanent total disability, hospitalization benefits for family members of the deceased insured are covered. Repatriation expenses are also covered under this plan in case when there is an employment contingency. Maternity coverage for the insured person and one way economic fare are also covered under this plan.  This is basically issued for the employees who are working on contract aborad.

Claim: 

Accident Claim intimation to be done through call centre / mail / letter / documents  for  all the above plans. The following details are needed:

  • Name of the Insured.
  • Date of the accident.
  • Nature of the accident.
  • Admission date
  • Hospital Name.

Documents needed for death claim

  • Duly filled claim form
  • Death Certificate from Government Authorities.
  • Post Mortem report.
  • Panchanama.
  • FIR.
  • Police Inquest Report.
  • Original Policy Copy.
  • Legal Heir Certificate.
  • Succession Certificate.
  • Death Summary
  • Viscera Report.

Documents needed for Disablement

  • Duly filled claim form and Disability Certificate
  • Photo of the amputated site.
  • Field Visit Report.
  • Certificate from the Treating Doctor for the percentage and the time period of disability based on the location of the amputated part from a Orthopedic Surgeon.
  • Employee Certificate  or a Leave Certificate for the disability period.

There can be two types of claims which are cashless claims and reimbursement claims.

For cashless claims through any of the network hospitals, the Insured person has to submit the following documents for claim:

  • Health Card.
  • Doctor’s Consultation Papers.
  • Duly filled claim form
  • Investigations’ Reports.
  • Invoices related to pharmacy.
  • Medico Legal Certificate (MLC) and FIR.
  • Discharge summary.

Star Care will verify the soundness and the coverage of the plan post which a filed Doctor will be deputed to facilitate the re authorized document request and to confirm the warranting treatment. Thereafter the claim is approved and the process is carried forward.

For Reimbursement Claims, intimation should be given to the Insurance Company within 24 hours of hospitalization. All the bills are to be settled with hospitals and then a claim to be lodged or filed with the Insurance Company. Within 30 days from the date of discharge, the claim documents needs to be submitted. Documents needed for Reimbursement Claims submission are as under:

  • Claim form duly filled. Important to note here is intimation to the toll free number is compulsory before filling up the form.
  • Original bills from the pharmacy accompanied by proper prescription.
  • Original Discharge Certificate/ card from the hospitals with the original bills and receipts.
  • Nature of operation done and Surgeon’s bill and receipt.
  • Investigation Test Reports and its Receipts from a Pathologist supported by a message from the attending practitioner/ surgeon prescribing the test.
  • Hospital Registration Certificate if the numbers of beds are less than 15.
  • Treating Doctor’s Certificate.
  • Self Declaration/ MLC/FIR for accident cases.

Grievances

The Insured person may contact the company if he/she has any disputes or disagreement with the plan. There are certain specified situations where one can write/ contact the Insurance Ombudsman.

  • Any partial or total denial of claims b the company.
  • Disputes regarding the premium paid or payable to the company.
  • Disputes in the legal construction of the plan.
  • Delay in settlement of claims.

Star Personal Accident Insurance - FAQs

1. How to pay premium? What are the modes of payment available?

Star Health and Allied Insurance offers a total online solution for the users. They provide two options for paying the premium.

Direct Debit- Use their online payment gateway to pay the premium amount through credit card, Debit cards and NEFT

Auto Debit- You can opt for automatic debit at the time of policy purchase. Alternatively, you can request for the same by contacting helpdesk.

2. How can I check policy status for Star personal accident insurance?

Only registered users can login to the e-portal, with valid username and password to check the policy status.

If you are not, then simply follow the steps mentioned in the “Register Now” section to create an account. Once done, you can login to the e-portal

3. What is the policy renewal process for Star personal accident insurance?

You can renew the policy by online and offline modes.

Online Mode involves payment via debit/credit care or Net Banking if you have an online account.

Offline mode involves auto-debit or cash/cheque deposit at any of the Star Health and Allied Insurance branches in your city.

4. What is the company’s process to settle claim for Star personal accident insurance?

Star Health and Allied Insurance settles claims within 7 working days of filing the accidental claim. Furthermore, cashless medical claim is also available from the insurer, provided you select the hospital that is on the insurer’s panel. If however you choose a non-network hospital, the insurance company should be contacted within 24 hours of hospitalization with Star Health card number and other medical details to avail cashless facility.

5. What is the policy cancellation process for Star personal accident insurance?

You get a 15-days free look period to cancel the policy. If however, at anytime you choose to cancel the policy, you need to submit a duly filled Surrender form and the policy documents to any of the nearest branch in your city.

The premium will be directly debited to your bank account. However, the refund premium is paid after deducting the cost of medical tests, and stamp duty charges.

Star Health Personal Accident Insurance Reviews

TOTAL REVIEWS (1)
Rustam
Jorhat
May 17, 2016

Good Policy

I have star health personal accident insurance plan. The policy coverage is high and the claims are good. The ambulance is facilitate for free and large number of hospitals are there for better and fast service. The behaviour of the executives and staff is calm and nice. Good policy, I like it.