ICICI Lombard Group Personal Accident Health Insurance Plan

Entry Age

The last birthday of the insured will be considered.

Sum Insured

Based on the earning capacity of the person insured, the sum insured can be determined.

Policy Tenure

12 months from the state date of the cover period.

Renewability

Ordinary renewal except in case of misrepresentation, fraud, moral hazard or non-cooperation on the insured’s part. The policy will be renewed as a separate contract under the prevailing group accident product. If the same product is not available, then the policy will renewed with its closest substitute.

Claims

Claims will be settled within 30 days from the date of receipt of all documents. Claims will be paid through electronic fund transfer.

Premiums

The amount of premium payable will depend upon the occupation of the person insured. It will also depend on the benefits opted for under the policy.

Benefits

Benefits are customisable as per the needs of the corporate and the group insured. General coverage includes:Death resulting from accidentPermanent total disablement from accidentPermanent partial disablement from accidentTemporary total disablement from accident

Documents Required for Claim

Photocopy of insured’s Health cardDuly-filled insurance claim form (attested by the treating doctor and the insured)Final hospital bill (with a detailed break-up) along with interim billsDischarge summaryDoctor’s consultation papersPayment ReceiptsPharmacy bills with doctor’s prescriptionsAll investigation reports (such as CT Scan, Original Blood report, X-ray, MRI, Sonography, etc.)Invoice or sticker of any Implant such as stents for angioplasty or lens for cataractMedico Legal Certificate and FIR for all accident cases might be requiredIf there are any miscellaneous charges, detailed bills with supporting prescription of the treating doctor are requiredAny other relevant documents

Main Exclusions

The plan will not cover costs arising out of self-injury, suicide, war, nuclear hazards, pregnancy, and venereal disease.

Group discount

Based on the size of the group, discounts are available. The discounts that can be availed depend on a set slab that increases with the size of the group insured.

Grace period

The policy must be renewed before or on the date of the expiry of the previous year’s policy.

Extension

The policy extends to medical expenses incurred.