Accidentcare
An accident can exhaust the savings of a lifetime and even cause irreversible disability and loss of income. Our AccidentCare Insurance Plan provides cover not just in the case of accidental death but also for Permanent Total or Partial Disability, along with a host of other benefits.
Coverage - Individual and Family Coverage
Sum Insured – Rs 5 Lacs to 5 Crore.
If you are claiming your insurance as an individual, you are entitled to 100% of the sum insured promised.
When you are claiming your sum insured on a family plan that covers yourself, a spouse and up to 2 children, you are entitled to 100% of the amount, your spouse is entitled to 50% or Rs. 10 Lacs (whichever is lower), and your children are entitled to 20% of the amount or Rs. 5 Lacs (whichever is lower).
Maximum Sum Insured will be 12/15 times of annual income for salaried/self-employed respectively.
Features
Click Here to read the policy wording.
Eligibility Criteria
AccidentCare: Coverage available for adults and children. Entry age for adults is 18 years to 65 years and entry age for children is 2 years to 21 years (dependent children)
Permanent Exclusions
Suicide or self inflicted injury, whether the Insured Person is medically sane or insane.
Treatment for any injury or illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism.
Service in the armed forces, or any police organization, of any country at war or at peace or service in any force of an international body or participation in any of the naval, military or air force operation during peace time.
Any change of profession after inception of the Policy which results in the enhancement of Our risk, if not accepted and endorsed by Us on the Schedule of Insurance Certificate.
Committing an assault, a criminal offence or any breach of law with criminal intent.
Taking or absorbing, accidentally or otherwise, any intoxicating liquor, drug, narcotic, medicine, sedative or poison, except as prescribed by a Medical Practitioner other than the Policyholder or an Insured Person.
Participation in aviation/marine including crew other than as a passenger in an aircraft/water craft that is authorized by the relevant regulations to carry such passengers between established airports or ports
Including but not limited to engaging in or taking part in professional/adventure sports or any hazardous pursuits, such as speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports, hunting etc;
Body or mental infirmity or any disease except where such condition arises directly as a correspondence of an accident during the policy period. However this exclusion is not applicable to claims made under the PPD benefit
Any costs or expenses specified in the List of Expenses Generally Excluded at Annexure II of policy document. This is applicable only for Accident Hospitalization benefit
Criticare
Acquiring critical illness such as cancer, stroke, kidney failure or lung disease is a life changing event which can disrupt dreams and goals for family and wipe out savings. Prepare for any critical illnesses with Niva Bupa, and get the help you need to get back on your feet when your body lets you down
Coverage - individual and family Coverage
Sum Insured – Rs 3 Lacs to 2 Crore
Coverage available for spouse as well. Family combinations – 1 Adult or 2 Adults.
Maximum Sum Insured will be 12/15 times of annual income for salaried/self-employed respectively.
Features
20 Critical Illnesses Covered
Benefit Options
You can choose any of the following benefit options. Option once chosen cannot be changed later during the lifetime of the policy.
2 OR 3 Year Policy Tenure Options
Opt for a 2 or 3 year tenure on your insurance plan and get discounts on your premium.
Assured Policy Renewal
Guarantee your policy renewals for life. Your premium is only calculated basis your age and city of residence, and NOT your claim history.
Tax Benefit
A Niva Bupa health insurance policy can help you save tax under Section 80D of the Income Tax Act. These benefits are subject to change in tax laws. You may consult your tax advisor for more in-depth advice pertaining to your personal finances.
Free Look Period
Your complete satisfaction is important to us. If you’re unsatisfied with your policy, you have a 15 day free look period during which you can cancel your policy simply by stating your reason. The free look period will be 30 days if the Policy is purchased through distance marketing mode and Policy Tenure is 3 years.
Eligibility Criteria
CritiCare: Coverage available only for adults. Entry age is 18 years to 65 years
Permanent Exclusions
Acquired Immune Deficiency Syndrome (AIDS), AIDS-related complex or infection by Human Immunodeficiency Virus (HIV)
The Insured Persons attempted suicide or self-inflicted injuries while sane or insane
Narcotics used by the Insured Person unless taken as prescribed by a Medical Practitioner, or the Insured Person’s abuse of drugs and/or consumption of alcohol
The directions, advice and guidance of the treating Medical Practitioner shall be strictly followed. We shall not be obliged to make any payment that arises out of willful failure to comply with such directions, advice or guidance
Treatment for any injury or illness resulting directly or indirectly from nuclear, radiological emissions, war or war like situations (whether war is declared or not), rebellion (act of armed resistance to an established government or leader), acts of terrorism
Taking part in any naval, military or air force operation during peace time
Participation in aviation/marine activities including crew other than as a passenger in an aircraft/water craft that is authorized by the relevant regulations to carry such passengers between established airports or ports
Including but not limited to engaging in or taking part in professional/adventure sports or any hazardous pursuits, such as speed contest or racing of any kind (other than on foot), bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing necessitating the use of guides or ropes, potholing, abseiling, deep sea diving using hard helmet and breathing apparatus, polo, snow and ice sports, hunting etc.
Participation by the Insured Person in a criminal or a breach of law with criminal intent
Maximum number of days covered for an insured person per year is 45 days (including 7 days under ICU).
Customers will have the flexibility to pick and choose their own cover. They can opt for any of the below 7 combinations:
The claims for AccidentCare or CritiCare have to be notified to Us within 30 days from the date of death or disability or diagnosis of the illness. The claims for HospiCash and Accident Hospitalization under AccidentCare are to be notified to Us within 48 hours from the date of occurrence of the accident or hospitalization. All necessary documents shall be submitted within 30 days from the date of intimation of the claim or date of discharge, whichever is earlier. Upon acceptance of a claim, the payment of the amount due shall be made within 30 days from the date of receipt of last necessary document.
Under AccidentCare, if the claim is made under Accident Death or Permanent Total Disability (PTD) or Permanent Partial Disability (PPD) for 100% of Sum Insured, then the AccidentCare benefit coverage will be terminated for the insured person and cannot be renewed.
Post claiming Permanent Partial Disability (PPD), the remaining sum insured for other benefits will be reduced. For example, if 50% of Sum Insured has been claimed under PPD, then this Sum Insured shall also be reduced from all other benefits as well. If Permanent Total Disability (PTD) claim is made and accepted afterwards, the the balance 75% of Sum Insured (125% - 50%) shall be paid and the AccidentCare coverage benefit shall terminate and cannot be renewed for the insured person.
If 100% of PPD benefit would have been claimed, the AccidentCare coverage benefit would be terminated and cannot be renewed for the insured person.
Accident or Accidental means a sudden, unforeseen and involuntary event caused by external visible and violent means
At the time of claim, lump sum (100% of Sum Insured) will be paid. Subsequently, 10% of Sum Insured will be paid every year for a period of 5 years. No separate form is required to be filled-up every year for the same.
For Ex: If the sum insured chosen at inception is Rs.50,00,000 then as per the chosen option:
- Option 1, Rs.50,00,000 shall be paid as lump sum
- Option 2, if Rs.50,00,000 is paid as lump sum on 1st June 2016. In addition from next year onwards at the
Beginning of each year for subsequent 5 years i.e on 1st June of every year from 2017 to 2021, payout equal to Rs 5,00,000 shall be paid to the beneficiary
Yes, for salaried it is maximum 12 times of annual income & for businessman it is 15 times of annual income.
Yes, you can apply for multiple policies subject to maximum limit as per your income and underwriting.
No, the proposer and policyholder (Primary Insured) shall be the same person under Health Assurance.
Yes, Income Proof is mandatory if sum Insured is equal to or more than 50 Lacs
Yes, it is mandatory for AccidentCare. Occupation and Risk class shall be mentioned in the proposal form.
Yes you can take all benefits together, No separate discount for this option.
No, an insured person can only claim once during his/her lifetime post which CritiCare benefit coverage cannot be renewed for that insured person.
In AccidentCare, if the claim is made under Accident Death or Permanent Total Disability (PTD) or Permanent Partial Disability (PPD) for 100% of Sum Insured, then also the AccidentCare benefit coverage cannot be renewed for that insured person
10 Lac and 20 Lac only. TTD Sum Insured shall not exceed Lower of (2 times of Annual Income or AccidentCare Sum Insured).
It will remain same. No reduction in cumulative bonus