Frequently Asked Questions (FAQs)-Smart Personal Accident Insurance Policy
1. What does the Smart Personal Accident Policy cover?
The Policy provides for a comprehensive cover against bodily injury, due to accident,
leading to:
WThe Policy provides for the following benefits, in case of a death of the Insured person due to accidental death injury:
1. Transportation of mortal remains
2. Funeral expenses
3. Education grant for children
The Policy also provides for a host of value-added benefits such as hospital daily cash allowance, accidental medical expenses, double death or PTD benefit and legal expenses.
2. What are the value-added benefits on offer?
The following are the value-added benefits, available under this Policy
a) Hospital Daily Cash Allowance: This benefit provides for payment of a fixed allowance per day of hospitalisation treatment in India for accidental bodily injury, if the hospitalisation exceeds a specified number of days. The rate of allowance and the minimum period of hospitalisation qualifying for payment of this allowance will be as per the plan opted by the Insured.
b) Accidental Medical Expenses: This benefit provides for reimbursement of actual medical expenses incurred in India following medical treatment for bodily injury. The limits of reimbursement under this benefit shall be as per the plan opted by the Insured.
c) Double Death or Permanent Total Disablement Benefit: This benefit provides for payment of Double benefit (200% of the Sum Insured) for death or Permanent Total Disablement due to accident whilst travelling as a passenger in a public conveyance.
d) Legal Expenses: This benefit provides for payment of legal costs and expenses incurred towards claims for compensation for death or disablement arising due to an accidental bodily injury during the Policy period.
3. What are the plan options available?
There are 7 different plan options to choose from. These options are given below:
1. Smart PA Basic
2. Smart PA Regular
3. Smart PA Standard without medical expenses cover
4. Smart PA Standard with medical expenses cover
5. Smart PA Silver
6. Smart PA Gold
7. Smart PA Superior
Out of these plans, Smart PA Superior is an underwritten plan, where as the rest are all pre-underwritten plans.
4. What are the major exclusions under this Policy?
The major exclusions under this Policy are:
1. Death or disablement caused by or attributable to pregnancy or child-birth
2. Compensation under more than one of the foregoing Clauses in respect of the same period of disablement except the Add-on covers.
3. Any payment in case of more than one claim under the Policy during any one period of insurance by which the maximum liability of the Company in that period would exceed the sum payable under the Basic Cover of the Policy.
- This would not apply to payments made under Add-on covers, education grant and expenses for transportation of mortal remains.
4. Any claim in respect of accidental death or permanent disablement of the Insured/Insured Persons.
i. from intentional self-injury, suicide or attempted suicide
ii. self exposure to needless perils except in an attempt to save human life
iii. whilst under the influence of liquor or drugs or other intoxicants
iv. whilst engaging in aviation or ballooning whilst mounting into, dismounting from or traveling in any aircraft or balloon other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world
v. directly or indirectly, caused by venereal disease, AIDS or insanity
vi. arising or resulting from the Insured/Insured Person committing any breach of law or participating in an actual or attempted felony, riot, crime, misdemeanour or civil commotion
vii. whilst engaging in racing, hunting, mountaineering, ice hockey, winter sports.
5. Payment of compensation in respect of death, injury or disablement of the Insured/Insured Person due to or arising out war and war like operations as well as nuclear perils.
5. Who are eligible to take this Policy?
This Policy can be taken by persons who are Residents in India. Residents in India shall include all Citizens of India and permanent residents of India as well as expatriates or foreigners who are holding an employment pass, dependant pass or work permit and residing in India.. Any one who is in the age group of 18 years to 70 years and renewal is available up to age 75 years.
6. How is premium calculated for pre-underwritten plans?
The premium for pre-underwritten plan is based on.
1. Plan Opted
2. Occupation group of the Insured
7. What are the occupation groups and how are they classified?
The insured persons can be divided into the four risk class, as per the profession of the proposer.
Occupation GROUP I:
Accountants, Doctors, Advocates, Architects, Consulting Engineers, Teachers, Bankers, Persons engaged in administrative functions, Small business owners wherein the business is not dealing in hazardous goods or not involving manual labour.
Occupation GROUP II:
Builders, Contractors and Engineers engaged in superintending functions only. Veterinary Doctors, paid drivers of motor cars and light motor vehicles and persons not engaged in manual labour
All persons engaged in manual labour (Except those falling under Group III) Cash Carrying Employees, Garage and Motor Mechanics, Machine Operators, Drivers of trucks or lorries and other heavy vehicles, Professional Athletics and Sportsmen, Woodworking Machinists.
Occupation GROUP III:
Persons Working in underground mines, explosives, magazines, workers involved in electrical installation with high tension supply, demolition workers, Jockeys, Circus personnel, Persons engaged in activities like racing on wheels or horseback, big game hunting, mountaineering, winter sports, skiing, ice hockey, ballooning, hand gliding, river rafting, polo.
Occupation GROUP IV: (declined category)
Persons working in Police force, armed forces, nuclear power stations, persons not sound in mind and mentally retarded persons, visually challenged persons, persons working as Air Crew and Ship Crew and Persons who are actively affiliated to political organizations.