When an accidental injury being the sole and direct cause results ( during the period of insurance) in:

On payment of extra premium medical expenses incurred up to 25 % of claim or 10 % of Sum Insured can be covered.

Policy also pays for education fund for dependant children (2) of deceased insured and expenses of carriage of dead body of insured from accident site ( as per details in policy)

Attractive cumulative bonus at the time of renewal by way of increasing the Sum Insured by 5 % for each completed claim free year of insurance ( maximum of 50 % CSI ) without collecting extra premium as per policy.

Policy will not pay under below circumstances:

• Compensation under more than one clause for same period of disability not exceeding capital sum insured
• Any payment after admission of a claim for 50 % / 100 % of Capital Sum Insured
• Any claim in the same period of insurance exceeding the Capital Sum Insured
• Suicide attempt there at VD criminal breach of law accidental death/injury under influence of liquor/drugs
• Pregnancy related claim
• War and nuclear perils

Policy will pay under below mentioned cases:

• Actual hospitalisation expenses of various types listed above subject to a maximum of Rs. 15 0 to Rs. 5 0 0 depending upon the sum insured chosen at the inception of the policy ( sum insured is maximum liability under the policy.)
• Actual domiciliary hospitalisation expenses limited to Rs. 3 0 to Rs. 50 0 depending on the sum insured chosen at inception.
• Cost of health check up reimbursable at the end of 4 continuously claim free underwriting years limited to 1% of Average sum insured of 4 claim free years
• The sum insured will be increased by 5 % cumulative bonus for every claim free year. If there is a claim in a policy with cumulative bonus 10% of the sum insured will be reduced from the earned bonus.

N.B.

Maternity expenses incurred in Hospital / Nursing Home as in-patient subject to limit of sum insured or Rs. 50 0 whichever is lower on payment of extra premium and policy being extended to cover maternity benefits. This benefit is only available in group policies.

All terms benefits conditions of cover are subject to the definitions of various terms under policy.

Policy will not pay under below circumstances:

• Broadly there would be no claim under policy under following circumstances DOMICILLARY HOSPITALISATION: Pre and post hospitalisation treatment treatment of Asthma Chronic Nephritis and Nephritis Syndrome Gastro-enteritis diabetes mellitus and insipidus epilepsy hypertension influenza cough and cold all psychiatric or psychosomatic disorder pyrexia of unknown origin for less than 10 days tonsilitis and URTI arthritis rheumatism ( the list is not exhaustive) Any treatment relating to any illness / disease already in existence at the time of proposal
• Any disease / injury during first 30 days of commencement of policy. ( accidental injury is not an exclusion
• During first year of cover of cataract Benign prostatic Hypertrophy Hysterectomy for menorrhagia on fibromyoma Hernia Hydrocele Congenital internal disease Fistula in anus sinusitis and related disorder
• Any pre-existing disease / illness is not covered during renewal also.
• Vaccination inoculation circumcision or change of life or cosmetic or aesthetic treatment plastic surgery unless dental treatment unless requiring hospitalisation necessitated due to accident or as a part of any illness.
• Cost of spectacles contact lenses hearing aids.
• Convalescence general debility run-down conditions sterility venereal disease intentional self-injury use of intoxicants
• Any variation of deficiency syndrome or AIDS.
• Hospital / nursing home charges not consistent with or incidental to the diagnosis and treatment : Vitamins tonics not forming part of any treatment.
• Any treatment related to pregnancy child birth and voluntary medical termination of pregnancy during the first 12 weeks of pregnancy
• Nuclear perils and war group of perils
• Naturo pathy treatment.

Section A - I - Personal Accident :

If the Insured / Injured person shall sustain any bodily injury resulting solely and directly from accident caused by outward violent and visible means then the company shall pay to the Insured the sum herinafter set forth that is to say:

If such injury shall within twelve calender months of its occurencce be the sole and direct cause of the

• Death
• Total and irrevocable loss of sight of both eyes or both hands or both Legs
• Total and irrevocable loss of sight of one eyes or one entire hand or one entire Leg
• Permanent or partial or absolute diablement

Section A - II - Medical Expenses for Bodily Injury
If the insured has to go undergo Medical treatement as adviced by a qualified physician / Medical Specialist for bodily injury RESULTING SOLELY AND DIRECT FROM road accident which would normally give rise to Third Party Claim under Motor Policies. Hospitalisation expenses for such treatment not exceeding the Sum Insured is payable under following heads.

• Room Boarding expenses as provided by the Hospital / Nursing Home.
• Nursing Expenses
• Surgeon Anaesthetist Medical Practitioner Consultant's Specialist's Fee
• Anaesthecia Blood Oxygen Operation Theatre Charges Surgical Appliances Drugs etc..
• Ambulance Charges

Section A - III - Extension to Cover Medical Expenses to Accident Arising during and in course of Employment

• It is hereby agreed and declared that notwithstanding anything in the within mentioned policy contained to the contrary this insurance extends to covers hospital expenses incurred due to accident during and in course of employement to the extent of Sum Insured ( as defined under Workman's Compensation ACT ). It is imperative that this extension is offered only if section I covering PA is covered.

What will policy pay ?

• Hospitalisation expenses arising solely because of Road accident

Policy will not pay under below circumstances:

• Any payment after admission of a claim for 50% / 100% of capital sum insured.
• Any claim in the same period of insurance exceeding the capital sum insured.
• Suicide / attempted suicide VD Criminal breach of law influence of liquor / drugs..
• Any Hospital Expense not directly related to road accident as defined.
• War and nuclear perils.
• Naturopathy treatment.
• Compensation under more than one clause for the same period of disability not exceeding capital Sum Insured.

In the event of any claim/s becoming admissible under this scheme the company will pay through TPA to the Hospital / Nursing Home or the insured person the amount of such expenses as would fall under different heads mentioned below.

Policy will not pay under below circumstances:

• All diseases/injuries which are pre-existing when the cover incepts for the first time.
• Treatement arising from or traceable to pregnancy ( including voluntary termination of pregnancy) and childbirth (including caesarean section).
• Naturopathy treatment.

Policy will pay as per below:

• Actual extent of loss/damage to property under respective sections chosen;
• Sum Insured is the limit of maximum liability under respective sections;
• Limit of liability to third party for Personal injury/Property damage is upto Rs.25 0 / Rs.10 0 / Rs.3000 under TV/Pedal Cycle/TV Antenna sections respectively.

Personal Accident Section

If injury directly/solely causes within 12 months of its occurrence:

• Death / loss of two limbs / eyes / Total permanent disablement : Full Sum Insured
• Loss of a hand / foot / eye / use of hand / foot : 50% Sum Insured
• Specified Percentage (%) of Sum Insured in other cases of permanent disablement [partial]
• Weekly benefits (Rs.3000/- max.) upto 100 weeks payable for Temporary Total Disability.

The policy will not pay loss/damage due to:

• War and war like perils
• Wear and tear depreciation consequential loss
• Nuclear group of perils
• Gross and wilful negligence of Insured
• Violation of policy conditions
• Loss/damage/liability where Insured's family or Insured's employee are involved as principal/accessory
• Intentional act/self injury/ influence of drug/intoxicant.