United India Insurance Company Limited

Any person can reclaim all the medical expenses incurred in a Hospital/Nursing home because of an accident.

Insurance can be taken for a value of 25,000/- to 1,00,000/- for a period of 1 to 5 years.

Insured Against What Risk

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 here in after set forth that is to say:

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

• Death
• Permanent or partial or absolute disablement
• 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

Section A - II - Medical Expenses for Bodily Injury

If the insured has to go undergo Medical treatment as advised 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. Hospitalization 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, Anaesthesist, Medical Practitioner, Consultant#$#s Specialist#$#s Fee
• Anaesthesia, 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 employment 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 the policy pay?

Hospitalization expenses arising solely because of Road accident

What will policy not pay?

• 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.

b) Mediclaim Policy

Policy Coverage

Expenses incurred by the insured for hospitalization for illness / diseases or injury sustained (domiciliary hospitalization also payable as per policy). These include Hospital charges (Room, Boarding & Operation theatre) fees for surgeon, Anesthetist Nursing, specialist etc., diagnostic tests, cost of medicines, blood, oxygen etc., cost of appliances like pacemaker, artificial limbs etc. are included.

Who can be Insured?

• Any person in the age group of 5 to 75 years Children between 3 months and 5 years can be covered only along with parent/s.
• Institutions (Government or Private ) for their employees
• Clubs / association for their members in the said age group.
• Group schemes for homogenous groups of more than 50 persons.

What are the risks insured against ?

Illness / disease, accidental injury sustained leading to one or more of class of expenses listed above.

Other Benefits

• Domiciliary hospitalization benefits can be excluded under group mediclaim policy and a premium discount can be availed
• Exemption under income tax (80D of Income Tax Act) for Premium paid by cheque.

A discount of 10% of total premium for coverage of family under a single policy is provided.

What will Policy Pay?

• Actual hospitalization expenses of various types listed above subject to a
  maximum of Rs. 15,000/- to Rs. 5,00,000/- depending upon the sum insured chosen at the inception of the policy (sum insured is maximum liability under the policy.)
• Actual domiciliary hospitalization expenses limited to Rs. 3,000/- to Rs. 50,000/- 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.

Maternity expenses incurred in Hospital / Nursing Home as in-patient subject to limit of sum insured or Rs. 50,000/- 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.

What will policy not pay?

• Broadly there would be no claim under policy under following circumstances
  Domiciliary hospitalization: Pre and post hospitalization 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, tonsillitis 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 hospitalization 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
• Naturopathy treatment.

Janata Personal Accident

Cover includes

Any Individual aged between 10 -70.

Sum Insured Details

Policy can be availed for an amount of Rs.25,000/- to Rs.1,00,000/- sum insured.

What is Insured?

Accident resulting in,

• Death
• Permanent total disablement
• Total and irrecoverable loss of use of limb
• Loss of eye sight

What will the Policy Pay?

In the event of accidental injury, it provides compensation as follows -

• Death or permanent total disablement - 100% of sum insured.
• Loss of one limb or one eye - 50% of sum insured.
• Loss of two limbs or two eyes or one limb and one eye - 100% of sum insured.

What is not Covered?

• No compensation is payable for any disablement that exists at the time of taking the policy. No payment will be made in excess of the sum insured for each individual.
• Intentional self-injury
• Suicide or attempted suicide
• Whilst under the influence of intoxicating liquor or drug
• Whilst racing on wheels
• Hunting
• Big game shooting
• Mountaineering or whilst engaged in winter sports or resulting from the insured committing any breach of law with criminal intent.
• War and nuclear perils

Gramin Accident Policy

Any Individual aged between 10-70.

What can be Sum Insured?

Policy can be availed for an amount of Rs.5000/- sum insured.

What is Insured?

• Death
• Permanent total disablement
• Total and irrecoverable loss of use of limb
• Loss of eye sight due to accidental injury.

What will Policy Pay?

In the event of accidental injury, it provides compensation as follows-

• Death or permanent total disablement - 100% of sum insured.
• Loss of two limbs or two eyes or one limb and one eye - 100% of sum insured.
• Loss of one limb or one eye - 50% of sum insured.

What is not covered?

• No compensation is payable for any disablement that exists at the time of taking the policy. No payment will be made in excess of the sum insured for each individual.
• Intentional self-injury
• Suicide or attempted suicide
• Whilst under the influence of intoxicating liquor or drug
• Whilst racing on wheels
• Hunting
• Big game shooting War and nuclear perils
• Mountaineering or whilst engaged in winter sports or resulting from the insured committing any breach of law with criminal intent.

Exclusive Health Policies include:

• Family Medicare
• Gold
• Platinum
• Senior citizen
• Super Top-up
• Top-up

a) Family Medicare

Salient Features:

This policy covers all the members of a family under a single sum insured.

Eligibility: Family comprising of Self, Spouse and Dependent Children

Age: Proposer between 18 and 80 years. Dependent children between the age of 3 months and 18 years provided either or both parents are covered concurrently. However, children above18 years will cease to be covered if they are employed/self-employed or married. For unmarried and unemployed girls, disabled children without income dependent upon Proposer, the age limit of 18 will not apply. Male child up to 26 years can be covered provided they pursue full-time higher studies and submit Bonafide Certificate from Institution.

Sum Insured: Beginning from Rs.1 lakhs in multiples of Rs.50,000/- up to Rs.5 Lac and from Rs.5 Lac to Rs.10 Lac in multiples of Rs.1 lakhs.

Existing Health Policyholders of the Company can also opt for Family Medicare Policy on expiry of their current policy if there has been no claim for the preceding two years in respect of insured persons. If parents are covered under existing health policy of the company they can opt for a separate Family Medicare Policy. Either parent or son/daughter can be the proposer for such a policy. Claim Discount/Cumulative Bonus, if any, under existing policy will not be carried forward.

b) Gold Plan

Salient Features Of The Policy 1.1 The Policy can be availed by persons who are in the age group of 36 years to 60 years and taking a Mediclaim Policy for the first time. In respect of persons with existing Insurance, they will be fitted into the respective age group.

Age Limit: Persons between the age of 36 years and 60 years at the time of taking policy. Children from the age of 3 months are covered provided the parents are covered concurrently.

Family Discount A family discount of 5% of the total premium will be allowed comprising the insured and any one or more of the following: a. Spouse, b. Dependent children (i.e. Legitimate or legally adopted children) c. Dependent Parents.

c) Platinum Plan:

The Policy can be availed by persons who are in the age group 3 months to 35 years and taking a Mediclaim Policy for the first time. In respect of persons with existing Insurance, they will be fitted into the respective age group.

Age Limit:- Persons between the age of 3 months and 35 years at the time of taking policy. Children from the age of 3 months are covered provided the parents are covered concurrently.

Family Discount: A family discount of5% of the total premium will be allowed comprising the insured and any one or more of the following: a. Spouse, b. Dependent children (i.e. Legitimate or legally adopted children) c. Dependent Parents.

No Claim Discount: The insured shall be entitled for No Claim Discount of 5% for every claim free year subject to a maximum of 25%.

Payment Of Premium: As per table attached. At each renewal, the Company will review the rate and loading, if any, will be applicable subject to a maximum of 200% of the expiring premium.

d) Senior Citizen Policy

Applicable for individuals above 60 years of age

e) Super Top Up Policy

f) Top Up Policy

Super Top-Up Policy and Top Up Policy are other health insurance covers being offered for individuals. A comparative study pertaining to the two products are as follows:

Published on Sep 19, 2014
Last Updated on Jul 27, 2020