L&T my: Health Personal Accident Insurance Policy

The my: health Personal Accident Policy offered by L&T Insurance is a personal accident disability plan which offers coverage for death or disability resulting from an accident within 12 months after the accident.

Plan variants –

None

Main highlights of the plan –

Along with the basic benefits that are offered under personal accident disability plan, the my:health Personal Accident Insurance policy by L&T Insurance offers additional benefits like:

1. Additional benefits worth INR 46,000 without payment of extra premium. Example: coverage for transportation cost, ambulance charges, out-patient costs, education fund and compensation on loss of employment resulting from the disability.

2. 10% discount on premium on family package cover or individual cover for minimum 3 members covered under this policy.

Scope of cover –

1. In case of individual policy, individuals between age 5 years up to 70 years can be covered under this health insurance plan. Children up to age 18 years are covered only if one of the parents is covered.

2. In case of family package policy, dependent children between age 3 months and 23 years are covered.

3. The individual has four coverage options to choose from:

• Table A - Only death resulting from accident.

• Table B - Death resulting from accident or Permanent total disability (PTD)

• Table C - Death resulting from accident or permanent partial or total disability (PPD or PTD)

• Table D - Death resulting from accident or Permanent Partial or Total disability or Temporary Total Disability (PPD or PTD or TTD)

1. In case of family package cover for relations like dependent parents, dependent child and lawful spouse can be covered under this policy as family package cover.

2. The sum insured limit for spouse and dependents (children or parents) is up to 50% and 25% of insured individual’s sum insured.

Note: Children between age 5 years and 18 years can be covered only if the parents are also covered in the policy.

Risk Group Classifications –

Risk Group I –

Bankers, Accountants, Doctors or individual engaged in of similar type of occupation would be categorized under Risk group I group. This also includes students, housewives

Risk Group II –

Paid driver, crew on aircraft, security guards, geologists or or individual engaged in of similar type of occupation would be categorized under Risk group II group.

Risk Group III –

Workers in explosives industry, mine and / or magazine workers, high tension supply, horse racing including jockeys, athletes and occupations of similar hazard are categorized under Risk Group III.

Eligibility –

Individual and family package cover

Coverage and benefits –

Most important –

Some of the important benefits under my:health Personal Accident Insurance offered by L&T Health Insurance are:

ACCIDENTAL DEATH –

In case an insured owning a personal accident policy dies as a result of an accident within 12 calendar months post its occurrence then, he/she would get a compensation equal to 100% of sum insured irrespective of any hospitalization expenses. All the coverage options (Table A, Table B, Table C and Table D) available for my:health Personal Accident plan offered by L&T have accidental death benefit.

PERMANENT TOTAL DISABILITY –

In case an insured owning a personal accident policy gets totally disabled on a permanent basis as a result of an accident within 12 calendar months post its occurrence then, he/she would get a compensation equal to 100% of sum insured irrespective of any hospitalization expenses. The Table B, Table C and Table D of my:health Personal Accident plan offers permanent total disability benefit.

PERMANENT PARTIAL DISABILITY –

In case an insured owning a personal accident policy gets partially disabled on a permanent basis as a result of an accident within 12 calendar months post its occurrence then, he/she would get a compensation in the range of 1% to 50% of sum insured irrespective of any hospitalization expenses. The compensation amount is dependent on the part of the body disabled. The Table C and Table D of my:health Personal Accident plan offers permanent partial disability benefit.

TEMPORARY TOTAL DISABILITY –

In case an insured owning a personal accident policy gets totally disabled on a temporary basis as a result of an accident within 12 calendar months post its occurrence then, he/she would get a compensation equal to 1% of sum insured up to maximum of INR 6000 per week. The Table D of my:health Personal Accident plan offers temporary total disability benefit.

Value added benefit –

Along with most important benefits covered under a personal accident disability plan the my:health Personal Accident plan of L&T offers some value added benefits without any extra premium which are:

1. Compensation in case of loss of employment –

In case the insured loses his/her job because of permanent partial or total disability resulting from an accident then, a compensation equal to 1% of sum insured up to a maximum of INR 15,000 is provided.

2. Education Fund –

In case the insured individual dies or gets totally disabled on a permanent basis and has a valid claim under this policy then, his/her dependent children will be provided with an education fund to cover up expenses on education.

• One child up to age 23 will be provided with education grant equal to 10% of the sum insured up to a maximum of INR 12,500.

• More than one children up to age 23 years will be provided with education fund equal to 10% of the sum insured up to a maximum of INR 25,000 for all children.

3. Coverage for ambulance expense –

In case of an accident of insured, ambulance charges for transporting insured to the hospital are covered up to INR 1000 per person.

4. Coverage for out-patient expense –

In case of an accident, under this benefit the cost of out-patient treatment is covered up to INR 1000 per person and a maximum of INR 2,500 per policy period.

5. Coverage for expenses on transportation to the hospital or morgue –

In case the insured individual dies and has a valid claim for the same under this policy then, cost of transportation of the death body to the insured individual house, funeral or cremation expenses are covered up to 2% of the sum insured for a maximum of INR 2,500.

Note: In case the actual expense for the benefits like ambulance expense cover and out-patient benefit or transportation cost cover mentioned above is lower than the maximum coverage limit then cost of compensation would be equal to the actual expense.

ADD-ON COVER

Some benefits offered by my:health Personal Accident policy on payment of additional premium are:

1. Coverage for expense on supporting items –

In case the insured uses supporting items like crutches, artificial limbs, etc. for injuries post an accident then, coverage for actual expenses up to a maximum of 2% of sum insured or INR 10,000 is provided.

2. Coverage for cost of travel –

In case the accident occurs away from the insured individual’s residence then the actual cost of travel of a nominated friend or relative to the place of accident is covered up to a maximum of 2% of sum insured or INR 10,000.

3. Coverage for cost of hospitalization –

In case the insured is hospitalized post-accident then with the cost of hospitalization would be covered with this add-on cover. The amount reimbursed in such case would be proportional to the additional premium paid.

Exclusions –

Some of the major exclusions under a personal accident plan are:

1. War or terrorism related injuries.
2. Self- injury or suicide.
3. Pre-existing injury or disability.
4. Loss of life because of some disease or infection.

Please refer the policy document for the detailed list of all the exclusions.