There is a lot of personal accident insurance policy available in the market. All these products have one or another unique benefits and features. It becomes very difficult for the individual to choose the right product out of the heap of schemes. So with the objective of having a standard product with common and basic coverage and policy wordings across the industry, The IRDAI has decided to mandate all general and health insurers to offer the Saral Suraksha Bima policy.
The standard personal accident insurance policy shall have all the basic and mandatory covers as mentioned below. This policy shall be uniform across the market and all the general and health insurance companies must have to offer this policy from 1st April 2021. The policy tenure for such policy will be one year from the date of issuance.
There will be some optional coverage also which will be offered with this standard personal accident insurance policy. The product will also be available as a group product covering the family members of the policyholder.
Saral Suraksha Bima – Insurance Policy Features
- The policy will be standard across all the insurance companies.
- The minimum sum insured shall be Rs.2.5 lakhs and the maximum sum insured shall be Rs.1 Crore. Sum insured offered shall be in multiples of Rs 50,000/-.
- The policy tenure will be for one year.
- The minimum entry age is 18 years and the maximum entry age is 70 years.
- Group policy option is also available.
- There is some optional coverage available if you want to choose.
- The policy will come into effect from 1st April 2021.
- There will be no policy variant allowed.
- The standard policy will be available through all the sales channels like distributors, insurance agents, online, etc.
- All modes of policy premium payment like yearly, half-yearly, quarterly, monthly are allowed.
Saral Suraksha Bima – What are the benefits?
The Standard Personal Accident Product shall offer the following covers.
Death:
Benefit equal to 100% of Sum Insured shall be payable on the death of the insured person, due to an injury sustained in an Accident during the Policy Period, provided that the Insured Person’s death occurs within 12 months from the date of the Accident.
Permanent Total Disablement:
Benefit equal to 100% of Sum Insured shall be payable if an insured Person suffers Permanent Total Disablement of the nature specified below, solely and directly due to an Accident during the Policy Period, provided that the Permanent Total Disablement occurs within 12 months from the date of the Accident:
a) Total and irrecoverable loss of sight of both eyes or
b) Physical separation or loss of use of both hands or feet or
c) Physical separation or loss of use of one hand and one foot or
d) loss of sight of one eye and Physical separation or loss of use of hand or foot
e) If such Injury shall as a direct consequence thereof, permanently, and totally, disables the Insured Person from engaging in any employment or occupation of any description whatsoever.
Permanent Partial Disablement:
Sum Insured specified below shall be payable if the Insured Person suffers Permanent Partial Disablement of the nature specified below solely and directly due to an Accident during the Policy Period provided that the Permanent Partial Disablement shall occur within 12 months of the date of the Accident.
| Loss Covered | % of Sum Assured |
|---|---|
| Loss of Use/ Physical Separation: | |
| One entire hand | 50% |
| One entire foot | 50% |
| Loss of Sight of one eye | 50% |
| Loss of toes – all | 20% |
| Great both phalanges | 05% |
| Great – one phalanx | 02% |
| Other than great if more than one toe lost | 01% |
| Loss of Use of both ears | 50% |
| Loss of Use of one ear | 20% |
| Loss of four fingers and thumb of one hand | 40% |
| Loss of four fingers | 35% |
| Loss of thumb: both phalanges one phalanx | 25% 10% |
| Loss of Index finger: three phalanges two phalanges one phalanx | 10% 08% 04% |
| Loss of middle finger: three phalanges two phalanges one phalanx | 06% 04% 02% |
| Loss of ring finger: three phalanges two phalanges one phalanx | 05% 04% 02% |
| Loss of little finger: three phalanges two phalanges one phalanx | 04% 03% 02% |
| . Loss of metacarpus: first or second (additional) third, fourth, or fifth (additional) | 03% 02% |
| Any other permanent partial disablement | Percentage as assessed by the independent Medical Practitioner |
Saral Suraksha Bima – Optional Cover
Below are the optional covers under the Sarak Suraksha Bima policy.
Temporary Total Disablement: If the insured person who survived an injury but is not able to engage in any employment or occupational activity, compensation shall be paid at the rate of 0.2% of the sum assured amount on the weekly basis subject to the maximum of 100 weeks.
For this, the unemployment period must be > 4 weeks. The temporary total disablement certificate needs to be provided by the practicing doctor for claiming this benefit.
Hospitalization Expense: Hospitalization expenses arising out of the injury is pay up to maximum of 10% of the sum assured amount.
Education Grant: One-time education grant of 10% of the sum assured amount is paid to the family of the deceased policyholder. This is given provided the children of the policyholder is pursuing an educational course as a full-time student in any of the educational institute and the age of such child/children should not be more than 25 years.
What is the claim procedure?
- Intimation of any injury is to be given within 30 days from the occurrence.
- Claims for insurance benefits must be submitted to the Company not later than one (1) month after the completion of the treatment or after transportation of the mortal remains/burial in the event of Death.
- If any treatment for which a claim may be made is to be taken and that treatment requires Hospitalization in an Emergency, the company shall be informed within 24 hours of the admission of the insured person in the Hospital.
Below are the list of documents required for claim:
- Fully filled up the claim form
- Photo ID proof of the insured person
- Copy of FIR/ Panchnama /Police Inquest Report (wherever these reports are required as per the circumstance of the Accident) duly attested by the concerned Police Station
- Copy of Medico-Legal Certificate
- Discharge summary of the hospital
- Fitness certificate issued by the treating doctor
- Prescriptions, and consultation papers of the treatment
- Death certificate (in case of death of the policyholder)
- Post Morterm Report (if conducted)
- Identity of the nominee
The claim will be settle or rejected within 30 days from the submission of the last document produced. In case there is any delay for the claim settlement for more than 30 days, the interest should be payable by the insurance company at the rate of 2% above the bank prevailing bank rate.
Conclusion:
This policy will be a standard accident policy across the cities in India. All the insurance companies must have to launch this policy from 1st April 2021. Here is the summary of the Saral Suraksha Bima policy.
| Policy Name | Saral Suraksha Bima Policy (Standard Personal Accident Policy |
| Policy Type | Individual (there is an option for group policy) |
| Category of cover | All the covers are benefit based except the optional cover “Hospitalisation Expenses due to Accident” which is indemnity based. |
| Sum Insured | On an Individual basis – SI shall apply to each individual family member |
| Policy Tenure | 1 year (renewable) |
| Base Cover | i. Death ii. Permanent total disablement iii. Permanent partial disablement |
| Optional Cover | i. Temporary total disablement ii. Hospitalisation Expenses due to Accident iii. Education grant |
| Cumulative Bonus | Sum insured (excluding CB) shall be increased by 5% in respect of each claim free policy year, provided the policy is renewed without a break subject to maximum of 50% of the sum insured. |