What is Personal Accident Insurance?

Personal Accident insurance or PA insurance is referred to an annual policy that offers compensation in the event of injuries, disability or death solely caused by violent, accidental, external and visible events. It is dissimilar to life insurance and medical and health insurance.

Features of personal accident insurance policy

On the unfortunate situation of accidental death which means that if the event of death owing to accident or accidental physical injuries happens during the policy tenure, the whole amount insured is paid out to the nominee or the person mentioned in the personal accident policy. The benefits offered under these categories are:

Permanent total disablement

If the physical injuries lead to the permanent and total disability of the policyholder, the entire sum insured under the non-public accident policy is compensated to the insured or the nominee.

Permanent partial disablement

In the situation where physical injuries lead to the permanent but partial disability of the policyholder, the insurer classically pays an explicit share up to the total insured sum to the insured or nominee. The extent of loss or incapacity determines the compensation amount under the non-public accident policy.

Temporary total disablement

If there is a situation where the insured meets with an accident that ends up in a temporary yet total incapacity and complete confinement, a weekly payment, subject to pre-determined limit, is paid to the insured to help get over the short term crisis that arises as the insured is unable to resume work for some time frame due to the temporary disability.

Benefits of accidental insurance

Accidents do not occur with prior appointment and any moment can become disastrous if a family member is met with an accident. The things get worst if the breadwinner has an accident as it means decline of income from the roots and rise in all kinds of expenses. To take =care of such unforeseen and unfortunate situations, accidental insurance is needed.

To provide you a better understanding, we've listed the prime advantages of getting insured:

24x7 support service

Can be bought for the family

Double indemnity for death/ incapacity

Easy claim method

Family security

Great cover at lower premium

Legal and observance expenses lined

No demand of medical tests and documentation

Worldwide coverage

What is covered under Personal Accident Insurance?

In the unfortunate event of an accident, personal accident insurance protects you if you become disabled and are unable to work; or have a distinct injury, such as loss of vision or hearing, or broken limbs. These personal insurance facilitates the payout to recipients either in one lump sum or on a monthly basis to supplement missed income.

It is not good not to have health insurance; that leaves the family very vulnerable. Elizabeth Warren

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Health insurance is a type of insurance coverage that protects an individual or a group of people against medical and surgical costs against payment of regular premiums.

Mounting healthcare and surgical costs are a major strain on household budgets. Like any other insurance, mediclaim or health insurance is the best possible protection you or your family may have against any medical (usually hospitalization or surgical) costs. Health insurance also makes medical help affordable for everyone.

Mediclaim or health insurance makes you eligible for tax benefits on premium paid under 80D of the Income Tax Act.

Given the current healthcare scenario, there is no right age to get medical insurance – the earlier, the better. Children can be added to either parent’s mediclaim policy. Many health insurance providers also have special plans for senior citizens and old age related health costs.

Most health insurance providers offer customized mediclaim or health plans. They are broadly of 4 types –

  • Individual health plan
  • Family health plan
  • Critical illness plan
  • Senior citizen health plan

Accident-related medical costs are generally covered by all health insurance plans or may be taken as an add-on rider.

Health insurance costs vary depending on the following factors –

  • Number of persons covered
  • Age of the person/persons assured
  • Health of the person/persons assured
  • Location (health risks in metros is deemed more than that of people residing in small cities and villages)
  • Additional riders (if any are opted for)

When a person signs up for a health insurance, the insurance company ascertains premium based on a number of criteria. Once determined, the company usually charges the same premium for that age group. The older a policy holder gets, the more the premium amount is. In the meantime, if there is a claim in any year, the premium may be hiked upon policy renewal. This is called load premium. The insurance company may sometimes offer a discount on premium, if no claim is registered for a number of years.

Mediclaim health insurance policies usually do not cover the following –

  • Congenital medical conditions and diseases
  • Pre-existing diseases diagnosed prior to policy issuance
  • Medical costs arising out of self-inflicted injuries and/or attempted suicide
  • Cosmetic surgeries and/or treatments including dental treatment
  • Drunken driving related accidents
  • Cost of spectacles or contact lenses
  • Treatment of HIV/AIDS

Planned hospitalization – Submit a written application with the TPA. Include doctor’s recommendation for hospitalization, medical records, and planned expenses. Once approval comes through go ahead with hospitalization. Notify TPA and make a claim through the hospital to avail cashless benefits.

Unplanned hospitalization/Accidents – Notify TPA within 24 hours of hospitalization. Submit a notification statement with name, policy number, and known medical details. The insurer is likely to clear your eligibility details within a day or two. Stake cashless claim through the hospital to avail cashless services or pay cash and stake claim with all bills and records at the completion of treatment.