Personal Accident Care Plan

Overview

The Niva Bupa Personal Accident Plan is designed to provide financial support in case of accidents. It offers a lump sum payout for accidental death or disability, and weekly income support if you are unable to work due to injury. The plan also includes ambulance cover and a daily hospital cash benefit to help manage immediate expenses after an accident.

It is important to understand that this is not a regular health insurance plan. It does not cover illnesses or most routine medical expenses. In the sections below, we have clearly explained what is covered and what is not, so you know exactly what to expect.

Coverage Allocation Table

Inclusions

• Guaranteed Cash Benefit: Customers can receive guaranteed cash benefits as permissible under the policy terms and conditions.
• Coverage from Day One: Coverage starts from the first day of the policy period, ensuring immediate protection with no waiting period.
• Enhanced Protection: The plan offers additional options for comprehensive coverage, allowing policyholders to choose between temporary total disability and accidental hospitalization.
• Tenure Options: The plan offers two- and three-year tenure options with discounts of 12.5% for two years and 15% for three years.
• Choose Sum Assured: Policyholders can choose from various sum insured options based on their risk assessment.
• Direct Claim Settlement: Claims are processed by the company's in-house service team, ensuring timely and hassle-free settlements.
• Lifetime Renewability: Customers can enjoy lifetime renewability, ensuring protection for life.
• Worldwide Coverage: The plan provides worldwide coverage for accidents, ideal for frequent travelers.
• Free Look Period: A 15-day free look period is available to review the policy and make necessary changes.

Exclusions

• Pre-existing Conditions: Any medical condition existing before policy purchase is not covered. If an accident is related to a pre-existing condition, benefits cannot be claimed.
• Intentional Harm: Accidents caused intentionally by the policyholder are not covered. For example, injuries sustained from an intentional fight will not be eligible for claims.
• Illegal Activities: Accidents occurring while engaging in illegal activities, such as driving under the influence of drugs or alcohol or participating in illegal street races, are not covered.
• Self-Harm: Intentional self-harm, including attempted suicide or self-inflicted injuries, is not covered.
• War and Terrorism: Accidents due to war or terrorism are not covered, as these events are considered beyond the insurance company's control.
• Dangerous Sports and Activities: Accidents sustained while participating in dangerous sports or activities like skydiving, bungee jumping, or mountain climbing are not covered.
• Professional Sports: Accidents occurring during participation in professional sports are not covered due to the higher risk of injury.
• Medical Procedures: Accidents occurring during medical procedures, including cosmetic procedures and experimental treatments, are not covered.

Niva Bupa Personal Accident Plan Benefits

• Accidental Death Coverage: Niva Bupa Personal Accident Plan provides 100% accidental death coverage, reimbursing the full sum insured in the event of the insured individual's accidental death.
• Permanent Total Disability Coverage: If the insured person is unable to work or suffers total and permanent loss of any body part, the Niva Bupa Personal Accident Plan covers 125% of the sum insured under permanent total disability. Total disability scenarios include:
  • Unable to Work: The insured individual is permanently unable to work in any occupation or employment due to the accident.
  • Loss of Limbs or Sight: Complete and permanent loss of use of two limbs, both eyes, or both eyes and one limb.
  • Loss of Independence: Inability to perform three or more daily activities independently, such as dressing, feeding, mobility, toileting, transferring, and washing.
• Permanent Partial Disability Coverage: Compensation for Permanent Partial Disability (PPD) varies based on the extent of disability and policy terms. It is typically calculated as a percentage of the sum insured, as specified in the policy's schedule of benefits.
• Child Education Benefits Coverage: In case of accidental death or permanent total disability, dependent children receive an education benefit of 5% of the sum assured or ₹50,000, whichever is lower.
• Funeral Expenses Coverage: Niva Bupa Personal Accident Plan includes a payment of ₹5,000 for funeral expenses in case of the insured person's accidental death.

Temporary Total Disability Coverage Table

It is a condition where the insured person suffers from a bodily injury resulting from an accident, which renders them unable to engage in any type of employment or occupation, whether or not it is related to their usual work, training, or education. Here is the coverage table:

Permanent Partial Disability Coverage List

The specific list of permanent partial disabilities and their corresponding coverage percentage may vary by policy and insurer. Below is a general list: