Overview

Accidents can happen at any time and you can’t foresee them. What you can do though is to always be ready to deal with the hospital expenses that arise out of an accident. An Accidental Hospitalization sachet insurance allows you to claim your expenses arising out of hospitalization due to an accident, in a cashless manner. This accident policy also covers expenses incurred on road ambulances up to a limit of Rs. 25000, apart from offering a sum insured benefit of Rs. 5 Lakh.

Coverages

  • Option 1
  • Option 2

The insured gets a Sum Insured of Rs. 5 Lakh in case of Permanent Partial or Permanent Total Disability due to an accident. The insured also gets accidental hospitalization benefit of Rs. 2 Lakh

The insured gets a Sum Insured of Rs. 5 Lakh in case of Permanent Partial or Permanent Total Disability due to an accident. The insured also gets accidental hospitalization benefit of Rs. 5 Lakh and road ambulance cover of Rs. 25,000.

Exclusions

 
  • Any Hospitalization for an existing disability from a previous Accident which has occurred prior to the first inception of this Policy.
  • Any stay in Hospital for an Injury due to Accident without undertaking any treatment.
  • Any Hospitalization for Accidental Injury aggravated by an existing disability or pre-existing illness /condition/injury.
  • Any Pre-existing Condition(s) and complications arising out of or resulting therefrom
  • Through suicide, attempted suicide (whether sane and insane) or intentionally self-inflicted injury or illness
  • Refer to the download section for the PDF mentioning more exclusions. 

Claim Process for Sachet Insurance

Filing claims was never so simple. Just follow these steps and you’re done!

  • 1

    Register your claim online

  • 2

    Upload documents online

  • 3

    Claim Assessment

  • 4

    Claim Decision

  • Process
  • Download
  • Emergency Contact
  • Cashless Claims
  • Claim Reimbursement
  • Cancellation Process
  • List of Claims Document

Cashless treatment is only available at Network Hospitals. In order to avail of cashless treatment, you need to follow the following procedure:

  1. Prior to taking treatment and/or incurring Medical Expenses for any Accidental Injury, at a Network Hospital, the Insured Person must call Us and request pre-authorization by way of the written form which the Company will provide. Waiver of this condition shall be considered in case of emergency hospitalization arising out of accidental bodily injury.
  2. After considering the Insured’s request and after obtaining any further information or documentation the Company have sought, the Company may if satisfied send to the Insured Person or the Network Hospital, an authorization letter. The authorization letter, the ID card issued to the Insured along with this Policy and any other information or documentation that the Company have specified must be produced to the Network Hospital identified in the pre-authorization letter at the time of Insured’s admission to the same.
  3. If the procedure above is followed, the Insured Person will not be required to directly pay for the Medical Expenses raised out of Accidental Bodily Injury, in the Network Hospital that the Company is liable to indemnify under Accidental Hospitalization Expenses Section and the original bills and evidence of treatment in respect of the same shall be left with the Network Hospital. Pre-authorization does not guarantee that all costs and expenses will be covered. We reserve the right to review each claim for Medical Expenses and accordingly coverage will be determined according to the terms and conditions of this Policy. Insured Person shall, in any event, be required to settle all other expenses directly.

If you meet with any Accidental Bodily Injury that may result in a claim, then as a condition precedent to our liability:

a. You or someone claiming on your behalf must inform us in writing immediately and in any event within 30 days from the date of the accident and submit all documents to us within 30 days from the date of intimation.

b. You must immediately consult a Doctor and follow the advice and treatment that he recommends.

c. You must take reasonable steps to lessen the consequence of Bodily injury.

d. You should allow examination by our medical advisors if we ask for this.

e. You or someone claiming on your behalf must promptly give us documentation and other information we ask for to investigate the claim or our obligation to make payment for it.

f. In case of your death, someone claiming on your behalf must inform us in writing immediately and send us a copy of the post mortem report (if conducted) within 30 days.

*Note: Waiver of conditions (a) and (f) may be considered in extreme cases of hardship where it is proved to Our satisfaction that under the circumstances in which the Insured Person was placed, it was not possible for the Insured Person or any other person claiming on his/her behalf to give notice or file claim within the prescribed time limit.

  • We may cancel this insurance by giving You at least 15 days written the notice, and if no claim has been made then we shall refund a pro-rata premium for the unexpired Policy Period. Under normal circumstances, Policy will not be canceled except for reasons of misrepresentation, fraud, non-disclosure of material facts or Your non-cooperation.
  •  You may cancel this insurance by giving us at least 15 days written the notice, and if no claim has been made then we shall refund premium on short term rates for the unexpired Policy Period as per the rates detailed below.

Period in Risk

Premium Refund

Policy Period 1 Year

Policy Period 2 Year

Policy Period 3 Year

Within 15 Days

Pro-Rate Refund

Exceeding 15 days but less than 2 months

75.00%

80.00%

85.00%

Exceeding 2 months but less than 4 months

60.00%

75.00%

80.00%

Exceeding 4 months but less than 6 months

45.00%

65.00%

75.00%

Exceeding 6 months but less than 8 months

30.00%

60.00%

70.00%

Exceeding 8 months but less than 10 months

15.00%

50.00%

65.00%

Exceeding 10 months but less than 12 months

0.00%

45.00%

60.00%

Exceeding 12 months but less than 14 months

 

35.00%

55.00%

Exceeding 14 months but less than 16 months

 

30.00%

50.00%

Exceeding 16 months but less than 18 months

 

20.00%

45.00%

Exceeding 18 months but less than 20 months

 

15.00%

40.00%

Exceeding 20 months but less than 22 months

 

5.00%

35.00%

Exceeding 22 months but less than 24 months

 

0.00%

30.00%

Exceeding 24 months but less than 26 months

 

 

25.00%

Exceeding 26 months but less than 28 months

 

 

20.00%

Exceeding 28 months but less than 30 months

 

 

15.00%

Exceeding 30 months but less than 32 months

 

 

10.00%

Exceeding 32 months but less than 34 months

 

 

5.00%

Exceeding 34 months but less than 36 months

 

 

0.00%

However, if any claim has been made then no refund will be given for cancellation of policy.

  • Duly completed pre-authorization signed by the Claimant
  • Other documents as may be required by the Company to process the claim
  • Aadhar card & PAN card Copies (Not mandatory if the same is linked with the policy while issuance or in the previous claim)

  • Cashless Claims
  • Claim Reimbursement
  • Other Health Insurance Related Claims
  • Links for Claim Settlement Forms
  • List of Network Hospitals
  • List of Exclusions

Link to redirect customers to links category.

  • Cashless Claims Request Form
  • Reimbursement Form
  • Self Declaration of KYC Document Submission - For Individual Partner
  • Non-Medical Expenses List of Exclusions
  • Personal Accident Claim Form
  • Cashless Claims Request Form
  • Reimbursement Form
  • Self Declaration of KYC Document Submission - For Individual Partner
  • Personal Accident Claim Form
  • Non-Medical Expenses List of Exclusions
  • List of Network Hospitals
  • This is the link to the list of remaining 'Exclusions'

Need further assistance? Reach out on the Toll-Free Number: 1800-209-5858 to connect with an insurance expert.

Manage all your queries here

  • What Is Accidental Hospitalization Benefit?

    No one can foresee accidents and they not only leave a person with bodily injuries but also have a financial impact. This accident policy cover helps you in claiming your hospital expenses arising out of any accident.

  • What are the benefit offered?

    This accident insurance covers hospitalization expenses incurred due to an accident and provides a Sum Insured of up to Rs. 5 Lakh. This policy also covers expenses incurred on road ambulances up to a limit of Rs. 25000 along with Permanent Total Disability & Permanent Partial Disability cover of Rs. 5 Lakh. This sachet insurance lets you choose between two variant covers.

  • After certain waiting periods, will pre-existing conditions be covered under accidental hospitalization expenses?

    Unfortunately, pre-existing diseases are a permanent/lifelong exclusion under the policy and will hence not be covered.

  • Is there any age limit involved if one wants to buy this insurance?

    Yes, there is an entry age limit. The insured’s entry age should be between 18 years to 70 years.

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