How is a Personal accident insurance policy different from a mediclaim insurance policy?
CS Professional · Insurance - Law & Practice · PYQS · December 2019
How is a Personal accident insurance policy different from a mediclaim insurance policy?
Answer & Explanation:
Personal Accident Insurance: Personal Accident is an insurance cover wherein, in the event of the person sustaining bodily injuries resulting solely and directly from an accident caused by EXTERNAL, VIOLENT & VISIBLE means, resulting into death or disablement. Events covered under Personal Accident Insurance include but are not limited to: Rail/Road/Air Accident. Injury due to any collision/fall. Injury due to bursting of gas cylinder. Snake-bite, Frost bite/Dog bite. Burn Injury, Drowning, Poisoning etc. Scope of Cover & Benefits available under Personal Accidental Cover: Personal Accidental policy covers accidental death, loss of limbs, permanent total and partial disablement as selected and granted by the insurance companies based on the underwriting norms. On payment of additional premium, medical expenses reimbursement can also be covered under personal accident insurance. These expenses are payable, in case, if the claim is admitted under the basic policy cover. Age Limits under Personal Accident Cover: This Policy is available to persons between the age of 5 and 70 years (Male & Female). In case of Family Package covers, the age of children should be between 5 to 19 years. Factors affecting Sum Insured under Personal Accident Insurance Sum insured is based on various factors namely: Income from gainful employment Type of occupation Age as on date of proposal Period of insurance Conditions prevailing at the place from where the proposal is made etc. Mediclaim Insurance Policy: Health insurance covers offered by non-life insurers are mainly hospitalization covers either on reimbursement or cashless basis. The cashless service is offered through Third Party Administrators who have arrangements with various service providers, i.e., hospitals. The Third Party Administrators also provide service for reimbursement claims. Sometimes the insurers themselves process reimbursement claims. Accident and health insurance policies are available for individuals as well as groups. A group could be a group of employees of an organization or holders of credit cards or deposit holders in a bank etc. Normally when a group is covered, insurers offer group discounts. While a health insurance plan provides a pure risk cover where the sum assured becomes payable upon the life assured being diagnosed of certain identified illness during the term of the policy. Health insurance is also popularly known as Medical Insurance or Mediclaim that covers medical expenses including hospitalization expenses. The type and amount of health insurance depends upon the scope of illnesses covered and the extent of expenses required to be covered. Health insurance benefits are also available as riders in group insurance plans. While life is very uncertain, a person may not stay healthy & fit throughout their life. Therefore it is prudent to have health cover at every stage of life. If a major illness like heart failure is diagnosed & the funds for treatment cannot be immediately arranged. It may lead to loss of life. If the family resorts to costly personal loans for treatment & the life of the person cannot be saved then the family could incur huge debts. Having health insurance cover can help to overcome this problem.
Topics: Types of Insurance
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