Insurance Product Name: Group Care 360

Insurance Company / Product Owner / Underwriter: Care Health Insurance
Policy Type: Individual
Entry Age: 18 to 60 years
Plan Type: Personal Accident Cover ( Accidental Death, Permanent Total Disablement, Permanent Partial Disablement)
Policy Tenure: 1 Year
Sum Insured: 10 Lakhs INR
Accidental Death = Sum Insured = 10 Lakhs INR

Permanent Total Disablement, Permanent Partial Disablement = 2 x Sum Insured x Percentage as per the PPD table
Distribution Type: Free Cover for SureBuddy users

Summary:

1. BENEFIT - PERSONAL ACCIDENT

a) If the Insured Person dies or suffers Permanent Total Disablement or Permanent Partial Disablement within twelve months from the date of occurrence of an Injury solely and directly due to an Accident occurring during the Period of Insurance, the Company will pay up to the Sum Insured specified in the Certificate of Insurance in accordance with the table below provided that death or Permanent Total Disablement is solely and directly due to the Injury and the Insured Person or his representative arranges for the immediate treatment of the Insured Person in a Hospital.
Sr. No. | Event | % of the Sum Insured payable

1. Death 100%

2. Permanent Total Disablement (PTD)
A | Total and irrecoverable loss of sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or one entire hand and one entire foot, or of the total and irrecoverable loss of sight of one eye and loss by physical separation of one entire hand or one entire foot 100%

B | Total and irrecoverable loss of (a) use of two hands or two feet, or (b) one hand and one foot, or (c) sight of one eye and use of one hand or one foot 100%

C | Total and irrecoverable loss of sight of one eye, or of the actual loss by physical separation of one entire hand or one entire foot 50%

D | Total and irrecoverable loss of use of a hand or a foot without physical separation |50%

E | Paraplegia or Quadriplegia or Hemiplegia 100%

3 Partial Permanent Total Disablement (PTD) 

A | Total and irrecoverable loss of hearing in: -
a) Both ears 75%
b) One ear 30%

B | Loss of toes
a) All 20%
b) Both phalanges of great toes bilateral 5%
c) Both phalanges of one great toe 2%
d) Both phalanges of other than great toe for each toe 1%

C | Loss of four fingers and thumb of one hand 40%

D | Loss of four fingers of one hand 35%

E | Loss of thumb
a) both phalanges 25%
b) one phalanx 10%

F | Loss of Index finger
a) three phalanges 10%
b) two phalanges 8%
c) one phalanx 4%

G | Loss of middle finger
a) three phalanges 6%
b) two phalanges 4%
c) one phalanx 2%

H | Loss of ring finger
a) three phalanges 5%
b) two phalanges 3%
c) one phalanx 2%

I | Loss of little finger
a) three phalanges 4%
b) two phalanges 3%
c) one phalanx 2%

J | Loss of metacarpus
a) first or second 3%
b) third, fourth or fifth 2%

K | Permanent partial disablement not otherwise provided for under Insured Events A to J inclusive. Such percentage of the Sum Insured as determined in accordance with the assessment carried out by Medical Practitioner of Our Network Hospital provided that the percentage under Insured Event J shall not exceed 50% of the Sum Insured.

Note: For the purpose of the above Insured Events, physical separation of a hand or foot shall mean separation of the hand at or above the wrist and of the foot at or above the ankle.

I. Hemiplegia means complete and irrecoverable paralysis of the arm, leg, and trunk on the same side of the body;
II. Paraplegia means complete and irrecoverable paralysis of the whole of the lower half of the body (below waist) including both the legs;
III. Quadriplegia means complete and irrecoverable paralysis of all four limbs.

 For the purpose of this Optional Benefit only, physical separation of a hand or foot means actual severance of hand at or above the wrist, and of foot at or above the ankle.

Claims Process:

Step 1: Initiating the claim Process and Documents to be submitted for any Claim under this Benefit:
It is a condition precedent to the Company’s liability under this Optional Benefit that the following information and documentation shall be submitted to the Company or the Assistance Service Provider immediately and in any event within 30 days of the event giving rise to the Claim under this Optional Benefit:

The Claim form can be downloaded from the website www.careinsurance.com. The completed claim form has to be sent along with the following documents –

For Personal Accident
1.Police Documents – First Information Report, Medico-legal Certificate, Spot Panchanama, Final policy investigation report
2.Medical Documents – Death Certificate, Postmortem Report, Viscera report (if applicable)
3.Hospital Document (If admitted) – Death Summary, Discharge and Indoor cases papers, All investigation reports with films, Casualty Papers, Alcohol Declaration
4.Legal Document – Legal Heir certificate, Succession certificate (in case of dispute) 

For Permanent Total Disability/Permanent Partial Disability
1.Disability Certificate – Disability certificate from Medical Officer/Civil Surgeon of Civil hospital / Govt. Hospital of the District (Certificate) stating extent disablement

2.Hospital Document (If admitted) – Discharge Card, Final Hospital Bill, Indoor cases papers, All investigation reports, Casualty papers, X-ray (pre-post) report and film, other radiological report, All paid receipts in original

Mandatory Documents Required For All Cases

1. Identity Document – Aadhar Card, Voter ID Card, PAN Card, Passport, Driving License
2. Verification of Age – Matriculation Pass Certificate, Birth Certificate, PAN Card, Passport
3. Claim Document – Duly filled and signed by Claimant, KYC document, NEFT Details

The claim form and additional documents are to be sent to the following address:

CARE Health Insurance Company Limited
Unit No. 604 - 607, 6th Floor, Tower C,
Unitech Cyber Park, Sector-39,
Gurugram-122001 (Haryana)

You can also submit the claim form and additional documents in case You have selected TPA, the name, contact details etc. is mentioned in the Policy certificate for the selected TPA. 

Step 2: Claim Processing and Reimbursement
If your request for reimbursement of expenses is approved, you will be duly intimated by us/ Our TPA.
In case of any information deficiency or further information requirements, you will be communicated instantly to ensure resolution of the same at the earliest
If your request for claims is declined, you will be communicated the same along with valid reason(s) for rejection. However, if the Insured Member/ Insured Member’s representative has further documents to enhance/substantiate his case for claim, the same can also be sent to us/ Our TPA; and if found rational, the case will be reopened for review of the documents and response, if any.
We /Our TPA will ensure that you are updated at all important stages of your claim process. To help us serve you better, please ensure the following-
▪ The claim form is filled completely, sincerely and truly and all the required documents are submitted along with the form and in original, wherever specified
▪ Retain a copy of the duly filled forms
▪ Please quote the member ID/reference number for all communication related to the above.

Alternate Digital Process for Claims:
Claims Gene – A self Service Web Interface for customers to file a claim online with following options
• Claim intimation
• Upload documents
• Claim Submission
• Claim Tracking

Digital Claim Process Flow
1. Visit- https://www.careinsurance.com
2. Go to “Already A Customer” Tab and Click on “Claim Genie
3. Add Policy Number & verify Captcha
4. Add DOB/Member ID

Step 1 - Claim Intimation

Details of the Insured Member will be auto populated
Select the Member whom you want to initiate the claim
Select the type of claim you want to initiate
Fill the details as per the requirements
Enter Mobile Number and Email ID
Intimation Number would be displayed on the screen
Mail and SMS will be Sent to Customer

Step 2 - Upload your documents

Upload documents from list of required documents
Same Intimation number would be displayed if the document uploading has been done
In case physical documents are required you shall receive a communication, please submit to our nearest branch/courier to Head office 

*Only Clear / Scanned Copies should be uploaded for seamless processing

Step 3 - Claim tracking can be done online

Grievance Process
The Company has developed proper procedures and effective mechanism to address complaints, if any of the customers. The company is committed to comply with the Regulations, standards which have been set forth in the Regulations, Circulars issued from time to time in this regard.

If you or the Insured Member or Dependent have a grievance that You or the Insured Member or Dependent wish Us to redress, You or the Insured Member may contact Us with the details of their grievance through:
Website www.careinsurance.com

E-mail - customerfirst@careinsurance.com

Customer Care - 1800-102-4488 / 1860-500-4488

Post /Courier Any of Our branch offices or our correspondence address, during normal business days

If the Insured Member is not satisfied with our redressal of their grievance through one of the above methods, You or the Insured Member may contact Our Head of Customer Service at:
The Grievance Cell,
Unit No. 604 - 607, 6th Floor, Tower C,
Unitech Cyber Park,
Sector-39, Gurugram-122001 (Haryana)

If the Insured Member is not satisfied with our redressal of their grievance through one of the above methods, You or the Insured Member may approach the nearest Insurance Ombudsman for resolution of their grievance. 

Disclaimer
This is only a summary of product features. The actual benefits available are as described in the policy, and will be subject to the policy Terms and Conditions. Please seek the advice of your insurance advisor if you require any further information or clarification or contact us.

Statutory Warning
Prohibition of Rebates (under section 41 of Insurance Act, 1938): No person shall allow or offer to allow, either directly or indirectly as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property, in India any rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any person taking out or renewing or continuing a Policy accept any rebate, except such rebate as may be allowed in accordance with the published prospectus or tables of the insurers.

Any person making default in complying with the provision of this section shall be punished with fine, which may extent to five hundred rupees.

Insurance is a subject matter of solicitation.

Care Health Insurance IRDA Registration number: 148