People generally assume that because they have a health insurance policy (HI), they would not require personal accident insurance as HI covers hospitalization due to an accident as well. Although this is a correct notion, accidents frequently result in losses that are not typically covered by health insurance.

A personal accident insurance helps to recover losses impacting due to accidents like loss of income, child education, loan protector, animal bites, body burns etc. which makes it different from health and other insurance covers. Later on in this article, we shall examine it in further detail.

Personal accident policy provides you and your family round-the-clock protection of any uncertainties occurring due to accidental injury or disability. This insurance shields the policyholder with the basic coverages of Accidental Death, Permanent Total Disability (PTD) and Permanent Partial Disability (PPD). It also has a variety of optional add-on features. Let us explore some of the important additional benefits under this policy:

1. Loss of Income: One cannot afford to lose his/ her income when there are numerous expenses happening post an accident. This add-on compensates for loss of income due to an accident, by paying a weekly amount for the period the insured person is unable to work. For instance, add-on cover is Rs. 25,000 per week. If an insured is unable to work for about two weeks due to an accident, he/she will receive Rs. 50,000 as a benefit under this add-on. 

2. Fracture Care: Usually fractures are excluded from health insurance policies. Whereas, personal accident cover provides it as an added benefit. Further, a claim can be received depending on the severity of the fracture under this add-on. For example, the fracture cover is Rs. 1,00,000. Insured facing a minor fracture can receive an amount of Rs. 25,000 under this add-on.

3. Loan Protector Cover: One would be most negatively affected for loan defaults at the time of an accident. Yet, if the accident resulted in a death, the scenario could become worse. The family of the insured will suffer both a financial and an emotional loss as a result of this incident. Here, the loan protector add-on can offer financial protection by covering a balance due for the holder in the event of a sudden death or total disability.

4. Adventure Sports: People are fond of participating in adventurous sports while going on a leisure trip. One can insure themselves for death and permanent disability with adventure sports cover. This comprises a variety of sports like rock climbing, scuba diving, bungee leaping, auto racing, etc.

5. Body Burns: It could lead from minor to major injury leading an insured to die or get severely injured due to fire or any chemical burns, and other similar burns. Hence, a fixed amount can be provided to the insured if this add-on is opted. 

6. Other add-ons: Coma benefits, air ambulance, wheelchair or crutches charges, artificial limb costs, and child tuition benefits are some add-ons available under personal accident insurance.

Along with these advantages, your insurance cover may increase due to a no-claim bonus (approx. 10% - 20%). One would now wonder that covering so many risks and providing numerous benefits could be pricey while buying this insurance. Fortunately, the premiums are affordable. We will understand this with an example. 

Mr. Rajinder holds a personal insurance coverage of 50 lakh rupees. In addition, his two children are each protected for Rs. 10 lakhs, along with his wife for Rs. 25 lakhs. He has decided to choose TTD (Temporary Total Disablement) benefits of Rs. 50,000 for himself and Rs. 10,000 for his wife per week. He also included a 10 lakh rupee fracture cover. He pays an annual premium of Rs. 21,231.

Let’s check what happens if Mr. Rajinder falls from stairs and his legs get fractured. 

Mr. Rajinder has been advised bed rest for 28 days by the doctor. In such a case he is eligible to claim the following from his personal insurance policy. 

Moreover, the premiums are decided on the basis of occupation of the insured person. The riskier the occupation (job profile) of the insured, higher will be the premium. Unlike health insurance, the premium does not change due to a change in age or city. For example, a doctor is less prone to risk for an accident as compared to manual labour. Hence, the premium for a doctor would be less than that of manual labour. Therefore, the policy has categorized insured into levels of risk classes like Risk Class-I, Risk Class-II and so on. The premiums for the age 18 to 69 years will remain the same. Instead, the premium is varied depending on the profession. 

An individual will get personal accident insurance cover according to his/her annual or monthly income. For example, 10 times of the annual income for salaried and 20 times for the self-employed. Also, while purchasing a policy or filing a claim, insurance firms may ask for income-proof documents such as an IT return or a Form 16.

Conclusion

Personal accident insurance is indeed a good option altogether for covering various accidental risks. These risks can result in modest to substantial losses. In reality, other people's mistakes can also contribute to some of our uncertainties. As a result, one must also be cautious to secure themselves against any costs or losses that may result from such an incident.

Insurance is an agreement between the insurer and the insured (policyholder). This agreement is based on the information the insured provides in the proposal form, making it the most important part of the entire insurance policy. An insurance company offers a policy on the basis of a proposal form and other information related to the insured. It seeks all the relevant information from the policyholder in order to underwrite the risk.

The proposal form includes the insured’s basic information such as an address, age, name, education, income, and occupation besides his medical history. Depending on the level of coverage you choose or your age group or occupation/family background, you may be required to undergo a medical examination.

Insurance operates on the principle of utmost good faith. This means that everyone who enters into a contract has a legal obligation to each other to disclose any material facts that may affect the contract's subject matter. The person must therefore provide the insurance company with accurate, complete and honest information.

There are many points you need to take care of when filling out the insurance proposal form, but here are some of the most crucial ones.

1. Mention Correct Details

Many people become casual while filling up the form and do not provide the correct details related to age, contact details, income, qualification, etc. Mentioning the correct details is extremely important. 

The insured must provide the correct address, contact number and e-mail id because the insurer will contact you using these details when a claim needs to be settled - the address is required for underwriting as well as any communication. Crores of claims and maturity amounts remain unpaid as insurers are unable to reach policyholders at the numbers and addresses provided by them. Further, the age, height, weight, health status, family medical background, income, occupation, qualification, etc; of the proposer/insured members have a significant impact on the decision of the insurance underwriter. It could result in the rejection of the proposal or a hike in the rate of premium.

2. Disclosure of Medical Condition

Many times, people do not disclose their current health condition in the proposal form so as to obtain better coverage for a lower premium or to avoid the waiting period or rejection. However, the entire medical history should be mentioned in the medical history/questionnaire section. While making the claim, if it is found that the medical history does not match, the claim might get rejected and/or the policy may be cancelled ab-initio. For example, Mr. Raj had diabetes for a long time but did not mention it in the form. However, when he was admitted to the hospital for treatment of heart disease, the fact that he had diabetes was revealed and as a result of which the entire medical claim got rejected. He had to bear all of the medical expenses himself because he did not mention diabetes in the proposal form while buying the policy.

3. Disclosure of Personal Health Habits

Insured member must disclose his/her habits regarding the consumption of alcohol, tobacco and other drugs. We are all aware that addictive substances such as tobacco and alcohol have a negative impact on health. So, if you are a tobacco user or alcohol consumer, insurers will charge more. The premium amount charged to such individuals is determined by their frequency, quantity consumed and type of addiction.

4. Disclosure of existing insurance policies

It is essential to mention all the policies taken from the same insurer as well as other insurers.. If you already have an insurance policy, the insurer will offer only the balance of the cover, that is, max cover allowed as per eligibility & underwriting guidelines - sum assured of the existing cover. Non-disclosure or improper disclosure of existing policies may result in proposal cancellation. In fact, if the insurer comes to know about a pre-held policy that was not declared at proposal stage, it can reject the claim and/or cancel policy on the basis of non-disclosure of material facts.

5. Mention occupational details accurately

People often do not mention the nature of the job or service they are involved in. Occupation is a parameter used to assess accident risk and wellness. For example, if you work in aviation, the risk to your life will be higher and the declaration needs to be done to the insurer. So, the nature of work is critical for risk assessment and the premium will depend on that information. Individuals with hazardous occupations or dangerous hobbies like paragliding, parasailing, rock climbing, etc. are charged more. The insurer can even refuse them coverage.

6.Mention Nominee Details

It is important to fill the nominee details in the proposal form in order to make sure that the benefit reaches the right hands.

Conclusion

From the above points, it is clear just how important the proposal form is. Hence, it is paramount that those buying an insurance policy should pay close attention while filling their details in this important document, failure of which may lead to adverse consequences such as rejection of claim.

In case you have any questions regarding the understanding of the proposal form, it is important to get it clarified from your insurer/insurance advisor. To let the underwriter assess your risk appropriately, it is imperative that you furnish the right appropriate details. It is better to be safe than sorry at the time of filing a claim.

Having a basic health insurance policy is a great start to protect yourself from rising hospitalization costs and receive hassle-free, timely treatment at high-quality medical facilities. Standard health insurance plans, however, may not be sufficient on their own as it is not “one-size-fits-all” in terms of catering to the diverse healthcare needs of each individual and family. This is where health insurance add-ons or riders come into play!

What is Health Insurance Add-On?

Health insurance add-ons or riders are additional coverage options that you can purchase to extend the scope of your standard health insurance policy. You can buy add-ons to suit your needs at the time of buying the policy or when you renew it, by paying an additional premium. These covers will help cover medical expenses that aren't covered by the regular plan.

Types of Add-on Covers in Health Insurance

There are several add-on covers in the market that cater to the various needs of the policyholders. Here are some add-on covers you can choose to boost your health insurance coverage and maximise its benefits.

1. Room Rent Waiver: In a standard health insurance policy, hospital room rent is capped to a particular limit. If you include a room rent waiver add-on to such health insurance policies, it either raises that limit or imposes no limit. In the case of no cap, room rent can be as high as the sum insured.

For example, Mr Rahul buys a health insurance policy of Rs. 5 lakhs with a room rent cap of 1% of the sum insured. After a few years, he had to be hospitalized for bypass surgery. His insurance policy allowed him a room that cost Rs. 5,000 per day. His hospital stay was 5 days long and he chose to stay in a room costing Rs. 8,000 per day. Rahul’s total hospital bill was of Rs.3,00,000. Nows, the claim calculations however work on the principle of proportionate deductions, except on medicines, as it is a non-associated expense. As one can see from the details below, the insurance company finally pays Mr Rahul Rs.1,96,875 even though the hospital bill was Rs. 3,00,000 only because of the room rent cap.

2. Unlimited Restoration: This add-on replenishes the sum insured upon exhaustion due to claim/s. With this add-on, the customer can claim multiple times without worrying about the risk cover exhausting. For example, you purchased a health insurance plan, with a cover of Rs. 5 lakhs. You had to undergo a heart surgery that uses up the whole sum insured. Let’s say, within the same year, you get hospitalised again for another ailment which requires a medical expense of Rs. 2.5 lakhs. Without the Restore Benefit, your health insurance plan will not cover the cost of second hospitalisation, and you’ll have to pay the bill from your own pocket. However, if you opt for the restoration benefit add-on, the cost of the second hospitalisation will get covered by your insurance plan up to the base sum insured, relieving you of any financial burden.

3. Consumables Coverage: Nebuliser kit, hand gloves, syringes, belts/braces, registration/admission charges, etc. are not covered under the standard policy. The customer has to bear the expense of such items out of the pocket. By purchasing an add-on/rider at an extra cost, customers can get coverage of non-payable items as well. 

4. Cumulative Bonus Booster: This add-on increases the sum insured by a fixed percentage if no claim is filed during a policy year. For eg; If your Sum Insured is Rs. 5 lacs and you have not registered any claim within the first policy year then your insurer gives 50% booster addition in base cover upon renewal. This means your sum insured becomes Rs. 7.5 lacs upon renewal without any increase in premium. So, with this add-on the insured need not worry even if the claim amount after renewal exceeds Rs. 5 lacs but up to Rs. 7.5 lacs.

5. OPD Care: OPD treatment is usually not included under the basic health insurance plan. The OPD care add-on covers costs associated with OPD visits, diagnostics, and medications. Please note that in order to claim this add-on benefit, the policyholder must submit a cashless or reimbursement claim.

6. Reduction in Waiting Period: Almost all health insurance policies include a waiting period for pre-existing diseases. By selecting this add-on, insured members can reduce or, in some cases, waive off the PED waiting period for an extra premium, thus allowing them to claim related expenses sooner than the stipulated time period.

Benefits of Buying Add-on Covers

On purchasing health insurance add-on covers, you will get:

- The ability to design or customise your policy to meet your specific medical needs.

- Less hassle during claims.

- Enhanced coverages and benefits.

- Tax benefits as per Section 80D of the Income Tax Act, 1961.

Conclusion:

Buying add-ons is a cost-effective way to cover the specific risks that are not covered under your standard health insurance policy. Now that you know about the various add-on options, ensure that you assess your existing medical conditions, family’s medical history, lifestyle, etc. before deciding which add-ons would be appropriate for you. It is also advisable that you go through all the terms and conditions in detail before you make the final decision. 

The world has become a smaller place. Today, be it education, career, business or leisure /holidays, the national boundaries have blurred for us. All these are no longer big news to us. But the time is ripe to add one more motive to this list - medical treatments. When we are planning the best for us when it comes to the said things, why not add medical care and intervention to this list? Treatment in foreign countries offering the most advanced health care treatments is no longer limited to just the super-rich and the celebrities. It is also time for you to think of it as an option available to you. 

Insuring medical emergencies in foreign locations is a must for many who are spending considerable time or frequently travelling abroad. But even for people who have never travelled abroad, access to quality and advanced medical treatments is one good reason for exploring such health products. Today, while you may have sufficient coverage under health insurance policies, what if medical treatment or surgery is recommended outside India? Your normal health insurance policy will not cover such a scenario. When your intent is the get the best for yourself and your family, why restrict yourself to treatments only in India? 

Meet global health insurance cover - your window to global /international medical treatments and health care.  Global health insurance sets you up with the best way to take care of yourself and your family in case you seek treatment for an illness or emergency outside India.

What is Global Health Insurance?

Global health insurance plans are designed to cover your hospitalization costs, whether planned or unplanned, seamlessly anywhere across the globe. Coverage usually includes in-patient and out-patient treatment expenses, air ambulance, and emergency treatments subject to the policy’s terms and conditions. The main advantage of having this policy is getting medical attention whenever and wherever required, be it in the country you reside in or any foreign land.

A global health insurance policy is not the same as a travel insurance policy. A global health cover is designed for those who need to have the option of treatments abroad, whether planned or unplanned. In case you are in India and planning treatment /hospitalization outside India, the same needs to be certified by a verified medical practitioner and you need to intimate the insurance company before travelling abroad for treatment.

Global Health Insurance Cover Benefits:

• Access to advanced healthcare facilities: When it comes to healthcare, many international destinations provide highly advanced treatment facilities. These facilities enable the insured to receive the best treatment possible for even the most critical illnesses. It even allows the insured to choose the hospital or doctor of his choice for faster, more comprehensive, and better international healthcare. Many policies even cover consultations with foreign doctors.

• Coverage for emergencies: With global health coverage, you get financial security in the event of a health emergency as well. If you face a medical emergency in outside India with no financial/personal support, it can be scary. However, with global coverage, you can receive treatment without worrying about financial implications. 

• Day-to-day medical expenses: Global health insurance coverage can also aid with day-to-day medical expenses that you and your family may encounter outside India.

• Tax benefits: Under Section 80D of the income tax act, the insured can claim a deduction of up to Rs. 25,000 if the policyholder's age is below 60 years.

Things to keep in mind: 

Buying any insurance policy requires you to have proper due diligence. With global health cover too, you should have a proper understanding of what you are getting. Here are a few things to keep in mind.

• The scope of the countries covered under the policy. 
• Policy terms & conditions related to pre-hospitalisation, post-hospitalisation costs, OPD treatments, copayment clauses, coverages & exclusions, waiting periods for pre-existing diseases, etc. These may vary from insurer to insurer.
• For international coverage, most plans have a specified sum insured and certain illnesses listed. You must choose an adequate coverage amount, given the high cost of treatment abroad. Usually, a cover of at least Rs.3 crores should be considered.
• Take note of the hospital network that the insurance company has. Usually, insurance companies have tie-ups with internal platforms with hospital chains and networks offering cashless facilities.
• Check the credibility of the insurance company for handling international claims and the claim registration process. 

To conclude:

The healthcare you aspire for is today closely linked to your financial status and lifestyle. The benefits offered by global health policies are quite exhaustive. Such a policy offers you great peace of mind and access to quality healthcare at a global level, whether you are a business person, an employee, an avid traveller or a normal individual who has never stepped outside India. Get in touch with your insurance expert to know more and find the right product for yourself. Who knows? This can lead to something no less than a blessing.