THE NEW INDIA ASSURANCE
COMPANY LIMITED
DIVISIONAL OFFICE - 712500
Allied
Mount Casa Blanca Building, 2nd Floor, 260 Anna Salai, CHENNAI-600 006.
Phone 044-852 2886, 044-852 3347 Fax : 044-858 6565
Email : nia25@vsnl.com
GOOD HEALTH PERSONAL ACCIDENT POLICY
Policy Benefits | Plan Options & Premium Rates | Age Limit | Insured/Insured Person | Claims Procedure| Nomination | Buy this policy
This policy provides for the following benefits to insured persons, arising out of an accident, subject to policy terms, conditions, and exclusions :
|
Benefit (% of Sum Insured) |
Description of Accidental Loss |
| 100% | Death. |
| 100% | Loss of sight of both eyes |
| 100% | Loss of two entire hands or two entire feet |
| 100% | Loss of one entire hand and one entire foot |
| 100% | Loss of sight of one eye and either one entire hand or one entire foot |
| 50% | Loss of one eye or one entire hand or one entire foot |
| 50% | Loss of use of a hand or a foot without physical separation. |
| Varying % | Permanent total disablement other than those named above. |
| Varying % | Certain specified permanent partial disablement |
| Medical expenses arising out of an accident resulting in death/permanent disablement, subject to a maximum of 10% of the sum insured or claim amount paid, whichever is less, under the respective plan. | |
| Expenses incurred for transportation of the mortal remains of the fatal accident victim (insured person) to the place of residence subject to a maximum of 2% of the Capital Sum Insured or Rs.2,500/- whichever is less. | |
PLAN OPTIONS AND PREMIUM RATES
Good Health Personal
Accident Insurance
|
Good Health Plan |
Sum Insured |
Citibank
Customer Rate |
|
| Personal Accident Cover (Rs.) |
Medical
Expenses Reimbursement (arising
out of an accident resulting in death or permanent total disablement of
the insured person) |
||
|
1 |
2,00,000 |
20,000 |
253 |
|
Those who are less than 21 years are eligible to apply only for Plan 1. |
|||
|
2 |
3,00,000 |
30,000 |
379 |
|
3 |
4,00,000 |
40,000 |
505 |
|
4 |
5,00,000 |
50,000 |
632 |
|
13 |
7,50,000 |
75,000 |
947 |
|
14 |
10,00,000 |
1,00,000 |
1263 |
Citibank customers need pay only the premium amount indicated in the Citibank customer rate column plus the transaction fee charged by Citibank, according to the plan option selected by them. The limits indicated for Medical Expenses Reimbursement under the various plan options is forming part of the Personal Accident Cover sum insured for such plan options. The Sum Insured and Premium indicated above are per person. Premium includes 12.24% service tax but does not include the Transaction fee charged by Citibank. Those who are less than 21 years are eligible to apply only for Plan 1.
This
insurance is available to persons between ages of 5 yrs and 70 yrs only.
Persons
between 5 years and 21 years of age are eligible to apply for plan option
1 only.
The right
to accept or reject for coverage any person proposed for this Personal Accident
Insurance, whether for fresh or renewal, shall rest solely with the Company.
4. INSURED / INSURED PERSON
INSURED
means Citibank Credit Card Members /
Customers who have proposed for this insurance.
INSURED PERSON
means Citibank Credit Card Members / Customers and/or their family members
covered by this policy.
5. What is the procedure for availing this Policy ? Go Top
Fill up the Proposal Form
The Proposer shall make an application either:
(a) in writing, in the prescribed application / proposal form, duly completed and signed, alongwith the prescribed Medical Practitioner’s Report and diagnostic test reports, wherever applicable, in respect of all the persons proposed for this mediclaim insurance, to Citibank Card Center (Attn. Good Health Policy), 2 Club House Road, Chennai-600 002 , so that the said forms are received at Citibank prior to the last date specified for this purpose, to be eligible for consideration of his/her request for Good Health Mediclaim Policy cover, or
(b) over phone, (local citiphone numbers) where the persons proposed for insurance are not over 45 years of age, by providing the required details to Citibank authorized telecalling company and for which Citibank would submit the prescribed Authorisation–cum- Advice for policy issuance (MOTO) to the Company, or
(c) over internet, where the persons proposed for insurance are not over 45 years of age, by filling up the required details in the application format provided at the Citibank website and for which Citibank would submit the prescribed Authorisation–cum- Advice for policy issuance (Internet) to the Company.
The Company shall not be liable for any dispute arising out of the transaction between the proposer and Citibank in respect of this insurance. The Company shall not be liable for omission or rejection of any such application either wholly or in part, due to any decision, action or omission of Citibank or due to non-receipt or delayed receipt (i.e., after the due date) of the application form or of the medical practitioner’s report, wherever required, or due to the application received being incomplete in any respect or due to any other reason whatsoever.
Send in the completed Proposal form
Kindly send in the duly completed proposal form(s) to CITIBANK CARD CENTRE, No.2 Club House Road, Anna Salai, CHENNAI-600 002, so as to reach before 1st of the month previous to the month in which you wish your Good Health policy to commence.
For the convenience of Citibank Card Members, we have 12 Good Health Policies in a year, one policy for every month, each commencing from the 1st day of the month. Each Good Health Policy is of 12 months duration.
6. CLAIMS PROCEDURE
Go Top
1) Preliminary notice of claim should be sent to the Company within
30 days from the date of death of the insured
card member.
2) The completed claim form duly signed by the claimant, who shall
necessarily be one of the legal heirs, together
with the following documents
should be submitted to the Company at the earliest and in any case not later
than
6 months from the date of death of the card member or within such further
time as may be granted by the Company
in this regard.
3) Documents to be submitted along with the claim form :
a) Death Certificate (Original or xerox copy duly notarised
or duly attested by an Officer of the Company)
b) FIR of Police Authorities (Original or xerox copy duly
notarised or duly attested by an Officer of the Company)
c) Post Mortem Report along with Chemical Analysis Report (Original or xerox copy duly notarised
or duly
attested by an Officer of the Company)
d) Police Inquest Report or Panchanama /Accident Reports (Original or xerox
copy duly notarised or duly
attested by an Officer of NIA)
e) Admission cum Death Summary from the Hospital in
case of Hospitalisation following accident.
f) Copies of any document translated into English from any
other language should be duly attested by the
offical language translator approved by
the Govt. and duly notarised)
4) While sending xerox copies to the Company kindly ensure that they
are of readable quality. This is very
important, especially in cases where such
documents are in any language other than English, to facilitate easy
and quick translation into English and faster claims processing.
5) While sending xerox copies to the Company kindly ensure that they are
duly verified and attested by a Class I
officer
of NIA on all pages with Signature, Name, Designation and Office Address
of the Official.
6) Upon approval of the claim, an approval letter will be sent by the
Company calling for the submission of the
following documents to evidence the
legal entitlement of the claimant to the insurance compensation payable
under this policy.
i) Nomination
ii) If nomination is not available, then Legal Heirship Certificate
issued by Competent Revenue Authority by
Tashildar or District
Collector or District/Divisional/Sub-Divisional Magistrate and
Indemnity Bond.
iii) If Legal Heir Certificate is not available, then
Succession Certificate issued by Court.
iv) If Succession Certificate issued by Court is not
available, then following set of documents should be
produced.:-
a) An Affidavit from the
claimant(s) that he/she/they is/are the Legal Heir(s) of the deceased.
b) An Affidavit from
other near relatives of the deceased that they have no objection if the claim
amount is
paid to the claimant(s).
c) Surety Bond executed
by persons of reasonable standing.
d) Indemnity Bond to be
executed by all Legal Hier(s).
7. NOMINATION
Nomination
facility is available for persons covered under this Group Personal
Accident Insurance. You may nominate the person of your choice to receive the personal accident compensation
on your behalf. Nominations would help the nominee to receive the claim monies
without any delay. To avoid any legal dispute it is always advisable that the
nominee may be one of the legal heirs.
Nomination form is available in the Good Health
policy salient features brochure. Filled in nominations should be sent to us in
duplicate so that we can return one copy to you after duly registering your
nomination in our records
Policy Benefits | Plan Options & Premium Rates | Age Limit | Insured/Insured Person | Claims Procedure| Nomination | Buy this policy