iii. Total and Permanent Disability (PTD)
If, as the result of an accidental injury an insured member becomes Totally Disabled within One hundred eighty three (183) days from the date of the accident and such disability has continued for a period of twelve (12) consecutive months, the benefit amount shall be paid in a lump-sum to such insured member.
iv. Accidental Medical Expenses Reimbursement (AMR)
If, as a result of an accidental injury, an insured member shall require treatment by a physician, use of hospital facilities, or the employment of a licensed nurse while at the hospital within the thirty (30) days after the date of the Accident, the Reasonable, Customary and Necessary medical expenses incurred within one (1) Year from the date of the accident for such physician treatment, hospital charges and nurses fees, which are in excess of the deductible (Rs. 500) and up to insured amount limit stated in the Policy shall be paid.
v. In-Hospital Weekly Income - Accident (IH- A)
If, as the result of accidental injury except pre-existing conditions, an insured member shall be necessarily confined within a hospital as an in-patient for at least 24 hours under the continuous attendance of a physician, the Weekly Benefit stated in the Policy shall be paid, for each week that the insured person shall be confined therein, up to fifty two (52) successive weeks. If an insured person is confined for a portion of week, one seventh (1/7) of the Weekly Benefit shall be paid for each day of the confinement.
vi In-Hospital Weekly Income – Accident or Sickness (IH-A/S)
If, as the result of commencement of accidental injury or sickness, except pre-existing conditions, an insured member shall be necessarily confined within a hospital as an in-patient for at least 24 hours under the continuous attendance of a physician, the Weekly Benefit stated in the Policy shall be paid, for each week that the insured person shall be confined therein, up to fifty two (52) weeks, commencing immediately following the Elimination period one (1) day. If the Insured member is confined for a portion of a week, one seventh (1/7) of the Weekly Benefit shall be paid for each day of the confinement commencing immediately following the Elimination period, if any. Waiting Period is 31 days and for injury or sickness related to tonsils, hernia or female organs of reproduction Waiting Period is 120 days as stated in the Policy.
Group Critical Illness
Critical Illness provides a lump sum payment to an insured member when the insured member is diagnosed to be suffering from the following critical illnesses, except pre-existing conditions, as listed and defined in the Policy commencing immediately following the Waiting Period (60 days). Insured members can be covered under one of the following three (3) plans:
Plan 1: Major Cancers Only.
Plan 2: Major Cancers, Stroke, First Heart Attack, Serious Coronary Artery Disease, Heart Valve Surgery, Primary Pulmonary Hypertension.
Plan 3: Major Cancers, Stroke, First Heart Attack, Serious Coronary Artery Disease, Heart Valve Surgery, Primary Pulmonary Hypertension, End Stage Lung Disease, End Stage Liver Failure, Fulminant Hepatitis, Kidney Failure, Coma, Aplastic Anaemia, Major Organ/Bone Marrow Transplantation.
NIA Product Code: NIA/LI005/2073/074/GP/0006
Group Affinity Policy Wording
