Personal Accident Insurance

What does Personal Accident insurance cover?

  1. 24-hour cover against accidental injuries.
  2. Treatment costs for accidental injuries (not self-inflicted).
  3. In-patient or outpatient treatment is covered.
  4. Treatment costs are consistent with generally accepted standards of medical practice in the country in which treatment is being received.
  5. Treatment is clinically appropriate in terms of type, duration, location and frequency for that condition.
  6. The insurance company will only pay for reasonable and customary charges. Costs should not be more than they would normally charge to other patients in the same area.
  7. Compensation for loss, disability or death.
    1. Loss of limbs, eyesight or combination of.
    2. Disability, most policies only cover total-permanent-disability.
    3. Death.
  8. Telephone medical advice by SOS or similar service.
  9. Arrangement for treatment by local doctors or hospitals.

 

What does Personal Accident insurance not cover?

  1. Treatment costs for pre-existing conditions and related conditions (exceptions only if agreed by underwriters of certain insurance companies)
  2. Treatment for any illness not related to an accident.
  3. Compensation for temporary disabilities.
  4. Participating in dangerous sports unless endorsed by the policy.
  5. Accidents while intoxicated or under the influence of illegal drugs.

 

Features common to all Personal Accident Insurances:

1. You must be perfectly honest and disclose everything required in the insurance application. If the insurance company finds out, they can either cancel your policy or deny paying claims.

2. Any claim as a result of a Pre-Existing Condition will not be covered. This applies even if you did not know about the Pre-Existing Condition and have never received treatment for this P/E Condition.

4. You must inform the insurance company anytime you change your address or change your job description.

5. In Non-Emergency Cases, contact the Insurance Company before being admitted as an In-Patient in a hospital for treatment, if you do not, you may find the insurance company will not pay the claim. In some cases, the insurance company will pay only part of the claim. The Health Insurance card offers no guarantee of payment.

6. In Emergency Cases, go directly to the hospital and seek treatment. Ask the hospital staff to contact the insurance company when you are admitted. If you are unconscious, the hospital staff will find your health insurance card and call the insurance company on behalf of you.

Major policy exclusions (not all apply, as policies vary):

  1. Action of the Insured while under the influence of alcohol, addictive drugs, narcotic drugs to the extent of being unable to control one’s mind. The term “under the influence of alcohol” in case of having a blood test refers to a blood/alcohol level of 150mg percent and over.
  2. Suicide or attempted suicide or self-inflicted injury.
  3. Infections except pyogenic infections, tetanus, or rabies from a wound or cut suffered as a result of an accident.
  4. Medical treatment or surgical treatment except the necessary treatment for the injury which is covered under this Insurance Policy and occurring within the period of this Insurance Policy.
  5. Treatment by a medical practitioner of hospital not recognized by the authorities of that country, or not recognized/authorized by the insurance company or any treatment by an immediate family member.
  6. Dental care, root canal treatment, replacement of or new sets of dentures except necessary first aid treatment following an accident.
  7. Treatment arising from a consequence of war, invasion, acts of foreign enemy hostilities, rebellion, revolution, mutiny, riot, strike or act of terrorism unless the insured person sustains injury as an innocent bystander.
  8. While the customer is taking part in a brawl, or inciting a brawl.
  9. While the customer is serves as a soldier, police, or volunteer and participates in war or crime suppression.
  10. While customer is taking part in dangerous sports or activities including hunting, racing of all kinds (except on foot) of car or boat, horse racing, ski playing or racing, skate racing, boxing, parachute jumping (except for the purpose of life saving), boarding or traveling in a hot-air balloon, gliding, bungee jumping, mountain climbing with equipment, or diving with oxygen tank and breathing equipment under water.
  11. Birth injuries, congenital defects, genetic deformities or disease and hereditary medical conditions and pre-existing conditions.
  12. Cosmetic treatment and any consequence thereof, exception being reconstructive surgery to restore your appearance after an injury or previous surgery covered by the same insurance policy.
  13. Travel costs to receive treatment unless agreed on before treatment.
  14. Suicide or attempted suicide or self-inflicted injury.
  15. Any injury as a result of a criminal offence or arrested or escaping arrest.
  16. Whilst boarding or alighting from or traveling as a passenger in an aircraft not licensed for carriage of passengers and not operated by a commercial airline
  17. Abortion.
  18. Some policies only; Driving of or riding as a passenger on a motorcycle
  19. Some policies only; Murder or assault, skiing (water or snow).
  20. Radioactivity, chemical contamination, nuclear fuel, asbestos or related condition.

Claims procedures for Emergency situations:

  1. Call or have someone else call on behalf of you, the 24 hour Emergency number nearest to your location as soon as possible. Get Emergency treatment first.
  2. Give your name, policy number, telephone number and location.

 

Claims procedures for Non-Emergency In-Patient & Day-Patient treatment:

  1. Notification of treatment should be submitted as soon as reasonable; or at least 24 hours within admission to the medical center.
  2. Provide your name, policy number, telephone number, and location of planned treatment, dates of treatment and the name of the Specialist / Doctor treating you.
  3. When the insurance company has sufficient information to appraise the claim, written confirmation will be dispatched to you and the medical center will be paid directly.
  4. If you should undergo treatment before obtaining confirmation from the insurance company, you may not receive a full refund for all expenses.

 

Applicable for all claims situations:

  1. It is the duty of the customer to make sure the insurance company is informed of any claim.
  2. If the customer cannot inform the insurance company, the hospital, relative or friend has to make sure the insurance company is informed.
  3. Not all hospitals are as efficient. It is not uncommon for hospitals to wait 2-3 days before informing insurance companies of a claim.
  4. All insurance companies want to be informed of claims as early as possible. Do not expect an insurance company to process a claim payment as you are waiting at the cashier of the hospital ready to leave for home within the hour.
  5. Certain insurance companies will not pay 100% of a claim or deny the claim payment, if you do not inform them at least 72 hours before admission to a hospital.
  6. THE CUSTOMER MUST ALWAYS CALL THE INSURANCE COMPANY FIRST.

 

Application procedures

  1. Applications must be completed in full BY THE CUSTOMER and signed by customer only (this is very important).
  2. Applications must be sent to broker office by post, email or fax.
  3. Details on medical answers should include the following information
  1. Date of medical condition or treatment.
  2. Treatment details.
  3. Name of clinic or hospital or doctor.

Documents required

  1. Application form
  2. Passport or ID card or birth certificate.

Premium payment

  1. Premium is paid to the Broker company bank account.
  2. Premium payment by credit card to the Insurance Company.

For applicants up to the age of 60.

ACE_P.A.Premium and cover not over 60 (E)-1