National Insurance Corporation
Published on: Mar 3, 2016
Transcripts - National Insurance Corporation
National Insurance CorporationBackground Incorporated in 1906, Registered office in Kolkata. Initially a subsidiary of General Insurance Corporation of India but after the notification of the General Insurance Business (Nationalisation) Amendment Act, th on 7 August 2002, it has been de-linked from its holding company GIC and presently operating as a Government of India undertaking. NIC foreign operations carried out from its branch offices in Nepal. It caters more than 200 policies. It transacts general insurance business of Fire, Marine and Miscellaneous insurance. Some of the sectors it caters to-Banking, Telecom, Aviation, Shipping, Information Technology, Power, Oil & Energy, Agronomy, Plantations, Foreign Trade, Healthcare, Tea, Automobile, Education, Environment, Space Research etc.NIC has been accorded “AAA/STABLE” financial strength rating by CRISIL rating agencyPersonal Accident PolicySalient FeatureThe policy compensates individual against death, loss of limbs, loss of eyesight, permanent totaldisablement, permanent partial disablement and temporary total disablement, solely and directlyresulting from accidental injuries.Scope of Cover and Premium RatingSerial Contingency and Benefit Benefits Rate (Rs. Per mile) No. Payable as % of CSI Covered Normal Medium Heavy Risks Risks Risks 1. Death only - 100% 1 0.40 0.60 0.90 2. Loss of two limbs, two eyes or one limb and one eye-100% 3. Loss of one limb or one eye-50% 4. Permanent Total Disablement 1 to 4 0.45 0.65 1.50 from injuries other than those named above (PTD-100%) 5. Permanent Partial Disablement 1 to 5 0.90 1.25 1.90 % of CSI as Detailed in the Policy 6. Temporary Total Disablement 1 to 6 1.50 2.00 3.00 1% of CSI per week up to 104 weeks maximum. Weekly benefits not to exceed Rs.5,000/-
Risk ClassificationNormal Risk:Bureaucrats, Doctors, Lawyers, Accountants, Architects, Bankers, Consulting Engineers,Teachers,Persons engaged in administrative functions, persons primarily engaged in occupations ofsimilar hazard.Medium Risk:Builders, Contractors, Engineers engaged in superintending functions only, Veterinary Doctors, PaidDrivers and Persons engaged in occupations of similar hazard and not engaged in manual labour. Allpersons engaged in manual labour (except those falling under heavy risk), cash carrying employees,Garage and Motor Mechanics, Machine Operators, Drivers of Heavy Vehicles, Professional Athletesand Sportsmen and Wood working Machinist and persons engaged in any occupations of similarhazard.Heavy Risk:Persons working in underground Mines, Explosive, Magazines, and Workers involved inelectricalinstallation with High-tension supply, jockeys, Circus personal, persons engaged in activitieslike racing on wheels or horseback, big game hunting, Mountaineering, Winter Sports, Skiing IceSkating, Ballooning, Hang gliding, River Rafting, Polo playing and persons engaged inoccupations/activities of similar hazards.Medical ExpensesReimbursement of medical expenses directly arising out of an accident can be covered at anadditional premium of 20% of the basic premium.Medical expenses reimbursable shall be 10% ofC.S.I. or 40% of the admissible claim whichever is lower (If no claim is admissible under the basiccover no medical expense shall be payable).Other Benefits:Expenses for carriage of dead bodyExpenses incurred for carriage of dead body of the insured (in case of death due to accident only, toplace of residence at 2% of C.S.I. subject to maximum Rs.1000/- shall be reimbursed.Educational Fund10% of C.S.I. per dependent child subject to Rs.5000/- per child up to maximum two dependentchildrenCumulative Bonus5% of C.S.I. per claim free year shall be added to the Capital Sum Insured subject to maximum of 50%of C.S.I.
Group Policies and Group Discount:Group policies can be issued covering more than one person.Group Discount shall be granted from5% onwards for groups consisting above 100 persons.Geographical LimitWorldwideHouse Holder PolicySalient Feature:Personal effects and household goods belonging to individual householders can becoveredunder this Insurance. It covers under single policy a number of risks.Scope of CoverSection I : Fire & Allied Perils Building ContentsThis covers loss of or damage to the building/contents by fire & allied perils, such as riot,strike,lightning, explosion, flood, cyclone, inundation earth quake etc.Rate of Premium : Rs.2.40 per milleSection III : All Risks This covers loss or damage to jewellery & valuables caused by accident whilst anywhere inIndia. Recent invoice/receipt or valuation Certificate should be obtained for items valued atmore than Rs.5000/- each.Rate of Premium: Rs.10.05 per mille.Section IV : Plate GlassThis covers loss of or damage to fixed plate glass in the insured premises by accidental breakage.Rate of Premium: Rs. 10.05 per mille.Section V : Breakdown of domestic appliancesThis Section Covers Loss or damage to domestic appliances caused by mechanicaland/orelectrical breakdown. Sum Insured in respect of each item should be its newreplacement value.Excess: One percent of the Sum Insured in respect of each domestic appliance
separately orRs.50/- whichever is higher.Rate of premium: Rs.2.50 per mille.Section VI : Television Sets & VCR/VCPThis covers :a) Loss of or damage to the television apparatus and VCR/VCP in insured premises by fireand allied perils, burglary and/or housebreaking Or theft, accidental external means andmechanical or electrical breakdown.b) Legal liability up to a limit of Rs.25,000/-c) Damage to Insured’s property caused by breakage of the antenna fittings up to a limit ofRs.3, 000/-.Rate of Premium: Rs.10.05 per milleSection VII : Pedal cycleThis covers:a) loss of or damage to pedal cycle belonging to Insured by Fire and allied perils, burglary,housebreaking or theft and accidental external means.b) Legal liability upto a limit of Rs.10,000/-Rate of premium: Rs.20.05 per milleSection IX : Personal AccidentThe Insured, his spouse and his children, all between the age of 5 and 70 years can be coveredunder this section. The insurance covers death, permanent total disablement, permanent partialdisablement and Temporary total disablement.Additional Benefits :1. Expenses incurred for carriage of dead body of Insured (death due to accident only) toplace of residence subject to a maximum of 2% of Capital Sum Insured of Rs.1,000/- whichever islower.2. Medical expenses arising out of an accident up to 10% of Capital Sum Insured or 40% ofthe admissible claim whichever is lower against an additional Premium of 20% of basic Premium.Rate of premium: Ranging from Rs. 0.40 to Rs.3.00 per mille (for details Please refer Policyliterature for our Personal Accident Policy).
Section X: Public Liabilitya) The Insured is indemnified in respect of legal liability up to a limit of Rs.25,000/-b) The Insured is indemnified against the compensation to his employees that he becomeslegally liable to pay under the Workmen’s Compensation Act 1923, Fatal Accidents Act, 1855 orat Common Law in respect of death of or bodily injury to such employees arising out of and inthe course of employment.Rate of Premium: Public liability - 0.50 per mille.Workmen’s compensation - as per Workmen Compensation tariff.Important:The minimum premium for Section I is Rs.10/- and for other Sections Rs.5/- each. Section I-b iscompulsory and out of the remaining nine sections, any two should be opted for as minimumrequirement.Group Discount:1. Where more than 4 and up to 15% of non-tariff 6 sections (including tariff premium only. Rated sections) are availed.2. Where more than 6 sections 20% on non-tariff (including tariff rated premium only. Sections) are availed.5% Service Tax shall be charged on final preimium.Critical Illness PolicySalient FeatureCritical Illness Policy is an exclusive benefit policy for individuals in the age group 20-65 yearscovering The following critical ailments :- Coronary Artery Surgery. Cancer Renal Failure ie. Failure of both Kidneys. Stroke Multiple Sclerosis Major organ transplants like kidney, lung, pancreas or bone marrow.
Scope of CoverThe Sum Insured under the policy will have four levels: Level I - Rs. 5 Lacs Level II - Rs. 10 Lacs Level III - Rs. 20 Lacs Level IV - Rs. 25 LacsThe amount chosen will be available in lump sum to the individual to take care of medicalexpenses incurredIs case of the above illness. Compensation for Coronary Artery Surgery shallbe limited to 20% of the limit of indemnity.Provisions In the event of a claim, the critical illness have to be diagnosed by a registered medical practitioner, supported by radiological, histological and laboratory evidence accepted to the company and to be reconfirmed by a Registered Medical Practitioner appointed by the company. The company shall compensate the insured only once in respect of any particular critical Illness. Cover under this policy shall cease upon payment of the compensation on the happening of a critical illness and no further payment will be made for any consequent disease or any dependent disease.Survival PeriodThe insured person needs to survive for 30 successive days after the diagnosis of the criticalillness in Order to make his claim.Waiting PeriodIf the critical illness incepts or manifests during the first 90 days of the inception of the policy noclaim Can be made.Mediclaim PolicySalient FeatureHospitalisation for illness, disease or accident, whether including surgery or not, imposesheavyfinancial burden on individuals, families, employers and welfare bodies.Scope of CoverMediclaim insurance policy has been devised under the aegis of the Government of India.
The policy provides the following benefits.1) Reimbursement of hospitalisation expenses which are reasonably and necessarily incurred,under the following heads: a) Room, boarding expenses as provided by the hospital/nursing home. b) Nursing expenses. c) Fees of surgeon, anaesthetist, medical practitioner, consultant and specialist. d) Expenses on account of anaesthesia, blood, oxygen, operation theatre charges,surgicalappliances, medicines and drugs, diagnostic material, X-ray, dialysis, chemotherapy,radiotherapy, cost of pacemaker, artificial limbs and cost of organs and similar expenses.2) Introduction of Sub-Limits:The following provisions have been introduced:a. Room, Board and Nursing Expenses as provided by the Hospital /Nursing Home- RoomRent limit: 1 % of the Sum Insured per day subject to maximum of Rs.5000./-. I.C. Unitexpenses:2 % of Sum Insured per day subject to maximum of Rs. 10,000/-. Over alllimits under this head:25% of S.I. per illness.b. surgeon, Anaesthetist, Medical Practitioner, Consultants Special fees – maximum limitsperillness – 25% of S.I.c.Anaesthesia, Blood, Oxygen, OT charges, Surgical appliance, Medicines, drugs, DiagnosticMaterial & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbsandcost of stent and implant. Maximum limit per illness – 50% of Sum Insured.d. Ambulance services - 1% of the sum insured subject to maximum of Rs 1000/-provided registered ambulance is used for shifting patient from residence to hospital if admittedto ICU or emergency ward OR from one hospital to another subject to sub-limits under ‘c’above.e.Hospitalization expenses of person donating an organ during the course of organ transplantwill also be payable subject to the sub-limits under ‘c’ above.3) Premium paid for the policy towards self, spouse, dependent children and dependentparentsare exempt from Income Tax under Sec. 80D of the l.T. Act.4) Cost of Health Check Up and Cumulative Bonus - Benefits will accrue only if the Policy is arenewal of ‘National’.Additional Feature1)Definition of Family:a)Self (Primary Insured).b)Spouse.c)Dependent Children (i.e. legitimate or legally adopted children). Children above 18 years, ifemployed, cannot be covered. Male children, if not employed, but a bonafide student can becovered up to age of 25 years. Female children, if not employed, can be covered until the timeshe is married.d)Dependent parents. All members of the family must be covered under one policy.2) Entry Age:This insurance is available to a person between the ages of 18 to 59 years. However, thePolicy can be renewed up to the age of 80 years as stipulated in the premium chart above.
a) Children above the age of 3 months can be covered provided parents are coveredconcurrently and suitable premium is paid. If the child above 18 years is employed or if the girlchild is married, he or she shall cease to be covered under the policy. However male child can becovered up to the age of 25 years if he is a bonafide regular student and fully dependent onprimary insured. Female child can be covered up to the time, she is unmarried.b) If the insured has taken continuous Mediclaim insurance policy with us for at least 5 yearsprior to attaining the age of 80 years the policy can be renewed beyond the age of 80 up to theage of 90 years as a special case with the approval of Regional In charge on case to case basis.The premium chargeable shall be 10% of the premium for 75-80 years age slabs for proposersabove 85 and 20% of the premium for 75-80 age slabs for proposers above 90.c) No inclusion of family member during currency of policy is permissible except for a newborn child between the age of 3 months to 6 months and newly married spouse within 60days of marriage. Otherwise inclusion of family member shall be allowed only at the time ofrenewal. Prorate premium shall be charged for such inclusion during the currency of thepolicy for the unexpired period.3) Sum Insured:Minimum sum insured shall be Rs 50,000/- and can be increased in multiples of Rs 25,000/-up to Rs 5 lacs. The sum insured must be identical for primary insured and the dependents.However, the children may be covered for 50% Sum Insured as per item no. 2 above.4)TPA option:The premium includes cashless facility through TPA. If the policyholder does not requirecashlessfacility then 6% discount on premium may be given.5)Pre -Acceptance Health Check-up:Pre acceptance health check-up is mandatory when age is 50 years and above and he/she isseeking insurance cover for the first time as an individual or as member of a family where thereis break in Insurance increase in sum insured on renewal.Proposer/Insured Person will be required to undergo the following Medical Check-up or anyother medical test as required by the Company either on his/her own or from its authorizedNetwork Diagnostic Centre in prescribed format. The cost shall be borne by the insured. Age (in years) 50 and above PHYSICAL EXAMINATION BLOOD URINE SUGAR MEDICAL TEST BLOOD PRESSURE ECHO CARDIOGRAPHY EYE CHECK UP INCLUDING RETINOSCOPYIf the insured was covered under any Health Insurance Policy of ‘National’ uninterruptedly forpreceding 3 years, no pre-acceptance Medical check-up is required.
ExclusionThe most important exclusion relates to pre-existing illness. If the insuring person had ahealthcondition, existing prior to taking the policy, which required medical treatment, the samegetsautomatically excluded in the policy. To ensure that in subsequent renewals medicalconditionsincepting since the policy was taken do not get excluded, the insuring person mustrenew the policywithout break. The other exclusions for illustrative purposes are :-a) Exclusion of certain named diseases in the first year of the policy.b) Congenital external disease, sterility, venereal disease, intentional self-injury, use ofdrugs,alcohol, rest cure etc.c) AIDS d) Charges primarily for diagnostic, laboratory examinations, and not related to any treatmentinhospital. So also for vitamins and tonics unless prescribed for treatment.e) Dental treatment not requiring hospitalisation. f) Treatment arising from or traceable to pregnancy, childbirth, including caesarean. g) Naturopathy treatment.EXCLUSION 4.a, 4.b & 4.c have been amended. Pre-existing diseases shall be covered after 4continuous claims free Policy years with ‘National’. However, in case of exclusion 4.3, forrenewals, existing condition shall apply, i.e. the one year exclusion applicable earlier shall bevalid.Product Liability InsuranceSalient FeaturePolicy indemnifies the insured against legal liability to third parties in consequence of death /bodily injury arising from the use of product sold to them.Scope of CoverPolicy indemnifies the insured all sums which the insured shall become legally liable to pay asdamages in consequence of accidental death/bodily injury or disease to third party or damageto their property arising out of any defect in the products manufactured and covered under thepolicy after such products have left the insured’s premises.Main Exclusion1. Product Recall.2. Deliberate, wilful or international non-compliance of any statutory provision.3. Loss of goodwill, loss of market.4. Fines, penalties, punitive/exemplary damages.5. War and War like situations.
6. Any loss occurring prior to the Retroactive Date mentioned in the policy.Premium RatingPremium: - Premium will depend on the kind of products produced by the insured i.e. insured’sclassification as per Risk Group. Turnover, Ratio of Any One Accident Limit to Any One YearLimit etc.Excess: - Policy is subject to Compulsory Excess i.e. in the event of a claim, the insured mustbear 0.50% to 1% of the limit of indemnity.Public Liability InsuranceSalient FeatureThe policy indemnifies the insured for his legal liability to pay compensation including claimant’scost and fees, in respect of death/injury to third party or damage to property belonging to thirdparty, arising out of the business of the Insured.Scope of coverThree types of covers are available under Public Liability Insurance1. Act policy2. Industrial and storage risks – Market Agreement3. Non-Industrial Risks – Market AgreementIndemnity Limits : 1. Act PolicyAOA (Any One Accident): Not less than the paid up capital of the Insured subject to Maximum Rs.5 crores.AOY (Any one Year) : Three times AOA subject to a maximum Rs. 15 crores. 2. Industrial & Storage / Non-Industrial Policy A.O.A./A.O.Y. As per requirements of the InsuredPremium RatingsThe premium is computed taking into account the risk group classification, limits of indemnity,
ratio between the limits of indemnity, number of factories, gross annual turnover and theextensions sought by Insured.Workmen’s Compensation InsuranceSalient FeatureThe employers’ legal liability under the W.C.Act to pay compensation to employees not coveredunder E.S.I.Act for bodily injury or disease sustained / contracted out of and in the course ofemployment is covered by this policy. Liability to employees under Indian Fatal Accident Act1855 and at Common Law isalso covered under the policy.Scope of Cover a) The Workmen’s Compensation Insurance Business in India is controlled by the Workmen’s Compensation Insurance Tariff (W.C.Tariff). The Tariff provides for two types of Insurance as follows: Table A: This policy provides indemnity to the Insured if any employee in the Insured’s immediate service shall sustain bodily injury by accident or contracts disease arising out of and in the course of his employment by the Insured in the Business and if the Insured shall be liable to pay compensation for such injury either under. i) Workmen’s Compensation Act, 1923 and subsequent amendments of the said Act prior to the date of issue of the Policy provided that the insurance granted is not extended to include any interest and/or penalty imposed on the insured on account of his / their failure to comply with the requirements laid down under the W.C. Act, 1923, and ii) the Fatal Accident Act, 1855 of a Common Law And in addition all costs and expenses incurred with the company’s consent in defending any claim for such compensation. Table B : This Policy provides indemnity to the Insured against their legal liability under the Fatal Accidents Act, 1855, and at Common Law. (This Policy is not issued to cover employees who fall within the definition of “workmen” under the Workmen’s Compensation Act, 1923, as amended).b) The Policy excludes i) Any injury by accident or disease directly attributable to war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, Mutiny, insurrection, rebellion, revolution or military or usurped power.
ii) The Insured’s liability to employees of contractors to the Insured.iii) Any employee who is not a workman within the meaning of the Lawsiv)Any liability of the Insured which attaches by virtue of an agreement but whichwould not have attached in the absence of such agreement. v) Any sum which the Insured would have been entitled to recover from any party butfor anagreement between the Insured and such party.