• Injury or Disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of
Foreign Enemy, Warlike Operations (whether war be declared or not)
• Circumcision unless necessary for treatment of a disease not excluded hereunder or as may be
necessitated due to an accident, vaccination or inoculation or change of life or Cosmetic or Aesthetic
Treatment of any description, plastic surgery other than as may be necessitated due to an accident or
as a part of any illness
• Cost of Spectacles and Contact Lenses, Hearing Aids
• Any Dental treatment or Surgery which is a Corrective, Cosmetic or Aesthetic procedure, including
wear & tear, unless arising from disease or injury and which requires hospitalization for treatment
• Convalescence, General Debility, “Run-down” condition or rest cure, congenital external disease or
defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs /
alcohol
• All Expenses arising out of any condition directly or indirectly caused to or associated with Human T-
Cell Lymph tropic Virus Type III (HTD-III) or Lymphadinopathy Associated Virus (LAV) or the Mutants
Derivative or Variations Deficiency Syndrome or any (HTBB_III) Syndrome or condition of a similar
kind commonly referred to as AIDS
Group Health Insurance
Exclusions:
The Insurance Company shall not be liable to make any payment under this Policy in respect of any
expenses whatsoever incurred by any Insured person in connection with or in respect of: -
• Charges incurred at Hospital or Nursing Home primarily for Diagnostic, X-Ray or Pathological
Tests / Examinations not consistent with or incidental to the diagnosis or treatment of the
positive existence or presence of any ailment, sickness or injury for which confinement is
required at a Hospital / Nursing Home
• On Vitamins and Tonics unless forming part of treatment for injury or disease as Certified by the
attending Physician
• Injury or Disease directly or indirectly caused or contributed to by Nuclear Weapons / Materials
• Treatment directly or indirectly related to management of Infertility / IVF / GIFT (Gamete Intra
Fallopian Transfer) etc.
• Domiciliary Hospitalization & Out Patient’s Department
Group Health Insurance
Insurance company
Insurance ID card printed and
sends
Company issues Policy dispatched along
Data to TPA H.Q. with Guide Book.
Cashless TAT
Procedure
24 hours (Mon-Sat)
TAT – 21 days
Re-imbursement After submission of
All Documents
Procedure
Please attach Xerox of Deficiency letter along with the documents required to
clear your file. The same has to be submitted within 15 days from the date of
deficiency letter
Note: Xerox Copy of the documents should be kept with the insured at all
times for the documents submitted to PHS
Group Personal Accident Insurance
Permanent Partial Disability
1. Loss of toes – all 20%
2. Loss of toes great both phalanges 05%
3. Loss of toes other than great, if more than one toe lost each 01%
4. Loss of hearing - both ears 75%
5. Loss of hearing – one ear 30%
6. Loss of 4 fingers & thumb of one hand 40%
7. Loss of 4 fingers 35%
8. Loss of thumb – both phalanges 25%
9. Loss of thumb – one phalanx 10%
10. Loss of index finger – 3 phalanges or 2 or 1 phalanx 10%
11. Loss of middle finger – 3 phalanges or 2 or 1 phalanx 06%
12. Loss of ring finger – 3 phalanges or 2 or 1 phalanx 05%
13. Loss of little finger – 3 phalanges or 2 or 1 phalanx 04%
14. Loss of metacarpals – 1st or 2nd (additional) or 3rd, 4th or 5th (additional) 03%
15. Any other permanent partial disablement % as assessed by the panel of doctors of Insurance
Company
Group Personal Accident Insurance
TAT – 8 weeks
Re-imbursement After submission of
All Documents
Procedure
Claim Papers
Payment released
Claim checked by checked by
to Claim Approval Insurance trained
Panel of Doctors
Insured executives.
Group Personal Accident Insurance
Requirement mandatory for processing of a Claim
Accidental Death Claim
• Certified True Copy of the F.I.R lodged by Police Authorities
• Post Mortem Report in Original or certified true copy
• Certified True Copy of Death Certificate issued by the Municipal Authorities
• Local Newspaper clipping if the accident has been reported or Eye Witness’s
version of the accident (this is not mandatory but it’s presence reduces the TAT of
the Investigating Agency)
• Claim form duly filled in, certified
Temporary Total Disablement
• Original Certificate from the treating doctor certifying the circumstances & extent of
the injury & period of bed rest advised
• Original Fitness Certificate from the same doctor mentioning that the claimant is fit
to resume duty
• Original Certificate from the Employer acknowledging the leave of absence
Group Personal Accident Insurance