Scope of Cover-What is Covered?
Motor Insurance covers the unforeseen risks which may result in:
- Creation of lLiabilities(called generically as tThird pParty cCover)
- Injuries/ Ddeath of persons outside or inside a vehicle. This could be the owner, passengers, driver, pedestrians, etc.
- Damage to property of others - also called as tThird pParty pProperty dDamage
- Partial damage to the vehicle itself. This may arise due to accidental external means, riot, strike, malicious act, fire, flood, cyclone, etc.
- Theft of parts or theft of the vehicle itself.
- Total loss/damage of the vehicle.
Compulsory Personal Accident (CPA) cover for oOwner-driver
- The CPA cover offers compensation up to Rs.15 lakhs for aAccidental dDeath/ddDisability of the registered oOwner of the iInsured vVehicle whilst driving or alighting into/out of the vVehicle.
- The registered oOwner should hold an effective driving license.
Key requirements for acceptance
- Proposal form
- Valuation report (where applicable)
- Renewal notice copy (in case of an insurance renewal)
- Break in iInsurance iInspection report if there is a break in insurance or there is no past insurance.
- Copy of RC book/iInvoice Copy (where applicable)
- Inform CholaMS customer care on a toll free number 1800 208 5544 and register the claim.
- Please provide policy number, driver details, incident details, location of accident, details of damages etc. to the customer care executive
- Safeguard self and try to prevent further damage to the vehicle by taking appropriate action.
- In case of a 2of 2 wheeler, there is no need for a spotfor spot survey. For other vehicles it is needed.
- Spot survey where applicable will happen in 6 hours.
- In case there are nois notThird pParty lLosses- no need for police intimation.
- Once an estimateOnce estimate for loss is obtained from the garagefrom garage, please inform us for a final survey by CholaMS loss assessor.
- Please provide the details/documents as requested.
- Once repaired, reinspection is done where required. Our assessor will guide customer on this.
- If cashless facility is availed, satisfaction certificate to be provided for Chola MS to settle with garage.
National Super Top Up Mediclaim Policy is a high threshold health insurance product, covering the members of a family under a single sum insured on floater basis or each member on individual sum insured basis. The policy provides the customer an option to choose a high sum insured at reasonable cost. This policy can be taken with/without a base policy. This policy provides unique features which address all health related concerns of our valued customers. The expenses incurred should be reasonable, customary and medically necessary.
Highlights of National Super Top Up Policy
- Sum Insured (SI) and Threshold
|Thise pPolicy is available with following combinations of tThreshold and sum insured.|
|Threshold||Sum Insured (Above Threshold)|
|3L||3, 5, 7L|
|5L||5, 7, 10L|
For pPolicy issued on individual basis, both tThreshold and sum insured shall apply on individual basis on each insured person.
For pPolicy issued on floater basis, both tThreshold and sum insured shall apply on floater basis to all the insured persons.
- Entry aAge of proposer â€“ 18 to 65 years
- Maximum entry age of any family member - 65 years.
- Who can be covered? â€ SSpouse, dDependent legitimate or legally adopted children, pParents/pParents-in law, new-bornnew born 3 monthsâ€“ or individual of 18 years.
- Lines of treatment covered â€“ aAllopathy, aAyurveda and hHomeopathy
- In-patient tTreatment including rRoom rRent/ICU charges, mMedical practitioners, surgeon, anaesthetist, consultants, specialistâ€™s fees and other charges are covered.
- Ambulance cCharges on actuals but will be paid once for any one illness for each insured person.
- Organ dDonorâ€™s medical expenses, pPre & pPost hHospitalisation expenses covered up to sSum iInsured.
- Pre and pPost hHospitalisation up to 30 days and 60 days respectively for the samefor same disease/illness/injury for which hHospitalisation occurred.
- 12 mModern treatments like rRobotic surgery, oral chemotherapies, immunotherapiesimmunotherapies and etc., are now covered in the policy.
- Treatment for morbid obesity isare now covered after specified waiting periods (refer policy for complete details).
- Correction of eyesight, i.e., refractive errors above -7.5 D are now covered after specified waiting periods.
- Treatment related to participation as a non-professional in hazardous or adventure sports subject sublimits.
- Mental illness, HIV/AIDS, gGenetic disorders are now covered.
- Cashless fFacility available at Nnetwork hHospitals oOnly through TPA.
- Pre nNegotiated pPackage rates for specific surgeries/procedure in network hospitals.
- Life lLong rRenewability.
- Portability (migration) allowed from/to similar products only as per IRDAI guidelines.
Pre Policy Check Up
For wWho?m - Proposers aged 50 years and above (including dependents) and availing the policy for the first time.
No pre-policypre policy health check-up shall be required for existing policyholders of the Company, covered under any retail indemnity health insurance policy for a continuous period 3 years or more as on date of opting for this policy.
The pPre- pPolicy check-up reports required are
- Physical examination (report to be signed by the Doctor with minimum MD (Medicine qualification)
- Blood sugar (fasting/ post prandial)
- Lipid profile
- Serum creatinine
- Urine routine and microscopic examination
- Any other investigation required by the Company
Note: The date of medical reports should not exceed 30 days prior to the date of proposal. 50% of the expenses incurred for pre-policypre policy check-up shall be reimbursed, if the proposal is accepted. Terms and conditions apply.
- Only claims arising out of accidents are payable for the first 30 days of iInception of the pPolicy
- All pre-existing diseases included after first 12 twelve months (12) of pPolicy and thereafter as follows:
|Months from inception||Limit of claim|
|13-24 months||50% of the admissible claim|
|25-36 months||75% of the admissible claim|
|After 36 months||100% of the admissible claim|
- 90 days, 1One, 2 Two and 3Three yYears waiting period for specific diseases
- Change-of-gGender tTreatments, cCosmetic or pPlastic sSurgery, eExcluded pProviders
- Vitamins, tTonics dDrug/alcohol abuse, sSelf-iInflicted Injury
- Non-prescription dDrug, hHome visit charges
- Dental treatment (unless arising out of accident and requiring hospitalisation) and Out Patient Department treatment (OPD treatment)
How to report a claim?
Cashless Facility â€“ is available only for policies serviced by a tThird pParty aAdministrator (TPA)
- Check if the hospital falls under the networked hospitals (pPreferred provider network/other network hHospitals), as cashless is available only for empanelled network hospitals of the Company/TPA.
- For planned hospitalisation, intimation is to be sent to the TPA/Company in advance (72 hours prior) with details of nName and address of the hospital and condition requiring hospitalisation.
- In case of an emergency hospitalisation, intimation is to be sent to the TPA/Company within 24 hours of admission.
- On admission, a pPre-authorisation rRequest for cashless will be sent to the TPA by the hospital â€“ duly signed by the insured and hHospital aAuthorities giving the details of admission, illness, proposed line of treatment and the estimated expenses. Pre and post hospitalisation expenses can be claimed separately after treatment.
- For the first claim under the pPolicy (i.e., the claim in which cumulative medical expenses exceeds the threshold) cashless facility shall be available provided all evidences and documents are produced prior to cashless authorisation, to substantiate that the Cumulative Medical Expenses (CME) exceeds the tThreshold. For all subsequent claims under the pPolicy cashless facility shall be available as usual.
- In case of hospitalizsation where the cumulative medical expenses are likely to exceed the threshold, notification of claim shall be sent to the TPA mentioned in the schedule/ Company.
- In case of hospitalizsation where initially the cumulative medical expenses are not foreseen to exceed the threshold but subsequently exceeds, notification of claim shall be sent to the TPA mentioned in the schedule/ Company, immediately.
- All documents in original are to be submitted within 15 days to TPA, after completion of pPost hHospitalizsation treatment.
- The insured shall preserve and submit all original documents and/ or certified copies of documents related to all hospitalizsation(s) during the policy period to enable the Company to calculate the cumulative medical expenses and threshold, for determining admissibility and payment of claims.
For Reimbursement Claims
- Written intimation/mail/fax about hospitalisation is to be sent to TPA /Company within 72 hours of hospitalizsation in the case of emergency hospitalisation and 72 hours prior in case of planned admission.
- Before leaving the hospital, dDischarge sSummary, investigation report and other relevant documents (cClaim form â€“ Part A & Part B) may be obtained from the hospital authorities. All the documents in original are to be submitted to TPA / Office within 15 days from date of discharge.
- Pre and post hospitalizsation expenses can be claimed separately after treatment.
- All documents (as mentioned in the prospectus) in original, to be submitted within 15 days after completion of pPost hHospitalisation treatment.
Bank of Baroda is authorized by the Insurance Regulatory and Development Authority to act as a Corporate Agent from 01/04/2019 to 31/03/2022 for procuring or soliciting business of Life Insurance, General Insurance & Standalone Health Insurance under Registration Code CA0004". Insurance is the subject matter of solicitation. For more details on risk factors, terms and conditions please read sales brochure carefully before concluding a sale. The purchase of Insurance product by Bank of Baroda customers is purely on a voluntary basis. The insurance products are underwritten by respective Insurance company. Bank of Baroda does not perform any Insurance e-commerce activity on its website. The contract of insurance is between the Insurer and the Insured; and not between the Bank and the Insured.
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