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GROUP PERSONAL ACCIDENT INSURANCE POLICY (V 1.8)   Prepared By Reviewed by Approved By Name

GROUP PERSONAL ACCIDENT INSURANCE POLICY (V 1.8)

 

Prepared By

Reviewed by

Approved By

Name

Padmaavathi D K

Aravind Srinivasaraghavan

Raj Dharmaraj

(244621)

(107415)

(127311)

Date

28 March, 2018

30 March, 2018

30 March, 2018

 

Version History

 

V

1.1

Annual review and process changes, if any, incorporated.

V

1.2

Types of disablements covered in definition.

 

V

1.3

Major exclusions, revision in coverage limits, details on medical expenses & child education grant incorporated.

V

1.4

Update on claim submission document timeline, clarification on medical expenses eligibility.

V

1.5

Annual renewal of policy. Option to top-up the base cover and / or purchase spouse policy cover

V

1.6

Change in the premium rates incorporated due to increase in service tax effective June 01, 2016

V

1.7

Changes incorporated as part of the annual review

 

V1.8

Changes incorporated as part of the annual review Updated benefit entitlements for the policy period: 2018 - 19.

Contents 1. Overview 3 2. Scope 3 3. Definitions 3 4. Eligibility 6 5. Approvals

Contents

1. Overview

3

2. Scope

3

3. Definitions

3

4. Eligibility

6

5. Approvals

6

6. Procedure

7

7. Responsibility Matrix

7

8. Exceptions Handling

7

Annexure A

8

Annexure B

9

GROUP PERSONAL ACCIDENT INSURANCE POLICY 1. Overview 1.1 The Personal Accident Insurance policy provides basic

GROUP PERSONAL ACCIDENT INSURANCE POLICY

1. Overview

1.1 The Personal Accident Insurance policy provides basic coverage for all associates for the risk of disablement due to accidents. This is administered through TATA AIG

1.2 The policy will be effective 01 April, 2018.

2. Scope

2.1 The policy covers

2.1.1 All associates on payrolls of Cognizant Technology Solutions India Private Limited and its Indian affiliates

2.1.2 It also covers the associates, who may not be on India payroll, to whom it has been communicated via their assignment letter/ related benefits statement / employee handbook, about their coverage under Cognizant India Group Personal Accident Insurance policy

2.1.3 Associates who are on assignment outside India, who may not be on India payroll and benefiting from Group Personal Accident Insurance policy, provided by a non-India Cognizant affiliate directly or through any other benefit plan, will not be covered within the scope of this policy.

3. Definitions

Coverage: The extent of the protection provided by insurance under base cover

3.1 Types of Disablement covered:

3.1.1 PTD (Permanent Total Disablement)

Disablement of permanent and irrecoverable nature i.e. the person is prevented from engaging in gainful employment of any kind. E.g. loss of sight of both eyes, physical separation of two entire hands. Please refer Annexure B for more details.

3.1.2 PPD (Permanent Partial Disablement)

Similar to PTD with the only difference being that the disablement is partial E.g. loss of a toe or a finger. The applicable compensation is payable on the % of loss, which is mentioned in Annexure A. Doctor’s assessment will be used in case of non-availability of information in Annexure A.

3.1.3

TTD (Temporary Total Disablement)

3.1.3 TTD (Temporary Total Disablement) Disablement is total but for a temporary period. E.g. Fracture, where

Disablement is total but for a temporary period. E.g. Fracture, where there is a disablement, but for a temporary period. Eligibility: Temporary Total Disablement (TTD) benefit based on level as per the below table to maximum of 104 weeks (as long as the associate is not able to resume his duties).

Category

Level

TTD per week

Upto PA

Level I

INR 10,000

A

& SA

Level II

INR 10,000

M

& SM

Level III

INR 15,000

AD and above

Level IV

INR 30,000

3.2 Additional Benefits

3.2.1 Medical Expenses covered

Medical expenses arising solely and directly out of the accident will be covered to a maximum limit of 40% of claim amount (as assessed under PPD/ PTD/TTD) or 10% of base cover or actual medical expenses whichever is less.

3.2.2 Children Education Grant

In the event of death of the associate due to accident, INR 10,000 per child (restricted to 2 children) will be paid as education grant for dependent children.

3.2.3 Carriage of Dead Body

In the event of death of the Insured person due to accident insurance company shall reimburse the expense incurred for transportation of Insured’s dead body to the place of residence subject to a maximum of 2% of base cover or INR 2,500/- whichever is less.

3.3 Major Exclusions under Personal Accident Insurance Policy:

Policy does not provide benefits for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of:

3.3.1 Any Pre-existing Condition and any complication arising from the same; or

3.3.2 Suicide, attempted suicide (whether sane or insane) or intentionally self-inflicted Injury or illness, or sexually transmitted conditions, mental or nervous disorder, anxiety, stress or depression, Acquired Immune Deficiency Syndrome (AIDS),

Human Immune-deficiency Virus (HIV) infection; or 3.3.3 Serving in any branch of the Military or

Human Immune-deficiency Virus (HIV) infection; or

3.3.3 Serving in any branch of the Military or Armed Forces of any country, whether in peace or War, and in such an event We, upon written notification by the Policyholder, shall return the pro rata premium for any such Insured Period of service under the circumstances described in a Hazard; or

3.3.4 Being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Physician and taken as prescribed

3.3.5 Participation in an actual or attempted felony, riot, crime, misdemeanor, (excluding traffic violations) or civil commotion; or

3.3.6 Operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft; or Scheduled Aircraft; or

3.3.7 War, civil war, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not), rebellion, mutiny, use of military power or usurpation of government or military power; or

3.3.8 Any loss, damage cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any Act of Terrorism regardless of any other cause or event contributing concurrently or in any other sequence to the loss. The warranty also excludes loss, damage, cost or expenses of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to action taken in respect of any act of terrorism. If the Company alleges that by reason of this Exclusion, any loss, damage, cost or expenses is not covered by this insurance the burden of proving the contrary shall be upon the Insured; or

3.3.9 The intentional use of military force to intercept, prevent, or mitigate any known or suspected Terrorist Act; or

3.3.10 Ionizing radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel; or

3.3.11 The radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment; or

3.3.12 Congenital anomalies or any complications or conditions arising therefrom; or

3.3.13 Participation in winter sports, skydiving/parachuting, hang gliding, bungee

jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle,

caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sport,

any bodily contact sport or any other hazardous or potentially dangerous sport for which you

any bodily contact sport or any other hazardous or potentially dangerous sport for which you are trained or untrained; or

3.3.14 Any loss resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy; or

3.3.15 Is caused by osteoporosis (porosity and brittleness of the bones due to loss of protein from the bones matrix) or pathological fracture (any fracture in an area where pre-existing Disease has caused the weakening of the bone) if osteoporosis or bone Disease diagnosed prior to the Policy Effective Date; or

3.3.16 For any loss of which a contributing cause was your actual or attempted commission of, or willful participation in, an illegal act or any violation or attempted violation of the law or your resistance to arrest; or

3.3.17 Any non-medical expenses incurred in case of Accidental Medical Expense Reimbursement.

4. Eligibility

4.1 The following table describes the base coverage limits based on the level of an associate.

Category

Level

Base Cover Limit

Upto PA

Level I

INR 10,00,000

A

& SA

Level II

INR 20,00,000

M

& SM

Level III

INR 30,00,000

AD and above

Level IV

INR 50,00,000

For more information click FAQs and type “Personal Accident” in the Navigator Search

Note: Cognizant provides benefits from a perspective of complete employee welfare to our associates under the Group Medical, Group Personal Accident and Group Life benefit programs. Associates to note that should there be any workplace incident or a statutory obligation, any payout under these above benefit programs (where it is higher) will be in lieu of or adjusted against any statutory liabilities that cognizant may be required to provide.

5. Approvals

Not Applicable

6.

Procedure

6. Procedure 6.1 The Employee/Supervisor/Concerned TM as the case may be, must intimate the claim within

6.1 The Employee/Supervisor/Concerned TM as the case may be, must intimate the claim within 90 days of occurrence of the event, on the following email id:Insuranceindia@cognizant.com

6.2 The Employee/Supervisor/Concerned TM as the case may be, must submit the required document within 90 days of the occurrence of the event, as per the requirement of the insurance agency to the Benefits HRSS representative for claim processing on the above mentioned email id

6.3 The Benefits HRSS representative verifies the documents and submits the same to the insurance agency for processing the claims

6.4 Please refer Annexure B for details regarding the documents required for Claim Processing

7. Responsibility Matrix

7.1 Associate: Complete all the formalities at the time of joining

7.1.1 Intimate the accident claims within 90 days of date of accident

7.1.2 Submit the documents for claim reimbursement within 90 days from the date of accident

8. Exceptions Handling

8.1 The benefits of this policy are governed by the terms and conditions of employment in practice at Cognizant. This is subject to change from time to time. Cognizant reserves the right to amend its policies as necessitated. All statutory requirements are applicable as mandated by law

8.2 All exceptions to this will be directed to HR India Benefits

Annexure A A. Permanent Partial Disablement (PPD) If such injury shall within twelve calendar months

Annexure A

A. Permanent Partial Disablement (PPD)

If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and/or partial irrecoverable loss of use or the actual loss by physical separation of the following then the percentage of the Insured Sum payable to the concerned associate is in the manner indicated below.

 

PPD - Loss: % of Base Cover

 

SNo.

 

Disability

%

of Loss

1

Permanent Total Loss of Use of One Thumb Of Either Hand

 

a) Both Joints 25%

 

25%

 

b)

One Joint 10%

 

10%

2

Permanent Total Loss of Use of Fingers of Either Hand

   

a) Three Joints

 

10%

   

b) Two Joints

 

7.5%

   

c) One Joint

 

5%

3

Permanent Total Loss of Use of Toes of Either Foot

 
 

a)

All - One Foot

 

20%

 

b) Great - Both Joints

 

5%

 

c) Great - One Joint

 

2%

 

d) other than Great, One Toe

 

1%

B. Permanent Total Disablement (PTD)

 

PTD - Loss: % of base cover

SNo.

Disability

%

of Loss

1

Permanent Total Disability

 

100%

2

Permanent and Incurable Paralysis of All Limbs

 

100%

3

Permanent Total Loss of Sight of Both Eyes

 

100%

4

Permanent Total Loss of Use of Two Limbs

 

100%

5

One Hand and One Foot

 

100%

6 Either Hand or Foot and Sight of One Eye 100% 7 Speech And Hearing

6

Either Hand or Foot and Sight of One Eye

100%

7

Speech And Hearing in Both Ears

100%

8

Speech

50%

9

Permanent Total Loss of Use of One Limb

50%

10

Permanent Total Loss of Hearing

 

a) Both Ears

75%

 

b) One Ear

30%

11

Permanent Total Loss of Sight of One Eye

50%

12

Permanent Total Loss of the Lens of One Eye

40%

13

Permanent Total Loss of Use of Four Fingers and Thumb of Either Hand

40%

14

Permanent Total Loss of Use of Four Fingers of Either Hand

35%

15

Thumb and Index Finger of Same Hand

25%

“Loss” with regard to:

a) Hand or foot means actual severance through or above the wrist or ankle joints respectively;

b) Eye means entire and irrecoverable loss of sight;

c) Thumb and index finger means actual severance through or above the joint that meets the hand at

the palm;

d) Speech or hearing means entire and irrecoverable loss of speech or hearing of both ears.

Annexure B

Type of Claim

Mandatory Document required for processing the claim.

Child Education Grant

Completely filled GPA claim Form with Company Stamp & Covering Letter From Employer

Attested Copy of FIR

Attested Copy of Post Mortem Report

Attested Death Certificate

Education proof of the child

Type of Claim Mandatory Document required for processing the claim.   Any certificate specifying the

Type of Claim

Mandatory Document required for processing the claim.

 

Any certificate specifying the parent child relationship between the child and the employee (Birth certificate or Ration card )

 

Completely filled GPA claim Form with Company Stamp & Covering Letter From Employer

Attested Copy Of FIR ( If Reported to police authority)

PTD

Disability Certificate (Authorized medical officer/civil surgeon of civil hospital / govt. hospital of the district / units concerned, (certificate) stating percentage of disablement)

Reports like , X-rays and reports essential of confirmation of the type and percentage of disability

Letter from the Employer stating the Description of accident and leave record

Color Photograph of the injured reflecting disability. Original medical bills with prescriptions/treatment papers.

 

Completely filled GPA claim Form with Company Stamp & Covering Letter From Employer

Attested Copy of FIR ( If Reported to police authority)

PPD

Disability Certificate (Authorized medical officer/civil surgeon of civil hospital / govt. hospital of the district / units concerned, (certificate) stating percentage of disablement)

Reports like , X-rays and reports essential of confirmation of the type and percentage of disability

Letter from the Employer stating the Description of accident and leave record

Color Photograph of the injured reflecting disability. Original medical bills with prescriptions/treatment papers.

TTD

Completely filled GPA claim Form with Company Stamp & Covering Letter From Employer

Type of Claim Mandatory Document required for processing the claim. Medical Practitioner’s certificate confirming the

Type of Claim

Mandatory Document required for processing the claim.

Medical Practitioner’s certificate confirming the Injury and advising rest/ unfit to work for specified number of day’s fitness certificate from treating doctor.

Attested Copy of FIR ( If reported to police authority)

Letter from the Employer stating the Description of accident and leave record

Employee Cum Leave Certificate from the employer.

Original Medical Bills with Prescription, photocopy of Discharge Card, X-ray report in case of fracture. Original medical bills required.

Completely filled GPA claim Form with Company Stamp & Covering Letter From Employer

Attested Copy of FIR ( If reported to police authority)

Medical Expenses

Letter from the Employer stating the Description of accident and leave record

Original Medical Bills with Prescription, photocopy of Discharge Card, X-ray report in case of fracture. Original medical bills required