gpa_gtl benefit manual
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Scorecard benefitTRANSCRIPT
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EMPLOYEE BENEFIT MANUAL Total Environment Building Systems Private Limited
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1. Group Personal Accident
(GPA)
Provides insurance coverage against the risk of death / injury during the policy
period sustained due to an accident caused by violent, visible and external
means
2. Group Term Life
(GTL)
Provides life (term) insurance protection in case of death
Insurance Benefit Details
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This insurance provides compensation/payment up to a financial limit as assigned by the company, to the insured person or his legal personal representative, if the insured person suffers death or disablement due to an accident. The cover is worldwide but payment of claim can only be made in India and in Indian Rupees.
Policy Parameter
Insurer The New India Assurance Co Ltd
Policy Start Date 22nd January 2014
Policy End Date 21st January 2015
Members Covered Employees
Sum Insured INR 5 lakhs
Coverage Details
Accidental Death Yes (100% of Capital Sum Insured)
Permanent Total Disablement Yes (100% of Capital Sum Insured)
Permanent Partial Disability Yes (Please refer to Policy for list)
Temporary Total Disability (Weekly Benefit- 1% of Sum Insured subject to a maximum of INR 5,000 for
104 weeks)
Geographical Limits World wide
Medical Extension 40% of claim amount or 10% of SI or actual whichever is less
Group Personal Accident (GPA) Benefit Details
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* Indicative list, Please refer to policy document
Group Personal Accident (GPA) Details
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Group Personal Accident (GPA) Claims Process
Claimant / Assignee notifies Maxim,
who in turn would intimate Marsh /
Insurer and submit required claim
documents within 30 days of the
event
On obtaining all relevant
documents, Insurance Co. will
begin processing the claims
Claim Investigation and Review
within 7 Days of submission of all
the required documents
Is claim
payable?
Cheque is sent to Employer (HR) within
10 working days, from where it is given
to the Claimant/ Assignee
Insurer provides a valid reason for the
rejection to HR/Claimant/ Assignee
No
Yes
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Weekly Benefit Claims
1. Completed Claim form
2. Doctor's Report
3. Disability Certificate from the
Doctor, if any
4. Investigation/ Lab reports (x-ray
etc.)
5. Original Admission/discharge
card, if hospitalized
6. Employers Leave Certificate &
Details of salary
Death Claims
1. Completed claim form
2. Attending Doctor's report
3. Death Certificate
4. Post Mortem/ Coroner's report
5. FIR ( First Information Report)
6. Police Inquest report, wherever
applicable
Dismemberment/ Disablement
Claims
1. Completed claim form
2. Doctor's Report
3. Disability Certificate from the
Doctor
4. Investigation/ Lab reports (x-ray
etc.)
5. Original Admission/ discharge
card, if hospitalized.
6. Police Inquest report, wherever
applicable
Group Personal Accident (GPA) Claims Document Checklist
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1. Service on duty with any armed force
2. Insanity
3. Venereal disease
4. AIDS
5. Influence of intoxicating drink or drugs
6. Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard
type of aircraft any where in the world
7. Nuclear radiation or nuclear weapons material
8. Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared
or not), civil war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure,
capture, arrest,, restraint, detainments of all kings, princes, and people of whatever nation,
conditions and qualities so ever
9. Childbirth, pregnancy or other physical causes peculiar to the female sex
10. While committing any breach of law with criminal intent
11. Any hazardous activities not limited to but including Adventure sports ( parasailing,
paragliding, bungee jumping, diving, swimming etc.)
Group Personal Accident (GPA) General Exclusions
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Total Environment Marsh
Group Personal Accident - Contacts
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Group Term Life (GTL) Benefit Details
Policy Parameter
Insurer Kotak Mahindra Old Mutual Life Insurance Limited
Policy Start Date 1st January 2014
Policy End Date 31st December 2014
Sum Insured INR 5 lakhs
Coverage Details
Death
In the event of death of a member from any cause (natural/accidental), provided that this shall occur while the assurance in respect of such member shall be in force, an amount determined in accordance with the Policy Schedule shall be paid
Yes
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Group Term Life (GTL) Exclusions
1. Service on duty with any armed force
2. Insanity
3. Venereal disease
4. AIDS
5. Influence of intoxicating drink or drugs
6. Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard
type of aircraft any where in the world
7. Nuclear radiation or nuclear weapons material
8. Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared
or not), civil war, rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure,
capture, arrest,, restraint, detainments of all kings, princes, and people of whatever nation,
conditions and qualities so ever
9. Childbirth, pregnancy or other physical causes peculiar to the female sex
10. While committing any breach of law with criminal intent
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Group Term Life (GTL) Claims Process
Claimant / Assignee notifies
Compliance, who in turn would
intimate Marsh / Insurer and submit
required claim documents within 15
days of the event
On obtaining all relevant
documents, Insurance Co. will
begin processing the claims
Claim Investigation and Review
within 7 days of submission of all
the required documents
Is claim
payable?
Cheque is sent to Employer
(Compliance) within 3 working days,
from where it is given to the Claimant/
Assignee
Insurer provides a valid reason for the
rejection to Compliance / Claimant/
Assignee
No
Yes
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From the Employer:
Claim form with Authorized signature & stamp of Client (Format attached).
Proof of age
Member ship & Member id Proof
Nomination declaration from the policy holder
Leave record will be asked in cases where the active employment clause will be
applicable
Income proof
Group Term Life (GTL) Document Checklist
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Group Term Life (GTL) Document Checklistcontinued
From the Claimant:
1. Original Death Certificate / attested by the concerned authority (if copy)
2. Nominee Bank Details Not mandatory
3. Last attending doctors death certificate
4. Guardian details for minor Beneficiary
5. Driving License (Accidental Claim)
6. First information report & Post Mortem Report (Accidental or any police case in natural
death)
7. Police case closure report (Accidental or any police case in natural death)
8. Viscera Report (Accidental or any police case in natural death, if applicable)
9. Cause of death certificate
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Group Term Life (GTL) Contact Details
Providers
Total Environment [email protected]
Kotak Mahindra Old Mutual Life Insurance Limited
Marsh
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