Acko General Insurance Limited Key Terms - Group Health & Accident Care |
Terms & Conditions
This is a summary of the key terms under the Group Health & Accident Care Insurance Policy (“Policy”) offered by Acko General Insurance Limited (“Acko”) to Zomato Media Private Limited (“Zomato”) subject to the receipt of premium in full in respect of the Insured Persons and the terms, conditions and exclusions of underlying Policy. The covers available under the Policy can be availed by registered delivery executives of Zomato.
The Insurance coverage period starts as soon as the delivery partner goes active with Zomato and is valid till the time he is an active partner.
1. Key Benefits
Key benefits available under the Policy for Zomato delivery executives as specified in the Certificate of Insurance:
Table 1: Schedule of Coverage
Coverage | Sum Insured (INR) | Additional Conditions |
---|---|---|
Accidental Death Benefit or Permanent Total Disability and/or Permanent Partial Disability | 10,00,000 | |
Additional Temporary Total Disability | INR 525 per day of disability for a maximum upto INR 50,000 | The benefit will be payable only if the total disability period exceeds 7 days. The total benefit under the cover will be paid at one go to the insured when he/she will provide the required disability certificate as per Terms & Conditions of the Cover. Alternatively, at the request of the insured, he/she will be paid the benefit under this cover, at the end of every month if the total period of disability exceed one month. |
Ambulance and Emergency Transportation Cover | 2,500 | Applicable for Ambulance transportation only in case of Accidental injury |
Repatriation of Mortal Remains | 50,000 | Applicable only in case of Accidental death |
Child Education Cover | 20,000 | Payable in the case of accidental death only |
Mobility Cover | 5,000 | Provides coverage for accidental disability requiring wheelchair |
Funeral Expenses | 50,000 | Applicable only in case of Accidental death |
OPD treatment | 5,000 | Coverage only provided only in case of Accidental injury Deductible: INR 1,000 on each claim |
Loan Protector | 50,000 | Payable only in case of accidental death and where loan is taken from authorized NBFCs and Scheduled Banks |
Loss of Baggage and Personal Effects | 500 | Provides coverage for only helmet damage due to accident and when the insured member is hospitalized due to such accident. |
Electronic Equipment Cover | 2,500 | Provides coverage for only damage to Mobile phone due to an accident and when the insured member is hospitalized due to such accident. (Theft or loss of Mobile phone or damage to mobile phone due to any other reason is not covered. Electronic equipment other than mobile phone are excluded) |
2. Special Conditions:
3. General Conditions:
4. General Exclusions:
Acko shall not be liable to make any payment for any claim under the Policy in respect of an Insured Person, directly or indirectly for, caused by, arising from or in any way attributable to any of the following, except where provided to the contrary under any Benefit(s) within the Policy:
5. Claim & Documents:
The delivery executive can file a claim for any of these coverages by emailing [email protected] or reach Acko at the Contact number provided below for registration of claim:
Acko: 1800 266 2256
Delivery executive needs to submit following documents in case of a claim:
The below list of documents, required for processing claims, are indicative and not exhaustive. Claims are subject to investigation & in case there is an additional requirement of documents, Acko will inform the claimant & Zomato in writing (email & phone). Any mandatory documents can be waived off at the discretion of Acko based on the nature, extent & information available about the loss.
Common Documents:
Accidental Death Benefit:
Permanent Total Disability or Permanent Partial Disability:
Temporary Total Disability:
OPD Treatment:
Ambulance Transportation Cover:
Loan Protector:
Loss of Baggage and Personal Effects or Electronic Equipment Cover
6. Definition
6.1. Accidental Death Benefit:
If an Insured Person suffers an Injury due to an Accident that occurs during the Coverage Period and that Injury solely and directly results in the Insured Person’s death within 365 days from the date of the Accident, We will pay the Sum Insured.
6.2. Permanent Total Disability
If an Insured Person suffers an Injury due to an Accident that occurs during the Coverage Period and that Injury solely and directly results in the Permanent Total Disability of the Insured Person which is of the nature specified in the table below, within 365 days from the date of the Accident, Acko will pay the Sum Insured:
Nature of Permanent Total Disability |
---|
Total and irrecoverable loss of sight in both eyes |
Loss by physical separation or total and permanent loss of use of both hands or both feet |
Loss by physical separation or total and permanent loss of use of one hand and one foot |
Total and irrecoverable loss of sight in one eye and loss of a Limb |
Total and irrecoverable loss of hearing in both ears and loss of one Limb/ loss of sight in one eye |
Total and irrecoverable loss of hearing in both ears and loss of speech |
Total and irrecoverable loss of speech and loss of one Limb/ loss of sight in one eye |
Permanent, total and absolute disability (not falling under any one the above) which results in the Insured Person being unable to engage in any employment or occupation or business for remuneration or profit, of any description whatsoever which results in Loss of Independent Living |
6.3. Permanent Partial Disability
If an Insured Person suffers an Injury due to an Accident that occurs during the Coverage Period and that Injury solely and directly results in the Permanent Partial Disability of the Insured Person which is of the nature specified in the table below within 365 days from the date of the Accident, Acko will pay the amount specified in the table below:
Nature of Permanent Partial Disability | Percentage of the Sum Insured payable |
---|---|
i. Total and irrecoverable loss of sight in one eye | 50% |
ii. Loss of one hand or one foot | 50% |
iii. Loss of all toes - any one foot | 10% |
iv. Loss of toe great - any one foot | 5% |
v. Loss of toes other than great, if more than one toe lost, each | 2% |
vi. Total and irrecoverable loss of hearing in both ears | 50% |
vii. Total and irrecoverable loss of hearing in one ear | 15% |
viii. Total and irrecoverable loss of speech | 50% |
ix. Loss of four fingers and thumb of one hand | 40% |
x. Loss of four fingers | 35% |
xi. Loss of thumb- both phalanges | 25% |
xii. Loss of thumb- one phalanx | 10% |
xiii. Loss of index finger-three phalanges | 10% |
xiv. Loss of index finger-two phalanges | 8% |
xv. Loss of index finger-one phalanx | 4% |
xvi. Loss of middle/ring/little finger-three phalanges | 6% |
xvii. Loss of middle/ring/little finger-two phalanges | 4% |
xviii. Loss of middle/ring/little finger-one phalanx | 2% |
6.4. Temporary Total Disability
If an Insured Person suffers an Injury due to an Accident that occurs during the Coverage Period and that Injury solely and directly results in the disability of the Insured Person which prevents the Insured Person from engaging in any employment or occupation on a temporary basis, then We will pay the amount specified in the Certificate of Insurance at the frequency specified in the Certificate of Insurance for the duration that the Temporary Total Disability continues.
6.5. Child Education Cover
We will pay the amount specified in the Certificate of Insurance at the frequency specified in the Certificate of Insurance in respect of each surviving Dependent Child, irrespective of whether the Dependent Child is an Insured Person under this Policy.
6.6. Repatriation of Mortal Remains
We will reimburse the expenses incurred up to the limit specified in the Certificate of Insurance for transportation of mortal remains from the place of death to the residence of the Insured Person.
6.7. Mobility Cover
We will reimburse the expenses incurred up to the limit specified in the Certificate of Insurance on the purchase of support items including but not limited to crutches, artificial limbs, wheelchairs, tri-cycles intra-ocular lenses, spectacles, hearing aids, dentures, artificial teeth, imported medicines or any other item which in the opinion of the treating Medical Practitioner is necessary for the Insured Person to resume normal living following the Injury sustained in the Accident during the Coverage Period.
6.8. Funeral Expenses
We will pay the amount specified in the Certificate of Insurance towards expenses on the funeral, cremation/ or burial and transportation of the body to the place of the funeral ceremony for the Insured Person.
6.9. Ambulance and Emergency Transportation Cover
If an Insured Person suffers from an Injury or Illness specified in the Schedule / Certificate of Insurance, during the Coverage Period. If an Insured Person contracts an Illness/Critical Illness or suffers an Injury due to an Accident specified in the Schedule / Certificate of Insurance that occurs during the Coverage Period and that Illness/Critical Illness/Injury solely and directly requires the Insured Person to be transported to the Hospital by an Ambulance or any public transport, then We shall reimburse the costs incurred up to the limits as specified in the Certificate of Insurance.
6.10. OPD treatment:
If an Insured Person requires OPD Treatment for any of the treatments/tests/consultations specified in the Certificate of Insurance, due to an Injury or Illness specified in the Schedule / Certificate of Insurance, suffered or contracted during the Coverage Period, If an Insured Person contracts an Illness or suffers an Injury due to an Accident specified in the Schedule / Certificate of Insurance that occurs during the Coverage Period and that Illness/Injury solely and directly requires the Insured Person to undergo OPD Treatment for any of the treatments/tests/consultations specified in the Certificate of Insurance then We will reimburse the costs incurred on Medical Expenses up to the limit specified Certificate of Insurance.
6.11. Loan Protector
If an Insured Person suffers an Injury due to an Accident that occurs during the Coverage Period, We will pay an amount equal to the outstanding loan principal amount in respect of the Insured Person’s outstanding Loan, subject to this amount not exceeding the amount specified in the Certificate of Insurance.
6.12. Loss of Baggage and Personal Effects
We will reimburse the actual loss upto the limit specified in the Certificate of Insurance incurred in relation to the permanent and total loss of the Insured Person’s luggage and personal possessions during the Coverage Period.
6.13. Electronic Equipment Cover
We will reimburse the actual loss incurred up to the amount specified in the Certificate of Insurance in relation to the permanent and total loss of the Insured Person’s Portable Electronic Equipment due to physical damage, destruction, loss or theft during the Coverage Period.
7. Grievance Redressal:
For resolution of any query or grievance, insured may write an e-mail at [email protected].. In case the insured is not satisfied with the response of the office, insured may contact the Grievance Officer of the Company at the following address:
Grievance Redressal Officer
2nd Floor, Acko General Insurance
36/5 Hustlehub One East, Somasandrapalya .
27th Main Rd, Sector 2, HSR Layout,
Bengaluru, Karnataka 560102
[email protected]
In the event of unsatisfactory response from the Grievance Officer, he/she may, register a complaint in the Integrated Grievance Management System (IGMS) of the IRDAI.
Where the grievance is not resolved, the insured may, subject to vested jurisdiction, approach the Insurance Ombudsman for the redressal of grievance.
Please note that these terms and conditions are only indicative, and the full list of policy conditions and exclusions are available at: http://www.acko.com/download
Once you have opted for cover, you will receive a Certificate of Insurance from Acko which will contain complete details of your cover under the Policy, and the applicable conditions and exclusions.
Acko General Insurance Limited
36/5, Hustlehub One East, Somasandrapalya, 27th Main Rd, Sector 2, HSR Layout, Karnataka 560102
IRDAI Reg No: 157 | CIN: U66000MH2016PLC287385 | UIN: ACKHLGP19122V011819
www.acko.com | Insurance Helpline Number: 1800 266 2256 | Mail: [email protected]