{"uin":"HDHHLIP21346V042021","name":"Individual Personal Accident","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021","insurer":{"slug":"hdfc-ergo-general-insurance","name":"HDFC ERGO General Insurance Company Limited","url":"https://indiainsurances.com/insurer/hdfc-ergo-general-insurance"},"line":"health","category":"personal-accident","category_name":"Personal accident","irdai_type":"Revision","kind":"product","status":"unknown","approved_on":"2020-09-21","withdrawn_on":null,"summary":"HDFC ERGO Individual Personal Accident is an accident-only policy in five plans (Standard, Premium, Essential, Advanced, Elite) that pays the sum insured for accidental death within 365 days and a table percentage for permanent disablement, with sum insured from Rs. 100,000 to Rs.10,00,00,000 by plan. It covers accidents worldwide, entry age is 91 days to 69 years, renewal is lifelong, and temporary total disablement is an optional cover.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:55.07064+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Standard","Premium","Essential","Advanced","Elite"],"display":"Standard, Premium, Essential, Advanced, Elite","note":"Each of these five plans has its own policy wording in this set. The prospectus also describes Trekker, Trip, Backpacker and Family Care variants, which have no wording here. The policy wording file for Advanced is titled Advance.","quote":"Individual Personal Accident – [Standard] ... Individual Personal Accident – [Premium] ... Individual Personal Accident – [Essential] ... Individual Personal Accident – [Advanced] ... Individual Personal Accident – [Elite]","sources":[{"clause":null,"heading":"Individual Personal Accident – [Standard]","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-standard"},{"clause":null,"heading":"Individual Personal Accident – [Premium]","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-premium"},{"clause":null,"heading":"Individual Personal Accident – [Essential]","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-essential"},{"clause":null,"heading":"Individual Personal Accident – [Advanced]","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-advanced"},{"clause":null,"heading":"Individual Personal Accident – [Elite]","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-elite"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"The policy is issued for 1, 2 or 3 years; it can also be issued for less than a year on a per day or per month basis, and case to case on a per kilometer basis.","display":"1, 2 or 3 years","note":"Per km cover ends automatically at the end of 30 days from coverage inception. Short term and per km bases are described for Trekker, Trip and Backpacker variants in the prospectus.","quote":"The policy will be issued for a period of 1, 2 & 3 year(s) period. Policy also can be issued for a period less than 1 year like in per day and per month basis, in case to case basis policy coverage can extend for covering individuals on per kilometer basis.","sources":[{"clause":null,"heading":"Eligibility","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-eligibility"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Tell the insurer within 30 days of the event; for emergency hospitalisation, within 24 hours of admission.","display":"Within 30 days of the event; 24 hours of admission for emergency hospitalisation","note":"Contingent benefits (those depending on a claim under Benefits 1 to 4) must also be notified within 30 days of the event. Cashless notice at a network hospital: within 24 hours after the treatment or hospitalisation. Same in all five plan wordings.","quote":"We must be informed of any event or occurrence that may give rise to claim under this Policy within 30 days of it happening. ... If any treatment for which a claim may be made is to be taken and that treatment requires Hospitalisation in an Emergency, we should be informed within 24 hours of the Insured person admission in Hospital.","sources":[{"clause":null,"heading":"J. Notification of Claims","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-j-notification-of-claims"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Our claim form, duly completed and signed","Death certificate","Disability certificate","Medical reports","Case histories, investigation reports","Treatment papers and discharge summaries","Original Bills","A precise diagnosis of the treatment","All investigation, treatment and follow up records pertaining to the past ailment(s)","Treating doctor's certificate regarding missing information in case histories","Copy of settlement letter from other insurance company","Stickers and invoice of implants used during surgery","Copy of MLC (Medico legal case) records and FIR (First information report)","NEFT and KYC (recent ID/Address proof and photograph)","Legal heir certificate","Marriage certificate (if applicable)"],"display":"Claim form, death or disability certificate, medical reports and bills, MLC and FIR, NEFT and KYC, legal heir certificate and others","note":"The insurer may ask for more documents if it suspects non-disclosure or fraud, and may require a medical examination at its cost.","quote":"• Our claim form, duly completed and signed for on behalf of the Insured Person.\n• Death certificate\n• Disability certificate\n• Medical reports\n• Case histories, investigation reports\n• Treatment papers and discharge summaries\n• Original Bills ... • A precise diagnosis of the treatment for which a claim is made.\n• All investigation, treatment and follow up records pertaining to the past ailment(s) since their first diagnoses or detection\n• Treating doctor’s certificate regarding missing information in case histories ... • Copy of settlement letter from other insurance company\n• Stickers and invoice of implants used during surgery\n• Copy of MLC (Medico legal case) records and FIR (First information report), in case of claims arising out of an accident\n• Regulatory requirements as amended from time to time, currently mandatory NEFT (to enable direct credit of claim amount in bank account) and KYC (recent ID/Address proof and photograph) requirements\n• Legal heir certificate\n• Marriage certificate (if applicable)","sources":[{"clause":null,"heading":"L. Supporting Documentation & Examination","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-l-supporting-documentation-examination"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"The insurer settles or rejects a claim within 15 days from the date of intimation; if payment is delayed it pays interest at 2% above the Bank Rate from intimation to payment.","display":"Within 15 days of intimation","note":"Essential wording says 15 days from the date of receipt of intimation. The CIS also gives cashless decisions within 1 hour (pre-authorisation) and 3 hours (final bill).","quote":"vi) The Company shall settle or reject a claim, as the case may be, within 15 days from the date of intimation ... vii) In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the Policyholder from the date of receipt of intimation to the date of payment of claim at a rate 2% above the Bank Rate.","sources":[{"clause":"Section D(vi)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-section-d-vi"},{"clause":"Section D(vii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-section-d-vii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Breach of law with criminal intent","Intentional self-inflicted injury, suicide or attempted suicide","Hazardous or Adventure Sports","Cosmetic or plastic surgery unless for reconstruction following an Accident, Burn(s) or Cancer","Sexually transmitted disease or illness (except HIV/ AIDS)","Abuse of intoxicants or hallucinogenic substances including narcotic drugs and alcohol","War, invasion, nuclear weapons/materials, chemical and biological weapons, radiation","Maternity Expenses, Pregnancy or childbirth","External Congenital diseases, defects or anomalies","Any non-allopathic treatment except In-patient care AYUSH Treatments","Diseases spread through an insect bite","Any non-medical expenses","Any infections except pyogenic infection developing on a wound caused by an accident","Medical or surgical treatment except as necessary solely and directly as a result of an Accident"],"display":"Crime, self-injury and suicide, hazardous sports, intoxicants, war, pregnancy, congenital conditions, insect-borne disease, infections and non-accident treatment","note":"No waiting-period exclusions: the CIS gives the waiting period as NA. Benefit-specific exclusions also apply: in-patient treatment outside India or not in a Hospital; broken bones from sickness, pathological or hair line fractures; dowry harassment and self-immolation; coma from alcohol or drug abuse; and workmen's compensation benefits. Adventure Sports is covered as a benefit in the Advance and Elite plans for non-professional participation under supervision.","quote":"a) Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.\nb) Intentional self-inflicted injury, suicide or attempted suicide..\nc) Hazardous or Adventure Sports ... e) Cosmetic or Plastic Surgery: Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer ... f) Sexually transmitted disease or illness (except HIV/ AIDS).\ng) The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances including all forms of narcotic drugs and alcohol.\nh) War, invasion, act of foreign enemy ... nuclear weapons/materials, chemical and biological weapons, radiation of any kind.\ni) Maternity Expenses, Pregnancy or childbirth or in consequence thereof.\nj) External Congenital diseases, defects or anomalies or in consequence thereof.\nk) Any non-allopathic treatment except In-patient care AYUSH Treatments.\nl) Diseases spread/ caused through an insect bite by transfer of organisms for which the insect is a known carrier or host.\nm) Any non-medical expenses ... a) Any infections except pyogenic infection developing on or as a result of a wound caused by an accident which occurs through an Accidental cut or wound.\nb) Medical or surgical treatment except as necessary solely and directly as a result of an Accident.","sources":[{"clause":"7","heading":"Specific General Exclusion applicable to all Benefits","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-7"},{"clause":"1","heading":"Special Exclusions to Benefit 1-4, 12, 13, 15 ,16 & 17","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-1-2"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"First call 022 6158 2020 / 022 6234 6234 or www.hdfcergo.com; then write to the Complaints & Grievance Cell (grievance@hdfcergo.com, 18002677444); if not resolved within 15 days, write to the Chief Grievance Officer (cgo@hdfcergo.com); then the Insurance Ombudsman.","display":"Call 022 6158 2020 / 022 6234 6234, then grievance@hdfcergo.com, then the Chief Grievance Officer at cgo@hdfcergo.com","note":"Grievance Cell address: D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai 400078. Senior citizen helpline seniorcitizen@hdfcergo.com. The CIS gives a senior citizen number of 022 6242 6226 where the wording gives 022 6158 2026.","quote":"First Point of Contact | Call us at 022 6158 2020 / 022 6234 6234/www.hdfcergo.com\nLevel 1 | For lack of a response or if the response provided does not meet your expectation, you can: 1. Write to The Complaints & Grievance Cell (C&G Cell) ... 2. You can also write an email to grievance@hdfcergo.com 3. Call on 18002677444 (operational Monday - Saturday 9AM to 6PM)\nLevel 2 | If you're not satisfied with the resolution or if no response was received within 15 days, you can: 1. Write to the Chief Grievance Officer ... 2. You can also write an email to cgo@hdfcergo.com ... If Insured Person is not satisfied with the redressal of grievance through above methods, the Insured Person may also approach the office of Insurance Ombudsman","sources":[{"clause":null,"heading":"O. Redressal of Grievance","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-o-redressal-of-grievance"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"By plan: Standard Rs. 100,000 to Rs. 5,00,00,000 in multiples of Rs. 100,000; Premium Rs. 500,000 to Rs. 5,00,00,000 in multiples of Rs. 500,000; Essential Rs. 20,00,000 to Rs. 1,00,00,000; Advanced Rs. 1,00,00,000 to Rs. 2,50,00,000; Elite Rs. 2,50,00,000 to Rs.10,00,00,000.","display":"Rs. 100,000 to Rs.10,00,00,000 depending on plan","note":"Adult dependent cover is restricted to 50% of the proposer's sum insured and child cover to 25%, with caps by plan. Income limits apply: 20 times annual income for salaried and 25 times for self-employed. From age 70 at renewal, sum insured is restricted to Rs. 20,00,000. The prospectus also prints 'The minimum AD Sum Insured will be Rs. 10,000', which does not match any plan's range.","quote":"Sum Insured would Range from: Rs. 100,000 to Rs. 5,00,00,000 (in multiples of Rs. 100,000) ... Sum Insured would Range from: Rs. 500,000 to Rs. 5,00,00,000 (in multiples of Rs. 500,000) ... Sum Insured would Range from: Rs. 20,00,000 to Rs. 1,00,00,000 ... Sum Insured would Range from: Rs. 1,00,00,000 to Rs. 2,50,00,000 ... Sum Insured would Range from: Rs. 2,50,00,000 to Rs.10,00,00,000","sources":[{"clause":null,"heading":"Individual Personal Accident – [Standard]","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-standard"},{"clause":null,"heading":"Individual Personal Accident – [Premium]","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-premium"},{"clause":null,"heading":"Individual Personal Accident – [Essential]","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-essential"},{"clause":null,"heading":"Individual Personal Accident – [Advanced]","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-advanced"},{"clause":null,"heading":"Individual Personal Accident – [Elite]","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-individual-personal-accident-elite"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"not-applicable","value":null,"display":null,"note":"This is a personal accident policy: it pays only for accidental injury, so an illness waiting period cannot apply. The CIS for each plan gives the waiting period as NA.","quote":null,"sources":[],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"not-applicable","value":null,"display":null,"note":"This is a personal accident policy paying only for accidental injury, so a pre-existing disease waiting period cannot apply. The CIS gives the waiting period as NA.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"not-applicable","value":null,"display":null,"note":"This is a personal accident policy paying only for accidental injury; there are no named illness waiting periods. The CIS gives the waiting period as NA.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"not-applicable","value":null,"display":null,"note":"No named illness waiting periods in a personal accident policy that pays only for accidental injury. The CIS gives the waiting period as NA.","quote":null,"sources":[],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"For an increased sum insured, the 60 months run from the date of enhancement on the enhanced part only.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":null,"heading":"L. Moratorium Period","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-l-moratorium-period"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. You can port the whole policy to another insurer by applying at least 30 days but not earlier than 60 days before renewal, and keep accrued continuity benefits in waiting periods as per IRDAI guidelines.","display":"Yes, apply 30 to 60 days before renewal","note":"Migration to another HDFC ERGO product is also allowed at renewal (CIS: apply at least 30 days before renewal).","quote":"The Insured Person will have the option to port the Policy to other insurers by applying to such Insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to Portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":null,"heading":"I. Portability","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-i-portability"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes","note":"From age 70 the sum insured is restricted to Rs. 20,00,000 and cannot be enhanced. Prospectus: no maximum cover ceasing age on renewals.","quote":"We offer lifelong renewal for all the Insured Persons. However, for age 70 and above during renewals the Sum Insured will be restricted to Rs. 20, 00,000 INR if the coverage is beyond 20,00,000","sources":[{"clause":"Section D(I)(d)(vi)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-section-d-i-d-vi"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No. No loading applies on renewals based on individual claims experience, and renewal is not denied because of claims.","display":"No loading for claims","note":"Prospectus: the renewal premium may change with a change in occupation or in the tax rate.","quote":"Renewal of a health insurance policy shall not be denied on the ground that the insured had made a claim or claims in the preceding policy years ... iii. No loading shall apply on renewals based on individual claims experience","sources":[{"clause":null,"heading":"E. Renewal of Policy","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-e-renewal-of-policy"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Breach of law with criminal intent","Intentional self-inflicted injury, suicide or attempted suicide","Hazardous or Adventure Sports","Treatment necessitated due to participation as a professional in hazardous or adventure sports","Cosmetic or Plastic Surgery, unless for reconstruction following an Accident, Burn(s) or Cancer","Sexually transmitted disease or illness (except HIV/ AIDS)","Abuse of intoxicants or hallucinogenic substances including all forms of narcotic drugs and alcohol","War, invasion, act of foreign enemy, civil war, nuclear weapons/materials, chemical and biological weapons, radiation of any kind","Maternity Expenses, Pregnancy or childbirth","External Congenital diseases, defects or anomalies","Any non-allopathic treatment except In-patient care AYUSH Treatments","Diseases spread/ caused through an insect bite","Any non-medical expenses","Any infections except pyogenic infection developing on a wound caused by an accident","Medical or surgical treatment except as necessary solely and directly as a result of an Accident","Treatment availed outside India","Treatment at a healthcare facility which is NOT a Hospital","Sickness or disease, any pathological fracture, any hair line fracture","Actual or alleged dowry harassment; actual or attempted self-immolation","Coma resulting directly from alcohol or drug abuse","Benefits receivable under the Workmen's Compensation Act 1923 or any similar enactment"],"display":"Crime, self-injury and suicide, hazardous or adventure sports, cosmetic surgery, sexually transmitted disease, intoxicants, war and nuclear risks, maternity, congenital defects, non-allopathic care, insect-borne disease, non-medical expenses, plus benefit-specific exclusions","note":"The documents use no IRDAI exclusion codes. The last eight items are printed as 'Special Exclusions' that apply only to named benefits; the benefit numbers they cite (1-4, 12, 13, 15, 16, 17, 19, 21) are the same in all five wordings and do not match each plan's own benefit numbering. Professional hazardous or adventure sports are excluded 'unless otherwise opted by Insured and mentioned'; the Advance and Elite plans include an Adventure Sports benefit for non-professional participation under supervision.","quote":"a) Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.\nb) Intentional self-inflicted injury, suicide or attempted suicide..\nc) Hazardous or Adventure Sports\nd) Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... e) Cosmetic or Plastic Surgery: Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer ... f) Sexually transmitted disease or illness (except HIV/ AIDS).\ng) The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances including all forms of narcotic drugs and alcohol.\nh) War, invasion, act of foreign enemy (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind.\ni) Maternity Expenses, Pregnancy or childbirth or in consequence thereof.\nj) External Congenital diseases, defects or anomalies or in consequence thereof.\nk) Any non-allopathic treatment except In-patient care AYUSH Treatments.\nl) Diseases spread/ caused through an insect bite by transfer of organisms for which the insect is a known carrier or host.\nm) Any non-medical expenses ... a) Any infections except pyogenic infection developing on or as a result of a wound caused by an accident which occurs through an Accidental cut or wound.\nb) Medical or surgical treatment except as necessary solely and directly as a result of an Accident. ... a) Treatment availed outside India\nb) Treatment at a healthcare facility which is NOT a Hospital. ... a) Sickness or disease.\nb) Any pathological fracture.\nc) Any hair line fracture. ... a) Actual or alleged dowry harassment.\nb) Actual or attempted self-immolation. ... Coma resulting directly from alcohol or drug abuse is excluded. ... a) Any benefits which an Insured Person is eligible to receive under the Workmen’s Compensation Act 1923 or any similar enactment.","sources":[{"clause":"7","heading":"Specific General Exclusion applicable to all Benefits","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-7"},{"clause":"1","heading":"Special Exclusions to Benefit 1-4, 12, 13, 15 ,16 & 17","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-1-2"},{"clause":"2","heading":"Special Exclusions to Benefit 13","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-2-2"},{"clause":"3","heading":"Special Exclusions to Benefit 16","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-3"},{"clause":"4","heading":"Special Exclusions to Benefit 17","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-4"},{"clause":"5","heading":"Special Exclusions to Benefit 19","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-5"},{"clause":"6","heading":"Special Exclusions to Benefit 21","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-6"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"You may cancel with 7 days' written notice and get a pro-rata refund of premium for the unexpired policy period; no refund if any claim has been admitted or benefit availed.","display":"Pro-rata refund for the unexpired period; none if a claim was admitted","note":"For instalment premiums, on an admissible claim the future instalments for the year are adjusted from the claim and no refund applies. No refund if the insurer cancels for fraud, non-disclosure or misrepresentation.","quote":"The Policyholder may cancel this policy by giving 7 days’ written notice and in such an event, the Company shall refund to the Insured a pro-rata premium for the unexpired Policy Period. ... iv. Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where any claim has been admitted or any benefit has been availed by the Insured Person under the Policy.","sources":[{"clause":null,"heading":"G. Cancellation","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-g-cancellation"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"Worldwide, unless limited by endorsement. Accidental medical expense, in-patient and out-patient hospitalisation, hospital cash, air ambulance and some other benefits pay only for expenses incurred in India, and payments are in Indian Rupees in India.","display":"Worldwide; medical expense benefits only for expenses incurred in India","note":"Modification of residence or vehicle is paid only for work done in India. Same clause in all five plan wordings.","quote":"This Policy applies to events or occurrences taking place anywhere in the world unless limited by Us in a through an endorsement. The benefit in respect of Accidental Medical Expense, Accidental In-patient Hospitalisation, Accidental Out-patient Hospitalisation, Accident Hospital Cash, Loss of Personal effects, Emergency Air Ambulance, Emergency Hotel stay, Cab and Bus Cover shall be paid only for expenses and or mugging, incurred in India","sources":[{"clause":null,"heading":"G. Geography","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-g-geography"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"New policies only, not renewals or porting. Refund less medical examination and stamp duty costs, or proportionate risk premium if cover has started. CIS also says 'within 30 days from the beginning of the policy'.","quote":"The Insured Person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.","sources":[{"clause":null,"heading":"G. Cancellation","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-g-cancellation"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Fifteen days where premium payment mode is monthly (policy wording definition).","quote":"can be renewed within the Grace Period of 30 days to maintain continuity of benefits without Break in Policy. ... fifteen days where premium payment mode is monthly and thirty days in all other cases","sources":[{"clause":null,"heading":"Rating Schedule","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-rating-schedule"},{"clause":"Def. 10","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-def-10"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Entry from 91 days to 69 years; adult dependents 18 to 69 years. Children below 5 years are covered from the 91st day only if a parent is covered under the same policy.","display":"91 days to 69 years","note":"Dependent children up to 25 years if unmarried. No maximum cover ceasing age on renewals.","quote":"The policy covers persons in the age group of 91 days to 69 years. The maximum entry age is restricted to 69 years. The Minimum entry age for Adult Dependent: is 18 years and Maximum entry age is 69 years.\nb) Children below 5 years can be covered from 91st day onwards if either parents are covered under the same policy","sources":[{"clause":null,"heading":"Eligibility","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-eligibility"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["2 and 3 years premium in advance as a single premium"],"display":"2 or 3 years' premium can be paid in advance as a single premium","note":"Policy terms are 1, 2 or 3 years. The prospectus prices 2 and 3 year policies from the annual premium ('2 year premium = Annual premium x 2 x ( 1- discount applicable)'). The wordings refer to premium paid by instalment and a 15-day grace period for monthly mode, but no instalment frequencies are offered in this product's documents.","quote":"An additional discount of 7.5% and 10% will be provided if insured person is paying 2 and 3 years premium in advance as a single premium.","sources":[{"clause":null,"heading":"I. Loading & Discounts","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-i-loading-discounts"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"cross-checked","value":["Total Temporary Disablement","Accidental Inpatient Hospitalisation + Restore Benefit","Loan Secure"],"display":"Temporary total disablement, accidental in-patient hospitalisation with restore, loan secure","note":"Essential, Advanced and Elite offer all three (Loan Secure is also called Loan Protector). Standard and Premium list only Total Temporary Disablement as an optional cover; Premium includes in-patient hospitalisation in the base plan. TTD, Loan Secure and Education Fund are for earning members only.","quote":"Optional Rider\nTotal Temporary Disablement* | 1 % SI per week for upto 100 weeks, max 5 Lacs\nAccidental Inpatient Hospitalisation + Restore Benefit | 100000\nLoan Secure | Outstanding loan amount","sources":[{"clause":null,"heading":"Benefits: Below mentioned benefits are offered under this plan","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-benefits-below-mentioned-benefits-are-offered-un-2"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"No. Coverage is not available during the grace period, except where premium is paid in instalments during the policy period.","display":"No, except for instalment premiums","note":null,"quote":"Coverage is not available during the Grace Period. ... Provided the insurers shall offer coverage during the grace period, if the premium is paid in instalments during the policy period. (Note: In case of non-instalment premium payment, coverage shall not be available for the period for which no premium is received).","sources":[{"clause":null,"heading":"Rating Schedule","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-rating-schedule"},{"clause":"Def. 10","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-def-10"}],"law":[]},{"key":"accidental_death","label":"Accidental death","section":"Cover","meaning":"What is paid if an accident causes death.","status":"cross-checked","value":"The accidental death sum insured is paid if an accidental injury during the policy period is the sole and direct cause of death within 365 days of the accident; the policy then ends for that person.","display":"Sum insured if death within 365 days of the accident","note":"Plus transport of mortal remains (Standard: lower of 2% of AD sum insured or actual cost, max 10,000; up to 25,000 Essential, 50,000 Advance, 10,000 Premium, 1,00,000 Elite) and a cremation ceremony amount in Essential, Advance and Elite. Cumulative bonus of 5% a year up to 50% applies to Benefits 1 to 3.","quote":"If an Insured Person suffers an Accidental bodily injury during the Policy Period which is the sole and direct cause of his death within 365 days from the date of the Accident, then We will pay the Sum Insured as specified in Policy schedule against this benefit to the assignee or the nominee or the legal representative","sources":[{"clause":"1","heading":"Accidental Death","page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-1"}],"law":[]},{"key":"permanent_total_disability","label":"Permanent total disability","section":"Cover","meaning":"What is paid for permanent total disability.","status":"cross-checked","value":"Paid as a percentage of the sum insured if disablement occurs within 365 days of the accident: 100% for loss of 2 limbs, a limb and an eye, sight of both eyes, or speech and hearing; 50% for loss of a limb or sight of one eye. Paralysis including paraplegia and quadriplegia is covered.","display":"100% of sum insured for loss of 2 limbs or both eyes; 50% for one limb or one eye","note":"Up to the AD sum insured in all plans. Elite adds Multiple Member Disability: 120% of the PTD benefit when two or more insured persons are disabled in one accident.","quote":"sole and direct cause of his permanent total disablement within 365 days from the date of the Accident in one of the ways detailed in the table below, then We will pay the percentage of the Sum Insured shown in the table. % of Sum Insured\nLoss of 2 Limbs (both Hands or both Feet or one Hand and one Foot) | 100%\nLoss of a Limb and an Eye | 100%\nComplete and irrecoverable loss of sight of both Eyes | 100%\nComplete and irrecoverable loss of speech & hearing of both Ears | 100%\nLoss of a Limb | 50%\nComplete and irrecoverable loss of sight of an Eye | 50% ... c) Includes cover for Paralysis Including Paraplegia, Quadriplegia with loss of functional use of limbs.","sources":[{"clause":null,"heading":"Benefit 2. Permanent Total Disablement","page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-benefit-2-permanent-total-disablement"}],"law":[]},{"key":"permanent_partial_disability","label":"Permanent partial disability","section":"Cover","meaning":"The table of payouts for losing a limb, eye, hearing...","status":"cross-checked","value":"A percentage of the sum insured by table, for loss within 365 days of the accident: each arm at shoulder 70%, above elbow 65%, below elbow 50%, hand at wrist 50%, thumb 20%, index finger 10%, other finger 5%, leg above centre of femur 70%, below femur 65%, below knee 50%, foot at ankle 40%, big toe 5%, other toe 2%, each eye 50%, hearing in each ear 30%, smell 10%, taste 5%.","display":"Table of % of sum insured, from 70% (arm at shoulder) to 2% (other toe)","note":"Losses not in the table are assessed with the insurer's medical advisors. Same table in all five plans.","quote":"Each arm at the shoulder joint | 70%\nEach arm to a point above elbow joint | 65%\nEach arm below elbow joint | 50%\nEach hand at the wrist | 50%\nEach thumb | 20%\nEach Index finger | 10%\nEach other finger | 5%\nEach leg above center of the femur | 70%\nEach leg upto a point below the femur | 65%\nEach leg to a point below the knee | 50%\nEach foot at the ankle | 40%\nEach big toe | 5%\nEach other toe | 2%\nEach eye | 50%\nHearing in each ear | 30%\nSense of smell | 10%\nSense of taste | 5% ... within 365 days from the date of the Accident","sources":[{"clause":null,"heading":"Benefit 3. Permanent Partial Disablement","page":7,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-benefit-3-permanent-partial-disablement"}],"law":[]},{"key":"temporary_total_disability","label":"Temporary total disability","section":"Cover","meaning":"Weekly income paid while you cannot work after an accident.","status":"cross-checked","value":"Only if the optional Total Temporary Disablement cover is bought: a weekly benefit of 1% of the sum insured for up to 100 weeks while an accident completely prevents you from working, capped at your base weekly income.","display":"Optional cover: 1% of sum insured per week, up to 100 weeks","note":"Sold as an optional cover in every plan (the prospectus lists it under 'Optional Cover' for Standard and Premium and 'Optional Rider' for Essential, Advance and Elite), for earning members only. TTD sum insured caps: Rs 5,00,000 Standard and Essential, Rs 15,00,000 Premium, Rs 25,00,000 Advance, Rs 50,00,000 Elite. Not offered for risk class III in Essential, Advance and Elite.","quote":"Our liability to make payment will be limited to of 1% of the Sum Insured for each week during the period of temporary total disablement for a period not exceeding 100 weeks from the date of the Accident ... We will not pay any amount in excess of the Insured Person’s base weekly income (at the time of accident) ... Optional Rider\nTotal Temporary Disablement* | 1 % SI per week for upto 100 weeks, max 5 Lacs","sources":[{"clause":null,"heading":"Benefit 4. Temporary Total Disablement","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-benefit-4-temporary-total-disablement"},{"clause":null,"heading":"Benefits: Below mentioned benefits are offered under this plan","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-benefits-below-mentioned-benefits-are-offered-un-2"}],"law":[]},{"key":"accident_medical","label":"Accident medical expenses","section":"Cover","meaning":"Treatment costs after an accident.","status":"conflicting","value":"Standard plan: after an accepted claim under Benefits 1 to 4, hospital medical expenses up to the lowest of actual expenses, 40% of the admitted claim, 10% of the death sum insured or Rs. 200,000; the wording's own schedule of benefits and the prospectus cap it at 50,000. Other plans instead cover accident in-patient hospitalisation (with 30 days pre and 60 days post hospitalisation) and accident out-patient expenses up to plan limits.","display":"Standard: lowest of actual cost, 40% of admitted claim, 10% of AD sum insured or Rs. 200,000","note":"Standard wording schedule of benefits says 'Up to 50,000' and the prospectus says 'Upto 10% of AD Sum Insured; maximum 50,000', against Rs. 200,000 in the benefit clause. In-patient hospitalisation limit: Premium 1,00,000 (base); optional with restore in Essential 1,00,000, Advance 3,00,000, Elite 3,00,000 in the wording (prospectus and CIS say 5,00,000 for Elite). Out-patient up to 5,000 (Essential, Advance) or 10,000 (Elite) with Rs 500 deductible per claim. Medical expenses are paid only if incurred in India.","quote":"If We have accepted a claim under Benefits 1-4, then We will in addition reimburse the Medical Expenses incurred by the Insured Person at a Hospital, provided that Our maximum liability under this Benefit shall be limited to the lowest of:\na) The actual expenses incurred, or\nb) 40% of the admitted claim amount under Benefits 1 to 4, or\nc) 10% of the Benefit 1 Sum Insured, or\nd) Rs. 200,000. ... Benefit 8. Accident Medical Expenses | Up to 50,000 ... Benefit 12. Accidental Medical Expenses | Upto 10% of AD Sum Insured; maximum 50,000 ... within 30 days of Accident ... Medical Expenses including Physiotherapy incurred in the 60 days","sources":[{"clause":null,"heading":"Benefit 8. Accident Medical Expenses","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-benefit-8-accident-medical-expenses"},{"clause":"1","heading":"Schedule of Benefits","page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-1-3"},{"clause":null,"heading":"Discounts","page":5,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-discounts"},{"clause":null,"heading":"Benefit 9. Accident In-patient Hospitalisation","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/147#c-benefit-9-accident-in-patient-hospitalisation"}],"law":[]},{"key":"occupation_classes","label":"Occupation rules","section":"Eligibility","meaning":"Whether your job affects cover or premium.","status":"cross-checked","value":"Yes. There are 6 occupation classes and the premium depends on the occupation class; a change of occupation must be notified within 30 days, or the claim is limited to what the premium paid would buy for the new occupation.","display":"Premium depends on 6 occupation classes","note":"Class 1 office and white collar work (includes housewife and students); 2 some outdoor work; 3 manual and skilled labour; 4 mines, explosives, high voltage, professional sports; 5 unearned income; 6 police, armed forces, pilots, heavy vehicle drivers. Some optional covers are NA for risk class III.","quote":"There will be 6 different classes of occupation basis which the coverage will be decided on. ... The price depends on several factors including the following\n• Sum insured\n• Occupation Class ... You will give Us notice of any change in the business or occupation of any Insured Person within 30 days of such change","sources":[{"clause":null,"heading":"Occupation Class","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-occupation-class"},{"clause":null,"heading":"Rating Schedule","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151#c-rating-schedule"},{"clause":"Section D(II)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146#c-section-d-ii-2"}],"law":[]}],"documents":[{"kind":"wording","label":"Individual Personal Accident_Standard","pages":25,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/individual-personal-accident--standard---sep-2021-443358790825.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/146"},{"kind":"wording","label":"Individual Personal Accident_Essential","pages":31,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/individual-personal-accident---essential--sep-2021-229434268364.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/147"},{"kind":"wording","label":"Individual Personal Accident_Advance","pages":33,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/individual-personal-accident--advance---sep-2021-406216828418.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/148"},{"kind":"wording","label":"Individual Personal Accident_Premium","pages":29,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/individual-personal-accident---premium--sep-2021-225544775475.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/149"},{"kind":"wording","label":"Individual Personal Accident_Elite","pages":35,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/individual-personal-accident---elite---sep-2021-62450688630.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/150"},{"kind":"prospectus","label":"Individual Personal Accident","pages":29,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/IndividualPersonalaccident-753709078887.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/151"},{"kind":"cis","label":"Individual Personal Accident - Essential","pages":11,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/cis---ipa---essential/pdf197-643132341046.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/152"},{"kind":"cis","label":"Individual Personal Accident - Advance","pages":12,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/cis---ipa---advance/PDF194-91063630795.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/153"},{"kind":"cis","label":"Individual Personal Accident - Premium","pages":10,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/cis---ipa---premium/pdf198-968081794978.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/154"},{"kind":"cis","label":"Individual Personal Accident - Elite","pages":13,"fetched_at":"2026-10-16 07:11:39.637396+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/hdfcergo.com/docs/default-source/downloads/cis/cis---ipa---elite/PDF196-369475368411.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021/document/155"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Individual Personal Accident (UIN HDHHLIP21346V042021), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/individual-personal-accident-hdhhlip21346v042021"}