EMPLOYEE BENEFIT MANUAL

Total Environment Building Systems Private Limited

Insurance Benefit Details

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

Group Personal Accident (GPA) Benefit Details

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) Details

* Indicative list, Please refer to policy document5

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

Is claim
payable?

On obtaining all relevant

documents, Insurance Co. will
begin processing the claims

Yes

No
Insurer provides a valid reason for the
rejection to HR/Claimant/ Assignee

Claim Investigation and Review

within 7 Days of submission of all
the required documents

Cheque is sent to Employer (HR) within

10 working days, from where it is given
to the Claimant/ Assignee

Group Personal Accident (GPA) Claims Document

Checklist
Weekly Benefit Claims

Death Claims

1.
2.
3.

1.
2.
3.
4.
5.
6.

4.
5.
6.

Completed Claim form

Doctor's Report
Disability Certificate from the
Doctor, if any
Investigation/ Lab reports (x-ray
etc.)
Original Admission/discharge
card, if hospitalized
Employers Leave Certificate &
Details of salary

Dismemberment/ Disablement
Claims

Completed claim form

Attending Doctor's report
Death Certificate
Post Mortem/ Coroner's report
FIR ( First Information Report)
Police Inquest report, wherever
applicable

1.
2.
3.
4.
5.
6.

Completed claim form

Doctor's Report
Disability Certificate from the
Doctor
Investigation/ Lab reports (x-ray
etc.)
Original Admission/ discharge
card, if hospitalized.
Police Inquest report, wherever
applicable

Group Personal Accident (GPA) General 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

11. Any hazardous activities not limited to but including Adventure sports ( parasailing,
paragliding, bungee jumping, diving, swimming etc.)
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Group Personal Accident - Contacts

Marsh

Total Environment

Rajesh.reddy@marsh.com

hr.ops@total-environment.com

10

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

11

Yes

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

12

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

Is claim
payable?

On obtaining all relevant

documents, Insurance Co. will
begin processing the claims

Yes

No
Insurer provides a valid reason for the
rejection to Compliance / Claimant/
Assignee

Claim Investigation and Review

within 7 days of submission of all
the required documents

13

Cheque is sent to Employer

(Compliance) within 3 working days,
from where it is given to the Claimant/
Assignee

Group Term Life (GTL) Document Checklist

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

14

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

15

Group Term Life (GTL) Contact Details

Providers

Total Environment

hr.ops@total-environment.com

Kotak Mahindra Old Mutual Life

Insurance Limited

Sneha.Babu@kotak.com

Marsh

Rajesh.reddy@marsh.com

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