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Asmita - Group Life Insurance Scheme PDF Print E-mail
Friday, 19 August 2011 09:53
Objective

The National Trust was setup in the context of parents’ worries that what will happen to their children with special needs when they are no more. In order to provide a sustainable solution to this rather difficult problem, Asmita -a scheme of Group Life Insurance is conceived with the following objectives

1. To ensure financial security and provide an assured minimum fund for the welfare of persons with Autism, Cerebral Palsy, Mental Retardation andamp; Multiple Disabilities in the event of death or permanent disability of their parent or guardian or any other person (supporter) on whom the person with such disability is physically / financially dependent.

2. To encourage and facilitate parents and guardians and such persons (supporters) to plan and ensure adequate financial security for their wards with such disabilities at affordable cost

3.  To facilitate assisted living with independence and dignity

Justification

It is a common knowledge that persons with disabilities in general face several barriers-physical, financial, psychological in leading a life with dignity and independence. Though financial resources are very important for achieving this, parents/ guardians/ supporters are usually unable to raise adequate fund. The situation gets aggravated in any eventuality of their death.  The situation is worse with the aforesaid four developmental disabilities as financial requirement for such persons will be much more.

So far several life insurance products are available but by and large they are quite expensive and really unaffordable to such parents/ guardians/ supporters. Besides, there is really no incentive for them to go for such insurance in favour of their special children. In order to overcome this problem and also to encourage parents/ guardians/ supporters to take life insurance cover in favour of their special children, an affordable group life insurance scheme is conceived.

The Scheme

Under the Scheme either one of the parents or the guardian or the supporter of a disabled person (Beneficiary) shall be insured for a sum of amount as determined by the National Trust in consultation with different stakeholders.  The insurance shall cover death - accidental or otherwise -of the person insured. There will be no survival benefit but in an unfortunate event of the death of the insured person, the insurance proceeds shall be received by the National Trust which will either retain andamp; utilize it in providing lifelong shelter and care of assured minimum standards as envisaged in its GHARAUNDA scheme to the Beneficiary (ward of the person insured) or if unable to do so, then disburse the proceeds to the Beneficiary in a manner which ensures his/ her best care.

The Scheme shall be implemented by the National Trust either directly or through a Nodal Agency duly appointed by the National Trust for this purpose. The Scheme shall be underwritten by an Indian Life Insurance company, duly licensed by the Insurance Regulatory andamp; Development Authority (IRDA).

Salient Features of the Scheme

1. Insurance Benefits under the scheme

In the event of death of an Insured Person, accidental or otherwise, the sum insured shall be payable by the Insurance Company to the National Trust. However, no benefit shall accrue under the Scheme for death arising out of suicide or intentional self injury by an Insured Person.

2. Utilization of the Insurance proceeds

The insurance proceeds of the Scheme shall be payable to the National Trust which shall use it to make all possible arrangements for the lifelong shelter andamp; care of the Beneficiary as envisaged in its GHARAUNDA scheme and ensure that the Beneficiary is looked after well. In the event the National Trust is not able to make such arrangement, it shall disburse the proceeds, in its good wisdom, to the Beneficiary, either through the Legal Guardian or in a manner which ensures his/ her best care.

3. Applicant , Beneficiary andamp; Insured Person

Any person or organization can apply under the Scheme, as Applicant, by paying the applicable fees with an undertaking to pay the applicable fees in future also, as determined by the National Trust from time to time.

Only those persons who have any of the disabilities covered under the National Trust Act shall be eligible to be a Beneficiary under the Scheme.

Only one of the Parents or the Legal Guardian or the Supporter of such a Beneficiary on whom s/he (Beneficiary) is financially dependent shall be eligible to be covered under the scheme, as an Insured Person.  An Insured person may or may not be the Applicant. Similarly an Applicant may or may not be the Insured Person.

The maximum entry andamp; exit age of the Insured Person under the Scheme shall be as given under the insurance policy of the selected insurance company.

A Guardian or Legal Guardian shall mean any person duly appointed as guardian/ legal guardian by a competent authority under the National Trust Act or any other relevant Act. An alternate guardian shall mean any person who is so declared in the legal guardian certificate issued by the competent authority.

A Supporter shall mean any such person on whom the person with such disability is physically or financially dependent and may include parent, spouse, siblings, any other relative or caregiver etc.  Besides a Supporter can also be any person who buys his life insurance policy under the scheme and pledges the proceeds of the insurance claim to the National Trust as donation for any poor Beneficiary under the Scheme.

Accordingly, every Insured Person should be categorised under either of the three categories, namely Parent, Legal Guardian and Supporter. A Beneficiary can be paired with only one Insured Person at a time so that a Beneficiary cannot avail multiple benefits under the Scheme. Obviously, this will not be applicable in case of donor (Supporter).

An Insured Person, on the other hand, can be paired with more than one Beneficiary at a time. So in case of more than one Beneficiary, an Insured Person can have multiple insurance cover but only one per each Beneficiary under the Scheme. Separate applications will however be required for each insurance cover.

The Applicant can change the Beneficiary with the prior consent of the National Trust. But in case no Beneficiary is declared in the application or in case no Beneficiary is substituted by the Applicant within 60 days of the death of the earlier Beneficiary, the National Trust will be at liberty to select a Beneficiary at its sole discretion as and when it deems fit.

4. Nominee

The National Trust shall be the sole nominee in all the cases under the Scheme and shall be the sole recipient of all insurance claim proceeds under the Scheme.

5. Premium and Other Charges

The insurance company shall be selected and premium shall be decided through a transparent process. The premium amount shall be paid by the National Trust to the selected Insurance Company. However, in order to make the scheme financially self financing and sustainable, there shall be suitable fee, as decided by the National Trust from time to time, which shall be payable to the National Trust in advance by the Applicant to join the Scheme or renew the insurance cover.

This fee can be different for different age groups of Insured Persons and will include the premium, tax and other costs of the Scheme.

6. Period of Insurance Cover

The insurance cover shall be valid for one year or till its renewal.

7. Renewal of the Insurance Cover

The insurance cover shall be renewable every year subject to payment of requisite fees and also subject to continuance of the Scheme. However, a Beneficiary can not avail the benefits more than once.  So once the insurance benefits have been availed by a Beneficiary, there will be no such renewal of the insurance cover to any other Insured Person for  that Beneficiary.

8. Termination of the Insurance Cover

Since the insurance benefit will flow on the pairing of Insured Person and the Beneficiary, any breaking of this pair shall mean the Beneficiary will not get the benefits of the insurance proceeds.  So, if the Beneficiary predeceases the Insured Person or if the Insured Person terminates/changes this pairing in writing with the consent of the National Trust, then the benefit of the insurance proceeds will not flow to the Beneficiary even if the insurance proceeds are received by the National Trust, such as in a situation where the Insured Person dies after breaking this pair. Obviously such a situation will not arise when no beneficiary is declared i.e. pair is not formed/does not exist, such as in case of donor (Supporter).

9. Scheme Facilitators andamp; Enrolment Agency

All Registered Organizations of the National Trust shall be the facilitators of the Scheme. Facilitation shall include carrying out enrolment activities and assist the Beneficiary in obtaining claims. Their role is further elaborated in the Enrolment and the Claims sections.

10. Nodal Agency

There will be a provision of Nodal Agency who will work as third party administrator or TPA and coordinate the implementation of the Scheme. The role of Nodal Agency will include – facilitation of enrolment of Beneficiaries, maintaining of records, facilitation of disbursement of claims etc.

11. Role of NGOs

All Registered Organizations of National Trust will be responsible for Enrolment of Beneficiaries, disbursement of claim, solving any local dispute etc. for the Beneficiaries under their jurisdiction.

12. Enrolment Process

1. All applications must be submitted in prescribed enrolment form duly filled up and all documents attached such as proof of disability certificate, income certificate, certificate of Legal Guardianship/ consent letter for supporting the Beneficiary and other requisite documents as per the enrolment form along with the requisite fees preferably by DD/ bank pay order or cheque but not in cash. Applicant can also directly deposit the requisite fees in the National Trust Bank Account and enclose a receipt of the same with enrolment form.

2. Enrolment forms have to be submitted to any Organisation registered with the National Trust which shall then verify all details given in the form and other documents before accepting the same. Only such forms which are submitted with full details and requisite fees shall be accepted. Form with incomplete information or non-payment of fees shall not be accepted at all.

3. Once accepted, Registered Organisations shall enter all details on-line in the website of the National Trust.

4. On receiving the credit of the remittance towards the requisite fees, the National Trust or its Nodal Agency, if any, shall forward the application to the Insurance Company for insurance coverage under the Scheme.

5. The Insurance Company may conduct its own scrutiny and/or medical examination of the applicant before approving the application.

6. In the event of Insurance Company disapproving any application, the amount received from the applicant by the National Trust shall be refunded in full but without any interest.

7. In the event of Insurance Company approving the application, the insurance cover shall become effective from the date of approval or any other date specifically mentioned in this regard and the same shall be confirmed in writing to the applicant.

8. This letter shall contain the names andamp; other details of the Insured Person and the Beneficiary, if any, and shall also contain address of the nearest office of the Insurance Company which is to be contacted in the event of a claim and the list of documents usually required for such claims.

13. Claims  Process

a. In the event of death of the Insured Person, immediate intimation, in writing, is to be given to the Insurance Company at the address mentioned in the aforementioned letter.

b. A copy of such intimation letter is to be endorsed to the concerned Registered Organization and the National Trust.

c. The documents which are typically required by the insurance company are as under

*  Claim Form
*  Death Certificate
*  Post-mortem report (in case of accidental death)

d. The Insurance Company shall pay the claim amount within 5 weeks from the date of receipt of complete documentation.

e. In case the insurance company requires some additional documents or information to verify the cause of death, they shall do so not later than 2 weeks from the date of receipt of intimation. Such verification shall be at the expense of the insurance company.

f. The claim amount shall be payable to the National Trust which, in turn, will either utilise it for providing lifelong shelter and care to the Beneficiary or disburse the same in the manner as it deems in the best interest of the Beneficiary.

g. In the event of repudiation of claim, the insurance company shall communicate the reasons for the same in writing, endorsing a copy of the communication to Registered Organizations and the National Trust.

14. Monitoring andamp; Reporting

The National Trust may constitute a Monitoring Committee comprising of different stakeholders to oversee the proper implementation of the Scheme. The Insurance Company shall participate with full details in periodic meetings of the National Trust, its Monitoring Committee and Nodal Agency.

The Insurance Company shall submit a monthly report to the National Trust which shall, inter alia, carry the following details.

Details of Insured Persons andamp; the Beneficiaries

a. Name of the Insured Persons

b. Name of the Beneficiaries

c. Full postal address

d. Unique ID given by the National Trust

e. Unique ID given by the Insurance Company

f. Starting Date of Insurance cover

g. Claim Received, if any

h. Claim Settled, if any

i. Reasons for non-settlement of claim, if any

j. Remarks

Abstract Report

a. Count and amount of claims received

b. Count and amount of claims settled

c. Count and amount of claims outstanding along with their reasons

d. Ageing of outstanding claims

e. Count and amount of claims rejected along with their reasons

15. Call Centre Services

The Insurance Company shall provide dedicated telephone services for the guidance and benefit to the Beneficiaries whereby Insured Person shall receive guidance about various issues by dialling a national toll free number.

16. Dispute Resolution and Grievance Redressal

If any dispute arises between the National Trust and the Insurance Company then the same shall be referred by the aggrieved party to the Chairperson / CEO / CMD of the other party for resolution.

In the event that the concerned Chairperson / CEO / CMD is unable to resolve the dispute within 60days of it being referred to him/her, then either party may refer the dispute for resolution to a sole arbitrator who shall be jointly appointed by both the parties, or, in the event that the  parties are unable to agree on the person to act as the sole arbitrator within 30days after any party has claimed for an arbitration in written form, by, three arbitrators, one to  be appointed by each party with power to the two arbitrators so appointed, to appoint the third arbitrator.

Rate Chart  of Fees under Asmita
(sum insured Rs. 10 lakhs)

Age

Fees under Asmita, in Rs pa

Age

Fees under Asmita, in Rs pa

Age

Fees under Asmita, in Rs pa

Age

Fees under Asmita, in Rs pa
18    1490    29    2020    40    4180    51    8280
19    1490    30    2120    41    4510    52    8890
20    1490    31    2240    42    4550    53    9750
21    1530    32    2390    43    4910    54    10690
22    1550    33    2560    44    5360    55    11000
23    1600    34    2750    45    5410    56    12210
24    1650    35    2940    46    6070    57    12460
25    1710    36    3200    47    6180    58    13510
26    1770    37    3460    48    6810    59    14780
27    1850    38    3750    49    7500          
28    1930    39    3970    50    8090

Last Updated on Wednesday, 23 November 2011 10:16
 
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