Pradhan Mantri Suraksha Bima Yojana (PMSBY) Eligibility, Apply, Claim

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As we know death due to accidents is very common and at a high rate in India. A death or a disability due to an accident leaves the family of the victim in an unstable situation. On one hand, the family has just lost their loved ones and on the other hand, the family faces a financial challenge. The Government of India understands and sympathizes with the people who face such challenges. Keeping this in mind the Government of India introduced a scheme that provides insurance to policyholders against loss of death or disability due to accident.

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What is Pradhan Mantri Suraksha Bima Yojana (PMSBY)?

The Pradhan Mantri Suraksha Bima Yojana is an Accident Insurance Scheme. It provides accidental death and disability insurance coverage for death or disability caused due to an accident to the policyholder. The Public Sector General Insurance Companies (PSGICs) along with other General Insurance companies will offer and administer the scheme.

However, The Public Sector General Insurance Companies (PSGICs) along with other General Insurance companies provide the product on similar terms. They must also tie-up with Banks for this purpose. Moreover, the participating banks have the liberty to engage an insurance company for implementing the scheme for their subscribers.

The participating banks will be the master policyholder on the behalf of all the participating subscribers to the scheme. The general insurance company in consultation with the master policyholder must establish a simple and subscriber-friendly administration & claim settlement process.

Eligibility for Pradhan Mantri Suraksha Bima Yojana

An individual who falls under the age group of 18 years (completed) and 70 years (age nearer birthday).
Such an individual must hold a savings bank account with the participating bank.
In case the individual holds more than one bank account with the same participating bank or all together with other such banks then he/ she can join the scheme with one bank account only.
If it is later found that the individual holds more than one scheme with more than one bank then the scheme will be terminated. The bank will forfeit the other premium.
For the purpose of enrollment to the scheme, the Aadhar will be the primary KYC for the bank account. Without Aadhar, an individual cannot apply for the scheme.
The mobile number associated with the bank account must be active. If not then the Bank will not issue the policy. Further, the bank is not under an obligation to intimate the individual regarding the same.

Features of PMSBY Pradhan Mantri Suraksha Bima Yojana

Accidental insurance coverage in the case of death or disability due to an accident.
Public Sector General Insurance Companies (PSGICs) along with other General Insurance companies will offer and administer the scheme
An individual who falls under the age group of 18 to 70 years is eligible for the scheme
You need a bank account with the participating bank along with Aadhar for KYC to enroll in the scheme.
The PMSBY scheme is a part of the Social Security scheme.
The enrollment and claim process is simple, timely, and straightforward.
The insurance coverage is for a period starting from the 1st June to 31st May of each year.
You must provide the consent for the scheme and auto-debit from the bank account by 31st May of each year.
In the case of death due to an accident, the benefit available is Rs 2,00,000.
In the case of a total and irrecoverable loss of both eyes or loss of use of both hands/ feet/ loss of sight of one eye and loss of use of hand or foot the benefits available are Rs 2,00,000.
A benefit of Rs 1,00,000 if there is an irrecoverable loss of sight of one eye or loss of use of one hand or foot.
The participating bank is a master policyholder.
An annual premium of Rs 12 is payable for the accidental insurance coverage
The insurance coverage will stand terminated on attaining the age of 70 years.
The Bank and insurance company must complete the entire claim settlement process within 60 days from the date of submission of the claim form. The bank will take 30 days to verify the claim. The insurance company will need another 30 days to remit the claim.

What is the Enrolment Period and Modality?

Enrolment Period

The insurance coverage is available for a period of one year only. If you a longer period of insurance then you need to renew the scheme every year.
The coverage period stretches from 1st June to 31st May of each year.
You need to give your content for enrollment in the scheme by 31st May of each year.
You must provide instruction or consent for an auto-debit from the bank account by 31st May of each year.

Enrolment Modality

An eligible individual can join subsequently on payment of full annual premium.
An applicant may provide an indefinite / longer option for enrolment / auto-debit of premium instruction as well. In such a case he/ she need not renew the scheme every year. Hence, the policy will be renewed automatically on an auto-debit of the premium. However, such an indefinite instruction is subject to continuation of the scheme with terms as may be revised on the basis of past experience.
An individual who had exited the scheme earlier can rejoin the scheme in future years. However, he/ she needs to go through the above enrollment modality.
An eligible person can opt for the scheme in future years while the scheme is continuing

Benefits under Pradhan Mantri Suraksha Bima Yojana

The enrollment and claim settlement is a very simple and seamless process.
In comparison to other insurance policies, the premium under the PMSBY scheme is lower.
The Government of India governs the PMSBY scheme. The Public Sector General Insurance Companies (PSGICs) administer the scheme. Hence, it is safe and trustworthy to opt for the policy.
The intent of the Yojana is to provide aid to the victim and their family.
Unlike many other insurance policies, the Pradhan Mantri Suraksha Bima Yojana provides insurance coverage of disability due to accidents as well.

Benefits under PMSBY scheme	Sum Assured (Rs)
Death due to an accident	Rs 2 lakh
Total and irrecoverable loss of both eyes or loss of use of both hands or feet or loss of sight of one eye and loss of use of hand or foot	Rs 2 lakh
Total and irrecoverable loss of sight of one eye or loss of use of one hand or foot	Rs 1 lakh

Premium under Pradhan Mantri Suraksha Bima Yojana

An annual premium is Rs 12 is payable
Consent must be received from the subscriber regarding an auto-debit from the savings account. Further, the customer response received through their registered mobile number is treated as their consent for an auto-debit.
The bank will deduct the premium with the auto-debit facility in one installment. Such an auto-debit must be made on or before 1st June of each annual coverage period under the scheme.
If the premium is deducted after 1st June then the insurance cover will commence from the date of auto-debit of premium by the Bank.
The Public Sector General Insurance Companies (PSGICs) can revise the premium amount on the basis of the annual claims experience.
Except in the case of annual claims experience, the PSGICs would ensure that there is no increase in the premium amount during the first 3 years.
Even if a subscriber joins the scheme under a Group Policy, he/ she must pay the entire premium amount of Rs 12.
If you want to discontinue the scheme then you must provide an intimation to the bank on or before the 30th April of the year.

How to apply for PMSBY?

Download the application form and submit the application to your banker by visiting the nearest branch.
Alternatively, activate your social security number by logging on to your internet banking. Every bank has more or less similar steps.
Log in to your account and click on the ‘Insurance’ tab. You can view the different types of insurance schemes. Select the PMSBY scheme and you can view the Policy cover amount, premium amount, and nominee details. Now select the bank account and provide consent for an auto-debit from a savings bank account. Lastly, provide a ‘Good Health Declaration’, nominee details, and accept the terms and conditions. Read the terms and conditions carefully and then click in ‘confirm’. Your application will be accepted and the acknowledgment will be available along with a unique reference number. You must save this unique reference number and download the acknowledgment receipt.

Termination of Assurance under PMSBY

In the following cases, the accident cover for the subscriber will be terminated. Hence, no benefit is available:

On attaining age 70 years (age nearest birthday). In a way, you cannot renew the scheme if on the Annual Renewal Day your age is 70 years.
If the subscriber closes the bank account linked with the scheme
The bank account which is linked with the scheme has an insufficiency of balance to deduct premium.
If the subscriber subscribes to the scheme with more than one bank account. The scheme or insurance coverage will be available for one bank account only. Moreover, the insurance company will forfeit the insurance premium it receives from the second bank account.
If the insurance coverage ceases due to any technical reason then the insurance company can reinstate it on a receipt of the premium. Such technical reasons could be insufficient bank balance, invalid or inactive account, invalid or inactive mobile number for the time being, or any other administrative reason.
If the personal details of the policyholder is found to be incorrect or misleading then the policy will be terminated. The insurance company will forfeit the premium.
During the above period, the insurance company will suspend the risk cover. Further, reinstatement of the risk cover will be at the sole discretion of the Insurance Company.
The participating bank must debit the premium amount in the same month in which auto-debit instruction is made available. It must then forward or remit the premium to the Insurance company.
The assurance is not available in the case of intentional self-injury, suicide, or attempted suicide either under the influence of intoxication liquor or drugs. Moreover, if the loss of death or disability is due to an act that is in breach of law with or without criminal intent then no assurance is available.

Administration of Pradhan Mantri Suraksha Bima Yojana

The administration of the scheme is as per the Insurance Company’s standard procedure.
The participating bank is responsible for the collection of premiums through an auto-debit process on or before the due date.
The participating bank is responsible to obtain and retain the Enrollment form / Auto-debit authorization.
In the case of a claim settlement, the Insurance Company can ask the bank to present such an Enrollment form / Auto-debit authorization. The insurance company reserves the right to call for these documents at any point in time.
The acknowledgment slip acts as an acknowledgment slip-cum-certificate of insurance. The bank cannot issue any other document as an insurance certificate.
The Public Sector General Insurance Companies (PSGICs) will monitor the experience of the scheme on an annual basis for the purpose of re-calibration.

How to Claim the Insurance Coverage under PMSBY?

Process for the Subscriber/ Nominee

The policyholder or the nominee must immediately after the occurrence of the accident contact the bank branch. The bank branch will be the bank with which the policyholder held the policy and the premium was deducted. On visiting the bank branch, the policyholder or the nominee must submit a duly completed claim form.
You can get the claim form from a bank branch or other sources like insurance company branches, hospitals, PHCs, BCs, insurance agents, etc. Alternatively, you can also download the claim from the social security service’s official designated website. The insurance company must ensure that the forms are available in all such locations.
The subscriber or the nominee must fill the claim form and submit it to the bank branch within 30 days of the occurrence of the accident. Always make sure that the occurrence of the accident rises to the claim under the policy.
The subscriber or the nominee must attach the documents with the claim form. if the subscriber dies then the nominee must provide the Original FIR/ Panchnama, Post Mortem Report, and Death Certificate. In the case of permanent disablement, the subscriber must provide the Original FIR/ Panchnama and a Disability Certificate issued by a Civil Surgeon. In both cases, the subscriber or the nominee must also provide the discharge certificate in the enclosed format.

Process for the Participating Bank

The bank official will verify the account, auto-debit particulars, the account details, nomination, debiting of premium /remittance to the insurer.
On successful verification, the official will then proceed towards certifying the correctness of the information mentioned in the claim form.
He/ she will then forward the case to the insurance company with 30 days of receiving the claim form.

Process For the Insurance Company

The insurance company will verify whether the premium has been remitted to the insurance company or not. It will also verify whether the subscriber’s name is included in the list of insured persons in the master policy.
On successful verification, the insurance company will process the claim within 30 days of receiving the case file from the bank. It will then remit the claim amount to the nominee or the subscriber.
If the policy does not specify any nominee then the scheme will remit claim to legal heirs. However, such a legal heir must provide the succession certificate or the legal heir certificate issued by any Competent Court or authority.

You may also like to read about the Pradhan Mantri Shram Yogi Mandhan

Read also about the Pradhan Mantri Awaas Yojana Gramin (PMAYG)

Frequently Asked Questions

Can eligible individuals who fail to join the scheme in the initial year join in subsequent years?

Yes, an eligible individual who failed to join the scheme in the initial year can join later. He. she must pay the annual premium.

Can individuals who leave the scheme rejoin?

Yes, the individuals who exited the scheme earlier can re-join the scheme in future years. He/ she must make the full payment of the annual premium.

I already hold an insurance policy, can I still opt for the PMSBY scheme?

Yes, the insurance cover under the PMSBY scheme is over and above the insurance policy already held by you.

Which Bank Accounts are eligible for subscribing to PMSBY?

Except for institutional account holders, all other bank account holders are eligible for a subscription to the PMSBY scheme.

I am an NRI, can I subscribe to the PMSBY scheme?

Yes, even an NRI is eligible for a subscription to the PMSBY scheme. Make sure that you hold a bank account in a branch located in India and satisfy other requirements. However, at the time of claim settlement, the claim will be remitted to a nominee in Indian currency only.

Is there any provision for reimbursement of hospitalization expenses following an accident resulting in death or disablement?

No, the hospitalization expenses following an accident resulting in death or disablement is not covered under the scheme.

Will the family get insurance benefits if the account holder commits suicide?

No, in the case of a death caused by suicide the insurance coverage is not available.

Is it mandatory to report the occurrence of an accident to the Police Department and obtain a copy of the FIR?

Only in a few cases, you are required to report the accident to the Policy Department. In the case of a road/ rail/ other vehicular accident or a death involving any crime, you must report the incident. If the death is due to incidents like falling from a tree, snake bite you must provide a supporting document issued by the hospital along with the claim form.

If the insured is missing and death is not confirmed, will the legal heirs get the benefit of insurance?

No, confirmation of death or a permanent disability is mandatory for the initiation of the claim.

Will the insurance benefit be available if the policyholder suffers a partial disability but no irrecoverable loss?

No, if the loss is recoverable then the insurance benefit is not available.

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