Academic accident insurance is based on an agreement between the Ministry of Education, the General Department of Cooperation and Social Security and the management of personal insurance, the regulation and method of accident insurance and treatment of all students and administrative and educational staff, work plan instructors, conservatory students, students and students of exceptional schools. , teacher training centers and technical and vocational schools and kindergartens and their personnel and literate students and employees of the literacy movement and dependents of all employees including spouses and non-student children over 4 months and less than 25 years, male employees and non-student children over 4 months And less than 25 years of female employees are announced during the academic year.
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According to this agreement, the officials of non-profit schools at different levels of education are required to cover the students, employees and dependents of their employees in the same way as other educational centers under the Ministry of Education.
• The subject of the main insurance: accident and treatment insurance is round-the-clock, since the net profit and the subject of participation in the benefits of the six-month performance statistics are agreed upon by the policyholder. Finally, the branches and centers of the company receive 3 copies of the compensation statistics every 6 months from the date of the contract start. After matching with the accounting offices, along with the copies of the relevant remittances, for the approval of the contract execution officials in the local education and administrations, and submit a copy of the mentioned list attached to the copies of the relevant remittances to the policyholder.
Deadline for payment of insurance premiums: to cover dependents and main insured persons according to the provisions of the contract or agreement.
According to the note from Article 3 of the second chapter: children of martyrs, freedmen, missing persons and veterans of the Islamic Revolution and imposed war, as well as students under the support of the Imam's Relief Committee, are exempt from paying insurance premiums. The criteria for calculating medical expenses will be the tariff of the Ministry of Health and Medical Education. In cases where the insured subjects of this contract have already used health insurance, the difference in medical expenses of such insured persons can be paid up to the amount of the insurer's (company's) obligation and in accordance with the tariff of the Ministry of Health and the level of parents or beneficiaries. will be.
In connection with kidney patients: In order to help such patients, in addition to the amount of the ceiling of obligations, an amount that changes every year, for the procurement or purchase of kidneys and according to the request and approval of the General Department of Cooperatives and Social Security - Ministry of Education was determined. And education should be paid to the insured. Regarding the patients who are treated by the stone crusher due to kidney stone disease, it is stipulated that an amount will be paid to the insured according to the contract, and this is exactly the same surgery, which is performed by the staff. In the educational or non-educational environment, in normal cases, the insured can introduce the injured or non-injured insured directly to the insurer to obtain a letter of recommendation for a hospital or medical center, or in urgent cases, introduce them to the nearest medical center and the insurance Patients are free to choose a treatment reference. But the expenses incurred will be paid exclusively based on the applicable tariff.
• The important point in accident insurance policies is that the capital of medical expenses cannot be more than 10% of the capital of death and disability.
The age limit in this type of insurance policy is 75 years, and for the insured over 75 years old, an additional 10% premium is charged from the insured. In this type of insurance policy, there is no medical examination for the insured. However, risk management is the responsibility of managers and heads of branches.
Damages covered
According to the conditions stated in the insurance policy, risks may be covered at one of the following levels:
• Main cover:
1. Compensation for death and disability caused by an accident
Optional coverage:
1. Earthquake hazards
2. Volcano hazards
In accident insurance policies, in addition to the above risks, additional risks are also covered, for example, a pilot who is class 5 and rate 3 and performs another activity such as riding, the second activity is calculated from the first class and 20% additional insurance premium And it is meant. Similarly, in the group insurance policy for a company where some of its personnel are motorcyclists, additional risk is also considered.
Each insured can have two types of insurance policy requests.
1. Compensation for death and disability
2. Death and disability compensation along with medical expenses
General conditions
Chapter 1 - General:
o Article 1- This insurance policy is drawn up between the insurer and the policyholder based on the insurance law approved in May 1316 and the policyholder's written proposal (which is an integral part of the policy) and is agreed upon by the parties. That part of the policyholder's written proposal that is not accepted by the insurer should be announced to the policyholder before the policy is issued, and the announced items are not considered part of the insurer's obligations, if the insured and the policyholder are not the same person, the written consent of the insurance and in the case of an insured person who does not have legal capacity, the consent of his guardian or guardian is necessary, otherwise the insurance policy is invalid.
o Article 2- Insurer: The insurer is an insurance company whose details are specified in this insurance policy and undertakes the compensation and payment of damages caused by possible accidents according to the conditions stipulated in this insurance policy.
o Article 3- Policyholder: The policyholder is a natural or legal person who has the mentioned characteristics, is mentioned in the insurance policy and undertakes to pay the insurance premium.
o Article 4- Insured: The insured is a person for whom the possibility of realizing the risk or risks included in this insurance policy has led to the conclusion of the insurance policy, and the specified specifications are mentioned in this insurance policy.
o Article 5- Beneficiary: Beneficiaries are the person or natural or legal persons for whose benefit the insurance policy is concluded and their details are mentioned in this insurance policy.
o Article 6- Insurance premium: The insurance premium is the money that the policyholder pays against the insurer's obligations.
o Article 7- Insurance capital or insurance compensation: Insurance capital or insurance compensation is the amount that the insurer undertakes to pay to the beneficiary in case of realization of the insured risk or risks according to the terms of this insurance policy.
o Article 8- Accident: The accident subject of this insurance is any sudden event caused by an external factor that occurs without the intention and will of the insured and leads to injury, disability, disability or death of the insured.
o Article 9- Permanent and definite disability or disability: Permanent and definite disability or disability is the interruption, change of job or loss of the ability to perform work of a body part that is caused by an accident and is a permanent condition and have definite
Article 10 - Term of the insurance policy: The term of this insurance is one full solar year and it starts at 12 noon on the day that is specified as the start date of the insurance policy and ends at 12 noon on the day the insurance policy expires, unless the parties agree to otherwise agreed.
The second chapter - conditions
o Article 11- The principle of good faith: the policyholder and the insured are obliged to provide the insurer with all the information regarding the subject of insurance in response to the insurer's questions with accuracy and honesty.
If the policyholder and the insured deliberately refuse to provide information in response to the insurer's question, or intentionally make statements contrary to the facts, the insurance policy will be void and ineffective, even if the information that was concealed or stated contrary to the facts did not have any effect on the occurrence of the accident. If not, not only the funds paid by the policyholder will not be returned, but the policyholder can also demand the balance of the insurance premium.
o Article 12 - Insured risks: The provision of the insurer, subject to the exceptions and limitations stated in the insurance policy, includes the realization of the risk (accident) subject of Article 8 of this insurance policy. Realization of the following risks is also considered among the insurer's obligations.
A) Drowning, poisoning, the effect of steam gas or corrosive substances such as acid.
b) Suffering from rabies, tetanus and anthrax.
c) Legitimate defense of the insured.
d) Saving people and property from danger.
o Article 13 - Insurable damages: This insurance policy covers death, disability, and limb defects that are directly caused by the cases mentioned in Article 12 of this insurance policy. If the parties agree and receive additional insurance premiums, medical expenses and daily compensation can also be provided.
o Article 14- Payment of insurance premium: The policy holder is obliged to pay the insurance premium in cash in return for receiving the insurance policy and obtain a receipt that has been stamped and signed by the insurer, unless the parties agree otherwise regarding the payment of the insurance premium.
o Article 15- Statements in writing: Any suggestions and statements of the policyholder and the insurer regarding this insurance policy must be sent in writing to the last announced address.
o Article 16- Change of risk: Whenever there is a change in the job or other activities of the insured during the insurance period, the insured or the policyholder is obliged to inform the insurer of the resulting changes within a maximum period of ten days. It offers an insurance premium commensurate with the risk for the remaining period. If the parties cannot agree on the adjusted insurance premium, each of the parties can cancel the insurance policy within a maximum period of ten days.
Article 17- Cases of cancellation of the insurance policy: The insurer or the policyholder can apply for the cancellation of the insurance policy in the following cases:
A- Cases of cancellation by the insurer: The insurer can cancel the insurance policy in the following cases. In this case, the return of the insurance premium will be calculated in days.
1. Failure to pay all or part of the insurance premium or its installments on the specified date or dates.
2. If the policyholder inadvertently or without malice states or refrains from stating information in such a way that in the opinion of the insurer, the subject of the risk is changed or its importance is reduced.
3. If the risk of the subject of the insurance policy worsens or the situation of the insured changes in such a way that if the said situation existed before the contract, the insurer would not be willing to conclude the contract with the conditions mentioned in the contract and the policyholder's failure to agree to the adjustment of the insurance premium.
4. If the insurance policy is for a period of more than one year, at the end of each year.
B- Cases of cancellation by the policyholder: the policyholder can cancel the policy, in this case the insurer will calculate the insurance premium until the cancellation based on the short-term tariff, except in cases where the cancellation by the policyholder is documented for one of the following reasons. In this case, the insurance premium will be calculated daily until the cancellation.
1. Transferring the insurer's portfolio.
2. Reducing the risk of the insurance subject and the insurer not agreeing to adjust the insurance premium.
o Article 18- Cases of cancellation of the insurance policy: In case of the death of the insured due to the occurrence of a risk that is not covered by this insurance policy, the insurance policy will be canceled from the time of the death of the insured. In cases of termination of the insurance premium, the expired period is calculated based on the short-term tariff.
o Article 19- Effects of annulment:
A: If the insurer wants to cancel the insurance policy, it is obliged to notify the other party by letter or telegram and other appropriate means. In this case, the insurance policy is canceled one month after notifying the policyholder. is considered
B: The policyholder can request cancellation of the insurance policy by submitting a written request to the insurer. In this case, the insurance policy will be considered canceled from the date of submission of said request to the insurer.
If a specific date for cancellation is specified in the policy holder's request, the effect of cancellation will be from the latest date.
o Article 20- Responsibilities of the insured, the policyholder and the beneficiary in the event of an accident: A- As soon as an accident other than death occurs, the insured is obliged to go to the doctor and follow his orders and undergo treatment. The insured or the policyholder must notify the insurer in writing within five days after the accident. b- In case of death of the insured, the policyholder or the beneficiary must notify the insurer as soon as possible within two weeks from the date of death. Inform the insurer in writing. Unless they prove that they were not able to declare due to reasons outside of their will. d- The insured or the beneficiary is required to accept any research or medical examination, the cost of which is accepted by the insurer.
o Article 22- Determining the amount of insurance compensation:
1. Death compensation, if the insured dies due to the occurrence of one of the risks included in this insurance policy, the insurer is obligated to pay the insurance capital to the beneficiary according to the terms of this insurance policy and the supplementary documents attached to it or any other written agreement.
2. Compensation for disability or permanent disability (total and partial) If the insured suffers disability or permanent disability due to the occurrence of one of the risks covered by the insurance, the insurer is obligated to pay the corresponding compensation according to the terms of this insurance policy and its appendices. And the table of member defects is as follows.