Pradhan Mantri Suraksha Bima Yojana

1.

What is the PMSBY scheme?

It is an Accident Insurance Scheme that offers coverage for accidental death and disability.

2.

What is the annual premium?

The premium is ₹20 per annum per member.

3.

What is the coverage period?

The cover is valid for one year, running from June 1st to May 31st.

4.

How is the premium paid?

The premium is deducted from the account holder’s bank/Post office account through an ‘auto-debit’ facility.

5.

Who is eligible to join the scheme?

Individual bank account holders between the ages of 18 years (completed) and 70 years (age nearer birthday) are eligible.

6.

Can I enroll through multiple bank accounts?

No. An individual can join the scheme through only one bank/post office account.

7.

Can joint account holders enroll?

Yes. All holders of a joint account can join, provided they meet the eligibility criteria and pay the premium of ₹20 per person, per annum.

8.

Can an NRI (Non-Resident Indian) join the scheme?

Yes, if they have an eligible bank account with a bank branch located in India. The claim benefit will be paid in Indian currency.

9.

What is the maximum cover amount?

A cover of ₹2 Lakh is provided for accidental death and total irrevocable disability.

10.

What benefits are payable for partial disability?

₹1 Lakh is payable for the total and irrecoverable loss of sight of one eye, or loss of use of one hand or foot. No benefit is payable for partial disability without these specific losses.

11.

Is death by suicide covered?

No. Death due to suicide is not covered. However, death from murder is covered.

12.

Are accidents due to natural calamities covered?

Yes. Death or disability (as defined) resulting from natural calamities like earthquakes or floods is covered under the scheme.

13.

Is there a provision for hospitalization expenses?

No. The scheme provides cover only for accidental death and disability, not for hospitalization expenses.

14.

Who can claim the benefit in case of the insured’s death?

The claim can be filed by the nominee/appointee as per the enrollment form, or by the legal heir(s) if no nomination was made.

15.

When does the accident cover terminate?

The cover terminates if the member attains 70 years of age, or upon the closure of the bank account, or due to insufficient balance for the auto-debit.

16.

Do I need a medical examination to enroll in PMSBY?

No. A major feature of PMSBY is its simplicity; it does not require any medical examination or health checkups for enrollment. Acceptance is based on the satisfactory health declarations in the consent form.

17.

What happens if I enroll after the May 31st deadline?

Enrollment is still possible after May 31st. However, the risk cover will only commence from the date the premium is debited from your account, not from June 1st.

18.

Can I re-join the scheme after leaving it?

Yes. Individuals who exit the scheme can re-join in subsequent years by submitting a fresh consent/enrollment form and paying the annual premium via auto-debit. The cover will start from the date the premium is debited.

19.

What is the role of the bank/Post Office in the scheme?

The participating bank/Post Office is the Master Policy Holder. Their primary role is to recover the annual premium (₹20) via auto-debit and remit it to the insurance company. They also handle the enrollment forms and assist in the claim process.

20.

What is the procedure to file a claim under PMSBY?

The claimant (nominee/appointee/legal heir) must collect and submit the prescribed Claim Form along with the necessary supporting documents (FIR, Post-Mortem Report/Disability Certificate, etc.) to the bank/Post Office where the insured person had the account.

21.

What documents are required in case of Accidental Death?

Key documents include the filled-in Claim Form, the Death Certificate, Original FIR (or Panchnama), and the Post-Mortem Report. KYC documents of the claimant are also mandatory.

22.

Is an FIR (Police Report) always necessary for a claim?

For accidents like road/rail incidents, drowning, or death involving a crime, yes, an FIR or Panchnama is required. For incidents like snake bites or falls from a tree, the cause must be supported by immediate hospital records.

23.

How is the claim amount paid out?

Disability claims are credited directly to the insured member’s bank account. Death claims are remitted to the bank account of the registered nominee/appointee/legal heir.

24.

What incidents are NOT covered by the PMSBY scheme?

The scheme does not cover death or disability due to: Natural causes (illness/sickness), Suicide, Intentional self-inflicted injuries, or injuries sustained while under the influence of alcohol or drugs.

25.

Is there any benefit for partial injury or medical expenses?

No. The scheme is a pure accident insurance policy. It does not provide any reimbursement for hospitalization expenses (mediclaim). Benefit for disability is only paid for the specific and severe losses defined (loss of sight/use of hands/feet).

26.

Is the coverage amount reduced if I get disabled at age 65?

No. The benefit is a fixed amount (₹2 Lakh or ₹1 Lakh) as defined in the policy terms, regardless of the insured’s age at the time of the accident, as long as the policy is active and the insured is below 70 years of age.