Tata AIG Group EMI Protect Policy wordings

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

Preamble

While this policy is in force we will pay the

insured person the benets as mentioned in

the policy schedule or certicate of insurance,

if the insured event occurs during the Policy

Period subject to:

i. The terms, conditions and exclusions of

this Policy,

ii. Statements in the proposal/enrolment

form and information disclosed to Us

by You or on Your behalf and on behalf

of all persons to be insured which is

incorporated into the Policy and is the basis

of it.

Commencement of risk cover under the policy

is subject to receipt of premium by Us.

Our liability at any time shall not exceed the

maximum sum insured applicable for the benet

as specied in Your policy schedule or Certicate

of insurance.

In case of any other sum insured and coverage

restrictions, the same shall be clearly specied

in Your Policy schedule/Certicate of Insurance.

Section 1: Denitions

The terms dened below and at other junctures

in the Policy Wording have the meanings

ascribed to them wherever they appear in this

Policy and, where appropriate, references to

the singular include references to the plural;

references to the male include the female and

references to any statutory enactment include

subsequent changes to the same:

i. Standard Denitions

1. Accident

An accident means sudden, unforeseen

and involuntary event caused by external,

visible and violent means.

2. Congenital Anomaly

Congenital Anomaly means a condition

which is present since birth, and which is

abnormal with reference to form, structure

or position.

a) Internal Congenital Anomaly

Congenital anomaly which is not in

the visible and accessible parts of the

body.

b) External Congenital Anomaly

Congenital anomaly which is in the

visible and accessible parts of the

body

3. Deductible

Deductible means a cost sharing

requirement under a health insurance

policy that provides that the insurer will

not be liable for a specied rupee amount

in case of indemnity policies and for a

specied number of days/hours in case

of hospital cash policies which will apply

before any benets are payable by the

insurer. A deductible does not reduce the

Sum Insured.

4. Grace Period

Grace period means the specied period of

time immediately following the premium

due date during which a payment can be

made to renew or continue a policy in force

without loss of continuity benets such

as waiting periods and coverage of pre-

existing diseases. Coverage is not available

for the period for which no premium is

received.

5. Hospital

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

A hospital means any institution established

for in-patient care and day care treatment

of illness and/or injuries and which has

been registered as a hospital with the local

authorities under Clinical Establishments

(Registration and Regulation) Act 2010 or

under enactments specified under the

Schedule of Section 56(1) and the said act

Or complies with all minimum criteria as

under:

i. has qualied nursing sta under its

employment round the clock;

ii. has at least 10 in-patient beds in

towns having a population of less

than 10,00,000 and at least 15 in-

patient beds in all other places;

iii. has qualied medical practitioner(s)

in charge round the clock;

iv. has a fully equipped operation

theatre of its own where surgical

procedures are carried out;

v. maintains daily records of patients

and makes these accessible to the

insurance company’s authorized

personnel;

6. Hospitalization

Hospitalization means admission in a

Hospital for a minimum period of 24

consecutive ‘In-patient Care’ hours except

for specified procedures/ treatments,

where such admission could be for a

period of less than 24 consecutive hours.

7. Illness

Illness means a sickness or a disease

or pathological condition leading to the

impairment of normal physiological

function and requires medical treatment.

(a) Acute condition

Acute condition is a disease, illness or

injury that is likely to respond quickly

to treatment which aims to return the

person to his or her state of health

immediately before suffering the

disease/ illness/ injury which leads

to full recovery

(b) Chronic condition

A chronic condition is defined as

a disease, illness, or injury that

has one or more of the following

characteristics:

i. it needs ongoing or long-

term monitoring through

consultations, examinations,

check-ups, and /or tests

ii. it needs ongoing or long-term

control or relief of symptoms

iii. it requires rehabilitation for the

patient or for the patient to be

specially trained to cope with it

iv. it continues indenitely

v. it recurs or is likely to recur

8. Injury

Injury means accidental physical bodily

harm excluding illness or disease solely

and directly caused by external, violent,

visible and evident means which is veried

and certied by a Medical Practitioner.

9. Intensive Care Unit

Intensive care unit means an identied

section, ward or wing of a hospital which

is under the constant supervision of

a dedicated medical practitioner(s),

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

and which is specially equipped for the

continuous monitoring and treatment of

patients who are in a critical condition,

or require life support facilities and

where the level of care and supervision

is considerably more sophisticated and

intensive than in the ordinary and other

wards.

10. Inpatient Care

Inpatient care means treatment for which

the insured person has to stay in a hospital

for more than 24 hours for a covered event.

11. Medical Advice

Medical Advice means any consultation

or advice from a Medical Practitioner

including the issuance of any prescription

or follow-up prescription.

12. Medical Practitioner

Medical Practitioner means a person who

holds a valid registration from the Medical

Council of any State or Medical Council of

India or Council for Indian Medicine or for

Homeopathy set up by the Government of

India or a State Government and is thereby

entitled to practice medicine within its

jurisdiction; and is acting within its scope

and jurisdiction of license.

13. Medically Necessary Treatment

Medically necessary treatment means any

treatment, tests, medication, or stay in

hospital or part of a stay in hospital which:

i. is required for the medical

management of the illness or injury

suered by the insured;

ii. must not exceed the level of care

necessary to provide safe, adequate

and appropriate medical care in

scope, duration, or intensity;

iii. must have been prescribed by a

medical practitioner;

iv. must conform to the professional

standards widely accepted in

international medical practice or by

the medical community in India.

14. Pre-Existing Disease

Pre-existing disease means any condition,

ailment, injury or disease:

a) That is/are diagnosed by a physician

within 48 months prior to the

eective date of the policy issued by

the insurer or its reinstatement or

b) For which medical advice or

treatment was recommended by,

or received from a physician within

48 months prior to eective date of

the policy issued by the insurer or its

reinstatement

15. Renewal

Renewal means the terms on which the

contract of insurance can be renewed on

mutual consent with a provision of grace

period for treating the renewal continuous

for the purpose of gaining credit for pre-

existing diseases, time-bound exclusions

and for all waiting periods.

16. Unproven/Experimental treatment

Unproven/Experimental treatment means

the treatment including drug experimental

therapy which is not based on established

medical practice in India, is treatment

experimental or unproven.

ii. Specic Denitions (Denitions other

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

than as mentioned under Section 1 (i)

above)

1. Age

Means the completed age of the Insured

Person on his / her most recent birthday

as per the English calendar, regardless of

the actual time of birth.

2. EMI or EMI Amount

EMI or EMI amount means and includes

the amount of monthly payment required

to repay the principal amount of Loan and

Interest by the Insured Person as set forth

in the amortization chart referred to in

the loan agreement (or any amendments

thereto) between the Bank/Financial

Institution and the Insured person prior

to the date of occurrence of the Insured

Event under this Policy. For the purpose

of avoidance of doubt, it is claried that

any monthly payments that are overdue

and unpaid by the Insured prior to the

occurrence of the Insured Event will not

be considered for the purpose of this

Policy and shall be deemed as paid by the

Insured.

3. Hazardous or Adventure sports

Hazardous or Adventure sports means

those sports / activities which involves

speed, height, a high level of physical

exertion and holds high degree of risk.

4. Policyholder

The Policyholder shall be the Employer

who has taken the group insurance policy

as a service benet to his Employees or a

Group Manager of a homogeneous group

of persons who assemble together for a

commonality of purpose and there is a

clearly evident relationship between the

member and group manager for services

other than insurance.

5. Portability

Portability means the right accorded to an

individual health insurance policyholder

(including family cover) to transfer the

credit gained by the insured for pre-

existing conditions and time bound

exclusions if the policyholder chooses to

switch from one insurer to another insurer

or from one plan to another plan of the

same insurer, provided the previous policy

has been maintained without any break.

6. Professional sports

Professional sports shall mean a sport,

which would remunerate a player in excess

of 50% of his or her annual income as a

means of their livelihood.

7. Proposal and Enrolment Form

Proposal form/Enrolment form means any

initial or subsequent Proposal / Enrolment

made by the Policyholder/ Insured Person

and is deemed to be attached and which

forms a part of this Policy.

8. We/Us/Our

We/US/Our means TATA AIG General

Insurance Company Limited.

9. Winter Sports

Winter Sports mean snow skiing, Heli

Skiing, Mountaineering & Ice Climbing,

Auli skiing or sports held in the open air

on snow or ice.

10. You/Your/Yourself

You/Your/Yourself means the Policy Holder

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

and/or Insured Person(s) who is named in

the Policy Schedule.

Section 2: Benets

Scope of coverage - Worldwide

B1. Inpatient Hospitalization Benet

We will pay the number of EMIs/EMI

amount as specied in the Policy Schedule/

Certicate of Insurance for every completed

continuous hospitalization period of 24

hours, in the event the insured person is

hospitalized as an Inpatient due to injury/

illness/ disease during the policy period,

subject to any deductible and for specied

number of days as mentioned in Policy

Schedule/ Certicate of Insurance.

B2. Critical Illness Benet (Category “A”)

We will pay the insured person the number

of EMIs/EMI amount as specied in the

Policy Schedule/Certicate of Insurance

for the listed critical illnesses subject to the

following conditions:

a. The claim is admissible for rst time

diagnosis of listed critical illnesses

or undergoing the listed Surgery for

Critical Illness for the rst time as

mentioned below under clause (f) of

this section.

b. The claim is admissible under this

section if the critical illness manifest

after 90 days from the first risk

commencement date.

c. Claims under this section will be

admissible only if the Insured Person

survives the Illness for a period as

specified on the Policy Schedule/

Certicate of Insurance after the date

of occurrence of the listed critical

illness.

d. Pre-existing conditions or its related

conditions shall be covered after

a waiting period as specified on

the Policy Schedule/Certificate of

Insurance. The said conditions must

be declared, if known, by the insured

person at the time of application

and must not have been explicitly

excluded in the policy.

e. Only one claim shall be payable to

the insured regardless of the number

of Critical Illness/Surgery for Critical

Illness, incapacities or treatments

suered by him/her unless explicitly

stated otherwise.

f. Covered Critical Illness/Surgery for

Critical Illness: A “Critical Illness/

Surgery for Critical Illness” shall mean

any one of the following critical illness

with specic meaning as dened in

the policy:

Sl.No. Critical Illness

C1 Cancer of Specied

Severity

C2 End Stage Renal Failure

requiring dialysis

C3 Major organ/Bone

Marrow Transplant

C4 Open Heart Valve

Replacement/Repair

C5 Open Chest Coronary

Artery Bypass Graft

C6 Myocardial Infarction

(First Heart Attack of

specic severity)

C7 Refractory heart failure

C8 Cardiomyopathy

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

C9 Stroke resulting in

permanent symptoms

C10 Permanent Paralysis of

Limbs

C11 Parkinson’s disease

C12 Primary (Idiopathic)

Pulmonary Hypertension

C13 End Stage Lung Failure

C14 Aplastic Anemia

C15 End Stage Liver Failure

C1 Cancer of Specied Severity

I. A malignant tumor characterized by

the uncontrolled growth and spread

of malignant cells with invasion and

destruction of normal tissues. This

diagnosis must be supported by

histological evidence of malignancy.

The term cancer includes leukemia,

lymphoma and sarcoma.

II. The following are excluded –

i. All tumors which are

histologically described as

carcinoma in situ, benign,

pre-malignant, borderline

malignant, low malignant

potential, neoplasm of unknown

behavior, or non-invasive,

including but not limited to:

Carcinoma in situ of breasts,

Cervical dysplasia CIN-1, CIN - 2

and CIN-3.

ii. Any non-melanoma skin

carcinoma unless there is

evidence of metastases to

lymph nodes or beyond;

iii. Malignant melanoma that has

not caused invasion beyond the

epidermis;

iv. All tumors of the prostate

unless histologically classied

as having a Gleason score

greater than 6 or having

progressed to at least clinical

TNM classication T2N0M0

v. All Thyroid cancers histologically

classified as T1N0M0 (TNM

Classication) or below;

vi. Chronic lymphocytic leukaemia

less than RAI stage 3

vii. Non-invasive papillary cancer

of the bladder histologically

described as TaN0M0 or of a

lesser classication,

viii. All Gastro-Intestinal Stromal

Tumors histologically classied

as T1N0M0 (TNM Classication)

or below and with mitotic count

of less than or equal to 5/50

HPFs;

C2 End Stage Renal Failure requiring

dialysis

End stage renal disease presenting as

chronic irreversible failure of both kidneys

to function, as a result of which either

regular renal dialysis (haemodialysis or

peritoneal dialysis) is instituted or renal

transplantation is carried out. Diagnosis

has to be conrmed by a specialist medical

practitioner.

C3 Major organ/Bone Marrow Transplant

i. The actual undergoing of a transplant

of:

a. One of the following human

organs: heart, lung, liver, kidney,

pancreas, that resulted from

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

irreversible end-stage failure of

the relevant organ, or

b. Human bone marrow using

haematopoietic stem cells. The

undergoing of a transplant has

to be conrmed by a specialist

medical practitioner.

ii. The following are excluded:

a. Other stem-cell transplants

b. Where only Islets of Langerhans

are transplanted

C4 Open Heart Valve Replacement/Repair

The actual undergoing of open-heart valve

surgery to replace or repair one or more

heart valves, as a consequence of defects

in, abnormalities of, or disease aected

cardiac valve(s). The diagnosis of the valve

abnormality must be supported by an

echocardiography and the realization of

surgery has to be conrmed by a specialist

medical practitioner.

Catheter based techniques including

but not limited to, balloon valvotomy/

valvuloplasty are excluded.

C5 Open Chest Coronary Artery Bypass

Graft

i. The actual undergoing of heart

surgery to correct blockage or

narrowing in one or more coronary

artery(s), by coronary artery bypass

grafting done via a sternotomy

(cutting through the breast bone) or

minimally invasive keyhole coronary

artery bypass procedures. The

diagnosis must be supported by

a coronary angiography and the

realization of surgery has to be

conrmed by a cardiologist.

ii. The following are excluded:

a. Angioplasty and/or any other

intra-arterial procedures

C6 Myocardial Infarction (First Heart

Attack of specic severity)

i. The rst occurrence of heart attack or

myocardial infarction, which means

the death of a portion of the heart

muscle as a result of inadequate

blood supply to the relevant area. The

diagnosis for Myocardial Infarction

should be evidenced by all of the

following criteria:

a. A history of typical clinical

symptoms consistent with the

diagnosis of acute myocardial

infarction (For e.g. typical chest

pain)

b. New characteristic

electrocardiogram changes

c. Elevation of infarction specic

enzymes, Troponins or other

specic biochemical markers.

ii. The following are excluded:

a. Other acute Coronary

Syndromes

b. Any type of angina pectoris

c. A rise in cardiac biomarkers or

Troponin T or I in absence of

overt ischemic heart disease

OR following an intra-arterial

cardiac procedure.

C7 Refractory heart failure

Refractory heart failure must be diagnosed

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

by a Cardiologist and optimal therapy

must have been established for at least

6 months. The diagnosis of heart failure

to be evidence by at least any 4 following

criteria:

a. Class 3 of the New York Heart

Association classification’s of

functional capacity (heart disease

resulting in marked limitation of

physical activities where less than

ordinary activity causes fatigue,

palpitation, breathlessness or chest

pain)

b. Presence of third heart sound

c. Jugular venous pressure above 6cms

d. Rales present in both bases on

auscultation

e. Cardiomegaly on chest x-ray

f. Grade 3, or gross ascites, associated

with marked abdominal distension or

peripheral oedema

g. 2-D echocardiography report

suggestive of LVEF of 40% or less

h. Elevated biomarkers – B-type

natriuretic peptide (BNP)/N-terminal

pro-BNP(NT-proBNP)

The following are excluded:

• Heart Failure due to Auto-immune

disorders

• Heart Failure secondary to drug or

alcohol abuse

C8 Cardiomyopathy

A diagnosis of cardiomyopathy by a

Specialist Medical Practitioner

(Cardiologist). There must be clinical

impairment of heart function resulting in

the permanent loss of ability to perform

physical activities for a minimum period

of 30 days to at least Class 3 of the New

York Heart Association classication’s of

functional capacity (heart disease resulting

in marked limitation of physical activities

where less than ordinary activity causes

fatigue, palpitation, breathlessness or

chest pain) and LVEF of 40% or less.

The following are excluded:

• Cardiomyopathy secondary to alcohol

or drug abuse.

• All other forms of heart disease, heart

enlargement and myocarditis.

C9 Stroke resulting in permanent

symptoms

i. Any cerebrovascular incident

producing permanent neurological

sequelae. This includes infarction

of brain tissue, thrombosis in an

intracranial vessel, haemorrhage and

embolisation from an extracranial

source. Diagnosis has to be conrmed

by a specialist medical practitioner

and evidenced by typical clinical

symptoms as well as typical ndings

in CT Scan or MRI of the brain.

Evidence of permanent neurological

decit lasting for at least 3 months

has to be produced.

ii. The following are excluded:

a. Transient ischemic attacks (TIA)

b. Traumatic injury of the brain

c. Vascular disease affecting

only the eye or optic nerve or

vestibular functions.

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

C10 Permanent Paralysis of Limbs

Total and irreversible loss of use of two or

more limbs as a result of injury or disease

of the brain or spinal cord. A specialist

medical practitioner must be of the opinion

that the paralysis will be permanent with

no hope of recovery and must be present

for more than 3 months.

C11 Parkinson’s disease

Unequivocal diagnosis of idiopathic or

primary Parkinson’s Disease (all other

forms of Parkinsonism are excluded)

before age 65 that has to be conrmed by

a Consultant Neurologist.

The disease cannot be controlled with

medication; objective sign of progressive

impairment and the disease must result

in a permanent inability to perform

independently three or more Activities of

Daily Living:

i. Bathing(ability to wash in the bath or

shower),

ii. Dressing (ability to put on, take o,

secure and unfasten garments),

iii. Personal hygiene (ability to use the

lavatory and to maintain a reasonable

level of hygiene),

iv. Mobility (ability to move indoors on

a level surface), continence(ability

to manage bowel and bladder

functions),

v. Eating/Drinking (ability to feed

oneself (but not to prepare the food)

vi. Must result in a permanent bedridden

situation and inability to get up

without outside assistance.

These conditions have to be medically

documented for at least 90 days. Excluded

are Drug-induced or toxic causes of

Parkinsonism.

C12 Primary (Idiopathic) Pulmonary

Hypertension

I. An unequivocal diagnosis of Primary

(Idiopathic) Pulmonary Hypertension

by a Cardiologist or specialist in

respiratory medicine with evidence of

right ventricular enlargement and the

pulmonary artery pressure above 30

mm of Hg on Cardiac Cauterization.

There must be permanent irreversible

physical impairment to the degree of

at least Class IV of the New York Heart

Association Classication of cardiac

impairment.

II. The NYHA Classication of Cardiac

Impairment are as follows:

i. Class III: Marked limitation of

physical activity. Comfortable

at rest, but less than ordinary

activity causes symptoms.

ii. Class IV: Unable to engage in

any physical activity without

discomfort. Symptoms may be

present even at rest.

III. Pulmonary hypertension associated

with lung disease, chronic

hypoventilation, pulmonary

thromboembolic disease, drugs and

toxins, diseases of the left side of the

heart, congenital heart disease and

any secondary cause are specically

excluded.

C13 End stage Lung Failure

End stage lung disease, causing chronic

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

respiratory failure, as confirmed and

evidenced by all of the following:

i. FEV1 test results consistently less

than 1 litre measured on 3 occasions

3 months apart; and

ii. Requiring continuous permanent

supplementary oxygen therapy for

hypoxemia; and

iii. Arterial blood gas analysis with partial

oxygen pressure of 55mmHg or less

(PaO2 < 55mmHg); and

iv. Dyspnea at rest.

C14 Aplastic Anemia

Chronic persistent bone marrow failure

which results in anaemia, neutropenia and

thrombocytopenia requiring treatment

with at least one of the following:

• Blood product transfusion;

• Marrow stimulating agents;

• Immunosuppressive agents; or

• Bone marrow transplantation

A certied hematologist must make the

diagnosis of severe irreversible aplastic

anemia. There must be permanent bone

marrow failure resulting in bone marrow

cellularity of less than 25% and there must

be two of the following:

• Absolute neutrophil count of less

than 500/mm³

• Platelets count less than 20,000/mm³

• Reticulocyte count of less than

20,000/mm³

Temporary or reversible Aplastic

Anemia is excluded.

C15 End stage Liver Failure

I. Permanent and irreversible failure of

liver function that has resulted in all

three of the following:

i. Permanent jaundice; and

ii. Ascites; and

iii. Hepatic encephalopathy.

II. Liver failure secondary to drug or

alcohol abuse is excluded.

Limitations applicable to Section B2 – Critical

illness

I. In the event of more than one claim of

critical illness (es) is/are lodged under

this policy, We shall only pay for one such

critical illness claim during the policy year,

unless explicitly stated otherwise Upon

payment of this claim, the coverage for

critical illness would cease to continue till

expiry of the policy. However, the cover for

other benets which have a separate sum

insured shall continue till the expiry of the

policy and our liability for such benets

shall be restricted to the sum insured for

such benet as mentioned on the Policy

Schedule/Certicate of Insurance.

II. We will not pay more than once for the

same critical illness claim under the policy

(even after renewals).

B3. Personal Accident

P1 Accidental Death

We will pay to Insured person’s beneciary

or legal representative the specified

number of EMIs/EMI amount/sum insured

as specified in the Policy Schedule/

Certificate of Insurance, if an Insured

Person suffers an accident during the

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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policy period and this is the proximate

cause of his death within 365 days from

the date of accident.

P2 Disappearance

We will pay to Insured person’s beneciary

or legal representative the specified

number of EMIs/EMI amount/sum insured

as specified in the Policy Schedule/

Certicate of Insurance, for Loss of Life

occurring within policy period if Insured

person’s body cannot be located within 365

Days after the forced landing, stranding,

sinking or wrecking of a conveyance in

which You were a passenger or as a result

of any Acts of God, subject to all other

terms and provisions of the Policy.

P3 Permanent Total Disability

We will pay the specied number of EMIs/

EMI amount as specified in the policy

schedule/Certicate of Insurance, if injury

to you results in you suering Permanent

Total Disability. The injury must occur

within the policy period as mentioned in

the policy schedule/Certicate of insurance

and the disability should continue for

365 days from the date of accident which

caused the injury. This waiting period of

365 days is not applicable for severance

or amputation cases.

If the Insured Person suers more than

one below mentioned loss as a result

of the same accident, our liability shall

be restricted to the specified benefit

amount mentioned on the Policy Schedule/

Certicate of Insurance.

For the purpose of this cover, Permanent

Total Disability shall mean either of the

following:

• Irrecoverable Loss of sight of both

eyes

• Physical Separation of or the

irrecoverable loss of ability to use

both hands or both feet

• Physical Separation of or the

irrecoverable loss of ability to use

one hand and one foot

• Irrecoverable Loss of sight of one eye

and the physical separation of or the

irrecoverable loss of ability to use

either one hand or one foot.

Specic Exclusions applicable to this Section B3

The following exclusions will be applicable in

addition to the General Exclusions listed in this

Policy:

i. Any Pre-existing injury or disability or any

complication arising from it. This exclusion

shall not be applicable if the proximate

cause is accident or

ii. Any physical disability which existed prior

to rst risk inception date which was not

disclosed , or

iii. Expenses for treatment directly arising

from or consequent upon any Insured

Person committing or attempting to

commit a breach of law with criminal

intent.

iv. Being under the inuence of drugs, alcohol,

or other intoxicants or hallucinogens

unless properly prescribed by a Physician

and taken as prescribed; or

v. War, civil war, invasion, insurrection,

revolution, act of foreign enemy, hostilities

(whether War be declared or not), rebellion,

mutiny, use of military power or usurpation

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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of government or military power; or

vi. Serving in any branch of the Military or

Armed Forces of any country, whether in

peace or War, and in such an event We,

upon written notification by You, shall

return the pro rata premium for any such

period of service; or

vii. Ionising radiation or contamination by

radioactivity from any nuclear fuel or from

any nuclear waste from burning nuclear

fuel; or

viii. The radioactive, toxic, explosive or other

dangerous properties of any explosive

nuclear equipment or any part of that

equipment; or

ix. Caused due to act of terrorism.

x. Expenses related to any treatment

necessitated due to participation as a

professional in hazardous or adventure

sports, including but not limited to, para-

jumping, rock climbing, mountaineering,

rafting, motor racing, horse racing or scuba

diving, hand gliding, sky diving, deep-sea

diving.

xi. Disability based on a Diagnosis made by

the Insured or his/her Immediate Family

Member or anyone who is living in the

same household as the Insured or by a

herbalists, acupuncturist or any other non-

traditional health care provider.

Limitations applicable to Section 2 – Benets

Upon payment of the claim under this section,

the coverage for this section would cease to

continue till expiry of the policy unless otherwise

explicitly stated. However, the cover for other

benets which have a separate sum insured

shall continue till the expiry of the policy and

our liability for such benets shall be restricted

to the sum insured for the benet as mentioned

on the Policy Schedule/Certicate of Insurance.

Section 3: Exclusions

i. Standard Exclusions

1. Exclusions with Waiting Period

Applicable for both B1 (Inpatient

Hospitalization Benet) & B2 (Critical Illness

Benet) of the base cover

i. Pre-existing Diseases(Code-Excl01)

a. Expenses related to the treatment

of a pre-existing Disease (PED)

and its direct complications shall

be excluded until the expiry of 48

months of continuous coverage after

the date of inception of the rst policy

with insurer.

b. In case of enhancement of sum

insured the exclusion shall apply

afresh to the extent of sum insured

increase.

c. If the Insured Person is continuously

covered without any break as dened

under the portability norms of the

extant IRDAI (Health Insurance)

Regulations, then waiting period for

the same would be reduced to the

extent of prior coverage.

d. Coverage under the policy after the

expiry of 48 months for any pre-

existing disease is subject to the

same being declared at the time of

application and accepted by Insurer.

Applicable for B1 (Inpatient Hospitalization

Benet) of the base cover

ii. A Specied disease/procedure waiting

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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period (Code-Excl02)

a. Expenses related to the treatment of the

listed Conditions, surgeries/treatments

shall be excluded until the expiry of 24

months of continuous coverage after the

date of inception of the rst policy with us.

This exclusion shall not be applicable for

claims arising due to an accident.

b. In case of enhancement of sum insured the

exclusion shall apply afresh to the extent

of sum insured increase.

c. If any of the specied disease/procedure

falls under the waiting period specied for

pre-Existing diseases, then the longer of

the two waiting periods shall apply.

d. The waiting period for listed conditions

shall apply even if contracted after the

policy or declared and accepted without a

specic exclusion.

e. If the Insured Person is continuously

covered without any break as defined

under the applicable norms on portability

stipulated by IRDAI, then waiting period for

the same would be reduced to the extent

of prior coverage.

f. The following Illnesses/diseases would be

covered after a waiting period irrespective

of the treatment undergone, medical or

surgical:

a. Tumors, Cysts, polyps including

breast lumps (benign)

b. Polycystic ovarian disease

c. Fibromyoma

d. Adenomyosis

e. Endometriosis

f. Prolapsed Uterus

g. Non-infective arthritis

h. Gout and Rheumatism

i. Osteoporosis

j. Ligament, Tendon or Meniscal tear

(due to injury or otherwise)

k. Prolapsed Inter Vertebral Disc (due

to injury or otherwise)

l. Cholelithiasis

m. Pancreatitis

n. Fissure/stula in anus, haemorrhoids,

pilonidal sinus

o. Ulcer & erosion of stomach &

duodenum

p. Gastro Esophageal Reux Disorder

(GERD)

q. Liver Cirrhosis

r. Perineal Abscesses

s. Perianal / Anal Abscesses

t. Calculus diseases of Urogenital

system Example: Kidney stone,

Urinary bladder stone.

u. Benign Hyperplasia of prostate

v. Varicocele

w. Cataract

x. Retinal detachment

y. Glaucoma

z. Congenital Internal Diseases

The following treatments are covered after

a waiting period irrespective of the illness

for which it is done:

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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a. Adenoidectomy

b. Mastoidectomy

c. Tonsillectomy

d. Tympanoplasty

e. Surgery for nasal septum deviation

f. Nasal concha resection

g. Surgery for Turbinate hypertrophy

h. Hysterectomy

i. Joint replacement surgeries Eg: Knee

replacement, Hip replacement

j. Cholecystectomy

k. Hernioplasty or Herniorraphy

l. Surgery/procedure for Benign

prostate enlargement

m. Surgery for Hydrocele/ Rectocele

n. Surgery of varicose veins and varicose

ulcers

iii. 30 days waiting period (Code-Excl03)

a. Expenses related to the treatment of

any illness within 30 days from the

rst policy commencement date shall

be excluded except claims arising due

to an accident, provided the same are

covered.

b. This exclusion shall not, however,

apply if the Insured Person has

Continuous Coverage for more than

twelve months.

c. The within referred waiting period

is made applicable to the enhanced

sum insured in the event of granting

higher sum insured subsequently.

2. Medical Exclusions

We will not make any payment for any

claim in respect of any Insured Person,

arising from or in any way attributable to

any of the following unless expressly stated

to the contrary in this Policy:

i. Investigation & Evaluation (Code-

Excl04)

a. Expenses related to any

admission primarily for

diagnostics and evaluation

purpose only are excluded.

b. Any diagnostic expenses which

are not related or not incidental

to the current diagnosis and

treatment are excluded.

ii. Rest Cure, rehabilitation and

respite care(Code-Excl05)

a. Expenses related to any

admission primarily for

enforced bed rest and not for

receiving treatment. This also

includes:

i. Custodial care either at

home or in a nursing

facility for personal care

such as help with activities

of daily living such as

bathing, dressing, moving

around either by skilled

nurses or assistant or non-

skilled persons.

ii. Any services for people

who are terminally ill to

address physical, social,

emotional and spiritual

needs.

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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iii. Obesity and weight control: (Code-

Excl06)

Expenses related to the surgical treatment

of obesity that does not fulll all the below

conditions:

1. Surgery to be conducted is upon the

advice of the Doctor

2. The surgery/Procedure conducted

should be supported by clinical

protocols

3. The member has to be 18 years of

age or older and

4. Body Mass Index (BMI);

a. greater than or equal to 40 or

b. greater than or equal to 35 in

conjunction with any of the

following severe co-morbidities

following failure of less invasive

methods of weight loss:

i. Obesity-related

cardiomyopathy

ii. Coronary heart disease

iii. Severe Sleep Apnea

iv. Uncontrolled Type2

Diabetes

iv. Change-of-Gender treatments

(Code- Excl07)

Expenses related to any treatment,

including surgical management, to

change characteristics of the body to

those of the opposite sex.

v. Cosmetic or Plastic Surgery (Code-

Excl 08)

Expenses for cosmetic or plastic

surgery or any treatment to change

appearance unless for reconstruction

following an Accident, Burn(s) or

Cancer or as part of medically

necessary treatment to remove a

direct and immediate health risk to

the insured. For this to be considered

a medical necessity, it must be

certified by the attending Medical

Practitioner.

vi. Treatment for, Alcoholism, drug or

substance abuse or any addictive

condition and consequences thereof.

(Code- Excl 12)

vii. Refractive Error(Code- Excl 15)

Expenses related to the treatment

for correction of eye sight due to

refractive error less than 7.5 dioptres.

viii. Unproven treatments (Code- Excl 16)

Expenses related to any unproven

treatment, services and supplies for

or in connection with any treatment.

Unproven treatments are treatments,

procedures or supplies that lack

signicant medical documentation

to support their eectiveness.

ix. Sterility and Infertility (Code- Excl 17)

Expenses related to Birth Control,

sterility and infertility. This includes:

a. Any type of contraception,

sterilization

b. Assisted Reproduction services

including articial insemination

and advanced reproductive

technologies such as IVF, ZIFT,

GIFT, ICSI

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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c. Gestational Surrogacy

d. Reversal of sterilization

x. Maternity (Code - Excl 18)

i. Medical treatment expenses

traceable to childbirth (including

complicated deliveries and

caesarean sections incurred

during hospitalization) except

ectopic pregnancy.

ii. Expenses towards miscarriage

(unless due to an accident) and

lawful medical termination of

pregnancy during the policy

period.

3. Non-Medical Exclusions

i. Breach of law (Code- Excl 10):

Expenses for treatment directly

arising from or consequent upon

any Insured Person committing or

attempting to commit a breach of law

with criminal intent.

ii. Excluded Providers: (Code-Excl 11)

Expenses incurred towards treatment

in any hospital or by any Medical

Practitioner or any other provider

specically excluded by the Insurer

and disclosed in its website /

notied to the policyholders are not

admissible. However, in case of life

threatening situations or following an

accident, expenses up to the stage of

stabilization are payable but not the

complete claim.

ii. Specific Exclusions (Exclusions other

than as mentioned under Section 3 (i)

above)

i. Alcoholic Pancreatitis

ii. Admission primarily for long term

connement or rehabilitative care

where there is no active line of

treatment in case of psychiatric/

mental disorders

iii. Parkinsons and Alzheimer’s disease

iv. General debility or exhaustion or run-

down condition

v. Congenital External Diseases, defects

or anomalies

vi. Stem cell implantation or surgery

(except for haematological

conditions); or growth hormone

therapy;

vii. Sleep-apnoea

viii. Charges related to Peritoneal Dialysis

(CAPD), including supplies (except

during per-post hospitalization

period)

ix. Venereal disease, sexually

transmitted disease or illness;

x. All preventive care, vaccination

including inoculation and

immunisations;

xi. Dental treatment or surgery of any

kind unless as a result of Accidental

Bodily Injury/Illness/Disease to

natural teeth and also requiring

hospitalization

xii. Any non-allopathic treatment

xiii. Any other Critical illness which is not

listed (applicable for Section B2 only)

xiv. Any Critical Illness/Disability based

on a Diagnosis made by the Insured

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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or his/her Immediate Family Member

or anyone who is living in the same

household as the Insured or by a

herbalists, acupuncturist or any other

non-traditional health care provider.

4. Non-Medical Exclusions

i. War or any act of war, invasion, act

of foreign enemy, civil war, public

defence, rebellion, revolution,

insurrection, military or usurped

acts, nuclear weapons/materials,

chemical and biological weapons,

ionising radiation.

ii. Expenses related to any treatment

necessitated due to participation

as a professional in hazardous or

adventure sports, including but

not limited to, para-jumping, rock

climbing, mountaineering, rafting,

motor racing, horse racing or scuba

diving, hand gliding, sky diving, deep-

sea diving.

iii. Intentional self-injury or attempted

suicide while sane or insane.

iv. Any claim incurred after date of

proposal/enrolment form and before

issuance of policy/Certificate of

Insurance where there is change in

health status of the member and the

same is not communicated to us.

Section 4 – General Terms and Clauses

Specic Terms and Clauses

1. Condition Precedent

i. Condition Precedent means a policy

term or condition upon which the

Insurer’s liability under the policy is

conditional upon.

ii. The fulfilment of the terms and

conditions of this Policy (including

the payment of premium by the due

dates mentioned in the Schedule)

insofar as they relate to anything

to be done or complied with by

You or any Insured Person shall be

conditions precedent to Our liability.

iii. The premium for the policy will

remain the same for the policy period

as mentioned in the policy schedule.

iv. No change in this Policy shall be valid

unless a valid endorsement is passed

in the policy.

v. In case of master policy, the policy

period would be 1 year however the

period of certificate of insurance

would be from 1 year to 5 years.

Details of the policy term applicable

to individual certicate of insurance

would be clearly stated in Your

certicate of insurance.

2. Insured Person

i. Only those persons named as

an Insured Person in the Policy

Schedule/Certificate of insurance

shall be covered under this Policy.

ii. Mid-term addition of Primary Insured

and Dependents:

Mid-term addition of Primary insured

and dependents shall be allowed in

the event of following:

1. Intimation is given to Us by

a dened & agreed date and

shall be subjected to IRDAI

(Insurance Regulatory and

Development Authority of

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

India) group insurance policies

guidelines, 2005 and any

subsequent amendments as

published by the Regulator

from time to time

2. Requisite premium has been

paid to Us.

3. All existing dependents must be

covered along with the Primary

Insured and the addition of

Dependents shall be allowed

only in the event of:

• Children in the event of

childbirth

• Spouse in the event of

marriage

If any of the conditions (1) & (2) above

are not met, coverage will commence

only from the date of intimation to Us

or premium remittance whichever is

later.

iii. Mid-term deletion of Primary Insured

and Dependents:

a. The coverage shall automatically

expire from the date the insured

person exits the scheme.

b. In case of refund of premium

being generated on the

Policy due to deletion of

Insured Persons, the same

will be refunded or adjusted

accordingly against the future

premium installments due on

the Policy.

3. Entire Contract

i. This Policy, its Schedule,

endorsement(s), proposal/enrolment

form constitutes the entire contract

of insurance. No change in this policy

shall be valid unless approved by

Us and such approval be endorsed

hereon.

ii. This Policy and the policy Schedule/

Certificate of insurance shall be

read together as one contract and

any word or expression to which a

specic meaning has been attached

in any part of this Policy or of the

Schedule shall bear such meaning

wherever it may appear.

4. Fraud

i. We will not be liable to pay under

the policy if any claim is in any

manner dishonest or fraudulent

or is supported by any dishonest

or fraudulent means or devices,

whether by You or any Insured

Person or anyone acting on behalf

of You or an Insured Person.

ii. In the event of fraud done by a primary

insured person/his dependents, the

certificate of insurance shall be

terminated ab initio without any

premium refund.

5. Mis-representation, or non-disclosure

of material facts

We will not be liable to pay under the policy

if any Mis-representation or non-disclosure

of material facts is noted at the time of

claim or otherwise, whether by You or any

Insured Person or anyone acting on behalf

of You or an Insured Person, & certicate

of insurance shall be void ab-initio without

any premium refund.

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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6. Renewal conditions

i. The Policy is ordinarily renewable

lifelong unless You or any one

acting on behalf of You has acted

in a fraudulent manner or any

misrepresentation under or in

relation to this policy or renewal of

the Policy poses a moral hazard.

ii. The Policy/Certicate of Insurance

may be renewed by upfront payment

of the total premium specified by

Us, which premium shall be at Our

premium rate in force at the time of

renewal. Premium rates are subject

to revision at the time of renewal

depending upon overall performance

of the product and / or the claim

experience under the policy.

iii. Your premium will also change if you

move into a higher age group, change

in Sum Insured, change the term or

change the plan.

iv. The Policy may be renewed by

mutual consent and in such event

the renewal premium should be

paid to Us on or before the date of

expiry of the Policy or within the grace

period of 30 days from the expiry of

the Policy. Grace Period of 30 days

for renewing the Policy/Certicate

of Insurance is provided under

this Policy. If the renewal is made

within the grace period, continuity of

benets will be allowed. We will not

be liable to pay for any claim under

this policy that occur during the grace

Period. Grace period at the time of

renewal is applicable for all policies

irrespective of premium payment

frequency.

v. We, however, are not bound to give

notice that it is due for renewal.

Unless renewed as herein provided,

this Policy or Certicate of Insurance

shall terminate at the expiration of

the period for which premium has

been paid.

vi. Any revision / modification in the

product will be done with the

approval of the Insurance Regulatory

and Development Authority of India

(IRDAI) and will be intimated to You

at least 3 months in advance.

7. Option to Migrate

We will oer the Insured Person an option

to migrate to similar health insurance

Policy with Us provided that:

i. Insured Person has been insured with

Us under this Policy

ii. This option for migration to similar

health insurance policy shall be

exercised by the Insured Person

only when he / she is at the end of

specied exit age and certainly at the

time of renewal only.

iii. Insured Person will be offered

continuity of coverage & suitable

credits, if any, for all the previous

policy years, provided the policy has

been maintained without a break.

8. Withdrawal of Policy

i. In the likelihood of this product being

withdrawn in future, we will intimate

you about the same 3 months prior

to expiry of the policy.

ii. You will have the option to migrate

to similar health insurance product

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

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available with us at the time of

renewal with all the accrued

continuity benets such as waiver

of waiting period etc. provided the

policy has been maintained without

a break as per portability guidelines

issued by IRDAI.

9. Portability

We shall allow portability under this

policy which shall be in accordance with

portability guidelines as dened by the

IRDAI from time to time.

10. Notices

Any notice, direction or instruction under

this Policy shall be in writing and if it is to:

a. Any Insured Person, then it shall be

sent to You at Your address specied

in the Schedule to this Policy and You

shall act for all Insured Persons for

these purposes.

b. Us, it shall be delivered to Our

address specified in the Schedule

to this Policy. No insurance agents,

brokers or other person or entity

is authorised to receive any notice,

direction or instruction on Our behalf

unless We have expressly stated to

the contrary in writing.

11. Termination

i. You may terminate this Policy /

Certicate of Insurance at any time

by giving Us written notice, and the

Policy/Certicate of Insurance shall

terminate when such written notice

is received.

ii. In case of master policy, each

Certificate of Insurance will get

terminated on the earliest of the

following dates:

a. The date You or We cancel the

Certicate of Insurance

b. Insured Person opts out of the

scheme

c. Foreclosure/closure of loan

availed (wherever applicable)

The insured person has an option to

continue the cover till the expiry of

the Certicate of Insurance in case

of condition (c) as mentioned above.

In the event of foreclosure/closure

of entire loan where certificate of

insurance is terminated, we shall

refund proportionate premium

provided there are no claims under

the policy. In case of prepayment of

the entire loan and upon making any

refund of premium under this Policy

in accordance with the terms and

conditions hereof in respect of the

Insured person, the cover in respect

of the Insured person shall forthwith

terminate and the Company shall not

be liable hereunder.

iii. If no claim has been made under

the Policy/Certicate of Insurance,

then We will refund premium in

accordance with the short rate table

below:

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

iv. We may at any time terminate this Policy

/Certicate of insurance on grounds of

misrepresentation, fraud, non-disclosure

of material facts or non-cooperation by

You or any Insured Person or anyone acting

on Your behalf or on behalf of an Insured

Person by sending an endorsement to

Your address shown in the Schedule to this

Policy.

v. In the event of termination of this Policy/

Certificate of insurance on grounds of

mis-representation, fraud, non-disclosure

of material facts, the policy shall stand

cancelled ab-initio and there will be no

refund of premium.

vi. In the event the policy/Certificate of

insurance is terminated on grounds of

non-cooperation of the Insured Person the

premium shall be computed in accordance

with Our short rate table for the period

the Policy has been in force, upon 15

days notice by sending an endorsement

to Your address shown in the Schedule

provided no claim has occurred up to the

date of termination. In the event a claim

has occurred in which case there shall be

no return of premium.

12. Free Look Period

i. You have a period of 15 days from

the date of receipt of the Policy /

Certicate of Insurance to review the

terms and conditions of this Policy.

If You have any objections to any of

the terms and conditions, You have

the option of cancelling the Policy/

Certicate of insurance stating the

Year

Length of time Policy in

force

1 2 3 4 5

Upto 1 Month 85.00% 87.50% 91.50% 96% 98%

>1 month & Upto 3

Months

70.00% 75.00% 88.50% 93% 95%

>3 months & Upto 6

Months

50.00% 62.50% 75% 78% 80%

>6 months & Upto 12

Months

Nil 50.00% 66.50% 70% 72%

>12 months & Upto 15

Months

Not Applicable 30% 50% 52% 54%

>15 months & Upto 18

Months

Not Applicable 20% 41.50% 43% 44%

>18 months & Upto 24

months

Not Applicable Nil 33% 35% 36%

>24 months & Upto 30

months

Not Applicable Not Applicable 15% 20% 30%

> 30 months & Up to 36

months

Not Applicable Not Applicable Nil 15% 25%

> 36 months & up to 42 Not Applicable Not Applicable Not Applicable Nil 20%

Exceeding 42 months Not Applicable Not Applicable Not Applicable Nil Nil

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

reasons for cancellation.

ii. You will be refunded the premium

paid by You after adjusting the stamp

duty charges and proportionate risk

premium.

iii. You can cancel Your Policy/Certicate

of insurance only if You have not

made any claims under the Policy.

iv. All Your rights under this Policy will

immediately stand extinguished

on the free look cancellation of the

Policy.

v. Free look provision is not applicable

and available at the time of renewal

of the Policy.

Section 5 – Claims Procedure and Claims

Payment

This section explains about the procedures

involved to file a valid claim by the insured

person and processes related in managing the

claim by Us. All the procedures and processes

such as notication of claim, supporting claim

documents and related claim terms of payment

are explained in this section.

1. Notication of Claim

Treatment,

Consultation or

Procedure:

We must be

informed:

1 If any treatment

for which a claim

may be made and

that treatment

requires planned

Hospitalisation:

At least 48

hours prior to

the Insured

Person’s

admission.

2 If any treatment

for which a claim

may be made and

that treatment

requires

emergency

Hospitalisation

Within 24

hours of

the Insured

Person’s

admission to

Hospital.

Failure to furnish such intimation within

the time required shall not invalidate nor

reduce any claim if You can satisfy us that

it was not reasonably possible for You to

give proof of such delay within such time.

The Company may relax these timelines

only in special circumstances and for the

reasons beyond the control of the insured.

2. Supporting Documentation &

Examination

i. You or someone claiming on

Your behalf shall provide Us with

documentation, medical records

and information We may request to

establish the circumstances of the

claim, its quantum or Our liability for

the claim within 15 days or earlier of

Our request or the Insured Person’s

discharge from Hospitalisation or

completion of treatment.

ii. Failure to furnish such evidence

within the time required shall not

invalidate nor reduce any claim if

you can satisfy us that it was not

reasonably possible for you to give

proof within such time.

iii. We may accept claims where

documents have been provided

after a delayed interval only in special

circumstances and for the reasons

beyond the control of the Insured

Person.

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

iv. Such documentation will include

the following:

I. Our claim form, duly completed

and signed for on behalf of

the Insured Person.We, upon

receipt of a notice of claim, will

furnish Your representative

with such forms as We may

require for ling proofs of loss

or you may download the claim

form from our Web site www.

tataaig.com

II. Regulatory requirements as

amended from time to time,

currently mandatory NEFT (to

enable direct credit of claim

amount in bank account) and

KYC (recent ID/Address proof

and photograph) requirements.

III. Current loan account statement

IV. In addition to the documents

mentioned above (I - III),

following documents are

applicable for:

Section B1 – Inpatient Hospitalization Benet:

a. All medical reports, case histories,

investigation reports, indoor case papers/

treatment papers (if available) discharge

summaries.

b. A precise diagnosis of the treatment for

which a claim is made.

c. Treating doctor’s certificate regarding

missing information in case histories e.g.

Circumstance of injury and Alcohol or

drug inuence at the time of accident, if

available.

d. Copy of MLC (Medico legal case) records,

if carried out and FIR (First information

report) if registered, in case of claims

arising out of an accident and available

with the claimant.

Section B2 – Critical Illness:

a. Medical Certicate and investigation report

conrming the diagnosis of Critical Illness/

Surgery

b. Copy of complete medical records such as

Hospital Discharge card/Summary, Indoor

case papers along with the diagnostic

Laboratory & radiological investigation

reports including CT Scan, MRI & USG

report with plates, wherever applicable

and done

c. A precise diagnosis of the treatment for

which a claim is made

d. i) Previous and subsequent

consultation letter, medical records

and prescriptions related to illness/

surgery.

ii) In the event insured person suers

from one of the following critical

illness and where death occurs within

3 months of such diagnosis, but after

conrmed diagnosis of the illness,

then the modified condition as

mentioned below shall be applicable

to the respective Critical Illness.

However, this is subject to fullment

of other conditions as laid down

under denitions of respective critical

illness and for the period for which

the Insured survived the diagnosis

of Critical Illness

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

e. Copy of MLC (Medico legal case) records,

if carried out and FIR (First information

report) if registered, in case of claims

arising out of an accident and available

with the claimant.

f. Recent Photograph

g. Death certificate/Death summary, if

applicable

h. Post Mortem report (wherever applicable

& conducted)

i. Legal heir/succession certificate, if

applicable & available

Section B3 – Personal Accident:

1. Accidental Death/Disappearance:

a. Attending Physician Statement if

applicable

b. Original \Nominee Attested copy of

Death Certicate

c. In the event of disappearance where

death certificate is not issued, we

would require missing compliant

report led with the police authorities

or police inquest/ investigation

report.

d. Copy of death summary, all previous

medical records, if hospitalised /

treatment given.

e. Copy of Post Mortem report, if

applicable and conducted

f. Copy of FIR, if led / Panchanama, if

conducted

g. Recent Photograph

h. Nominee-attested copy of news

paper cutting, if any.

2. Permanent Total Disability:

a. Attending Doctor Statement if

applicable

b. certificate from Civil Surgeon or

Medical Superintendent/Dean of

government hospital/medical board,

conrming the Disability percentage

/ period and prognosis

c. Copy of Admission/ discharge card

with complete medical records

Critical

Illness

(Section

1-B2)

Name of Critical Illness Modied Condition applicable

C9 Stroke resulting in permanent

symptoms

Evidence of permanent neurological decit

lasting for the period for which the Insured

person survived

C10 Permanent Paralysis of Limbs Evidence of existence of paralysis for the

period for which the Insured person survived

C11 Parkinson’s disease Medical documentation of conditions (i-vi) for

the period the Insured Person survived

C13 End Stage Lung Failure Condition (i) wherein FEV1 test results for the

period the Insured Person survived

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

including relevant Investigation/ Lab

reports (X-Ray, MRI etc.)

d. Copy of FIR, if led / Panchanama, if

conducted

e. Photograph of injured area, if

required

f. Self-attested copy of news paper

cutting, if any.

V. For any claim related assistance,

notication of claim and submission of

claim related documents, insured person

can contact Us through:

• Website : www.tataaig.com

• Toll Free No.: 1800 266 7780/ For

Senior Citizens: 1800 22 9966

• Courier:

Accident & Health Claims

Department (EMI Protect policy)

Tata AIG General Insurance Co. Ltd.

and 8

Floor, Romell Tech Park,

Cama Industrial Estate, Western

Express Highway, Goregaon(E),

Mumbai, Maharashtra 400063

We at our own expense, shall have the

right and opportunity to examine insured

persons through an Independent Medical

Practitioner whose details will be notied

to insured person when and as often as

We may reasonably require during the

pendency of a claim hereunder.

3. Claims Payment

i. We shall be under no obligation

to make any payment under this

Policy unless We have received

all premium payments in full in

time and We have been provided

with the documentation and

information requested to establish

the circumstances of the claim,

its quantum or Our liability for it,

and unless the Insured Person has

complied with his obligations under

this Policy.

ii. We will make payment to You or in

case of death of insured person to

the Insured person’s beneciary or

legal representative under this Policy.

Your receipt shall be considered as

a complete discharge of Our liability

against any claim under this Policy.

iii. In the event of Your death, We will

make payment to the Nominee (as

named in the Schedule).

iv. We shall settle or reject a claim, as

may be the case, within 30 days of

the receipt of the last ‘necessary’

document

v. We shall make the payment of claim

that has been admitted as payable

by Us under the Policy terms and

conditions within 30 days from the

date of receipt of last necessary

document.

vi. In the case of delay in the payment

of a claim, We shall be liable to pay

interest from the date of receipt of

last necessary document to the date

of payment of claim at a rate 2%

above the bank rate. For the purpose

of this clause, ‘bank rate’ shall mean

bank rate xed by the Reserve Bank

of India (RBI) at the beginning of the

financial year in which claim has

fallen due.

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

vii. All claims will be settled in

accordance with the applicable

regulatory guidelines, including IRDAI

(Protection of Policyholders Interests

Regulation), 2017.

Section 6 - Dispute Resolution

The Company is committed to extend the best

possible services to its customers. However,

if you are not satised with our services and

wish to lodge a complaint, please feel free to

call our 24X7 Toll free number 1800-266-7780or

you may email to the customer service desk at

[email protected]. Senior citizens

can call our dedicated line at 1800 22 9966.

Nodal Ocer

Please visit our website at www.tataaig.com to

know the contact details of the nodal ocer for

your servicing branch.

After investigating the grievance internally and

subsequent closure, We will send Our response

within a period of 10 days from the date of

receipt of the complaint by the Company or its

oce in Mumbai. In case the resolution is likely

to take longer time, We will inform you of the

same through an interim reply.

Escalation Level 1

For lack of a response or if the resolution still

does not meet your expectations, you can write

to [email protected].

After investigating the matter internally and

subsequent closure We will send Our response

within a period of 8 days from the date of receipt

at this email id.

Escalation Level 2

For lack of a response or if the resolution still

does not meet your expectations, you can

write to the Head - Customer Services at head.

[email protected]. After examining

the matter, We will send you our nal response

within a period of 7 days from the date of receipt

of your complaint on this email id.

Within 30 days of lodging a complaint with us,

if you do not get a satisfactory response from

us and you wish to pursue other avenues for

redressal of grievances, you may approach

Insurance Ombudsman appointed by IRDAI

under the Insurance Ombudsman Scheme.

Annexure A

NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

SN Centre Address & Contact

1 Ahmedabad

Oce of the Insurance Ombudsman, Jeevan Prakash Building, 6th

oor, Tilak Marg, Relief Road, Ahmedabad – 380 001.

Tel.: 079 - 25501201/02/05/06

Email: [email protected]

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

SN Centre Address & Contact

2 Bengaluru

Oce of the Insurance Ombudsman, Jeevan Soudha Building,

PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road,

JP Nagar, Ist Phase, Bengaluru – 560 078.

Tel.: 080 - 26652048 / 26652049

Email: [email protected]

3 Bhopal

Oce of the Insurance Ombudsman, Janak Vihar Complex,

2nd Floor, 6, Malviya Nagar, Opp. Airtel Oce,

Near New Market, Bhopal – 462 003.

Tel.: 0755 - 2769201 / 2769202

Email: [email protected]

4 Bhubaneswar

Oce of the Insurance Ombudsman, 62, Forest park,

Bhubaneswar – 751 009.

Tel.: 0674 - 2596461 /2596455

Email: [email protected]

5 Chandigarh

Oce of the Insurance Ombudsman, S.C.O. No. 101,

102 & 103, 2nd Floor, Batra Building, Sector 17 – D,

Chandigarh – 160 017.

Tel.: 0172 - 2706196 / 2706468

Email: [email protected]

6 Chennai

Oce of the Insurance Ombudsman, Fatima Akhtar Court,

4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018.

Tel.: 044 - 24333668 / 24335284

Email: [email protected]

7 New Delhi

Oce of the Insurance Ombudsman, 2/2 A, Universal Insurance

Building, Asaf Ali Road, New Delhi – 110 002.

Tel.: 011 - 23232481/23213504

Email: [email protected]

8 Guwahati

Oce of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor,

Nr. Panbazar over bridge, S.S. Road, Guwahati – 781001(ASSAM).

Tel.: 0361 - 2632204 / 2602205

Email: [email protected]

9 Hyderabad

Oce of the Insurance Ombudsman, 6-2-46, 1st oor, “Moin Court”,

Lane Opp. Saleem Function Palace, A. C. Guards,

Lakdi-Ka-Pool, Hyderabad - 500 004.

Tel.: 040 - 23312122

Email: [email protected]

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

SN Centre Address & Contact

10 Jaipur

Oce of the Insurance Ombudsman, Jeevan Nidhi – II Bldg.,

Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005.

Tel.: 0141 - 2740363

Email: [email protected]

11 Ernakulam

Oce of the Insurance Ombudsman, 2nd Floor, Pulinat Bldg.,

Opp. Cochin Shipyard, M. G. Road, Ernakulam - 682 015.

Tel.: 0484 - 2358759 / 2359338

Email: [email protected]

12 Kolkata

Oce of the Insurance Ombudsman, Hindustan Bldg. Annexe,

7th Floor, 4, C.R. Avenue, KOLKATA - 700 072.

Tel.: 033 - 22124339 / 22124340

Email: [email protected]

13 Lucknow

Oce of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan,

Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001.

Tel.: 0522 - 2231330 / 2231331

Email: [email protected]

14 Mumbai

Oce of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe,

S. V. Road, Santacruz (W), Mumbai - 400 054.

Tel.: 69038821/23/24/25/26/ 27/28/28/29/30/31

Email: [email protected]

15 Noida

Oce of the Insurance Ombudsman, Bhagwan Sahai Palace

4th Floor, Main Road, Naya Bans, Sector 15,

Distt: Gautam Buddh Nagar, U.P-201301.

Tel.: 0120-2514252 / 2514253

Email: [email protected]

16 Patna

Oce of the Insurance Ombudsman, 2nd Floor, North wing,

Lalit Bhawan, Bailey Road, Patna 800 001.

Tel.: 0612-2547068

Email: [email protected]

17 Pune

Oce of the Insurance Ombudsman, Jeevan Darshan Bldg.,

3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road,

Narayan Peth, Pune – 411 030.

Tel.: 020-41312555

Email: [email protected]

Tata AIG General Insurance Company Limited

Registered Oce: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel, Mumbai- 400013,

Maharashtra, India 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen) • Visit us at www.tataaig.com

IRDA of India Registration No.:108 • CIN: U85110MH2000PLC128425 • UIN: TATHLGP20116V011920

Tata AIG Group EMI Protect

Policy wordings

For updated list and details of Insurance

Ombudsman Oces, please visit website

http://www.cioins.co.in/ombudsman.html

Prohibition of Rebates - Section 41 of the

Insurance Act, 1938 as amended by Insurance

Laws (Amendment) Act, 2015.

1. No person shall allow or oer to allow,

either directly or indirectly, as an

inducement to any person to take out

or renew or continue an insurance in

respect of any kind of risk relating to lives

or property in India, any rebate of the

whole or part of the commission payable

or any rebate of the premium shown on

the policy, nor shall any person taking out

or renewing or continuing a policy accept

any rebate, except such rebate as may be

allowed in accordance with the published

prospectuses or tables of the insurer.

2. Any person making default in complying

with the provisions of this section shall be

liable for a penalty which may extend to

ten lakh rupees.

“Insurance is the subject matter of the

solicitation”. For details on benets, exclusions,

limitations, terms & conditions, please refer

sales brochure/ policy wordings carefully,

before concluding a sale.”