Tata AIG MediCare Premier Policy Wording

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: TATHLIP21257V022021

Tata AIG MediCare Premier

Policy Wording

Tata AIG General Insurance Company Limited (We, Our

or Us) will provide the insurance cover, described in this

Policy and any endorsements thereto, for the Insured

Period, as dened in the Policy schedule. The insurance

cover provided under this Policy is only with respect to

such and so many of the benets upto the Sum Insured

as mentioned in the Policy Schedule. Commencement

of risk cover under the policy is subject to receipt of

premium by us.

The statements contained in the Proposal signed by

the Policyholder (You) shall be the basis of this Policy

and are deemed to be incorporated herein. The

insurance cover is governed by and subject to, the

terms, conditions and exclusions of this Policy.

For Tata AIG General Insurance Company Limited

Authorized Signatory

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: TATHLIP21257V022021

“Insurance is the subject matter of solicitation”. For more details

on risk factors, terms and conditions, please read policy document

carefully before concluding a sale.

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: TATHLIP21257V022021

Preamble

While the policy is in force, if the Insured Person

contracts any disease or suers from any illness

or sustains bodily injury through accident and if

such event requires the insured Person to incur

expenses for Medically Necessary Treatment,

We will indemnify You for the amount of

such Reasonable and Customary Charges or

compensate to the extent agreed, upto the limits

mentioned, subject to terms and conditions of

the Policy. Each Benet is subject to its Sum

Insured, but Our liability to make payment in

respect of any and all Benets shall be limited

to the Sum Insured unless expressly stated to

the contrary.

In case of family oater policy, the sum insured

for all or any of the benets shall be on a per

policy per year basis unless explicitly stated to

the contrary. In case of an individual policy, the

sum insured for all or any of the benets shall be

on a per insured per year basis unless explicitly

stated to the contrary.

The said Medically Necessary Treatment must be

on the advice of a qualied Medical Practitioner.

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. Any one illness

Any one illness means continuous period of

illness and includes relapse within 45 days

from the date of last consultation with the

Hospital/Nursing Home where treatment

was taken.

3. AYUSH Hospital

An AYUSH Hospital is a healthcare facility

wherein medical/surgical/para-surgical

treatment procedures and interventions

are carried out by AYUSH Medical

Practitioner(s) comprising of any of the

following :

a. Central or State Government AYUSH

Hospital or

b. Teaching hospital attached to AYUSH

college recognized by the Central

Government/ Central Council of

Indian Medicine/ Central Council for

Homeopathy, or

c. AYUSH Hospital, standalone or co-

located with in-patient healthcare

facility of any recognized system of

medicine, registered with the local

authorities, wherever applicable,

and is under the supervision of a

qualied registered AYUSH Medical

Practitioner and must comply with

all the following criterion :

i. Having atleast 5 in-patient beds;

ii. Having qualied AYUSH Medical

Practitioner round the clock;

iii. Having dedicated AYUSH therapy

sections as required and/or has

equipped operation theatre

where surgical procedures are

to be carried out

Maintaining daily records of the

patients and making them accessible

to the insurance company’s authorized

representative.

4. Cashless facility

Cashless facility means a facility extended

by the insurer to the insured where the

payments, of the costs of treatment

undergone by the insured in accordance

with the policy terms and conditions, are

directly made to the network provider by

the insurer to the extent pre-authorization

is approved.

5. Condition Precedent

Condition Precedent means a policy term

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: TATHLIP21257V022021

or condition upon which the Insurer’s

liability under the policy is conditional

upon.

6. 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

7. Cumulative Bonus

Cumulative Bonus means any increase or

addition in the Sum Insured granted by the

insurer without an associated increase in

premium.

8. Day Care Centre

A day care centre means any institution

established for day care treatment of illness

and/or injuries or a medical setup with a

hospital and which has been registered

with the local authorities, wherever

applicable, and is under supervision

of a registered and qualified medical

practitioner AND must comply with all

minimum criterion as under –

i. has qualied nursing sta under its

employment;

ii. has qualied medical practitioner/s

in charge;

iii. has fully equipped operation theatre

of its own where surgical procedures

are carried out;

iv. maintains daily records of patients

and will make these accessible to

the insurance company’s authorized

personnel.

9. Day Care Treatment

Day care treatment means medical

treatment, and/or surgical procedure

which is:

i. undertaken under General or Local

Anesthesia in a hospital/day care

centre in less than 24 hrs because of

technological advancement, and

ii. which would have otherwise required

hospitalization of more than 24

hours.

Treatment normally taken on an out-

patient basis is not included in the scope

of this denition

10. Dental Treatment

Dental treatment means a treatment

related to teeth or structures supporting

teeth including examinations, fillings

(where appropriate), crowns, extractions

and surgery.

11. Domiciliary Hospitalization

Domiciliary hospitalization means medical

treatment for an illness/disease/injury

which in the normal course would require

care and treatment at a hospital but is

actually taken while confined at home

under any of the following circumstances:

i. the condition of the patient is such

that he/she is not in a condition to

be removed to a hospital, or

ii. the patient takes treatment at home

on account of non-availability of

room in a hospital.

12. 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.

13. Hospital

A hospital means any institution established

for in-patient care and day care treatment

of illness and/or injuries and which has

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: TATHLIP21257V022021

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;

14. 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.

15. 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

16. 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.

17. 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.

18. Maternity expenses

Maternity expenses means;

a. medical treatment expenses traceable

to childbirth (including complicated

deliveries and caesarean sections

incurred during hospitalization);

b. expenses towards lawful medical

termination of pregnancy during the

policy period.

19. Medical Advice

Medical Advice means any consultation

or advice from a Medical Practitioner

including the issuance of any prescription

or follow-up prescription.

20. Medical Expenses:

Medical Expenses means those expenses

that an Insured Person has necessarily and

actually incurred for medical treatment

on account of Illness or Accident on the

advice of a Medical Practitioner, as long as

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: TATHLIP21257V022021

these are no more than would have been

payable if the Insured Person had not been

insured and no more than other hospitals

or doctors in the same locality would have

charged for the same medical treatment.

21. 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.

22. 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.

23. Migration

“Migration” means, the right accorded to

health insurance policyholders (including

all members under family cover and

members of group health insurance

policy), to transfer the credit gained for

pre-existing conditions and time bound

exclusions, with the same insurer.

24. Network Provider

Network Provider means hospitals or

health care providers enlisted by an

insurer, TPA or jointly by an Insurer and

TPA to provide medical services to an

insured by a cashless facility.

25. New Born Baby

Newborn baby means baby born during

the Policy Period and is aged upto 90 days

26. Notication of Claim:

Notication of claim means the process

of intimating a claim to the insurer or TPA

through any of the recognized modes of

communication

27. OPD treatment

OPD treatment means the one in which

the Insured visits a clinic / hospital or

associated facility like a consultation room

for diagnosis and treatment based on

the advice of a Medical Practitioner. The

Insured is not admitted as a day care or

in-patient.

28. 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 the effective date of the

policy issued by the insurer or its

reinstatement

29. Pre-hospitalization Medical Expenses

Pre-hospitalization Medical Expenses

means medical expenses incurred during

predefined number of days preceding

the hospitalization of the Insured Person,

provided that:

i. Such Medical Expenses are incurred

for the same condition for which the

Insured Person’s Hospitalization was

required, and

ii. The In-patient Hospitalization claim

for such Hospitalization is admissible

by the Insurance Company.

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: TATHLIP21257V022021

30. Portability

“Portability” means, the right accorded to

individual health insurance policyholders

(including all members under family

cover), to transfer the credit gained for

pre-existing conditions and time bound

exclusions, from one insurer to another

insurer.

31. Post-hospitalization Medical Expenses

Post-hospitalization Medical Expenses

means medical expenses incurred during

predened number of days immediately

after the insured person is discharged from

the hospital provided that:

i. Such Medical Expenses are for

the same condition for which the

insured person’s hospitalization was

required, and

ii. The inpatient hospitalization claim for

such hospitalization is admissible by

the insurance company

32. Qualied Nurse

Qualified nurse means a person who

holds a valid registration from the Nursing

Council of India or the Nursing Council of

any state in India.

33. Reasonable and Customary Charges

Reasonable and Customary charges means

the charges for services or supplies, which

are the standard charges for the specic

provider and consistent with the prevailing

charges in the geographical area for

identical or similar services, taking into

account the nature of the illness / injury

involved.

34. 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.

35. Room Rent

Room Rent means the amount charged

by a Hospital towards Room and Boarding

expenses and shall include the associated

medical expenses.

36. Surgery or Surgical Procedure

Surgery or Surgical Procedure means

manual and / or operative procedure

(s) required for treatment of an illness

or injury, correction of deformities and

defects, diagnosis and cure of diseases,

relief from suering and prolongation of

life, performed in a hospital or day care

centre by a medical practitioner.

37. 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

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. Policy

Policy means the contract of insurance

including but not limited to Policy Schedule,

Endorsements and Policy Wordings.

3. Policy period

Policy Period means the time during

which this Policy is in eect. Such period

commences from Commencement Date

and ends on the Expiry Date and specically

appears in the Policy Schedule.

4. Policy Schedule

Policy Schedule means the Policy Schedule

attached to and forming part of Policy

5. Policy year

Policy Year means a period of twelve

months beginning from the date of

commencement of the Policy period

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: TATHLIP21257V022021

and ending on the last day of such

twelve-month period. For the purpose of

subsequent years, policy year shall mean

a period of twelve months commencing

from the end of the previous policy year

and lapsing on the last day of such twelve-

month period, till the Policy Expiry date

6. Shared Accommodation

Shared Accommodation means a hospital

room with two or more patient beds. This

denition does not apply to ICU or ICCU.

Section 2 – Benets

The following benets are payable subject to

Terms and Conditions of the policy:

B1. In-Patient Treatment

We will cover for expenses for

hospitalization due to disease/illness/Injury

during the policy period that requires an

Insured Person’s admission in a hospital

as an inpatient.

Medical expenses directly related to the

hospitalization would be payable.

B2. Pre-Hospitalization expenses

We will cover for expenses for Pre-

Hospitalization consultations,

investigations and medicines incurred

upto 60 days before the date of admission

to the hospital.

The benet is payable if We have admitted

a claim under B1 or B4 or B6.

B3. Post-Hospitalization expenses

We will cover for expenses for Post-

Hospitalization consultations,

investigations and medicines incurred upto

90 days after discharge from the hospital.

The benet is payable if We have admitted

a claim under B1 or B4 or B6.

B4. Day Care Procedures

We will cover expenses for listed Day Care

Treatment due to disease/illness/Injury

during the policy period taken at a hospital

or a Day Care Centre. The list of such day

care procedures covered is available on

our website (www.tataaig.com)

Treatment normally taken on out-patient

basis is not included in the scope of this

cover.

B5. Organ Donor

We will cover for Medical and surgical

Expenses of the organ donor for harvesting

the organ where an Insured Person is the

recipient provided that:

i. The organ donor is any person whose

organ has been made available

in accordance and in compliance

with The Transplantation of Human

Organs (Amendment) Bill, 2011 and

the organ donated is for the use of

the Insured Person, and

ii. We have accepted an inpatient

Hospitalization claim for the

insured member under In Patient

Hospitalization Treatment (section

B1).

B6. Domiciliary Treatment

We will cover for expenses related to

Domiciliary Hospitalization of the insured

person if the treatment exceeds beyond

three days. The treatment must be for

management of an illness and not for

enteral feedings or end of life care.

At the time of claiming under this benet,

we shall require certification from the

treating doctor fullling the conditions as

mentioned under the general denitions

(Section 1) of this policy.

B7. Restore benets

We will automatically restore the Basic

Sum Insured upon exhaustion of the Sum

Insured and accrued Cumulative Bonus,

during the policy period. This benet can

be availed once during the policy period

subject to the following conditions:

a. The restored sum insured can be used

for all claims made by the insured

person(s) who have not claimed

earlier under Sections B1 to B4. In

case the insured has claimed under

these sections, then this automatic

restoration benet is available for

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: TATHLIP21257V022021

admissions due to unrelated illness/

diseases. However, this benet for

related illness/diseases would be

available, in case of claimed insured

person(s), for admissions after 45

days from the date of discharge of

the earlier claim.

b. In case of Family Floater policy,

Reinstatement of Sum Insured will

be available for all Insured Persons

in the Policy on oater basis

c. This benefit shall be applicable

annually for policies with tenure of

more than 1 year.

d. The unutilized restored sum insured

cannot be carried forward.

This benet shall not be applicable for

Global Cover (section B13).

B8. AYUSH Benet

We will cover for expenses incurred for

treatment as in-patient in an Ayush Hospital.

B9. Ambulance Cover

We will cover for expenses incurred on

transportation of Insured Person in a

registered ambulance to a Hospital for

admission in case of an Emergency or from

one hospital to another hospital for better

medical facilities and treatment, subject to

Rs. 5000 per Hospitalization.

For this claim to be paid, the claim must be

admissible under section B1 or B4 of this

policy.

B10. Health Checkup

We will cover for expenses for a Preventive

Health Check-up upto 1% of sum insured

subject to a maximum of Rs. 10,000/- per

policy. The limit is the maximum per policy

and more than one insured can utilize the

amount.

The benefit is payable every year

irrespective of claims under the policy.

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

B11. Compassionate travel

In the event the Insured Person is

Hospitalized for more than Five consecutive

days in a place where no adult member of

his immediate family is present, we will

cover for expenses related to a round

trip economy class air ticket, or rst-class

railway ticket, to allow the Immediate

Family Member be at his bedside for the

duration of his stay in the hospital.

The expenses must be incurred within India

and shall not exceed Rs. 20,000 during a

policy year.

The benet shall be payable if We have

accepted an inpatient Hospitalization claim

for the insured member under In Patient

Hospitalization Treatment (Section B1).

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

We shall require the following additional

documents (proof of travel) supporting the

claim under this benet: Boarding Pass, or

Railway ticket or any other document to

show proof of travel

B12. Consumables Benet

We will pay for expenses incurred, for

specied consumables which are listed in

‘Annexure I – List I- Optional Items’ under

‘Guidelines on Standardization in Health

Insurance, 2016’ and its amendments,

which are consumed during the period

of hospitalization directly related to the

insured’s medical or surgical treatment of

illness/disease/injury. Details of Annexure

I-List I-Optional items are available on our

website (www.tataaig.com)

However the following items shall be

excluded from scope of this coverage:

• Items of personal comfort, toiletries,

cosmetics and convenience shall be

excluded from scope of this coverage.

• External durable devices like Bilevel

Positive Airway Pressure (BIPAP)

machine, Continuous Positive Airway

Pressure (CPAP) machine, Peritoneal

Dialysis (PD) equipment and supplies,

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: TATHLIP21257V022021

Nimbus/water/air bed, dialyzer and

other medical equipments.

• Any item which is neither medical

consumable nor medically necessary

nor prescribed by Doctor.

For this claim to be paid, the main claim

must be admissible under section B1 or

B4 of this policy.

B13. Global Cover

We will cover for Medical Expenses of the

Insured Person incurred outside India,

upto the sum insured, provided that the

diagnosis was made in India and the

insured travels abroad for treatment.

The Medical Expenses payable shall

be limited to Inpatient and daycare

Hospitalization only on reimbursement

basis. Cashless facility may be arranged

on case to case basis. Insured person can

The payment of any claim under this

benefit will be in Indian Rupees based

on the rate of exchange as on the date

of invoice, published by Reserve Bank of

India (RBI) and shall be used for conversion

of foreign currency into Indian Rupees

for claims payment. If these rates are

not published on the date of invoice, the

exchange rate next published by RBI shall

be considered for conversion.

Only basic sum insured along with

Cumulative Bonus can be used for this and

not the restored sum insured.

We shall require the following additional

documents supporting the claim under

this benet:

• Proof of diagnosis in India

• Insured’s Passport and Visa

B14. Bariatric Surgery Cover

We will cover for reasonable and customary

expenses for Bariatric Surgery if the insured

fullls all of the following conditions:

i. Surgery to be conducted is upon the

advice of the Doctor

ii. The member has to be 18 years of

age or older and

iii. Body Mass Index (BMI) greater than

or equal to 40 or

iv. BMI is 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:

a. Obesity-related cardiomyopathy

b. Coronary heart disease

c. Severe sleep apnea

d. Uncontrolled Type2 Diabetes

In view of this coverage getting extended,

exclusion code (Code-Excl06) of this policy

stands deleted.

B15. In-Patient Treatment - Dental

We will cover for medical expenses

incurred towards hospitalization for dental

treatment under anesthesia necessitated

due to an accident/injury/illness.

B16. Vaccination cover

We will cover for expenses related to the

cost of the following vaccines only:

Without any waiting period:

- Anti-rabies vaccine following an

animal bite

- Typhoid vaccination

After 2 years of continuous coverage with

Us:

- Human Papilloma Virus (HPV) vaccine

- Hepatitis B Vaccine

Expenses related to the doctor, nurse or

any incidental expenses are not payable.

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

B17. Hearing Aid

We will cover for reasonable charges for a

hearing aid every third year. The maximum

amount payable is 50% of actual cost or Rs.

10,000/- per policy, whichever is lower.

The items must be prescribed by a

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: TATHLIP21257V022021

specialized Medical Practitioner as

medically necessary.

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

B18. Daily Cash for choosing Shared

Accommodation

We will pay a xed amount per day as

mentioned in the policy schedule if the

Insured Person is Hospitalized in Shared

Accommodation in a Network Hospital for

each continuous and completed period

of 24 hours. The benet payable per day

would be 0.25% of base sum insured and

a maximum of Rs. 2000 per day.

For this claim to be paid, the main claim

must be admissible under section B1 of

this policy. This benet has a separate limit

(over and above base sum insured) and

does not aect cumulative bonus.

B19. Daily Cash for Accompanying an Insured

Child

We will pay a xed amount per day, as

mentioned in the schedule, if the Insured

Person Hospitalized is a child Aged 12

years or less, for one accompanying adult

for each complete period of 24 hours. The

benet payable per day would be 0.25%

of base sum insured and a maximum of

Rs.2000 per day.

For this claim to be paid, the main claim

must be admissible under section B1 of

this policy.

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

B20. Second Opinion

We will provide You a second opinion from

Network Provider or Medical Practitioner,

if an Insured Person is diagnosed with

the below mentioned Illnesses during the

Policy Period. The expert opinion would be

directly sent to the Insured Person.

i. Cancer

ii. Kidney Failure

iii. Myocardial Infarction

iv. Angina

v. Coronary bypass surgery

vi. Stroke/Cerebral hemorrhage

vii. Organ failure requiring transplant

viii. Heart Valve replacement

ix. Brain tumors

This benet can be availed by an insured

person once during a Policy Year.

B21. Maternity Cover

We will cover for Maternity Expenses upto a

maximum of Rs. 50,000/- per policy subject

to a waiting period of 4 years of continuous

coverage under this policy subject to IRDAI

portability guidelines. In case of birth of a

girl child, the maximum limit under this

coverage would be Rs. 60,000/- per policy.

We will not cover ectopic pregnancy under

this benet (although it shall be covered

under section B1).

Expenses incurred for following shall be

excluded from the scope of this coverage:

• Expenses incurred for pre/post natal

care

• Pre/Post hospitalization benefit

(Benet B2 and B3)

In view of this coverage getting extended,

maternity exclusion code 18 stands

deleted. However, no coverage is available

for voluntary termination of pregnancy

during the policy period under this policy.

B22. New Born Baby Cover

We will cover for medical expenses

incurred for the medically necessary

treatment of the new born baby upto

Rs.10,000/- for complications related to

delivery if claim is admitted under the

maternity benet (B21).

B23. First year Vaccinations

We will pay for vaccination expenses for

up to one year after the birth of the child

subject to a limit of Rs. 10,000/- provided

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: TATHLIP21257V022021

the child is covered with Us. In case of girl

child, applicable limit under this coverage

would be Rs.15,000/-.

For the claim to be paid under this benet,

the expenses related to maternity should

be admissible under B21. The limit of

Rs.10,000 (Rs.15,000 in case of girl child) is

a lifetime limit and not a policy limit which

will be applicable for each child.

B24. Prolonged Hospitalization Benet

We will pay a fixed amount of 1% of

sum insured, in the event of insured

hospitalized for a disease/illness/injury for

a continuous period exceeding 10 days.

This benet will be triggered provided that

the hospitalization claim is accepted under

benet B1.

This benet shall not be applicable in case

of domiciliary hospitalization (Section B6).

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

B25. High End Diagnostics

We will cover for reasonable charges

incurred for the following diagnostic tests

only on OPD basis if required as part of a

medically necessary treatment subject to

a maximum Rs. 25,000 per policy year:

i. Brain Perfusion imaging

ii. Computed Tomography (CT) guided

Biopsy

iii. Computed Tomography (CT)

Urography

iv. Digital Subtraction Angiography (DSA)

v. Liver Biopsy

vi. Magnetic Resonance Cholangiography

Scan

vii. Positron Emission Tomography–

Computed Tomography (PET/CT)

viii. Positron emission tomography–

Magnetic Resonance Imaging (PET/

MRI)

ix. Renogram

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

B26. OPD Treatment

Once the insured has completed two years

of continuous coverage with Us, We will pay

for expenses related to consultations and

pharmacy subject to Rs. 5,000/- per policy

year annually subject to policy terms and

conditions.

This benet has a separate limit (over and

above base sum insured) and does not

aect cumulative bonus.

B27. OPD Treatment - Dental

Once the Insured has completed two years

of continuous coverage with Us, we will pay

for expenses related to the following dental

treatments only subject to a maximum of

Rs.10,000 per policy year annually:

- Root Canal Treatment (single or

multiple sittings)

- Tooth extraction(s)

- Filling

This benet has a separate limit (over and

above base sum insured) and does not

aect Cumulative Bonus.

In view of this coverage getting extended,

dental exclusion (exclusion – xviii) is not

applicable for this particular coverage.

B28. Emergency Air Ambulance Cover

We will pay for ambulance transportation

of the Insured Person in an airplane or

helicopter subject to maximum of Rs.

500,000, for emergency life threatening

health conditions which require immediate

and rapid ambulance transportation to the

hospital/medical centre for further medical

management.

The Medical Evacuation should be

prescribed by a Medical Practitioner and

should be Medically Necessary.

This benet shall only be payable if We

have accepted an inpatient Hospitalization

claim for the Insured member under In

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: TATHLIP21257V022021

Patient Hospitalization Treatment (Section

B1).

This benet has a separate limit (over and

above base sum insured) and does not

aect Cumulative Bonus.

B29. Accidental Death Benet

If an Insured Person suers an accident

during the policy period and this is the

sole and direct cause of his death within

365 days from the date of accident, then

We will pay a xed amount of 100% of the

base Sum Insured.

This benet is not applicable for dependent

children covered in the policy.

B30. Cumulative Bonus

i. 50% cumulative bonus will be applied

on the Sum Insured for next policy

year under the Policy after every

claim free Policy Year, provided

that the Policy is renewed with Us

and without a break. The maximum

cumulative bonus shall not exceed

100% of the Sum Insured in any Policy

Year.

ii. If a Cumulative Bonus has been

applied and a claim is made, then

in the subsequent Policy Year We

will automatically decrease the

Cumulative Bonus by 50% of the

Sum Insured in that following Policy

Year. There will be no impact on

the Inpatient Sum Insured, only the

accrued Cumulative Bonus will be

decreased.

iii. In policies with a tenure of more than

one year, the above guidelines of

Cumulative Bonus shall be applicable

post completion of each policy year

iv. In relation to a Family Floater, the

Cumulative Bonus so applied will

only be available in respect of those

Insured Persons who were Insured

Persons in the claim free Policy Year

and continue to be Insured Persons

in the subsequent Policy Year.

v. For purpose of computation of

Cumulative Bonus, the percentage

(%) of Cumulative Bonus will be

applied on the base Sum Insured

only. Restored sum insured will not

be taken into consideration.

Section 3 – Exclusions

We will neither be liable nor make any payment

for any claim in respect of any Insured Person

which is caused by, arising from or in any way

attributable to any of the following exclusions,

unless expressly stated to the contrary in this

Policy.

i. Standard Exclusions

1. Exclusions with waiting periods

i. Pre-existing Diseases Waiting Period

(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 24 months of

continuous coverage after the

date of inception of the first

policy with us.

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 defined 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 24 months for any

pre-existing disease is subject

to the same being declared

at the time of application and

accepted by us.

ii. Specied Disease/Procedure Waiting

Period (Code-Excl02):

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: TATHLIP21257V022021

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 specified 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 dened 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. List of Specific Diseases/

procedures as furnished below:

I. Tumors, Cysts, polyps

including breast lumps

(benign)

II. Polycystic ovarian disease

III. Fibromyoma

IV. Adenomyosis

V. Endometriosis

VI. Prolapsed Uterus

VII. Non-infective arthritis

VIII. Gout and Rheumatism

IX. Osteoporosis

X. Ligament, Tendon or

Meniscal tear (due to

injury or otherwise)

XI. Prolapsed Inter Vertebral

Disc (due to injury or

otherwise)

XII. Cholelithiasis

XIII. Pancreatitis

XIV. Fissure/fistula in anus,

haemorrhoids, pilonidal

sinus

XV. Ulcer & erosion of stomach

& duodenum

XVI. Gastro Esophageal Reux

Disorder (GERD)

XVII. Liver Cirrhosis

XVIII. Perineal Abscesses

XIX. Perianal / Anal Abscesses

XX. Calculus diseases of

Urogenital system

Example: Kidney stone,

Urinary bladder stone.

XXI. Benign Hyperplasia of

prostate

XXII. Varicocele

XXIII. Cataract

XXIV. Retinal detachment

XXV. Glaucoma

XXVI. Congenital Internal

Diseases

The following treatments

are covered after a waiting

period of two years

irrespective of the illness

for which it is done:

XXVII. Adenoidectomy

XXVIII. Mastoidectomy

XXIX. Tonsillectomy

XXX. Tympanoplasty

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: TATHLIP21257V022021

XXXI. Surgery for nasal septum

deviation

XXXII. Nasal concha resection

XXXIII. Surgery for Turbinate

hypertrophy

XXXIV. Hysterectomy

XXXV. Joint replacement surgeries

Eg: Knee replacement, Hip

replacement

XXXVI. Cholecystectomy

XXXVII. Hernioplasty or

Herniorraphy

XXXVIII. Surgery/procedure

for Benign prostate

enlargement

XXXIX. Surgery for Hydrocele/

Rectocele

XL. 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 first 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

i. Investigation and evaluation (Code-

Excl04):

a. Expenses related to any

admission primarily for

diagnostics and evaluation

purposes 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.

iii. Expenses related to surgical

treatment of obesity that does not

fulfil the below conditions (Code-

Excl06):

a. Surgery to be conducted is upon

the advice of the Doctor

b. The surgery/Procedure

conducted should be supported

by clinical protocols

c. The member has to be 18 years

of age or older and

d. Body Mass Index (BMI);

i. greater than or equal to 40

ii. 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:

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: TATHLIP21257V022021

1. Obesity-related

cardiomyopathy

2. Coronary heart

disease

3. Severe Sleep Apnea

4. Uncontrolled Type2

Diabetes

iv. Change-of-Gender treatments

(Code- Excl 07): 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 – Excl08) : 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 certied by the attending

Medical Practitioner.

vi. Treatment for, Alcoholism, drug or

substance abuse or any addictive

condition and consequences thereof

.(Code-Excl12)

vii. Treatments received in heath

hydros, nature cure clinics, spas or

similar establishments or private

beds registered as a nursing home

attached to such establishments or

where admission is arranged wholly

or partly for domestic reasons. (Code

-Excl13)

viii. Dietary supplements and substances

that can be purchased without

prescription, including but not limited

to Vitamins, minerals and organic

substances unless prescribed by

a medical practitioner as part of

hospitalization claim or day care

procedure. (Code -Excl14)

ix. Refractive error (Code -Excl15):

Expenses related to the treatment

for correction of eye sight due to

refractive error less than 7.5 dioptres.

x. Unproven treatments (Code-Excl16)

: 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.

xi. Expenses related to Sterility and

infertility (Code-Excl17). This includes:

i. Any type of contraception,

sterilization

ii. Assisted Reproduction services

including articial insemination

and advanced reproductive

technologies such as IVF, ZIFT,

GIFT, ICSI

iii. Gestational Surrogacy

iv. Reversal of sterilization

xi. Maternity (Code - Excl18):

a. Medical treatment expenses

traceable to childbirth (including

complicated deliveries and

caesarean sections incurred

during hospitalization) except

ectopic pregnancy;

b. Expenses towards miscarriage

(unless due to an accident) and

lawful medical termination of

pregnancy during the policy

period

3. Non-Medical Exclusions

i. Hazardous or Adventure Sports

(Code Excl09) : 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

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: TATHLIP21257V022021

ii. Breach of law (Code Excl10): Expenses

for treatment directly arising from or

consequent upon any Insured Person

committing or attempting to commit

a breach of law with criminal intent.

iii. Excluded Providers (Code-

Excl11):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)

1. Medical Exclusions

i. Alcoholic pancreatitis

ii. Congenital External Diseases, defects

or anomalies;

iii. Stem cell therapy ; however

hematopoietic stem cells for

bone marrow transplant for

haematological conditions will be

covered under benet B1 or B4 of

this policy;

iv. Growth hormone therapy;

v. Sleep-apnoea

vi. Admission primarily for

administration of Intra-articular

or intra-lesional injections or

Intravenous immunoglobulin infusion

or supplementary medications like

Zolendronic Acid

vii. Venereal disease, sexually

transmitted disease or illness;

viii. All preventive care, vaccination

including inoculation and

immunisations (except in case of

post- bite treatment and other

vaccines explicitly covered);

ix. Dental treatment or surgery of any

kind except as specied in ‘Inpatient

Treatment – Dental’.

x. Any existing disease specifically

mentioned as Permanent exclusion

in the Policy Schedule

2. Non-Medical Exclusions

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

of foreign enemy, war like operations

(whether war be declared or not or

caused during service in the armed

forces of any country), civil war,

public defence, rebellion, revolution,

insurrection, military or usurped acts,

nuclear weapons/materials, chemical

and biological weapons, ionising

radiation.

ii. Any Insured Person’s participation or

involvement in naval, military or air

force operation,

iii. Intentional self-injury or attempted

suicide while sane or insane.

iv. Items of personal comfort and

convenience like television (wherever

specically charged for), charges for

access to telephone and telephone

calls, internet, foodstuffs (except

patient’s diet), cosmetics, hygiene

articles, body care products and bath

additive, barber or beauty service,

guest service

v. Treatment rendered by a Medical

Practitioner which is outside his

discipline

vi. Doctor’s fees charged by the Medical

Practitioner sharing the same

residence as an Insured Person or

who is an immediate relative of an

Insured Person’s family.

vii. Provision or tting of hearing aids,

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: TATHLIP21257V022021

spectacles or contact lenses including

optometric therapy unless explicitly

stated and covered in the policy,

viii. Any treatment and associated

expenses for alopecia, baldness,

wigs, or toupees, medical supplies

including elastic stockings, diabetic

test strips, and similar products.

ix. Any treatment or part of a treatment

that is not of a reasonable charge,

not medically necessary; drugs or

treatments which are not supported

by a prescription.

x. Crutches or any other external

appliance and/or device used for

diagnosis or treatment (except when

used intra-operatively and explicitly

stated and covered in the policy).

xi. Any illness diagnosed or injury

sustained or where there is change

in health status of the member

after date of proposal and before

commencement of policy and the

same is not communicated and

accepted by us

Section 4 – General Terms and Clauses

i. Standard General Terms and Clauses:

1. Disclosure of Information

The policy shall be void and all premium

paid thereon shall be forfeited to the

Company in the event of misrepresentation,

misdescription or non-disclosure of any

material fact by the policyholder.

(Explanation: “Material facts” for the

purpose of this policy shall mean all

relevant information sought by the

company in the proposal form and other

connected documents to enable it to

take informed decision in the context of

underwriting the risk)

2. Condition Precedent to Admission of

Liability

The terms and conditions of the policy

must be fullled by the insured person

for the Company to make any payment for

claim(s) arising under the policy.

3. Claim Settlement (provision for Penal

Interest)

i. The Company shall settle or reject a

claim, as the case may be, within 30

days from the date of receipt of last

necessary document.

ii. In the case of delay in the payment of

a claim, the Company shall be liable

to pay interest to the policyholder

from the date of receipt of last

necessary document to the date of

payment of claim at a rate 2% above

the bank rate.

iii. However, where the circumstances

of a claim warrant an investigation

in the opinion of the Company, it

shall initiate and complete such

investigation at the earliest, in any

case not later than 30 days from

the date of receipt of last necessary

document. In such cases, the

Company shall settle or reject the

claim within 45 days from the date of

receipt of last necessary document.

iv. In case of delay beyond stipulated

45 days, the Company shall be liable

to pay interest to the policyholder at

a rate 2% above the bank rate from

the date of receipt of last necessary

document to the date of payment of

claim.

(Explanation: “Bank rate” shall mean

the rate xed by the Reserve Bank

of India (RBl) at the beginning of

the financial year in which claim

has fallen due).The Clause shall be

suitably modified by the insurer

based on the amendment(s), if

any to the relevant provisions of

Protection of Policyholder’s Interests

Regulations, 2017)

4. Complete Discharge

Any payment to the policyholder, 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: TATHLIP21257V022021

person or his/ her nominees or his/ her

legal representative or assignee or to

the Hospital, as the case may be, for any

benet under the policy shall be a valid

discharge towards payment of claim by the

Company to the extent of that amount for

the particular claim.

5. Multiple Policies

i. In case of multiple policies taken by an

insured person during a period from

one or more insurers to indemnify

treatment costs, the insured person

shall have the right to require a

settlement of his/her claim in terms

of any of his/her policies. In all such

cases the insurer chosen by the

insured person shall be obliged to

settle the claim as long as the claim

is within the limits of and according

to the terms of the chosen policy.

ii. Insured person having multiple

policies shall also have the right to

prefer claims under this policy for

the amounts disallowed under any

other policy / policies even if the sum

insured is not exhausted. Then the

insurer shall independently settle

the claim subject to the terms and

conditions of this policy.

iii. If the amount to be claimed exceeds

the sum insured under a single policy,

the insured person shall have the

right to choose insurer from whom

he/she wants to claim the balance

amount.

iv. Where an insured person has policies

from more than one insurer to

cover the same risk on indemnity

basis, the insured person shall only

be indemnied the treatment costs

in accordance with the terms and

conditions of the chosen policy.

6. Fraud

If any claim made by the insured person,

is in any respect fraudulent, or if any false

statement, or declaration is made or used

in support thereof, or if any fraudulent

means or devices are used by the insured

person or anyone acting on his/her behalf

to obtain any benet under this policy, all

benets under this policy and the premium

paid shall be forfeited.

Any amount already paid against claims

made under this policy but which are

found fraudulent later shall be repaid by all

recipient(s)/policyholder(s), who has made

that particular claim, who shall be jointly

and severally liable for such repayment to

the insurer.

For the purpose of this clause, the

expression “fraud” means any of the

following acts committed by the insured

person or by his agent or the hospital/

doctor/any other party acting on behalf of

the insured person, with intent to deceive

the insurer or to induce the insurer to issue

an insurance policy:

a) the suggestion, as a fact of that which

is not true and which the insured

person does not believe to be true;

b) the active concealment of a fact by the

insured person having knowledge or

belief of the fact;

c) any other act tted to deceive; and

d) any such act or omission as the law

specially declares to be fraudulent

The Company shall not repudiate the

claim and / or forfeit the policy benets

on the ground of Fraud, if the insured

person / beneciary can prove that the

misstatement was true to the best of his

knowledge and there was no deliberate

intention to suppress the fact or that

such misstatement of or suppression of

material fact are within the knowledge of

the insurer.

7. Cancellation

i. The policyholder may cancel this

policy by giving 15 days written

notice and in such an event, the

Company shall refund premium

for the unexpired policy period as

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: TATHLIP21257V022021

detailed below:

Length of

time Policy

in force

Tenure (Years)

1 2 3

Upto 1

Month

75.00% 87.50% 91.5%

>1 month

& Upto 3

Months

50.00% 75.00% 88.5%

>3 months

& Upto 6

Months

25.00% 62.50% 75%

>6 months

& Upto 12

Months

Nil 50.00% 66.5%

>12 months

& Upto 15

Months

NA 25% 50%

>15 months

& Upto 18

Months

NA 12.5% 41.5%

>18 months

& Upto 24

months

NA Nil 33%

>24 months

& Upto 30

months

NA NA 8%

Exceeding

30 months

NA NA Nil

Notwithstanding anything contained herein

or otherwise, no refunds of premium shall

be made in respect of Cancellation where,

any claim has been admitted or has been

lodged or any benet has been availed by

the insured person under the policy.

ii. The Company may cancel the

policy at any time on grounds of

misrepresentation non-disclosure of

material facts, fraud by the insured

person by giving 15 days’ written

notice. There would be no refund of

premium on cancellation on grounds

of misrepresentation, non-disclosure

of material facts or fraud.

8. Migration

The insured person will have the option to

migrate the policy to other health insurance

products/plans oered by the company by

applying for migration of the policy at least

30 days before the policy renewal date as

per IRDAI guidelines on Migration. lf such

person is presently covered and has been

continuously covered without any lapses

under any health insurance product/

plan oered by the company, the insured

person will get the accrued continuity

benets in waiting periods as per IRDAI

guidelines on migration.

For Detailed Guidelines on Migration, kindly

refer Guidelines issued by IRDAI (Insurance

Regulatory and Development Authority

of India) on Migration and Portability of

Health Insurance policies – Ref: IRDAI/HLT/

REG/CIR/194/07/2020) dated 22

July 2020

and subsequent amendments thereof.

9. Portability

The insured person will have the option

to port the policy to other insurers by

applying to such insurer to port the

entire policy along with all the members

of the family, if any, at least 45 days

before, but not earlier than 60 days

from the policy renewal date as per

IRDAI guidelines related to portability.

If such person is presently covered and

has been continuously covered without

any lapses under any health insurance

policy with an Indian General/Health

insurer, the proposed insured person

will get the accrued continuity benets in

waiting periods as per IRDAI guidelines on

portability.

For Detailed Guidelines on Portability,

kindly refer Guidelines issued IRDAI

(Insurance Regulatory and Development

Authority of India) on Migration and

Portability of Health Insurance policies

– Ref: IRDAI/HLT/REG/CIR/194/07/2020)

dated 22

July 2020 and subsequent

amendments thereof.

10. Renewal of Policy

The policy shall ordinarily be

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: TATHLIP21257V022021

renewable except on grounds of fraud,

misrepresentation by the insured person.

i. The Company shall endeavor to give

notice for renewal. However, the

Company is not under obligation to

give any notice for renewal.

ii. Renewal shall not be denied on the

ground that the insured person

had made a claim or claims in the

preceding policy years.

iii. Request for renewal along with

requisite premium shall be received

by the Company before the end of

the policy period.

iv. At the end of the policy period, the

policy shall terminate and can be

renewed within the Grace Period

of 30 days to maintain continuity

of benets without break in policy.

Coverage is not available during the

grace period.

v. No loading shall apply on renewals

based on individual claims experience

11. Withdrawal of Policy

i. In the likelihood of this product being

withdrawn in future, the Company

will intimate the insured person

about the same 90 days prior to

expiry of the policy.

ii. Insured Person will have the option

to migrate to similar health insurance

product available with the Company

at the time of renewal with all the

accrued continuity benets such as

cumulative bonus, waiver of waiting

period as per IRDAI guidelines,

provided the policy has been

maintained without a break.

12. Moratorium Period

After completion of eight continuous

years under the policy no look back to be

applied. This period of eight years is called

as moratorium period. The moratorium

would be applicable for the sums insured

of the first policy and subsequently

completion of 8 continuous years would

be applicable from date of enhancement of

sums insured only on the enhanced limits.

After the expiry of Moratorium Period no

health insurance claim shall be contestable

except for proven fraud and permanent

exclusions specied in the policy contract.

The policies would however be subject

to all limits, sub limits, co-payments,

deductibles as per the policy contract.

13. Possibility of Revision of Terms of the

Policy Including the Premium Rates

The Company, with prior approval of

IRDAI, may revise or modify the terms of

the Policy including the premium rates.

The Insured Person shall be notied three

months before the changes are eected.

14. Free look period

The Free Look Period shall be applicable

on new individual health insurance policies

and not on renewals or at the time of

porting/migrating the policy.

The insured person shall be allowed free

look period of fteen days from date of

receipt of the policy document to review

the terms and conditions of the policy, and

to return the same if not acceptable.

If the insured has not made any claim

during the Free Look Period, the insured

shall be entitled to

i. a refund of the premium paid

less any expenses incurred by the

Company on medical examination

of the insured person and the stamp

duty charges or

ii. where the risk has already

commenced and the option of return

of the policy is exercised by the

insured person, a deduction towards

the proportionate risk premium for

period of cover or

iii. Where only a part of the insurance

coverage has commenced,

such proportionate premium

commensurate with the insurance

coverage during such period

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: TATHLIP21257V022021

15. Redressal of Grievance

In case of any grievance the insured person

may contact the company through

Website: www.tataaig.com

Toll Free: 1800 266 7780 or 1800 22 9966

(only for Senior Citizen policyholders)

Email: [email protected]

Courier: Customer Support, Tata AIG

General Insurance Company Limited,

and 8

Floor, Romell Tech Park, Cama

Industrial Estate, Western Express Highway,

Goregaon(E), Mumbai, Maharashtra 400063

Insured person may also approach the

grievance cell at any of the company’s

branches with the details of grievance.

If Insured person is not satised with the

redressal of grievance through one of

the above methods, insured person may

contact the grievance ocer at manager.

[email protected].

For updated details of grievance ocer,

kindly refer the link (https://www.tataaig.

com/grievance-redressal-policy)

lf Insured person is not satisfied with

the redressal of grievance through

above methods, the insured person may

also approach the office of Insurance

Ombudsman of the respective area/region

(details as mentioned in the Annexure A of

this policy) for redressal of grievance as per

Insurance Ombudsman Rules 2017.

Grievance may also be lodged at IRDAI

Integrated Grievance Management System

(https://igms.irda.gov.in/)

16. Nomination

The policyholder is required at the inception

of the policy to make a nomination for

the purpose of payment of claims under

the policy in the event of death of the

policyholder. Any change of nomination

shall be communicated to the company in

writing and such change shall be eective

only when an endorsement on the policy

is made. In the event of death of the

policyholder, the Company will pay the

nominee {as named in the Policy Schedule/

Policy Certicate/Endorsement (if any)} and

in case there is no subsisting nominee, to

the legal heirs or legal representatives of

the policyholder whose discharge shall be

treated as full and nal discharge of its

liability under the policy.

ii. Specic terms and clauses (terms and

clauses other than those mentioned

under Section 4 (i) above)

17. Premium Payment

i. Premium to be paid for the Policy

Period before Policy Commencement

date as opted by You in the proposal

form.

ii. If you have opted to pay premium

in full (lumpsum) upfront then the

entire premium for the policy period

shall be paid before the policy

commencement date with an option

of policy tenure 1/2/3 years.

iii. Long term premium discount of 5%

and 10% is applicable for policy with

tenure of 2 and 3 years respectively.

18. Insured Person

i. Only those persons named as an

Insured Person in the Schedule shall

be covered under this Policy.

ii. Any person may be added during

the Policy Period after his application

has been accepted by Us, additional

premium has been paid and We have

issued an endorsement conrming

the addition of such person as an

Insured Person.

iii. We will be offering continuous

renewal with no exit age subject

to regular premium payment and

compliance with all provisions and

terms & conditions of this policy by

the Insured Person.

19. Loadings

i. We may apply a risk loading on the

premium payable (based upon the

declarations made in the proposal

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: TATHLIP21257V022021

form and the health status of the

persons proposed for insurance).

ii. The maximum risk loading applicable

for an individual shall not exceed

100% of premium per diagnosis /

medical condition and an overall risk

loading of over 150% of premium per

person.

iii. The loading shall only be applied

basis an outcome of Our medical

underwriting.

iv. These loadings are applied from

Commencement Date of the Policy

including subsequent renewal(s) with

Us or on the receipt of the request

of increase in Sum Insured (for the

increased Sum Insured).

a. We will inform You about the

applicable risk loading through

a counter oer letter.

b. You need to revert to Us

with consent and additional

premium (if any), within 15 days

of the issuance of such counter

oer letter.

c. In case, you neither accept the

counter oer nor revert to Us

within 15 days, We shall cancel

Your application and refund the

premium paid within next 10

days subject to deduction of the

Pre-Policy Check up charges, as

applicable.

v. Please note that We will issue Policy

only after getting Your consent.

20. Entire Contract

i. This Policy, its Schedule,

endorsement(s), proposal 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 Schedule 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.

21. Change of Policyholder

i. The change of Policyholder is

permitted only at the time of renewal.

ii. If the Insured Person is no longer

eligible on grounds of age or

dependency, the insured member

will be eligible to apply for a new

policy and enjoy continuity benets

upto Sum Insured.

22. Notices

i. 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

specified 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.

Section 5 – Claims Procedure and Claims

Payment

This section explains about the procedures

involved to file a valid claim by the insured

member and processes related in managing

the claim by TPA or Us. All the procedures and

processes such as notication of claim, availing

cashless service, supporting claim documents

and related claim terms of payment are

explained in this section.

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: TATHLIP21257V022021

1. Notication of Claim

Treatment, Consultation or

Procedure:

We or Our TPA* 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.

*TPA as mentioned in the policy schedule

2. Cashless Service

Treatment,

Consultation or

Procedure:

Treatment,

Consultation or

Procedure Taken at:

Cashless Service is

Available:

We must be given

notice that the Insured

Person wishes to

take advantage of

the cashless service

accompanied by full

particulars:

If any planned

treatment,

consultation or

procedure for which

a claim may be made:

Network Hospital We will provide

cashless service by

making payment to

the extent of Our

liability directly to the

Network Hospital.

At least 48 hours

before the planned

treatment or

Hospitalisation

If any treatment,

consultation or

procedure for which

a claim may be made,

requiring emergency

hospitalisation

Network Hospital We will provide

cashless service by

making payment to

the extent of Our

liability directly to the

Network Hospital.

Within 24 hours after

the treatment or

Hospitalisation

3. Procedure for Cashless Service

i. Cashless Service is only available at

Network Hospitals.

ii. In order to avail of cashless treatment,

the following procedure must be

followed by You:

a. Prior to taking treatment and/

or incurring Medical Expenses

at a Network Hospital, You must

call our designated TPA/Us and

request pre-authorization.

b. For any emergency

Hospitalisation, our designated

TPA/We must be informed

no later than 24 hours of the

start of Your hospitalization/

treatment.

c. For any planned hospitalization,

our designated TPA/We must

be informed atleast 48 hours

prior to the start of your

hospitalization/treatment.

d. Our designated TPA/We will

check your coverage as per

the eligibility and send an

authorization letter to the

provider. You have to provide

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: TATHLIP21257V022021

the ID card issued to You along

with any other information

or documentation that is

requested by the TPA/Us to

the Network Hospital.

e. In case of deficiency in the

documents sent to TPA/Us for

cashless authorization, the

same shall be communicated

to the hospital by TPA/Us

within 6 hours of receipt of the

documents.

f. In case the ailment /treatment

is not covered under the policy

or cashless is rejected due

to insufficient documents

submitted, a rejection letter

would be sent to the hospital

within 6 hours.

g. Rejection of cashless in no way

indicates rejection of the claim.

You are required to submit

the claim along with required

documents for us to decide on

the admissibility of the claim.

h. If the cashless is approved,

the original bills and evidence

of treatment in respect of the

same shall be left with the

Network Hospital.

i. Pre-authorization does not

guarantee that all costs and

expenses will be covered. We

reserve the right to review each

claim for Medical Expenses and

accordingly coverage will be

determined according to the

terms and conditions of this

Policy.

4. Supporting Documentation &

Examination

i. You or someone claiming on

Your behalf shall provide Us with

documentation, medical records

and information We or Our TPA

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.

iv. Such documentation will include

the following:

a. 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.

b. Original Bills (pharmacy

purchase bill, consultation

bill, diagnostic bill) and any

attachments thereto like

receipts or prescriptions in

support of any amount claimed

which will then become Our

property.

c. All medical reports, case

histories, investigation reports,

indoor case papers/ treatment

papers (in reimbursement

cases, if available), discharge

summaries.

d. A precise diagnosis of the

treatment for which a claim is

made.

e. A detailed list of the individual

medical services and treatments

provided and a unit price for

each in case not available in 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: TATHLIP21257V022021

submitted hospital bill.

f. Prescriptions that name the

Insured Person and in the

case of drugs: the drugs

prescribed, their price and a

receipt for payment. In case of

pre/post hospitalization claim

Prescriptions must be submitted

with the corresponding Doctor/

hospital invoice.

g. All pre and post investigation,

treatment and follow up

(consultation) records

pertaining to the present

ailment for which claim is being

made, if and where applicable.

h. 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

i. Copy of settlement letter from

other insurance company or

TPA

j. Stickers and invoice of implants

used during surgery

k. 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.

l. 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

m. Legal heir/succession certicate

, if required

n. PM report (wherever applicable)

v. Note: In case You are claiming for

the same event under an indemnity

based policy of another insurer and

are required to submit the original

documents related to Your treatment

with that particular insurer, then You

may provide Us with the attested

copies of such documents along with

a declaration from the particular

insurer specifying the availability of

the original copies of the specied

treatment documents with it.

We at our own expense, shall have the

right and opportunity to examine insured

persons through Our Authorised 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.

5. 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

We or Our TPA has 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. This Policy only covers medical

treatment taken within India (except

in case of benet B13- Global cover),

and payments under this Policy shall

only be made in Indian Rupees within

India.

Section 6 - Dispute Resolution

1. Dispute Resolution Clause

Any and all disputes or differences

under or in relation to this Policy shall

be determined by the Indian Courts and

subject to Indian law.

2. Arbitration

If any dispute or dierence shall arise as

to the quantum to be paid by the Policy,

(liability being otherwise admitted) such

dierence shall independently of all other

questions, be referred to the decision

of a sole arbitrator to be appointed in

writing by the parties here to or if they

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: TATHLIP21257V022021

Annexure A

NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

cannot agree upon a single arbitrator

within thirty days of any party invoking

arbitration, the same shall be referred to a

panel of three arbitrators, comprising two

arbitrators, one to be appointed by each

of the parties to the dispute/dierence

and the third arbitrator to be appointed by

such two arbitrators and arbitration shall

be conducted under and in accordance

with the provisions of the Arbitration and

Conciliation Act 1996, as amended by

Arbitration and Conciliation (Amendment)

Act, 2015 (No. 3 of 2016).

It is clearly agreed and understood that no

dierence or dispute shall be preferable

to arbitration as herein before provided, if

the Company has disputed or not accepted

liability under or in respect of the policy.

It is hereby expressly stipulated and

declared that it shall be a condition

precedent to any right of action or suit

upon the policy that award by such

arbitrator/arbitrators of the amount of

expenses shall be rst obtained.

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]

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]

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: TATHLIP21257V022021

SN Centre Address & Contact

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]

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]

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: TATHLIP21257V022021

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.

SN Centre Address & Contact

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]