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Title

Primium/Yearly
8000
Sum Assured
3 Lakhs
Buy Now
Tata_AIG@2x

Title

Primium/Yearly
8000
Sum Assured
3 Lakhs
Buy Now
Key Benefit
Over and above Sum assured Benefits
Sum assured Benefits
Value Added Benefit
Claim Process
General Exclusions

Features

cil_room
No Claim Bonus is the reward for not making a claim. Depending on plan, Insurer adds a 5%-100% bonus to the Sum Insured at no extra premium.
Renewal bonus
50% up to 5x
icon-park-solid_chart-proportion
Co-pay is the share of claim to be paid by the policyholder, while the rest is paid by the insurer. Always look out for plan with 0% co-pay or minimum co-payment.

Co Pay

Available without network hospital
medical-icon_i-waiting-area
The minimum period policyholder needs to wait before filing a claim. In case of pre-exisitng illnesses such as diabetes, thyroid etc., look for plans with less waiting periods.
Waiting Period
48 month
Group
Room rent limit is the maximum amount per day cost allowed by the insurer. Related expenses, such as doctor consultation etc. are paid in proportion to the room rent limit.
Room rent limit
Single private room
health-checkup
Complimentary health checkups in the policy to ensure wellbeing of the policyholders.
Health Checkup
Optional
No Claim Bonus is the reward for not making a claim. Depending on plan, Insurer adds a 5%-100% bonus to the Sum Insured at no extra premium.
cil_room
Renewal bonus
50% up to 5x
Co-pay is the share of claim to be paid by the policyholder, while the rest is paid by the insurer. Always look out for plan with 0% co-pay or minimum co-payment.
icon-park-solid_chart-proportion

Co Pay

Available without network hospital
The minimum period policyholder needs to wait before filing a claim. In case of pre-exisitng illnesses such as diabetes, thyroid etc., look for plans with less waiting periods.
medical-icon_i-waiting-area
Waiting Period
48 month
Room rent limit is the maximum amount per day cost allowed by the insurer. Related expenses, such as doctor consultation etc. are paid in proportion to the room rent limit.
Group
Room rent limit
Single private room
Complimentary health checkups in the policy to ensure wellbeing of the policyholders.
health-checkup
Health Checkup
Optional

KEY Benefit

  • Young Family Discount – 5%

Provided all the Insured Persons covered are of age of 40 years or below at the time of first inception of the policy. This discount will be effective from the first year of the policy and will continue, irrespective of claims.

  • 5X Supercharge Bonus

Offers bonus of 50% of the base Sum Insured of our expiring Policy, on each Renewal, irrespective of claims in preceding Policy Years. The 5X Supercharge Bonus can get accumulated maximum up to 500% of the base Sum Insured in any Policy Year, provided that the Policy is renewed with Us without a break.

  • Medical Devices Cover

Covers expenses incurred by the Insured Person towards renting or purchase of Crutches, Wheel chair, Walker, walking stick and Lumbo-sacral belt, during the Policy year, if the same is prescribed by the treating Medical Practitioner post Hospitalization.

  • Restore Benefit

Automatically reinstates 100% of the Sum Insured, once during the Policy Year, if the balance Sum Insured and accrued 5X Supercharge Bonus is insufficient to pay an admissible claim.

  • Advanced Cover (Optional)

This cover will reduce ‘Pre – existing Diseases Waiting Period for the following named pre – existing diseases from 48 months to 30 days: 1 Diabetes Mellitus, 2 Hypertension, 3 Hyperlipidemia, 4 Asthma

Over and above Sum assured Benefits

Compassionate Travel

In the event the Insured Person is Hospitalized in India for more than Five consecutive days in a place where no adult member of his immediate family is present, We will cover expenses related to round trip economy class domestic air ticket, or first-class railway ticket, to allow the Immediate Family Member be at his bedside for the duration of his stay in the Hospital, subject to the maximum limit during a Policy Year, as mentioned in the ‘Benefit Table’.

Prolonged hospitalization benefit

`10,000 per policy year, over and above base Sum Insured, subject to Hospitalization for a continuous period exceeding 10 days at Our Network of Valued Provider - Pan India.

Medical Devices Cover

Covers expenses incurred by the Insured Person towards renting or purchase of Crutches, Wheel chair, Walker, walking stick and Lumbo-sacral belt, during the Policy year, if the same is prescribed by the treating Medical Practitioner post Hospitalization for the same condition for which the hospitalization claim was admissible.

Vaccination cover

Covers the cost of the following vaccines,
1.Anti-rabies vaccine following an animal bite 2.Typhoid vaccination

Sum assured Benefits

In-Patient Treatment

Covers Medical Expenses for Medically necessary treatment in a hospital, due to disease/Illness/Injury, that requires an Insured Person’s admission in a Hospital for an Inpatient Care, during the Policy Period. Medical Expenses directly related to the Hospitalization would be payable.

Pre-Hospitalization Expenses

Covers Medical Expenses incurred up to 90 days prior to the date of admission to the Hospital

Post-Hospitalization Expenses

Covers Medical Expenses incurred in up to 90 days immediately after the Insured Person was discharged post hospitalization.

Day Care Treatment

Covers expenses for Day Care Treatment due to disease/illness/Injury taken in a hospital or a Day Care Centre, during the Policy Period.

Domiciliary Treatment

Covers Medical Expenses related to Domiciliary Hospitalization of the Insured Person if the treatment exceeds beyond three consecutive days and is availed during the Policy Period. The treatment must be for management of an Illness and not for enteral feedings or end of life care.

Organ Donor

Covers Medical Expenses incurred by or in respect of the organ donor, for an organ transplant Surgery, solely towards the harvesting of the organ donated. The insured person must be the recipient of the organ so donated by the organ donor.

AYUSH Benefit

Covers medical Expenses incurred for In-patient/Day care treatment taken in an AYUSH hospital/AYUSH day care centre, including pre and post hospitalization expenses.

Road Ambulance Cover

Covers expenses incurred on transportation of Insured Person in a registered ambulance to a hospital for admission in case of an Emergency.

Restore Benefit

Automatically reinstate 100% of the Sum Insured, if the balance Sum Insured and accrued 5X Supercharge Bonus is insufficient to pay an admissible claim under In-Patient Treatment, Pre-Hospitalization Expenses, Post-Hospitalization Expenses, Day Care Treatment, Domiciliary Treatment or Organ Donor cover, during the policy year.

Second Opinion

Provides the Insured Person second medical opinion from Our empanelled service provider in India, if an Insured Person is diagnosed with the listed Illnesses during the Policy Period.

Optional Covers (ADD ON)

Restore Infinity

Provides reinstatement of sum insured unlimited number of times during a Policy Year post exhaustion of the Restore Benefit.

Emergency Air Ambulance Cover

Covers cost of air ambulance for transportation of the Insured Person in an airplane or helicopter, on reimbursement basis, subject to the maximum limit per Policy Year, as mentioned in the ‘Benefit Table’, for Emergency Care of life-threatening health conditions which require immediate and rapid ambulance transportation to a hospital for further medical management.

Consumables Benefit

Covers expenses incurred for specified consumables, subject to balance sum insured, which are mentioned in Annexure I – List I of optional items available on Our website (www.tataaig.com) which are consumed during the period of Hospitalization directly related to the Insured Person’s medical or surgical treatment of Illness/disease/Injury.

Preventive Annual Health Check-Up

We/ Our empanelled service provider will arrange for listed medical tests every Policy Year for all Insured Persons covered under the Policy irrespective of claim. The health check-ups shall be arranged by Us only on cashless basis either at Our empanelled service providers or at insured person’s residence, as per availability.

Advanced Cover

In lieu of the policyholder opting for this Advanced Cover and paying additional premium for the specific Insured Person(s), the word “48 months” should be read as “30 days” under ‘Pre-existing

Diseases Waiting Period only for the following named pre-existing diseases

a.Diabetes Mellitus,
b.Hypertension,
c.Hyperlipidemia &
d:Asthma

Accidental Death Benefit

If an Insured Person suffers 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 the Sum Insured as mentioned in the ‘Benefit Table’. This benefit is not applicable for insured children or Insured person less than 18 years of age as on Policy commencement date

Value Added Benefit

Wellness Services

We / our Empanelled Service Provider will provide below mentioned wellness services:
  • Teleconsultation – General
  • Teleconsultation – Specialty
  • Ambulance Booking facility
  • Emergency Help me feature
  • Redeemable voucher/Discount on services
  • Health Condition Management

Wellness Program

We / our empanelled service provider will provide a wellness program designed to promote wellness and fitness amongst the insured persons through:
  • Health risk assessment
  • Wellness Rewards: Wellness Reward accumulated through fitness activities can be converted into monetary value and can be utilized towards the payment of services/items under below categories, available through our Network/ empanelled service provider:
      1. OPD consultation/ treatment
      2. Pharmaceuticals
      3. Health-check-ups/ diagnostics
      4. Health Supplements
      5. Coverage of cost of treatment of any admissible claim in respect of non-payable items that are specified under the terms and conditions of the base policy

Home Care Treatment

Covers expenses incurred for treatment taken at home for Dialysis/Chemotherapy/Pandemic Care at home.

Home Physiotherapy

As a part of Post Hospitalization expenses cover, 15 physiotherapy sessions arranged at home by our empanelled service providers within India.

Cost Sharing

  • Age Linked Co-Payment: If the entry Age of the Insured Person is 61 years or above at the time of first coverage under this Policy, then such Insured Person shall bear 20% of each admissible claim.
  • Co-payment for treatment availed out of Our Network of Valued Provider – Pan India:
    Under this plan, if the Insured Person avails treatment outside Our network of “Valued Provider – Pan India”, then a Co – Payment of 30% will be applicable for each such claim resulting from admission of the Insured Person in a Hospital / Day Care Centre / AYUSH Hospital / AYUSH Day Care Centre except for Hospitalization for an Injury arising from an Accident.
    Mandatory Sub-Limits Our liability for any and all claims related to Hospitalization/ Day Care Treatment (including their associated Pre & Post Hospitalization expenses) arising out of following ailments/surgical procedures shall be restricted to the following Sub-limits
(Ailment / Surgical Procedure) Annual Sub-limit, as applicable to each Insured Person based on the Sum Insured (in `)
5 Lacs 7.5 Lacs 10 Lacs 15 Lacs 20 Lacs
Cataract Surgery (per eye) ₹45,000 ₹60,000 ₹90,000 ₹1,30,000 ₹1,75,000
Balloon Sinuplasty / FESS ₹30,000 ₹40,000 ₹55,000 ₹85,000 ₹1,10,000
Oral chemotherapy ₹85,000 ₹1,15,000 ₹1,65,000 ₹2,50,000 ₹3,30,000
Immunotherapy – Monoclonal Antibody all forms ₹1,40,000 ₹1,95,000 ₹2,75,000 ₹4,15,000 ₹5,50,000
Robotic surgeries ₹1,40,000 ₹1,95,000 ₹2,75,000 ₹4,15,000 ₹5,50,000
Stem cell therapy for Hematopoietic stem cells for bone marrow transplant for hematological conditions ₹1,40,000 ₹1,95,000 ₹2,75,000 ₹4,15,000 ₹5,50,000
Total Knee Replacement (per knee) ₹1,65,000 ₹1,75,000 ₹1,80,000 ₹2,15,000 ₹2,30,000
Any type of Hernia Surgery ₹70,000 ₹75,000 ₹75,000 ₹95,000 ₹1,00,000
Any type of Hysterectomy ₹70,000 ₹75,000 ₹75,000 ₹95,000 ₹1,00,000
Benign Prostate Hypertrophy ₹70,000 ₹75,000 ₹75,000 ₹95,000 ₹1,00,000
Stones of Renal System ₹70,000 ₹75,000 ₹75,000 ₹95,000 ₹1,00,000

Claim Process

Time Value Wealth Assistance

1

Contact TVW
The customer will contact TUV Via Email / Calls for any of the above-mentioned queries.

2

Claim Intimation
The Service Team will make a note of the customer and claim details. The same would be then forwarded to the Insurer for further action.
Insurer Processes
The Insurer takes action – ( Claim Intimated, Documents received, Cashless Approval given, etc )

3

Customer Intimation
The Insurer's decision will be informed to the customer and as per the request raised the Service team will guide the customer for further claim settlement.

4

5

Follow up with Customer & Insurers
Any pending dependency from the customer shall be conveyed to him/her and likewise, it will be forwarded to the Insurer again.
Claim Settlements
Post all the above procedure is done, the claim stands settled when the customer gets cashless approval or reimbursement amount is received.

6

General Exclusions

Waiting periods
  • Policy coverage for treatment of any illness starts after 30 days from the first inception of the policy (except accident).
  • Listed illnesses / treatments will be covered after a waiting period of 24 months.
  • Pre – existing condition will be covered after a waiting period of 48 months.
Medical Exclusions:
  • Congenital External Diseases, defects or anomalies
  • Alcoholic pancreatitis or Alcoholic liver disease
Non-Medical Exclusions:
  • Intentional self – injury or attempted suicide while sane or insane.
  • Expenses for treatment directly arising from or consequent upon any Insured Person committing or
  • attempting to commit a breach of law with criminal intent.
  • Treatment rendered by a Medical Practitioner which is outside his discipline
#Please refer to the policy wordings for complete list of benefits, exclusions, limitations, terms and conditions.
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Plan Brochure

terms-and-conditions

Terms & Conditions

Notes on Loading Charges for Pre-Existing Conditions (PEDs): Loading charges are extra fees added to the base premium of health insurance policies. These charges are implemented to offset the increased financial risk associated with insuring individuals who have pre-existing conditions (PEDs). Insurers may increase premiums if they expect higher medical care utilization due to these conditions, if applicable.

Plan Brochure

Policy Wording

Prospect

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