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Title

Primium/Yearly
8000
Sum Assured
3 Lakhs
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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
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
100% paid by the insurer
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Expenses incurred BEFORE hospitalization, such as doctor visits, diagnostic tests etc. Insurance company pays for such expenses upto a certain number of days (ex. 30-90 days) prior to hospitalization.
Pre hospitalization expenses covered
60 days before hospitalized
medical-icon_i-waiting-area
Expenses incurred AFTER hospitalization, such as doctor visits, medicines etc. Insurance company pays for such expenses upto a certain number of days (ex. 30-180 days) after the hospitalization.
Post hospitalization expenses covered
90 days is after discharge
Group
Covers for ambulance charges before or after the hospitalization.
Ambulance cover (per hospitalization)
Up to `5000
health-checkup
Complimentary health checkups in the policy to ensure wellbeing of the policyholders.
Health Checkup
Up to 1% of Sum Insured; maximum `10,000 per policy
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.
cil_room
Co-pay
100% paid by the insurer
Expenses incurred BEFORE hospitalization, such as doctor visits, diagnostic tests etc. Insurance company pays for such expenses upto a certain number of days (ex. 30-90 days) prior to hospitalization.
icon-park-solid_chart-proportion
Pre hospitalization expenses covered
60 days before hospitalized
Expenses incurred AFTER hospitalization, such as doctor visits, medicines etc. Insurance company pays for such expenses upto a certain number of days (ex. 30-180 days) after the hospitalization.
medical-icon_i-waiting-area
Post hospitalization expenses covered
90 days is after discharge
Covers for ambulance charges before or after the hospitalization.
Group
Ambulance cover (per hospitalization)
Up to `5000
Complimentary health checkups in the policy to ensure wellbeing of the policyholders.
health-checkup
Health Checkup
Up to 1% of Sum Insured; maximum `10,000 per policy

KEY Benefit

  • Global Cover for Planned Hospitalization

Covers Medical Expenses related to Inpatient & Day Care Hospitalization of the Insured Person incurred outside India, provided that the diagnosis was made in India. Expenses incurred towards obtaining visa for medical treatment is also covered.*

  • Consumables Benefit

Covers expenses incurred, for specified consumables which are consumed during the period of hospitalization directly related to the insured person’s medical or surgical treatment of illness/disease/injury.

  • Restore Benefits

We will automatically restore the Basic Sum Insured if the Sum Insured and accrued Cumulative Bonus is insufficient to pay a claim during the policy year. For single premium multi-year policies, the insured can utilize maximum upto 3X Restore in a policy year. i.e can utilize the available restorations anytime during the policy period, except for the first claim, for e.g.. a policy with tenure of 3 years, the insured is eligible for a total of 3 restorations anytime during the policy period and 2 restorations for a 2 years policy.*

  • Emergency Air Ambulance

Covers expense for ambulance transportation by airplane or helicopter for emergency life threatening health conditions, which require immediate ambulance transportation to the hospital/medical centre for further medical management.

Over and above Sum assured Benefits

Compassionate travel (per policy year)

Up to `20,000 per policy, for immediate family member of insured on making travel arrangement to meet the insured who is hospitalized for 5 or more consecutive days.

Hearing Aid

50% of actuals; maximum `10,000 per policy every third year.

Daily cash for choosing shared accommodation

0.25% of base Sum Insured; maximum `2000 per day.

Daily cash for accompanying an insured child

0.25% of base Sum Insured; maximum `2000 per day

Maternity Cover

`50,000 for birth of Boy & 60,000 for birth of girl child.

Delivery Complications Cover

Up to `10000 cover

First year Vaccinations

Up to `10000 for Boy Child & `15000 for girl child).

OPD Treatment

Up to `5,000

OPD Treatment – Dental

Up to `10,000.

Prolonged Hospitalization

1% of Sum Insured, if insured hospitalized due to dieses, illness, injury for more than 10 consecutive days

High End Diagnostics (per policy year)

Up to `25,000 per policy year on listed OPD High and Diagnostics test.

Sum assured Benefits

In-Patient Treatment

Covers expenses for hospitalization due to disease/illness/lnjury 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.

Day Care procedures

If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.

Organ Donor

Covers Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient.

Domiciliary Treatment

The insurer will bear the costs even if you are hospitalized at home due to a condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.

Restore Benefit

50% of sum assured to max 100% on every claim free years

AYUSH Benefit

Available up to Sum Assured

Consumables Benefit

Cover all consumables items which are related to insured treatment

Global Cover for Planned Hospitalization

Covered up to base Sum assured and available cumulative bonus

Bariatric Surgery Cover

Covered up to sum assured with reasonable and customary expanses: no waiting periods

In-patient Treatment – Dental

Covers expenses related to root canal, filling, tooth extractions over and above sum insured. Does not impact cumulative bonus.

Vaccination cover

Covers expenses related to Human Papilloma Virus (HPV) vaccine & Hepatitis B Vaccine after 2 years of continuous coverage and Anti-rabies vaccine & Typhoid vaccination without any waiting period.

Accidental Death

100 % base Sum assured if insured meets with an accident- in built

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

Emergency Air Ambulance Cover

Up to `5, 00,000 over and above Sum assured

Wellness Services

  • Unlimited Teleconsultation General
  • Unlimited Teleconsultation – Specialist
  • Health Condition Management
      1. Diet & Weight Management Program
      2. Stress Management Program
  • Redeemable voucher/Discount on services
      1. Ambulance Booking facility
      2. Emergency Help me feature

Wellness Program

  • Health Risk Assessment
  • Reward Earning
  • Reward utilization (towards OPD Consultation/ Treatment, Pharmaceuticals, Health Check-Ups/ Diagnostics, etc.)

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
  • 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
  • Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
  • Pre-Existing Disease Waiting Period: There’s a 2-year waiting period for any pre-existing disease you may have while buying the policy.
  • Maternity and New-born Waiting Period: There’s a 4-year waiting period before you can make claims related to pregnancy and childbirth.
  • OPD Treatment & OPD-Dental Treatment Waiting Period: There’s a 2-year waiting period before you can claim benefits for OPD Treatments
Medical Exclusions:
  • Congenital External Diseases, defects or anomalies
  • Alcoholic pancreatitis
Non-Medical Exclusions:
  • Intentional self – injury or attempted suicide while sane or insane.
  • Expenses for treatment directly arising from attempting to commit a breach of law with criminal intent
  • Treatment rendered by a Medical Practitioner which is outside his discipline
Please refer to policy wordings for complete list of Exclusions*
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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

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