1. Women Suraksha (She Care+, Polycystic Ovarian Cover , Women+ Screening & Vaccination Cover ) 2. Restore Infinity Plus(inbuild – mandatory) 3. Inflation Protect(inbuild – mandatory) 4.Cancer Benefit 5. Pocket Saver (Out-patient Treatment , OPD Treatment – Dental , OPD Vision Care , OPD Pharmacy , High End Diagnostics, OPD Physiotherapy Benefit , Medical Device Cover ) 6. Voluntary Aggregate Deductible(Discount) 7. Mental Wellbeing (Mental Health Screening , Psychological Therapy and Procedures, Diet Consultation Rider, Vocational Rehabilitation , Stress Management Rider , Addiction Cessation Program ) 8. Accident Suraksha (Additional Sum Insured for Accidental Hospitalization , Permanent Total Disability Benefit Rider ) 9. Advance Cover (ABCD – 31st day onwards)
MediCare
1. Women Suraksha (She Care+, Polycystic Ovarian Cover , Women+ Screening & Vaccination Cover ) 2. Restore Infinity Plus(inbuild – mandatory) 3. Inflation Protect(Not Available) 4.Cancer Benefit 5. Pocket Saver (Out-patient Treatment , OPD Treatment – Dental , OPD Vision Care , OPD Pharmacy , High End Diagnostics, OPD Physiotherapy Benefit , Medical Device Cover ) 6. Voluntary Aggregate Deductible(Discount) 7. Mental Wellbeing (Mental Health Screening , Psychological Therapy and Procedures, Diet Consultation Rider, Vocational Rehabilitation , Stress Management Rider , Addiction Cessation Program ) 8. Accident Suraksha (Additional Sum Insured for Accidental Hospitalization , Permanent Total Disability Benefit Rider ) 9. Advance Cover (ABCD – 31st day onwards) 10. Accidental Death Benefit — 100% of SA 11. Room Category (Shared — Discount, Any Category Rooms)
MediCare LITE
1. Consumables Benefit 2. Accidental Death Benefit – 100% of SA
Medicare Plus
1. Global Cover
Super Charge – Geo
1. Restore Infinity 2. Emergency Air Ambulance 3. Consumables Benefit 4. Advance Cover (ABCD – 31st day onwards) 5. Accidental Death Benefit — 100% of SA 6. Preventive Annual Check up 7. Room Category (Shared — Discount, Any Category Rooms) 8. Aggregate Deductable (5%, 10%) 9. Voluntary Sublimits Discounts 10. Waiver of Higher Zone Co Payment 11. Modifications Of Mandatory Sub Limits.
Consumables Benefit
We will pay for expenses incurred, for specified consumables 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.
Riders You should get these additional benefits to enhance your current plan
Note: Terms and conditions of the Rider are to be read in conjunction with the terms and conditions of the Base Policy.
1. Cancer Benefit (25% – 40%) (UIN: TATHLIA25038V012425)
Get lump sum payout If an insured person is diagnosed with “Cancer of Specified Severity” as defined herein during the Policy Period, then we will pay the sum insured as specified.
Section 1:
1.Suitability:
This Rider covers persons in the age group 18 Years onwards. This Rider is not applicable for dependent children covered in the Policy.
This Policy can be issued to an individual and/or family. However, in case of family, the coverage shall be available on individual basis only.
All the other eligibility conditions, relationships covered under this Rider will be applicable as per the base Policy.
2. Rider Conditions:
Rider can only be opted along with the base Policy and cannot be opted in isolation or as a separate product.
The Riders are provided in lieu of additional premium and subject to the terms, conditions and exclusions as stated in the Rider wordings in addition to the Policy Terms, Conditions and Exclusions.
This Rider, if selected, shall be mentioned in the Policy Schedule and will be available up to the limit specified therein, for all Insured Person(s) covered under the underlying base Policy, unless stated otherwise.
Cover(s) provided under this Rider and their limits are only with respect to such and so many as indicated in the Policy Schedule.
The Rider shall offer coverage subject to below conditions:
Terms and conditions of the Rider are to be read in conjunction with the terms and conditions of the Base Policy.
The continuance of risk cover under the Base Policy is a necessary precondition for continuance of cover under Rider.
Admission of liability under any cover in this Rider shall not have any bearing on admissibility of a claim under the Base Policy on any ground including non-disclosure of material fact or pre-existing disease.
3. Sum Insured Options:
5 Lakhs
10 Lakhs
15 Lakhs
20 Lakhs
25 Lakhs
50 Lakhs
75 Lakhs
100 Lakhs
Section 2: General Definitions
All Standard and Specific Definitions as defined in the respective base Policy shall also apply for Riders, wherever applicable.
Additional Specific Definitions:
1. Cancer of Specified Severity ‘Cancer of Specified Severity’ is defined as the following: I. A malignant tumor characterized by the uncontrolled growth and spread of malignant cells with invasion and destruction of normal tissues. This diagnosis must be supported by histological evidence of malignancy. The term cancer includes leukemia, lymphoma and sarcoma.
II. The following are excluded –
i. All tumors which are histologically described as carcinoma in situ, benign, pre-malignant, borderline malignant, low malignant potential, neoplasm of unknown behavior, or noninvasive, including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia CIN1, CIN – 2 and CIN-3. ii. Any non-melanoma skin carcinomaunless there is evidence of metastases to lymph nodes or beyond; iii. Malignant melanoma that has not caused invasion beyond the epidermis; iv. All tumors of the prostateunless histologically classified as having a Gleason score greater than 6 or having progressed to at least clinical TNM classification T2N0M0.
V. All Thyroid cancers histologically classified as T1N0M0 (TNM Classification) or below;
vi. Chronic lymphocytic leukaemialess than RAI stage 3 vii. Non-invasive papillary cancer of the bladder histologically described as TaN0M0 or of a lesser classification, viii. All Gastro-Intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with mitotic count of less than or equal to 5/50 HPFs.
R1. Cancer Benefit: (Fixed Amount)
In consideration of additional premium paid if an insured person is diagnosed with “Cancer of Specified Severity” as defined herein during the Policy Period, then we will pay the sum insured specified in the policy schedule provided:
“Cancer of Specified Severity” which the Insured Person is suffering from occurs or first manifest itself during the Policy Period, post initial waiting period of 30 days, as a first incidence.
The person survives for a period of at least 30 days from the diagnosis of the “Cancer of Specified Severity”.
On our admission of claim under this section in respect of an Insured Person, the cover under this section terminates in respect to that Insured Person.
Our liability for a lifetime of an Insured Person under this cover will be limited to the Sum Insured specified against this cover in the Policy Schedule.
Initial waiting period of 30 days shall also be applicable on the amount by which Sum Insured is increased in case of enhancement of Sum Insured at renewal.
Cancer arising due to Pre-Existing Disease shall not be covered under this Rider.
This benefit has a separate limit (over and above base Sum Insured).
– Upto Sum Insured (Sum Insured Options (₹ Lacs) 5 / 10 / 15 / 20 / 25 / 50 / 75 / 100) ⁻ As diagnosed with “Cancer of Specified Severity” as defined. ⁻ Post initial waiting period of 30 days, as a first incidence. ⁻ Survival Period of 30 Days. ⁻ This benefit has a separate individual limit (over and above base Sum Insured).
This Rider covers persons in the age group 18 Years onwards. This Rider is not applicable for dependent children covered in the policy.
R2. CanCare Booster: (Not Available)
In consideration of additional premium paid, if an insured person is diagnosed with “Cancer of Specified Severity” as defined herein during the Policy Period, then we will pay the Sum Insured applicable in the Policy Year. The Sum Insured under this cover will be increased by 10% every year subject to below conditions:
CanCare Booster Sum Insured increase % will be applied on the CanCare Booster benefit Sum Insured opted for the first time under this rider. The maximum accrued increased Sum Insured shall not exceed 100% of the initial CanCare Booster Sum Insured opted, in any Policy Year.
“Cancer of Specified Severity” which the Insured Person is suffering from occurs or first manifest itself during the Policy Period, post initial waiting period of 30 days, as a first incidence.
The person survives for a period of at least 30 days from the diagnosis of the “Cancer of Specified Severity”.
In case of Policies with a tenure of one year, the above mentioned increase in Sum Insured shall be applicable at renewal of the Policy along with this cover, without any break.
In policies with a tenure of more than one year, the above mentioned increase in Sum Insured shall be applicable post completion of each Policy Year.
On our admission of claim under this cover in respect of an Insured Person, the cover will terminate in respect to that Insured Person.
Cancer arising due to Pre-Existing Disease shall not be covered under this Rider.
This benefit has a separate limit (over and above base Sum Insured).
Revision in Sum Insured shall not be allowed any time post inception of the Policy including subsequent renewal of the Policy.
Illustration:
Policy Year
1st Year
2nd Year
3rd Year
4th Year
CanCare Booster %
–
10%
10%
10%
Sum Insured under CanCare Booster
₹10,00,000 (Initial Sum Insured Opted)
₹11,00,000
₹12,00,000
₹13,00,000
Note1: Pre-Policy Medical Check up:
Pre-Policy Check up at our network may be required based upon the age, gender and Sum Insured. 100% of the expenses incurred per Insured Person will be payable by TATA AIG only on the acceptance of the Proposal. The Medical Reports are valid for a period of 90 days from the date of Pre-Policy Check up.
Gender
Age
Sum Insured
Pre-Policy Check up Tests*
Male
Above 45 years
₹50 Lakhs and above
1. Prostate Specific Antigen (PSA) 2. Test Carcinoembryonic Antigen (CEA) Test
Female
Above 45 years
₹50 Lakhs and above
1. Cancer Antigen – 125 (CA – 125) Test 2.Carcinoembryonic Antigen (CEA) Test
In case of adverse medical declaration, we may call for Tele-MER/additional medical tests.
Tele-MER means Tele Medical Examination Reporting.
100% of Tele-MER cost would be borne by the Company, in case of Proposal acceptance.
*At least 50% of Pre-Policy medical checkup cost would be borne by the Company in case where Proposal is accepted.
Financial underwriting may be done in case of higher Sum Insured options.
Note2. Premium Rates (Rate Per Lakh):
a. Cancer Benefit:
Age Band
Premium (In ₹)
18-35
99
36-45
265
46-55
566
56+
1,240
b. CanCare Booster:
Age Band
Premium (In ₹)
18-35
158
36-45
419
46-55
880
56+
1,862
Note 3. Terms and Conditions:
All the general terms and conditions, waiting periods, exclusions and claim procedure shall be applicable as per the base Policy.
2. Women suraksha (up to 10%)(UIN: TATHLIA25036V012425)
Comprehensive women’s health cover offering consultations, PCOS treatment, cancer screening and cervical cancer vaccination through empanelled providers in India
Section 1:
1. Suitability:
This Policy can be issued to an individual and/or family. However, in case of family, the coverage shall be available on individual basis only.
All the other eligibility conditions, entry age limits, relationships covered under this Rider will be applicable as per the base Policy.
Minimum one benefit from the Rider has to be opted by the Policyholder.
2. Rider Conditions:
Rider can only be opted along with the base Policy and cannot be opted in isolation or as a separate product.
The Riders are provided in lieu of additional premium and subject to the terms, conditions and exclusions as stated in the Rider Wordings in addition to the base Policy terms, conditions and Exclusions.
These Rider(s), if selected, shall be mentioned in the Policy Schedule and will be available up to the limit specified therein,for female Insured Person(s) covered under the underlying base Policy, unless stated otherwise.
Terms and conditions of the Riders are to be read in conjunction with the terms and conditions of the base Policy.
The continuance of risk cover under the base Policy is necessary precondition for continuance of cover under Riders.
The scope of coverage under these Riders are restricted to the geography of India.
Admission of liability under any cover in this Rider shall not have any bearing on admissibility of a claim under the base Policy on any ground including non-disclosure of material fact or pre-existing disease.
Coverage under this Rider shall be availed during the Policy Period only.
Benefits under this Rider have separate limits (Over and above the base Sum Insured), as specified in the Policy Schedule, and does not affect Cumulative Bonus in the base Policy, if applicable.
Section 2: General Definitions
All Standard and Specific Definitions as defined in the respective base Policy shall also apply for Riders, wherever applicable.
Additional Specific Definitions:
1. Health Care Professional:
A Health Care Professional is a person who holds a valid qualification from regulatory body as set up by the Government of India or a State Government or any other relevant authority and is engaged in actions with an objective of maintaining and improving individual’s good health.
2. Service Provider:
Service Provider means the providers empanelled and engaged by Us for arranging/providing services under Riders mentioned in the base Policy Schedule.
A. Women Suraksha Package 1
R1. She Care+ (Covered)
We/Our empanelled service provider will arrange for the specified Consultations at the request of the female insured person(s), at our empanelled service provider in India.
In consideration of additional premium paid and notwithstanding the exclusion mentioned under base Policy with respect to Sterility and Infertility (Code-Excl 17) and Maternity (Code-Excl 18), We/Our empanelled service provider will arrange for the below mentioned consultations at Your request, at our empanelled service provider in India.
Gynaecologist Consultation
Premenstrual Syndrome (PMS) Counseling
Menarche Counseling
Menopause Counseling
Infertility Counseling
Dermatologist Consultation
Sum Insured (₹)
No. of consultations
Less than 20 Lacs
Upto 10
20 Lacs – 50 Lacs
Upto 15
More than 50 Lacs
Upto 20
These consultations will be provided through various specified modes of communications (including but not limited to) like In-person, audio, video, online portal, chat, digital customer application or any other digital mode.
R2. Polycystic Ovarian Cover (Covered)
We will cover the Reasonable and Customary Charges for Evaluation of irregular menstrual cycles as prescribed by the treating Medical practitioner and towards the treatment of Polycystic ovarian disease/syndrome, as prescribed by the treating a Medical practitioner.
We/Our empanelled Service Provider will arrange for the specified cancer screening in India and We will also cover the Reasonable and Customary Charges for the Cervical Cancer Vaccination.
In consideration of additional premium paid and notwithstanding the exclusion mentioned under base Policy with respect to Specified Disease/Procedure Waiting Period (Code-Excl 02), We/Our empanelled Service Provider will:
Arrange for the below mentioned covers in India:
In person consultation with a Medical Practitioner for Polycystic Ovarian Disease/Syndrome.
Following diagnostic tests as prescribed by the treating Medical Practitioner:
Prolactin, Serum
Testosterone
Thyroid Function Test
HbA1c
CBC ESR
Luteinizing Hormone (LH)
Follicular Stimulating Hormone (FSH)
LH: FSH Ratio
Cover the Reasonable and Customary Charges towards the treatment of Polycystic Ovarian Disease/Syndrome, as prescribed by the treating Medical practitioner.
Sum Insured (₹)
Consultation & Listed diagnostic Tests (₹)
Treatment for Polycystic ovarian disease/syndrome (₹)
In consideration of additional premium paid and notwithstanding the exclusion mentioned under base Policy with respect to all preventive care including Health Check-Ups, vaccination including inoculation and immunizations, We/Our empanelled Service Provider will:
Arrange for the below mentioned cancer screening in India, at Your request:
Breast cancer Screening – Mammography
Ovarian Cancer Screening – Ultrasound and CA 125
Cervical Cancer Screening – Pap Smear
Cover the Reasonable and Customary Charges for the Cervical Cancer Vaccination including the cost of vaccine, provided the vaccination is availed at our network of empanelled service provider. However, the expenses related to the doctor, nurse or any other incidental expenses shall not be payable if the cancer vaccination has been availed.
Sum Insured (₹)
Cancer Screening
Cervical cancer Vaccination Cost (₹)
Less than 20 Lacs
Annually
Upto 5000
20 Lacs – 50 Lacs
Annually
Upto 5000
More than 50 Lacs
Bi-annually
Upto 5000
R4. Maternity Protect: (Not Available)
In consideration of additional premium paid, this benefit shall offer below covers:
a. Infertility Treatment:
Notwithstanding the exclusion mentioned under base Policy with respect to Sterility and Infertility (Code – Excl 17), We will cover the Reasonable and Customary Charges for the cost of the following Treatment(s), if the Insured Person(s) is medically prescribed by the treating Medical Practitioner to procure the same for the treatment of infertility:
Intrauterine Insemination (IUI)
In-Vitro Fertilization (IVF)
Embryo Transfer
The benefit is payable only for one such treatment cycle for each female insured person(s) per Policy Year.
Sum Insured (₹)
Less than 20 Lacs
20 Lacs – 50 Lacs
More than 50 Lacs
Infertility Treatment(₹)
Upto 1,00,000
Upto 1,00,000
Upto 3,00,000
b. Sterilization Treatments:
Google: Sterilization treatments refer to processes that eliminate or destroy all forms of microbial life, including bacteria, spores, and viruses, on surfaces or in fluids, ensuring a sterile environment.
Notwithstanding the exclusion mentioned under base Policy with respect to Sterility and Infertility (Code-Excl 17), We will cover the Reasonable and Customary Charges for Medical Expenses towards the voluntary sterilization of a female adult Insured Person(s) after a Waiting Period of two continuous years with Us under this cover.
For availing this benefit, the Female Insured must be a married person and her age should be22 years or above during the treatment.
The treatment is covered once in the lifetime of the Insured Person under this cover. We shall not pay for the expenses incurred towards reversal treatments of such sterilization, under this cover.
Once in the policy lifetime
Waiting period 2 years
For availing this benefit, the female insured must be a married person and her age should be 22 years or above during the treatment
We shall not pay for the expenses incurred towards reversal treatments of such sterilization
Sum Insured (₹)
Less than 20 Lacs
20 Lacs – 50 Lacs
More than 50 Lacs
Sterilization Treatments (₹)
Upto 25,000
Upto 25,000
Upto 25,000
c. Ante-Natal & Post-Natal Care:
Notwithstanding the exclusion mentioned under base Policy with respect to Maternity (Code-Excl 18), We will arrange for the following Ante-Natal & Post-Natal Check-Ups, on an outpatient basis.Ante-Natal consultation shall be covered since the date of confirmation of pregnancy and Post-Natal consultation shall be covered for a period up to six weeks post delivery.
Ante-Natal check up shall include:
5 in-person consultations with gynecologist
One Ultrasound
Evaluation of Hypertension
One Blood Test
Blood Group Antibodies
HIV, Syphilis, Rubella, Hepatitis
Rhesus Negative Status
Anaemia
Vitamin D
HbA1c
Urine Culture
Post-Natal Checkup shall include:
5 In person consultations with gynaecologist
Lactation Consultation
Up to two in-person consultation for post-partum depression with psychiatrist
Consultations & Listed Diagnostics Tests
Sum Insured (₹)
Less than 20 Lacs
20 Lacs – 50 Lacs
More than 50 Lacs
Ante-Natal Care & Post Natal Care (₹)
Upto 3000
Upto 5000
Upto 10,000
d. Maternity Buddy Program:
We/Our empanelled Service Provider will arrange for Health Care Professional who will advise and conduct sessions on matters related to pregnancy and child birth for the Insured Person provided you are covered for Maternity benefit under the base Policy.
This program will be provided through various specified modes of communications (including but not limited to) like audio, video, online portal, chat, digital customer application or any other digital mode.
Sum Insured (₹)
Less than 20 Lacs
20 Lacs – 50 Lacs
More than 50 Lacs
Maternity Buddy Program
Available
Available
Available
e. Home Assessment and Modification for Baby Care/Infant Care:
We/Our empanelled service provider will arrange for a home assessment to evaluate and recommend the modifications required in home to suit the safety and mobility needs for an infant.
In addition, We will pay a fixed amount as mentioned in the Policy Schedule to undertake home alteration, if recommended by the home assessor arranged by Us. Coverage under this Rider is available subject to request for assessment received within 24 months post-delivery. However, under this benefit claim will be paid only once in the policy lifetime for similar type of modification recommended by our assessor.
This benefit becomes payable only if a claim is admissible under Maternity Cover under the base Policy.
Sum Insured (₹)
Less than 20 Lacs
20 Lacs – 50 Lacs
More than 50 Lacs
Home Assessment and Modification for Baby Care/Infant Care (₹)
Upto 5,000
Upto 8,000
Upto 10,000
R5. Personalized Health Care Manager: (Not Available)
In consideration of additional premium paid, We/Our empanelled service provider will offer telephonic assistance of a personalized health care manager, who will assist in booking appointments of the Insured Person and coordinating with providers for below listed services in India, as per Insured Person’s requirement.
Personalized Health Care Manager shall only be responsible for booking and coordination on call, whereas, booking fees, cost of items or service charges, if any, shall be borne by the Insured Person. Coverage under this benefit will be subject to below conditions:
Services of Personalized Health Care Manager will be available only during the Post Hospitalization period after a claim.
A Hospitalization claim under the base Policy is admissible by Us for medically necessary surgery under In-Patient Treatment and Day Care Treatments/Procedures cover of the base Policy.
Personalized Health Care Manager will help in arranging and coordinating below services:
Assistance on availing consultations, booking screening test etc.
Appointment at Hospital / Diagnostic Center
Claim Assistance
Ambulance Booking
Vaccination Appointment
Availing any Home Care Services
R6. Loss of Pay – Bereavement: (Not Available)
In consideration of additional premium paid and in case of death of an immediate family member (spouse/ child/ parent, covered under the base Policy),due to an accident or illness, requires leave by one of the Insured Persons from work which results in Leave Without Pay (LWP), We will pay a daily cash benefit towards loss of pay as specified in the Policy Schedule. The claim under this cover is payable subject to the following condition:
Bereavement leave is availed within first thirty days from the death of the immediate family member (spouse/child/parent);
The Insured Person has suffered loss of pay for the bereavement leave availed;
Daily cash (Fixed pay(₹) 800 per day) under this cover is payable only within first thirty days from the death of the immediate family member (spouse/child/parent) and for a maximum of up to thirty days.
Disclaimers:
Any service under this Rider will only be provided on the request of the insured person through our empanelled service providers on cashless basis only.
Availing the services under this Rider is upon the Insured Person’s sole discretion and risk.
For services that are provided through empanelled Service Providers, we are acting as a facilitator; hence would not be liable for any incremental costs or the services. Any additional services availed, or expenses incurred on such services or benefits which are other than those covered under this policy and explicitly excluded by this Policy, shall not be covered under this Policy and all expenses incurred shall be borne by the Insured Person.
We shall not be responsible for or liable for, any action, claim, demand, loss, damage, cost, charges and expenses which Insured Person claims to have suffered, sustained or incurred, by way of and/or on account of the benefit. We shall not be liable for any deficiency or discrepancy in the services provided by empanelled service provider/network provider under this Policy.
Insured Person may consult any medical/service professional at any network provider/empanelled service provider at his/her sole discretion. The cost of service arising out of insured Person choice of medical professional at any network provider/empanelled service provider shall be completely borne by the Insured Person unless covered otherwise. However, the services under this Policy should not be construed to constitute medical advice and/or substitute the Insured Person’s visit/consultation to an independent Medical Practitioner/Healthcare professional.
The Medical/service Practitioner may suggest/recommend/prescribe over the counter medications based on the information provided, if required on a case-to-case basis. Provided that any recommendation under this Policy shall not be valid for any medico legal purposes.
The Insured Person is free to choose whether or not to act on the recommendation after seeking consultation.
Any advice, recommendation or suggestion made by any medical/service professional shall be solely based on the information and documentation provided by the Insured Person to such medical/service professional. We shall not be liable towards any loss or damage (immediate or consequential) arising out of or in relation to any opinion, advice, prescription, actual or alleged errors, omissions and representations made by the medical/service professional from whom we have availed services or taken benefit or for any consequence of any act or omission in reliance thereon.
Above mentioned services are non-portable, annual contracts, independent of policy contract and not lifelong renewable. The services provided may be added / deleted / modified at our discretion.
Provision of these services is subject to availability as per the duration specified by Us/the empanelled service provider. Details are available on our website (www.tataaig.com).
Any service availed by the Insured Person under these Benefits will not impact Cumulative Bonus under the Base Policy, if applicable.
We reserve the right to change any service provider during the currency of the Policy or at renewal. The same shall be intimated to the Insured Person atleast 15 days prior to the effective date of change. During such change, all the credits earned by the insured Person shall be transferred to the new service provider.
In case We or the Assistance/empanelled Service Provider fails to provide any of the services as mentioned in this Policy or is unable to implement, in whole or in part due to Force Majeure, non-availability of Services, change in law, rule or regulations which affects the Services, or if any regulatory or governmental agency having jurisdiction over a party takes a position which affects the services, then the Assistance Services’ suspended, curtailed or limited performance shall not constitute Breach of Contract and the Company or the Assistance/empanelled Service Provider shall have no liability whatsoever including but not limited to any loss or damage resulting therefrom
We shall not accept any liability towards quality of the services made available by Service Provider. The Service Provider is responsible for providing the availed services and We are not liable for any defects or deficiencies on the part of the Service Provider.
The above-mentioned assistance services, as applicable, are purely on referral or arrangement basis, We/Our empanelled service provider shall not be responsible for any third-party expenses incurred and it shall be the responsibility of the Insured Person.
Comprehensive out patient care covering consultations, diagnostics, dental and vision care, pharmacy, high-end diagnostics, physiotherapy and medical devices, as prescribed by medical practiotioners.
1. Suitability:
This Policy can be issued to an individual and/or family. However, in case of family, the coverage shall be available on individual basis only.
All the other eligibility conditions, entry age limits, relationships covered under this Rider will be applicable as per the base Policy.
Minimum one benefit from the Rider has to be opted by the Policyholder.
2. Rider Conditions:
Rider can only be opted along with the base Policy and cannot be opted in isolation or as a separate product.
The Riders are provided in lieu of additional premium and subject to the terms, conditions and exclusions as stated in the Rider wordings in addition to the Policy terms, conditions and exclusions.
These Rider(s), if selected, shall be mentioned in the Policy Schedule and will be available up to the limit specified therein, for all Insured Person(s) covered under the underlying base Policy, unless stated otherwise.
Terms and conditions of the Riders are to be read in conjunction with the terms and conditions of the base Policy.
The continuance of risk cover under the base Policy is necessary precondition for continuance of cover under Riders.
The scope of coverage under these Riders are restricted to the geography of India.
Admission of liability under any cover in this Rider shall not have any bearing on admissibility of a claim under the base Policy on any ground including non-disclosure of material fact or pre-existing disease.
Coverage under this Rider shall only be offered if prescribed by the treating Medical Practitionerexcept for doctor consultations.
Coverage/Services under this Rider can be availed only during the Policy Period, subject to the condition that the Insured Person contracts any disease or suffers from any illness or sustains bodily injury through accident, within the Policy Period.
Benefits under this Rider have separate limits (over and above the base Sum Insured), as specified in the Policy Schedule, and does not affect Cumulative Bonus in the base Policy, if applicable.
Section 2: General Definitions
All Standard and Specific Definitions as defined in the respective base Policy shall also apply for Riders, wherever applicable.
Additional Specific Definitions:
1. Health Care Professional:
A Health Care Professional is a person who holds a valid qualification from regulatory body as set up by the Government of India or a State Government or any other relevant authority and is engaged in actions with an objective of maintaining and improving individual’s good health.
2. Service Provider:
Service Provider means the providers empanelled and engaged by Us for arranging/providing services under Riders mentioned in the base Policy Schedule.
Section 3: Rider Benefit
At least one benefit has to be opted to avail.
R1. Out-patient Treatment and Consultation:
In consideration of additional premium paid, We will cover the Reasonable and Customary Charges for in-person consultations and diagnostic tests subject to below conditions:
The Insured Person is suffering from any illness or injury and is not availing the services for preventive consultations;
Diagnostic test is prescribed by the treating Medical Practitioner.
R2. Out-patient Treatment – Dental:
In consideration of additional premium paid, We will cover:
Reasonable and Customary Charges for expenses related to in-person consultations with Dental Specialist on an Out-patient basis.
Reasonable and Customary Charges for expenses related to following dental treatments/procedures as prescribed by the treating Medical Practitioner and availed by the Insured Person, subject to limits and waiting period as specified in the Policy Schedule.
Root Canal Treatment (Single or multiple sittings)
Tooth Extraction(s)
Restoration/Filling
All Forms of Dental X-ray
Crown
Pulpectomy
Therapeutic Pulpotomy
In view of this coverage getting extended, dental exclusion (Dental treatment or surgery of any kind) of the base Policy will not be applicable for this particular Rider.
In case of Accidental Damage to natural teeth following the accident, the claim under this Rider will be admissible only if the treatment for the same shall be taken immediately within thirty (30) days following damage.
The claim under this Rider shall not be payable:
If the damage was caused as a result of consumption of pan masala, gutka, tambaku, alcohol, or any substance use/abuse;
Towards scaling/polishing, bleaching, cap of teeth, braces, aligner, tooth replacement or any other cosmetic or aesthetic treatment.
R3. OPD – Vision Care:
In consideration of additional premium paid, We will cover:
i. Reasonable and Customary Charges for expenses related to in person consultations withOphthalmologist on an Out-patient basis, including Medically necessary procedures and Medically Prescribed diagnostic tests associated to eye/vision, subject to limits and waiting period as specified in the Policy Schedule.
ii. Reasonable and Customary Charges for corrective spectacle lenses as prescribed by the Ophthalmologist or Optometrist once after every block of two continuous Policy Year with Us under this Rider, irrespective of claim in the base Policy.
This cover excludes cost of tinted / reactive lenses, sunglasses, non-corrective contact lenses, and/or similar expenses, whether medically prescribed or not, under this cover.
R4. OPD – Pharmacy:
In consideration of additional premium paid, We will cover the Reasonable and Customary Charges for expenses related to purchase of medicines, drugs and medical consumables, as prescribed by the treating Medical Practitioner under the following cover(s) and availed by the Insured Person on an Out-patient basis.
Out-patient Treatment and Consultation
Out-patient Treatment – Dental
OPD – Vision Care
Teleconsultation – General
Teleconsultation – Specialty
Under this cover, amount for below listed products shall be restricted to 50% of the OPD Pharmacy Sum Insured, as specified in the Policy Schedule:
Health supplements,
Nutraceuticals,
Foods for special dietary use/special medical purpose/ with added probiotics and/or foods with added prebiotics,
Vaccinations,
Vitamins, tonics or other related products.
For the purpose of this Benefit, the exclusion mentioned under Code-Excl 14 (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) shall not be applicable.
R5. High End Diagnostics Rider:
In consideration of additional premium paid, We will cover for the Reasonable and Customary Charges incurred for the following diagnostic tests only on OPD basis if required as part of a medically necessary treatment subject to the limits as specified in the Policy Schedule:
Positron Emission Tomography Magnetic Resonance Imaging (PET MRI)
Renogram
R6. OPD Physiotherapy:
In consideration of additional premium paid, We/Our empanelled service provider will arrange for physiotherapy sessions from qualified Physiotherapist to treat illness/injury or deformity suffered by the Insured Person during the Policy Period, on an Out-patient basis, subject to the following conditions:
Physiotherapy being advised in writing by the treating Medical Practitioner.
The limit on physiotherapy sessions is applicable to each Insured Person, per Policy Year.
R7. Teleconsultation – General Rider: (Not Available)
In consideration of additional premium paid, We/Our empanelled service provider will arrange for teleconsultations upon Insured Person’s request through telecommunications and digital communication technologies for Insured Person’s health related complaints or preventive health care by a qualified Medical Practitioner/Health Care Professional, as per the limit specified in Your base Policy Schedule.
This service can only be availed subject to condition below:
Consultation will be provided through various specified modes of communication like audio, video, online portal, chat, digital customer application or any other digital mode.
In consideration of additional premium paid, We/Our empanelled service provider will arrange for teleconsultations upon Insured Person’s request through telecommunications and digital communication technologies for Insured Person’s health related complaints or preventive health care by a qualified & specialist Medical Practitioner/Health Care Professional, as per the limit/ speciality specified in your Policy Schedule.
This service can only be availed subject to conditions below:
Consultation, will be provided through various specified modes of communication like audio, video, online portal, chat, digital customer application or any other digital mode.
R9. Medical Devices Cover Rider:
In consideration of additional premium paid, We will cover reasonable and customary expenses incurred by the Insured Person towards renting or purchase of below mentioned medical devices during the Policy Year only if the same is prescribed by the treating Medical Practitioner under OPD Consultation , where OPD Consultation is admissible under the Out-patient treatment Rider.
List of medical devices:
Wheel Chair
Air Mattress
Walker
Belts
Collar
Caps
Splints
Braces
Stockings
Crutches
Commode Chair
Walking Stick
The benefit to the extent covered here shall supersede the exclusion for external appliance and/or device (“Any external appliance and/or device used for diagnosis or treatment except when used intra-operatively”) mentioned in the base Policy.
Section 4 – 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.
A. Standard Exclusions:
1. Exclusions with Waiting Periods:
a. 30 Days Waiting Period (Code-Excl 03):
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.
This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve months.
The within referred waiting period is made applicable to the enhanced Sum Insured in the event of granting higher Sum Insured subsequently.
b. Pre-Existing Diseases Waiting Period (Code-Excl 01):
Expenses related to the treatment of a Pre-Existing Disease (PED) and its direct complications shall be excluded until the expiry of months of continuous coverage as mentioned in the Policy Schedule after the date of inception of the first Policy with us.
In case of enhancement of Sum Insured/change of plan/ the Exclusion shall apply afresh to the extent of Sum Insured increase.
If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI Regulations, then Waiting Period for the same would be reduced to the extent of prior coverage.
Coverage under the Policy after the expiry of months as mentioned in the Policy Schedule for any Pre-Existing disease is subject to the same being declared at the time of application and accepted by us.
B. General 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.
2. Medical Exclusions:
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.
Cosmetic or Plastic Surgery (Code-Excl 08):
Expenses for cosmetic or plastic Surgery or any treatment to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of Medically Necessary Treatment to remove a direct and immediate health risk to the Insured Person. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof (Code-Excl 12).
Treatments received in health 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-Excl 13).
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-Excl 14).
Unproven Treatments (Code-Excl 16):
Expenses related to any Unproven Treatment, services and supplies for or in connection with any treatment. Unproven Treatments are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.
Sterility and Infertility (Code-Excl 17):
Expenses related to Sterility and Infertility. This includes:
Any type of contraception, sterilization
Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
Gestational Surrogacy
Reversal of Sterilization
Maternity (Code-Excl 18):
Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during Hospitalization) except ectopic pregnancy;
Expenses towards miscarriage (unless due to an Accident) and lawful medical termination of pregnancy during the Policy Period.
3. Non-Medical Exclusions:
Hazardous or Adventure Sports (Code-Excl 09):
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.
Breach of Law (Code-Excl 10):
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
Specific Exclusions (Exclusions other than as those mentioned under Section 4 (i) subsection 1, 2 & 3 above):
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.
1. Medical Exclusions:
Alcoholic pancreatitis or alcoholic liver disease;
Congenital External Diseases, defects or anomalies;
Venereal disease, sexually transmitted disease or Illness;
Any existing disease specifically mentioned as Permanent exclusion in the Policy Schedule.
Circumcision unless necessary for treatment of an Illness or as may be necessitated due to an Accident.
Hydrotherapy, Acupuncture, Reflexology, Chiropractic treatment or treatment related to any unrecognized systems of medicine.
Expenses related to rest cure, rehabilitation and respite care:
Expenses incurred primarily towards enforced bed rest and not for receiving treatment. This also includes:
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.
Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
2. Non-Medical Exclusions:
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.
Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event contributing concurrently or in any other sequence to the loss, claim or expense. For the purpose of this exclusion:
Nuclear attack or weapons means the use of any nuclear weapon or device or waste or combustion of nuclear fuel or the emission, discharge, dispersal, release or escape of fissile/ fusion material emitting a level of radioactivity capable of causing any Illness, incapacitating disablement or death.
Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous chemical compound which, when suitably distributed, is capable of causing any Illness, incapacitating disablement or death.
Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death.
Any Insured Person’s participation or involvement in naval, military or air force operation.
Intentional self-Injury or attempted suicide while sane or insane.
Charges for, cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service.
Doctor’s/Physiotherapist’s fees charged by the Medical Practitionersharing the same residence as an Insured Person or who is an immediate relative of an Insured Person’s family.
Any treatment and associated expenses for alopecia, baldness, wigs or toupees, medical supplies including diabetic test strips and similar products.
Any treatment or part of a treatment that does not form part of ‘Reasonable and Customary Charges’, nor is medically necessary.
Expenses which are either not supported by a prescription of a Medical Practitioner or are not related to Illness/injury or disease.
Any external appliance and/or device used for diagnosis or treatment except when used intra-operatively.
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.
Any treatment taken in a clinic, rest home, convalescent home for the addicted, detoxification center, sanatorium, home for the aged, remodeling clinic or similar institutions.
Option 1:
Rider Name
Base Sum Insured (In ₹)
5 Lakhs
7.5 Lakhs
10 Lakhs
15 Lakhs
20 Lakhs
25 Lakhs
50 Lakhs
75 Lakhs
1 Cr
2 Cr
3 Cr
Out-patient Treatment and Consultation (In ₹)
Up to 5,000
Up to 6,000
Up to 8,000
Up to 15,000
Up to 22,000
Up to 25,000
Up to 50,000
Up to 70,000
Up to 1,00,000
Up to 1,00,000
Up to 1,00,000
Out-patient Treatment – Dental (In ₹)
Up to 7,500
Up to 10,000
Up to 15,000
Up to 20,000
Up to 32,000
Up to 50,000
Up to 70,000
Up to 90,000
Up to 1,00,000
Up to 1,00,000
Up to 1,00,000
OPD – Vision Care (In ₹)
Up to 1,500
Up to 2,500
Up to 5,000
Up to 12,000
Up to 12,000
Up to 20,000
Up to 20,000
Up to 25,000
Up to 30,000
Up to 30,000
Up to 30,000
OPD – Pharmacy (In ₹)
Up to 1,000
Up to 1,500
Up to 2,000
Up to 3,000
Up to 4,000
Up to 5,000
Up to 10,000
Up to 15,000
Up to 20,000
Up to 20,000
Up to 20,000
OPD Physiotherapy
Up to 5 Sessions
Up to 5 Sessions
Up to 5 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 20 Sessions
Up to 20 Sessions
Up to 20 Sessions
High End Diagnostics Rider (In ₹)
Up to 10,000
Up to 10,000
Up to 10,000
Up to 25,000
Up to 25,000
Up to 25,000
Up to 25,000
Up to 50,000
Up to 50,000
Up to 50,000
Up to 50,000
Medical Devices Cover Rider (In ₹)
Up to 5,000
Up to 5,000
Up to 5,000
Up to 10,000
Up to 10,000
Up to 10,000
Up to 10,000
Up to 20,000
Up to 20,000
Up to 20,000
Up to 20,000
Teleconsult- ation – General Rider
Unlimited
Teleconsult- ation – Specialty Rider
Unlimited
Option 2:
Rider Name
Base Sum Insured (In ₹)
5 Lakhs
7.5 Lakhs
10 Lakhs
15 Lakhs
20 Lakhs
25 Lakhs
50 Lakhs
75 Lakhs
1 Cr
2 Cr
3 Cr
Out-patient Treatment and Consultation (In ₹)
Up to 2,500
Up to 3,750
Up to 4,000
Up to 6,500
Up to 8,500
Up to 12,500
Up to 25,000
Up to 37,500
Up to 50,000
Up to 50,000
Up to 50,000
Out-patient Treatment – Dental (In ₹)
Up to 3,500
Up to 5,000
Up to 8,000
Up to 10,000
Up to 17,500
Up to 25,000
Up to 40,000
Up to 50,000
Up to 50,000
Up to 50,000
Up to 50,000
OPD – Vision Care (In ₹)
Up to 1,500
Up to 2,500
Up to 5,000
Up to 12,000
Up to 12,000
Up to 20,000
Up to 20,000
Up to 25,000
Up to 30,000
Up to 30,000
Up to 30,000
OPD – Pharmacy (In ₹)
Up to 500
Up to 750
Up to 1,000
Up to 1,500
Up to 2,000
Up to 2,500
Up to 5,000
Up to 7,500
Up to 10,000
Up to 10,000
Up to 10,000
OPD Physiotherapy
Up to 5 Sessions
Up to 5 Sessions
Up to 5 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 10 Sessions
Up to 20 Sessions
Up to 20 Sessions
Up to 20 Sessions
High End Diagnostics Rider (In ₹)
Up to 10,000
Up to 10,000
Up to 10,000
Up to 25,000
Up to 25,000
Up to 25,000
Up to 25,000
Up to 50,000
Up to 50,000
Up to 50,000
Up to 50,000
Medical Devices Cover Rider (In ₹)
Up to 5,000
Up to 5,000
Up to 5,000
Up to 10,000
Up to 10,000
Up to 10,000
Up to 10,000
Up to 20,000
Up to 20,000
Up to 20,000
Up to 20,000
Teleconsult- ation – General Rider
Unlimited
Teleconsult- ation – Specialty Rider
Unlimited
Section 5: Process for Availing the Benefits
Step 1: Register Yourself on Customer Application
Please download TATA AIG customer application on your device and complete registration process by providing Policy and Insured Person’s details.
Link to download TATA AIG Customer Application:
For Android: https://play.google.com/store/apps/detailsid=com.tataaig.android
For iOS: https://apps.apple.com/in/app/tata-aig-insurance/id1586595850
Step 2: Select the Service Required
Please select the desired service from the list of services available on the Home Page of the application.
Step 3: Please provide the required information and follow the prescribed process for availing the services.
Disclaimers:
Any service under this Rider will only be provided on the request of the insured person through our empanelled service providers on cashless basis only.
Availing the services under this Rider is upon the Insured Person’s sole discretion and risk.
For services that are provided through empanelled Service Providers, we are acting as a facilitator; hence would not be liable for any incremental costs or the services. Any additional services availed, or expenses incurred on such services or benefits which are other than those covered under this policy and explicitly excluded by this Policy, shall not be covered under this Policy and all expenses incurred shall be borne by the Insured Person.
We shall not be responsible for or liable for, any action, claim, demand, loss, damage, cost, charges and expenses which Insured Person claims to have suffered, sustained or incurred, by way of and/or on account of the benefit. We shall not be liable for any deficiency or discrepancy in the services provided by empanelled service provider/network provider under this Policy.
Insured Person may consult any medical/service professional at any network provider/empanelled service provider at his/her sole discretion. The cost of service arising out of insured Person choice of medical professional at any network provider/empanelled service provider shall be completely borne by the Insured Person unless covered otherwise. However, the services under this Policy should not be construed to constitute medical advice and/or substitute the Insured Person’s visit/consultation to an independent Medical Practitioner/Healthcare professional.
The Medical/service Practitioner may suggest/recommend/prescribe over the counter medications based on the information provided, if required on a case-to-case basis. Provided that any recommendation under this Policy shall not be valid for any medico legal purposes.
The Insured Person is free to choose whether or not to act on the recommendation after seeking consultation
Any advice, recommendation or suggestion made by any medical/service professional shall be solely based on the information and documentation provided by the Insured Person to such medical/service professional. We shall not be liable towards any loss or damage (immediate or consequential) arising out of or in relation to any opinion, advice, prescription, actual or alleged errors, omissions and representations made by the medical/service professional from whom we have availed services or taken benefit or for any consequence of any act or omission in reliance thereon.
Above mentioned services are non-portable, annual contracts, independent of policy contract and not lifelong renewable. The services provided may be added / deleted / modified at our discretion.
Provision of these services is subject to availability as per the duration specified by Us/the empanelled service provider. Details are available on our website (www.tataaig.com).
We reserve the right to change any service provider during the currency of the Policy or at renewal. The same shall be intimated to the Insured Person atleast 15 days prior to the effective date of change. During such change, all the credits earned by the insured Person shall be transferred to the new service provider.
In case We or the Assistance/Empanelled Service Provider fails to provide any of the services as mentioned in this Policy or is unable to implement, in whole or in part due to Force Majeure, non-availability of Services, change in law, rule or regulations which affects the Services, or if any regulatory or governmental agency having jurisdiction over a party takes a position which affects the services, then the Assistance Services’ suspended, curtailed or limited performance shall not constitute Breach of Contract and the Company or the Assistance/Empanelled Service Provider shall have no liability whatsoever including but not limited to any loss or damage resulting therefrom.
We shall not accept any liability towards quality of the services made available by Service Provider. The Service Provider is responsible for providing the availed services and We are not liable for any defects or deficiencies on the part of the Service Provider.
The above-mentioned assistance services are purely on referral or arrangement basis, We/Our empanelled service provider shall not be responsible for any third-party expenses incurred and it shall be the responsibility of the Insured Person.
4 . Mental well being (Nominal Price) (UIN: TATHLIA25037V012425)
Section 1:
1. Suitability
This Policy can be issued to an individual and/or family. However, in case of family, the coverage shall be available on individual basis only.
All the other eligibility conditions, entry age limits, relationships covered under this Rider will be applicable as per the base Policy.
Minimum one benefit from the Rider has to be opted by the Policyholder.
2. Rider Conditions
Rider can only be opted along with the base Policy and cannot be opted in isolation or as a separate product.
The Riders are provided in lieu of additional premium and subject to the terms, conditions and exclusions as stated in the Rider wordings in addition to the Policy terms, conditions and exclusions.
These Rider(s), if selected, shall be mentioned in the Policy Schedule and will be available up to the limit specified therein, for all Insured Person(s) covered under the underlying base Policy, unless stated otherwise.
Terms and conditions of the Riders are to be read in conjunction with the terms and conditions of the base Policy.
The continuance of risk cover under the base Policy is necessary precondition for continuance of cover under Riders.
The scope of coverage under these Riders are restricted to the geography of India.
Admission of liability under any cover in this Rider shall not have any bearing on admissibility of a claim under the base Policy on any ground including non-disclosure of material fact or pre-existing disease.
Coverage/services under this Rider can be availed only during the Policy Period.
Benefits under this Rider have separate limits (over and above the base Sum Insured), as specified in the Policy Schedule, and does not affect Cumulative Bonus in the base Policy, if applicable.
Section 2: General Definitions
All Standard and Specific Definitions as defined in the respective base Policy shall also apply for Riders, wherever applicable.
Additional Specific Definitions:
1. Health Care Professional:
A Health Care Professional is a person who holds a valid qualification from regulatory body as set up by the Government of India or a State Government or any other relevant authority and is engaged in actions with an objective of maintaining and improving individual’s good health
2. Service Provider:
Service Provider means the providers empanelled and engaged by Us for arranging/providing services under Riders mentioned in the base Policy Schedule.
Section 3: Rider Covers
R1. Mental Health Screening
In consideration of additional premium paid, We/Our empanelled service provider will arrange for Mental Health Screening of the Insured Person, once in a Policy Year provided the Policy is in force with us. Such screening shall include:
One evaluation with psychiatrist
An online questionnaire for personality assessment
Below mentioned diagnostic tests, if prescribed by the consulting psychiatrist:
Thyroid function Test
Liver Function Test
Kidney Function Test
ECG
Serum Electrolyte Test
Blood Sugar
Once every policy year, only on Cashless basis
Stress Management Rider –UNLIMITED
Addiction Cessation Program –UNLIMITED
R2. Psychological Therapy and Procedures
In consideration of additional premium paid, We/Our empanelled service provider will arrange for psychological therapy/talking therapy session with a registered psychiatric/psychologist for management of mental/behavioural/psychiatric or psychological disorders including but not limited to anxiety, depression, stress, bipolar disorder, substance use/abuse, subject to the below conditions:
The condition has been diagnosed and confirmed by the treating Health Care Professional/Medical Practitioner.
Psychiatric counselling has been prescribed by the treating Medical Practitioner.
Maximum Upto 10 sessions per person with a registered psychiatric/psychologist in a policy year, only on Cashless basis
R3. Vocational Rehabilitation
In consideration of additional premium paid, and notwithstanding the exclusion mentioned under ‘’Rest cure, rehabilitation and respite care (Code- Excl 05)’’ of the base Policy:
If an illness or injury impacts mental health of the Insured Person affecting the career/job performance, then We will cover expenses for vocational rehabilitation of the Insured Person and improve overall mental wellbeingif an illness or injury impacts mental health of the insured person impacting the career/job performance subject to the same being prescribed by the Health Care Professional/Medical Practitioner.
Up to base Sum Insured, Over and above the base Sum Insured, Maximum upto 30 days
R4. Diet Consultation Rider
In consideration of additional premium paid and with an objective of maintaining good health, We/Our empanelled service provider will arrange for a consultation with a nutritionist/dietitian during the Policy Period. if the same has been prescribed by a Mental Health Care Professional during the Policy Period.
Consultation will be provided through various specified modes of communication (including but not limited to) like in person, audio, video, online portal, chat, customer application or any other digital mode.
Maximum Upto 4 sessions per person consultation with a nutritionist/dietitian in a policy year, only on Cashless basis
R5. Stress Management Rider
In consideration of additional premium paid, We/Our empanelled service provider will arrange for consultative services to Insured Person by a Health Care Professional to maintain good health through Stress Management Program including but not limited to sessions on work/life balance, awareness sessions on mental wellbeing, mental health screening and fitness coach.
Consultation will be provided through various specified modes of communication (including but not limited to) like audio, video, online portal, chat, customer application or any other digital mode.
UNLIMITED
R6. Addiction Cessation Program
In consideration of additional premium paid, We/Our empanelled service provider will arrange for consultative services to Insured Person by a Health Care Professional related to controlling substance addiction with the objective of helping quit substance addiction through the cessation program including but not limited to expert counselling, and consultations.
Consultation will be provided through various specified modes of communication (including but not limited to) like audio, video, online portal, chat, customer application or any other digital mode.
UNLIMITED
Cover/ Benefit Name
Coverage Limit
Mental Health Screening
Once every policy year for listed tests, only on Cashless basis
Psychological Therapy and Procedures
Maximum up to 10 sessions per person in a policy year, only on Cashless basis
Diet Consultation Rider
Maximum up to 4 sessions per person in a policy year, only on Cashless basis
Vocational Rehabilitation
Up to base Sum Insured, Over and above the base Sum Insured, Maximum up to 30 days
Stress Management Rider
Unlimited
Addiction Cessation Program
Unlimited
Terms and Conditions
All the general terms and conditions, waiting periods, exclusions and claim procedure shall be applicable as per the base Policy.
Disclaimers
Any service under this Rider will only be provided on the request of the Insured Person through our empanelled Service Providers on cashless basis only.
Availing the services under this Rider is upon the Insured Person’s sole discretion and risk.
For services that are provided through empanelled Service Providers, we are acting as a facilitator; hence would not be liable for any incremental costs or the services. Any additional services availed, or expenses incurred on such services or benefits which are other than those covered under this policy and explicitly excluded by this Policy, shall not be covered under this Policy and all expenses incurred shall be borne by the Insured Person.
We shall not be responsible for or liable for, any action, claim, demand, loss, damage, cost, charges and expenses which Insured Person claims to have suffered, sustained or incurred, by way of and/or on account of the benefit. We shall not be liable for any deficiency or discrepancy in the services provided by empanelled Service Provider/Network Provider under this Policy.
Insured Person may consult any medical/service professional at any network provider/empanelled Service Provider at his/her sole discretion. The cost of service arising out of Insured Person choice of medical professional at any Network Provider/empanelled Service Provider shall be completely borne by the Insured Person unless covered otherwise. However, the services under this Policy should not be construed to constitute medical advice and/or substitute the Insured Person’s visit/consultation to an independent Medical Practitioner/Healthcare professional.
The medical/service Practitioner may suggest/recommend/prescribe over the counter medications based on the information provided, if required on a case-to-case basis. Provided that any recommendation under this Policy shall not be valid for any medico legal purposes.
The Insured Person is free to choose whether or not to act on the recommendation after seeking consultation.
Any advice, recommendation or suggestion made by any medical/service professional shall be solely based on the information and documentation provided by the Insured Person to such medical/service professional. We shall not be liable towards any loss or damage (immediate or consequential) arising out of or in relation to any opinion, advice, prescription, actual or alleged errors, omissions and representations made by the medical/service professional from whom we have availed services or taken benefit or for any consequence of any act or omission in reliance thereon.
Above mentioned services are non-portable, annual contracts, independent of Policy contract and not lifelong renewable. The services provided may be added/deleted/modified at our discretion.
Provision of these services is subject to availability as per the duration specified by Us/the empanelled Service Provider. Details are available on our website (www.tataaig.com).
Any service availed by the Insured Person under these Benefits will not impact Cumulative Bonus under the base policy, if applicable.
We reserve the right to change any Service Provider during the currency of the Policy or at renewal. The same shall be intimated to the Insured Person atleast 15 days prior to the effective date of change. During such change, all the credits earned by the Insured Person shall be transferred to the new Service Provider.
In case We or the Assistance/empanelled Service Provider fails to provide any of the services as mentioned in this Policy or is unable to implement, in whole or in part due to Force Majeure, non-availability of Services, change in law, rule or regulations which affects the Services, or if any regulatory or governmental agency having jurisdiction over a party takes a position which affects the services, then the Assistance Services’ suspended, curtailed or limited performance shall not constitute Breach of Contract and the Company or the assistance/empanelled Service Provider shall have no liability whatsoever including but not limited to any loss or damage resulting therefrom.
We shall not accept any liability towards quality of the services made available by Service Provider. The Service Provider is responsible for providing the availed services and We are not liable for any defects or deficiencies on the part of the Service Provider.
The above-mentioned assistance services, as applicable are purely on referral or arrangement basis, We/Our empanelled Service Provider shall not be responsible for any third-party expenses incurred and it shall be the responsibility of the Insured Person.
Flexi Shield (UIN: TATHLIA25039V012425)
Section 1:
1. Suitability
This Policy can be issued to an individual and/or family. However, in case of family, the coverage shall be available on individual basis only.
All the other eligibility conditions, entry age limits, relationships covered under this Rider will be applicable as per the base Policy.
Minimum one benefit from the Rider has to be opted by the Policyholder.
2. Rider Conditions
Rider can only be opted along with the base Policy and cannot be opted in isolation or as a separate product.
The Riders are provided in lieu of additional premium or discount as applicable and subject to the terms, conditions and exclusions as stated in the Rider wordings in addition to the Policy Terms, Conditions and Exclusions.
These Rider(s), if selected, shall be mentioned in the Policy Schedule and will be available up to the limit specified therein, for all Insured Person(s) covered under the underlying base Policy, unless stated otherwise.
Cover(s) provided under this Rider and their limits are only with respect to such and so many as indicated in the Policy Schedule.
The Rider shall offer coverage subject to below conditions:
Terms and conditions of the Rider are to be read in conjunction with the terms and conditions of the base Policy.
The continuance of risk cover under the base Policy is necessary precondition for continuance of cover under Rider.
The scope of coverage under these Riders are restricted to the geography of India, unless specified otherwise in the respective Rider cover.
Admission of liability under any Rider shall not have any bearing on admissibility of a claim under the base Policy on any ground including non-disclosure of material fact or Pre-Existing Disease.
Section 2: General Definitions
All Standard and Specific Definitions as defined in the respective base Policy shall also apply for Riders, wherever applicable.
Additional Specific Definitions:
1. Health Care Professional:
A Health Care Professional is a person who holds a valid qualification from regulatory body as set up by the Government of India or a State Government or any other relevant authority and is engaged in actions with an objective of maintaining and improving individual’s good health.
2. Service Provider:
Service Provider means the providers empanelled and engaged by Us for arranging/providing services under Riders mentioned in the base Policy Schedule. The name, address and contact particulars of such service providers shall be specified by Us in the base Policy Schedule.
In consideration of premium discount availed by You, Our liability under the base Policy shall be subject to Aggregate Deductible as specified (Eg: 50,000 )in the Policy Schedule.
Voluntary Aggregate Deductible, if opted and as specified in the Policy Schedule, shall be applicable on aggregate of final assessed amount of all admissible claims in a Policy Year.
In case of multi-year base Policy (i.e. tenure more than 1 year), such Aggregate Deductible would be applicable per Policy Year.
Aggregate Deductible shall continue for all the subsequent Renewals of the base Policy, provided the base Policy is renewed with Us without any break.
Aggregate Deductible shall be applicable for all indemnity claims under following covers of the base Policy, as applicable:
In-Patient Treatment,
Pre/Post Hospitalization Expenses,
Day Care Procedures/Treatments (as applicable),
Domiciliary Treatment,
Organ Donor,
AYUSH Benefit,
Consumables Benefit (if Opted under Base Policy or Rider),
Global Cover/Global Cover for Planned Hospitalization/Global Cover,
Global Cover for Emergency Hospitalization (if opted under Rider)
Bariatric Surgery Cover,
In-Patient Treatment- Dental,
Home Care Treatment Cover (if opted under Rider)
Home Physiotherapy
Aggregate Deductible shall not be applicable for any claim under following covers of the base Policy, as applicable:
a. Ambulance Cover/ Road Ambulance Cover b. Maternity Cover c. Delivery Complications Cover d. First year Vaccinations e. Mental Wellbeing Rider f. Additional Sum Insured for Accidental Hospitalization g. OPD Rider h. Any cover under the base Policy or any Rider which has Sum Insured over and above the base Sum Insured.
For the purpose of this Rider, Aggregate Deductible is an irrevocable cost sharing requirement under this Policy which provides that We will not be liable for a specified amount in aggregate for all claims during the Policy Year.
25,000
50,000
1,00,000
soon Available
Available
soon Available
Accident Suraksha (Nominal Price)
R6. Additional Sum Insured for Accidental Hospitalization
In consideration of additional premium paid for this Rider, if the Insured Person suffers an accident during the Policy Period and this accident is the sole and direct cause for the Hospitalization of the Insured Person, then We will provide an additional Sum Insured, as specified in the Policy Schedule against this Rider, for Medical Expenses incurred towards the In-Patient Treatment of the Insured Person during such Hospitalization,subject to the following conditions:
For individual as well as family floater policies, this limit is individually available for each Insured Person covered under the Policy.
Additional Sum Insured for Accidental Hospitalization, if applicable, shall be utilized before the Sum Insured in the base Policy.
Once triggered, the total amount available under this cover shall be available for utilization for In-Patient Hospitalization expenses linked to Accident only, in a Policy Year.
Any unutilized ‘Additional Sum Insured for Accidental Hospitalization’, shall not be carried forwarded.
The admissibility of claim under this Rider shall be subject to the terms, conditions and exclusions of the base Policy.
Specific exclusions applicable to this Rider:
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:
Where the Insured Person is under the influence of intoxicating liquor or drugs or other intoxicants, except where the Insured Person is not directly responsible for the injury/accident though under influence of intoxication.
Insured Person committing or attempting to commit an illegal activity or violation of law.
Upto base Sum Insured;
Over and above the base sum insured
For individual as well as family floater policies, this limit is individually available for each insured person covered under the policy.
R36. Permanent Total Disability Benefit Rider
In consideration of additional premium paid, if an Insured Person suffers an Accident during the Policy Period and this accidental injury results in You suffering Permanent Total Disability, then We will pay the 100% of the Sum Insured as mentioned under this Rider against the respective Insured Person in the Policy Schedule provided:
The Functional Loss is within 365 days from the date of Accident which caused the Injury.
This clause is however not applicable for immediate Dismemberment cases.
Permanent Total Disability is certified by a Medical Practitioner and has continued for a period of 365 days and is total, continuous and permanent at the end of this period.
For the purpose of this cover, Permanent Total Disability shall mean either of the following: • Loss of sight of both eyes • Loss by physical Separation or ability to use both hands or both feet • Loss by physical Separation or ability to use one hand and one foot. • Loss of sight of one eye and the physical separation of or the loss of ability to use either one hand or one foot.
With respect to the above, loss means physical separation of the body part, or the total loss of functional use provided this has continued for at least twelve (12) months from the onset of such disablement and provided further that We are satisfied based on a written confirmation by a Medical Practitioner at the expiry of the twelve (12) months that there is no reasonable medical hope of improvement.
Specific conditions applicable to this benefit: • Once a claim has been accepted and 100% of the Sum Insured as specified in the Policy Schedule has been paid under this Rider, then this Rider shall immediately and automatically cease in respect of that Insured Person. • This benefit is not applicable for Insured Children or Insured Person less than 18 years of Age as on base Policy commencement date. • This benefit has a separate limit (over and above base Sum Insured).
Specific Exclusions applicable to this Rider This Rider does not provide benefits for any loss resulting from: i. An accident that do not occur within the Policy Period II. Ionizing radiation or contamination by radioactivity from any nuclear waste from combustion of nuclear fuel; or the radioactive, toxic, explosive or other hazardous properties of any explosion nuclear assembly or nuclear component, thereof iii. Asbestosis (ఊపిరి తిత్తులలో సంభవించు జబ్బు) or other related sickness or disease resulting from the existence, production, handling, processing, manufacture, sale, distribution of asbestos or other products thereof. iv. Participation in any Professional Sports which remunerates in excess of 50% of the Insured Person‘s annual income as a means of their livelihood v. Being under the influence of intoxicating liquor or drugs or other intoxicants except where the insured is not directly responsible for the injury / accident though under influence of intoxication vi. Whilst engaging in Adventure Sports, where Adventure Sports means Recreational activities perceived as involving a high degree of risk. These activities involve speed, height, a high level of physical exertion, and highly specialized gear. vii. Whilst engaging in aviation or ballooning, whilst mounting into, dismounting from or traveling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world viii. Infections (except pyogenic infections which shall occur through an Accidental cut or wound) or any other kind of Disease; ix. Insured Person committing or attempting to commit an illegal activity or violation of law
Claim Documentation a. Completed Claim Form. b. Competent Medical Authority / Doctor like Civil Surgeon, confirming the Disability percentage / period and prognosis for Permanent Total Disability. c. Self-attested copy of FIR, if filed / Police Panchnama, if conducted. d. Self-attested copy of Discharge Summary or all Medical records Self-attested copy of news paper cutting, if any. e. Self-attested copy of KYC documents with NEFT details of nominee and KYC form.
100% of the Sum Insured or (₹)50,00,000 whichever is lower
This benefit is not applicable for insured children or Insured Person less than 18 years of Age as on base Policy commencement date.
Once in a lifetime of an Insured Person.
Over and above the base sum insured.
For individual as well as family floater policies, this limit is individually available for each insured person covered under the policy.
R8. Advanced Cover ( 35% – 40% loading)
In consideration of additional premium paid for this Rider, the Pre-Existing Disease Waiting Period as applicable under the base Policy should be read as “30 days” under Pre-existing Diseases Waiting Period (Code- Excl 01) for the Insured Person(s) specified in the Policy Schedule for the following named Pre-Existing Diseases only:
Diabetes Mellitus (Type 2),
Hypertension,
Hyperlipidemia &
Asthma
The above substitution shall only be applicable for such specified Insured Person(s) for whom ‘Advanced Cover’ has been opted and additional premium paid, which shall be specified in the base Policy Schedule.
The above would be applicable if the above-named Pre-Existing Diseases have been declared by You for the specific Insured Person for whom this coverage has been opted and the same has been accepted by Us at the time of first coverage under this Policy.
The additional premium charged under this Rider shall be a rate applied on the applicable base Policy premium for that individual at the base Policy inception or on the base Policy renewal date.
In case of portability, the “30 days” as mentioned above should be read as “0 Days” and waiver of waiting period for the above named four illnesses shall be restricted to the lower of the expiring Sum Insured or opted Sum Insured under this Policy, provided the above-named Pre-Existing Diseases had been declared by You at the time of applying for the first Policy and mentioned as accepted under the expiring ported/Our Policy.
If this Rider is availed, then it has to be mandatorily opted for all Insured Persons who have any of the above mentioned Pre-Existing Disease.
R10. Restore Infinity Plus (Inbuilt – Mandatory)
We will provide reinstatement of sum insuredunlimited number of times during a Policy Year post exhaustion of the Restore Benefit.
In consideration of additional premium paid, notwithstanding the Restore Benefit/Restore Infinity Cover (if applicable) under the base Policy, We will provide reinstatement of base Policy Sum Insured, if the Sum Insured and Cumulative Bonus or 5X Supercharge Bonus or Supercharge Bonus or Inflation Protect or Carry Forward of Unutilized Sum Insured (if applicable) is insufficient to pay an admissible Hospitalization claim in the underlying base Policy. The reinstatement will be available for unlimited number of times during a Policy Year, subject to below conditions:
This benefit shall not be available for the first admissible Hospitalization / Domiciliary Hospitalization claim in each Policy Year.
This benefit shall not be available for the first admissible Hospitalization / Domiciliary Hospitalization Claim in each Policy Year. The Sum Insured will be restored for the subsequent claim in the Policy Year.
In case of Family Floater Policy, Reinstatement of Sum Insured will be available for all Insured Persons in the Policy on floater basis.
The unutilized restored Sum Insured cannot be carried forward to the next Policy Year.
This benefit shall also be applicable annually for policies with tenure of more than 1 year.
Any restored Sum Insured can only be utilized for an admissible claim under following indemnity covers of the base Policy, as applicable:
In-Patient Treatment,
Pre/Post Hospitalization Expenses,
Day Care Treatment/Day Care Procedure,
Domiciliary Treatment,
Organ Donor,
AYUSH Benefit,
Ambulance Cover / Road Ambulance cover,
Consumables Benefit,
Bariatric Surgery Cover
In-Patient Treatment- Dental
Any restored Sum Insured under this benefit cannot be utilized for an admissible claim under:
Any cover other than the ones mentioned in the above section or
Any cover under the base Policy/Rider which has Sum Insured over and above the base Sum Insured.
Our maximum liability in aggregate of all claims arising out of a single Hospitalization shall not exceed the Sum Insured of the underlying base Policy.
Unlimited Restoration for related & unrelated Illness/Injury;(Even BEFORE 45 days from preceding Hospitalization)
Upto Base Sum Insured.
In case of Family Floater policy, Our maximum liability in aggregate of all claims arising out of a single Hospitalization shall not exceed the Sum Insured.
NOEXCLUSION for Cancer Treatment & Dialysis
R5. Inflation Protect (Inbuilt – mandatory)
In consideration of additional premium paid for this Rider We will provide an additional increase in the Sum Insured on the basis of inflation rate (all India) in the previous calendar year for next Policy Year,irrespective of claims in preceding Policy Years, provided that:
The Policy is renewed with Us and without a break.
In policies with a tenure of more than one year, Inflation Protect shall accrue post completion of each Policy Year.
The inflation rate shall be applied on the base Policy Sum Insured of the expiring Policy. In case the Sum Insured under the Policy is reduced at the time of Renewal then the accrued Inflation Protect under this benefit shall be reduced in proportion to the reduced Sum Insured.
Unutilized accrued Inflation Protect amount will get carried forward to the next Policy Year provided the Policy is renewed with Us without any break.
If this Rider is not renewed before Policy expiry (including the Grace Period) then all the accrued and carried forward Inflation Protect amount shall lapse.
Any accrued Inflation Protect amount shall be utilized after the Sum Insured in the base Policy is exhausted.
For Floater policies, the accrued Inflation Protect amount shall be available on a floater basis for all Insured Persons, who were covered under the expiring Policy, on a per Policy Year basis
Additional increase in the sum insured on the basis of inflation rate (all India) in the previous calendar year for next policy year.
Increase as per the average consumer price index (CPI)
Illustration 1: Sum Insured same for subsequent Policy Year.
Base Policy Year
1st Year
2nd Year
3rd Year
4th Year
5th Year
Base Policy Sum Insured
10 Lakhs
10 Lakhs
10 Lakhs
10 Lakhs
10 Lakhs
Inflation Rate
6%
7%
8%
7%
7%
Inflation Protect Amount
60,000
70,000
80,000
70,000
70,000
Total Sum Insured
–
10,60,000
11,30,000
12,10,000
12,80,000
Illustration 2: Sum Insured Enhancement in subsequent Policy Year.
Base Policy Year
1st Year
2nd Year
3rd Year
4th Year
5th Year
Base Policy Sum Insured
10 Lakhs
10 Lakhs
20 Lakhs
20 Lakhs
20 Lakhs
Inflation Rate
6%
7%
8%
7%
7%
Inflation Protect Amount
60,000
70,000
1,60,000
1,40,000
1,40,000
Total Sum Insured
–
10,60,000
21,30,000
22,90,000
24,30,000
Illustration 3: Sum Insured reduction in subsequent Policy Year.
Base Policy Year
1st Year
2nd Year
3rd Year
4th Year
5th Year
Base Policy Sum Insured
10 Lakhs
10 Lakhs
10 Lakhs
5 Lakhs
5 Lakhs
Inflation Rate
6%
7%
8%
7%
7%
Inflation Protect Amount
60,000
70,000
80,000
35,000
35,000
Total Sum Insured
–
10,60,000
11,30,000
6,05,000 (50% * {80K + 130K})
6,40,000
Illustration 4: Rider not Renewed.
Base Policy Year
1st Year
2nd Year
3rd Year
4th Year
5th Year (Rider not Renewed at the end of 4th Policy Year)
Base Policy Sum Insured
10 Lakhs
10 Lakhs
10 Lakhs
10 Lakhs
10 Lakhs
Inflation Rate
6%
7%
8%
7%
7%
Inflation Protect Amount
60,000
70,000
80,000
70,000
– (Total amount Lapse)
Total Sum Insured
–
10,60,000
11,30,000
12,10,000
10,00,000
For the purpose of this cover, the inflation would be computed as the change in average CPI of the entire calendar year published by the National Statistical Office (NSO), Ministry of Statistics and Program Implementation. The average CPI of the previous calendar year shall be applicable only after three months of the release of the CPI of the last month of the previous calendar year. In case inflation rate of previous calendar year is not available then the inflation rate available for penultimate (Last) calendar year shall be considered.
R4. Cumulative Bonus Shield (now available only for Zone C for new & port)
In consideration of additional premium paid for this Rider the Cumulative Bonus accrued under the base Policy shall not be reduced at renewals subject to the total amount of all claims made in a Policy Year, under the base Policy which impacts Cumulative Bonus under the respective base Policy, does not exceed the specified limit in the Policy Schedule for this Rider.
However, if total claims paid in the base Policy for benefits which impacts Cumulative Bonus under the respective base Policy in a Policy Year exceeds the specified limit for this Rider, then the Cumulative Bonus shall reduce at a rate as defined in the base Policy.
In policies with a tenure of more than one year, the above provisions of Cumulative Bonus Shield shall be applicable post completion of each Policy Year.
All other terms and conditions applicable to the Cumulative Bonus of base Policy shall also be applicable to this Rider.
Cumulative Bonus accrued under the base Policy shall not be reduced, If total amount of all claims made in a Policy year does not exceed 50,000/ 75,000/ 1,00,000 (₹)
NO IMPACT on Cumulative Bonus for small claims
11. Global Suraksha (available only for Port)
Fixed daily cash amount, subject to deductible of 2 days for each continuous and completed period of 24 hours of Hospitalization, if an Insured Person avails treatment outside India, during the Policy Period maximum up to 30 days of hospitalization. TAGIC will provide You a second medical opinion from Our empaneled service provider or Medical Practitioner located worldwide outside India, if an Insured Person is diagnosed with the listed Illnesses during the Policy Period.
R3. International Second Opinion
In consideration of additional premium paid for this Rider, We will provide You at your request a second medical opinion from Our Network Provider/empanelled Service Provider or Medical Practitioner located worldwide outside India, 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.
Cancer
Kidney Failure
Myocardial Infarction
Angina
Coronary Bypass Surgery
Stroke/Cerebral Hemorrhage
Organ failure requiring transplant
Heart Valve Replacement
Brain Tumors
End stage Lung Disease
End stage Liver Failure
Bone Marrow Transplant
Permanent Paralysis of Limbs
Motor Neuron Disease
Parkinson’s Disease
This benefit can be availed by an Insured Person once for each Illness in a Policy Year.
Once for each illness mentioned for each insured in a policy year
At our empanelled service provider
R38. Worldwide Hospital Cash Benefit Rider
In consideration of additional premium paid if an Insured Person avails treatment outside India, during the Policy Period, We will pay a fixed daily cash amount,subject to deductible (number of days) as specified in the Policy Schedule, for each continuous and completed period of 24 hours of Hospitalization provided that:
The In-Patient Hospitalization claim is admissible under Global Cover for Planned Hospitalization/Global Cover (as applicable in the base Policy), for the same Hospitalization.
This benefit will be available up to the number of days specified in the Policy Schedule.
On the day of discharge, when Insured Person is discharged before completion of consecutive 24 hours of Hospitalization but after the completion of 12 hours, We shall pay 50% of daily cash benefit.
This benefit has a separate limit (over and above base Sum Insured).
For In-patient Hospitalization claim is admissible under Global Cover for Planned Hospitalization/Global Cover (as applicable in the base policy).
After the completion of 12 hours, we shall pay 50% of daily cash benefit
This benefit has a separate limit (over and above base Sum Insured)
This limit is individually available for each insured person covered under the policy.
