TATA AIG MediCare Plus

Policy Wording

TATA AIG General Insurance Company Limited

(We, Our or Us) will provide the insurance cover,
described in this Policy and any endorsements
thereto, for the Insured Period, as defined in the
Policy schedule. The insurance cover provided
under this Policy is only with respect to such and so
many of the benefits upto the Sum Insured in excess
of Aggregate Deductible as mentioned in the Policy
Schedule. Commencement of risk cover under the
policy is subject to receipt of premium by us.
The statements contained in the Proposal signed
by the Policyholder (You) shall be the basis of this
Policy and are deemed to be incorporated herein.
The insurance cover is governed by and subject to,
the terms, conditions and exclusions of this Policy.
For TATA AIG General Insurance Company Limited

Authorized Signatory

Registered Office:

Peninsula Business Park, Tower A,

15th Floor, G. K. Marg,
Lower Parel, Mumbai- 400013, Maharashtra, India
24x7 Toll Free No. 1800 266 7780 or 1800 22 9966
(Senior Citizen)
Visit us at www.tataaig.com
IRDA of India Registration No.:108
CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021
“Insurance is the subject matter of solicitation”. For more details
on risk factors, terms and conditions, please read policy document
carefully before concluding a sale.

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
Preamble Dispensary, Clinic, Polyclinic or any such
While the policy is in force, if the Insured Person health centre which is registered with the
contracts any disease or suffers from any illness local authorities, wherever applicable and
or sustains bodily injury through accident and if having facilities for carrying out treatment
such event requires the insured Person to incur procedures and medical or surgical/para-
expenses for Medically Necessary Treatment, surgical interventions or both under the
We will indemnify You for the amount of supervision of registered AYUSH Medical
such Reasonable and Customary Charges or Practitioner (s) on day care basis without
compensate to the extent agreed, upto the limits in-patient services and must comply with
mentioned, subject to terms and conditions of all the following criterion:
the Policy. Each Benefit is subject to its Sum i. Having qualified registered AYUSH
Insured and deductible as specified in the Policy Medical Practitioner(s) in charge;
Schedule, but Our liability in aggregate to make
payment in respect of any and all Benefits shall ii. Having dedicated AYUSH therapy
be limited to the Sum Insured and will only begin sections as required and/or has
when the deductible is exceeded. equipped operation theatre where
surgical procedures are to be carried
In case of family floater policy, the sum insured out;
& deductible for all or any of the benefits shall
be on a per policy per year basis. In case of an iii. Maintaining daily records of the
individual policy, the sum insured & deductible patients and making them accessible
for all or any of the benefits shall be on a per to the ins ur a nce co mpa ny’s
insured person per year basis. authorized representative.
All claims under the policy benefits shall be 3. AYUSH Hospital
payable only if the aggregate of covered medical An AYUSH Hospital is a healthcare facility
expenses, in respect to hospitalization(s) in a wherein medical/surgical/para-surgical
policy year is in excess of deductible specified in treatment procedures and interventions
the policy schedule. In case of multi-year policy are carried out by AYUSH Medical
(i.e. tenure more than 1 year), such aggregate Practitioner(s) comprising of any of the
deductible would be applicable on annual basis. following :
The said Medically Necessary Treatment must be a. Central or State Government AYUSH
on the advice of a qualified Medical Practitioner. Hospital or
Section 1 – Definitions b. Teaching hospital attached to AYUSH
college recognized by the Central
The terms defined below and at other junctures Government/ Central Council of
in the Policy Wording have the meanings Indian Medicine/ Central Council for
ascribed to them wherever they appear in this Homeopathy, or
Policy and, where appropriate, references to
the singular include references to the plural; c. AYUSH Hospital, standalone or co-
references to the male include the female and located with in-patient healthcare
references to any statutory enactment include facility of any recognized system of
subsequent changes to the same: medicine, registered with the local
authorities, wherever applicable,
i. Standard Definitions
and is under the supervision of a
1. Accident qualified registered AYUSH Medical
An accident means sudden, unforeseen Practitioner and must comply with
and involuntary event caused by external, all the following criterion :
visible and violent means. i. Having atleast 5 in-patient beds;
2. AYUSH Day Care Centre ii. Having qualified AYUSH Medical
AYUSH Day Care Centre means and Practitioner round the clock;
includes Community Health Centre iii. Having dedicated AYUSH therapy
(CHC), Primary Health Centre (PHC), sections as required and/or has

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 equipped operation theatre 9. Cumulative Bonus
where surgical procedures are
to be carried out; Cumulative Bonus means any increase or
addition in the Sum Insured granted by the
iv. Maintaining daily records of insurer without an associated increase in
the patients and making them premium.
accessible to the insurance
co m p a n y ’ s a u t h o r i z e d 10. Day Care Centre
representative. A day care centre means any institution
4. AYUSH Treatment established for day care treatment of illness
and/or injuries or a medical setup with a
AYUSH treatment refers to the medical and hospital and which has been registered
/ or hospitalization treatments given under with the local authorities, wherever
Ayurveda, Yoga and Naturopathy, Unani, applicable, and is under supervision
Siddha and Homeopathy systems. of a registered and qualified medical
5. Break in policy practitioner AND must comply with all
Break in policy means the period of gap minimum criterion as under –
that occurs at the end of the existing policy i. has qualified nursing staff under its
term/installment premium due date, when employment;
the premium due for renewal on a given ii. has qualified medical practitioner/s
policy or installment premium due is not
in charge;
paid on or before the premium renewal
date or grace period. iii. has fully equipped operation theatre
of its own where surgical procedures
6. Cashless facility
are carried out;
Cashless facility means a facility extended iv. maintains daily records of patients
by the insurer to the insured where the
and will make these accessible to
payments, of the costs of treatment
the insurance company’s authorized
undergone by the insured in accordance personnel.
with the policy terms and conditions, are
directly made to the network provider by 11. Day Care Treatment
the insurer to the extent pre-authorization Day care treatment means medical
is approved. treatment, and/or surgical procedure
7. Congenital Anomaly: which is:
Congenital Anomaly means a condition i. undertaken under General or Local
which is present since birth, and which is Anesthesia in a hospital/day care
abnormal with reference to form, structure centre in less than 24 hrs because of
or position. technological advancement, and
a) Internal Congenital Anomaly ii. which would have otherwise required
hospitalization of more than 24
Congenital anomaly which is not in
hours.
the visible and accessible parts of the
body. Treatment normally taken on an out-
patient basis is not included in the
b) External Congenital Anomaly
scope of this definition.
Congenital anomaly which is in the
12. Deductible
visible and accessible parts of the
body. Deductible means a cost sharing
requirement under a health insurance
8. Condition Precedent
policy that provides that the insurer will
Condition Precedent means a policy term not be liable for a specified rupee amount
or condition upon which the Insurer’s in case of indemnity policies and for a
liability under the policy is conditional specified number of days/hours in case
upon. of hospital cash policies which will apply

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 before any benefits are payable by the Schedule of Section 56(1) and the said act
insurer. Or complies with all minimum criteria as
under:
A deductible does not reduce the Sum
Insured. i. has qualified nursing staff under its
employment round the clock;
13. Dental Treatment
ii. has at least 10 in-patient beds in
Dental treatment means a treatment towns having a population of less
related to teeth or structures supporting than 10,00,000 and at least 15 in-
teeth including examinations, fillings patient beds in all other places;
(where appropriate), crowns, extractions
and surgery. iii. has qualified medical practitioner(s)
in charge round the clock;
14. Domiciliary Hospitalization
iv. has a fully equipped operation
Domiciliary hospitalization means medical theatre of its own where surgical
treatment for an illness/disease/injury procedures are carried out;
which in the normal course would require
care and treatment at a hospital but is v. maintains daily records of patients
actually taken while confined at home and makes these accessible to the
under any of the following circumstances: insurance company’s authorized
personnel;
i. the condition of the patient is such
17. Hospitalization
that he/she is not in a condition to
be removed to a hospital, or Hospitalization means admission in a
Hospital for a minimum period of 24
ii. the patient takes treatment at home
consecutive ‘In-patient Care’ hours except
on account of non-availability of
for specified procedures/ treatments,
room in a hospital.
where such admission could be for a
15. Grace Period period of less than 24 consecutive hours.
“Grace period” means the specified 18. Illness
period of time, immediately following the
Illness means a sickness or a disease
premium due date during which premium or pathological condition leading to the
payment can be made to renew or continue impairment of normal physiological
a policy in force without loss of continuity function and requires medical treatment.
benefits pertaining to waiting periods and
coverage of pre-existing diseases. For (a) Acute condition
single premium payment policies, coverage Acute condition is a disease, illness or
is not available during the period for which injury that is likely to respond quickly
no premium is received. However, If the to treatment which aims to return the
premium is paid in instalments during the person to his or her state of health
policy period, coverage will be available immediately before suffering the
during the grace period, within the policy disease/ illness/ injury which leads
period. The grace period for payment of to full recovery.
the premium shall be: fifteen days where (b) Chronic condition
premium payment mode is monthly and
thirty days in all other cases. A chronic condition is defined as
a disease, illness, or injury that
16. Hospital has one or more of the following
A hospital means any institution established characteristics:
for in-patient care and day care treatment i. it needs ongoing or long-
of illness and/or injuries and which has term mo nitoring through
been registered as a hospital with the local consultations, examinations,
authorities under Clinical Establishments check-ups, and /or tests;
(Registration and Regulation) Act 2010 or ii. it needs ongoing or long-term
under enactments specified under the

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 control or relief of symptoms; Council of any State or Medical Council of
iii. it requires rehabilitation for the India or Council for Indian Medicine or for
patient or for the patient to be Homeopathy set up by the Government of
specially trained to cope with it; India or a State Government and is thereby
entitled to practice medicine within its
iv. it continues indefinitely; jurisdiction; and is acting within its scope
v. it recurs or is likely to recur; and jurisdiction of license.
19. Injury 25. Medically Necessary Treatment
Injury means accidental physical bodily Medically necessary treatment means any
harm excluding illness or disease solely treatment, tests, medication, or stay in
and directly caused by external, violent, hospital or part of a stay in hospital which:
visible and evident means which is verified i. is re quir e d fo r the me dica l
and certified by a Medical Practitioner. management of the illness or injury
20. Inpatient Care suffered by the insured;
Inpatient care means treatment for which ii. must not exceed the level of care
the insured person has to stay in a hospital necessary to provide safe, adequate
for more than 24 hours for a covered event. and appropriate medical care in
21. Intensive Care Unit scope, duration, or intensity;
Intensive care unit means an identified iii. must have been prescribed by a
section, ward or wing of a hospital which medical practitioner;
is under the constant supervision of iv. must conform to the professional
a dedicated medical practitioner(s), standards widely accepted in
and which is specially equipped for the international medical practice or by
continuous monitoring and treatment of the medical community in India.
patients who are in a critical condition, 26. Migration
or require life support facilities and “Migration” means a facility provided to
where the level of care and supervision policyholders (including all members
is considerably more sophisticated and under family cover and group policies), to
intensive than in the ordinary and other transfer the credits gained for pre-existing
wards. diseases and specific waiting periods from
22. Medical Advice one health insurance policy to another with
Medical Advice means any consultation the same insurer.
or advice from a Medical Practitioner 27. Network Provider
including the issuance of any prescription Network Provider means hospitals or
or follow-up prescription. health care providers enlisted by an
23. Medical Expenses insurer, TPA or jointly by an Insurer and
Medical Expenses means those expenses TPA to provide medical services to an
that an Insured Person has necessarily and insured by a cashless facility. The updated
actually incurred for medical treatment list of Network Provider is available on Our
on account of Illness or Accident on the website (www.tataaig.com).
advice of a Medical Practitioner, as long as 28. Notification of Claim
these are no more than would have been Notification of claim means the process
payable if the Insured Person had not been of intimating a claim to the insurer or TPA
insured and no more than other hospitals through any of the recognized modes of
or doctors in the same locality would have communication.
charged for the same medical treatment. 29. OPD treatment
24. Medical Practitioner OPD treatment means the one in which
Medical Practitioner means a person who the Insured visits a clinic / hospital or
holds a valid registration from the Medical associated facility like a consultation room

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 for diagnosis and treatment based on 34. Qualified Nurse
the advice of a Medical Practitioner. The
Insured is not admitted as a day care or Qualified nurse means a person who
in-patient. holds a valid registration from the Nursing
Council of India or the Nursing Council of
30. Pre-Existing Disease any state in India.
“Pre-existing disease (PED)” means any
35. Reasonable and Customary Charges
condition, ailment, injury or disease:
Reasonable and Customary charges means
a) that is/are diagnosed by a physician
not more than 36 months prior to the the charges for services or supplies, which
date of commencement of the policy are the standard charges for the specific
issued by the insurer; or provider and consistent with the prevailing
charges in the geographical area for
b) for which medical advice or treatment identical or similar services, taking into
was recommended by, or received account the nature of the illness / injury
from, a physician, not more than
involved.
36 months prior to the date of
commencement of the policy. 36. Renewal
31. Pre-hospitalization Medical Expenses Renewal means the terms on which the
contract of insurance can be renewed on
Pre-hospitalization Medical Expenses
mutual consent with a provision of grace
means medical expenses incurred during
predefined number of days preceding period for treating the renewal continuous
the hospitalization of the Insured Person, for the purpose of gaining credit for pre-
provided that: existing diseases, time-bound exclusions
and for all waiting periods.
i. Such Medical Expenses are incurred
for the same condition for which the 37. Room Rent
Insured Person’s Hospitalization was Room Rent means the amount charged
required, and by a Hospital towards Room and Boarding
ii. The In-patient Hospitalization claim expenses and shall include the associated
for such Hospitalization is admissible medical expenses.
by the Insurance Company. 38. Surgery or Surgical Procedure
32. Portability Surgery or Surgical Procedure means
“Portability” means a facility provided to the manual and / or operative procedure
health insurance policyholders (including (s) required for treatment of an illness
all members under family cover), to or injury, correction of deformities and
transfer the credits gained for, pre-existing defects, diagnosis and cure of diseases,
diseases and specific waiting periods from relief from suffering and prolongation of
one insurer to another insurer. life, performed in a hospital or day care
33. Post-hospitalization Medical Expenses centre by a medical practitioner.
Post-hospitalization Medical Expenses 39. Unproven/Experimental treatment
means medical expenses incurred during Unproven/Experimental treatment means
predefined number of days immediately the treatment including drug experimental
after the insured person is discharged from therapy which is not based on established
the hospital provided that: medical practice in India, is treatment
i. Such Medical Expenses are for experimental or unproven.
the same condition for which the
insured person’s hospitalization was ii. Specific Definitions (Definitions other than
required, and as mentioned under Section 1 (i) above)
ii. The inpatient hospitalization claim for
1. Age
such hospitalization is admissible by
the insurance company.
Means the completed age of the Insured

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 Person on his / her most recent birthday to the hospital.
as per the English calendar, regardless of The benefit is payable if We have admitted
the actual time of birth. a claim under B1 or B4 or B6.
2. Policy B3. Post-Hospitalization expenses
We will cover for expenses for Post-
Policy means the contract of insurance Ho s p i t a l i z a t i o n co ns u l t a t i o ns ,
including but not limited to Policy Schedule, investigations and medicines incurred upto
Endorsements , Policy Wordings and Riders. 90 days after discharge from the hospital.
3. Policy period The benefit is payable if We have admitted
a claim under B1 or B4 or B6.
Policy Period means the time during B4. Day Care Procedures
which this Policy is in effect. Such period We will cover expenses for listed Day Care
commences from Commencement Date Treatment due to disease/illness/Injury
and ends on the Expiry Date and specifically during the policy period taken at a hospital
appears in the Policy Schedule. or a Day Care Centre. The list of such day
care procedures covered is available on
4. Policy Schedule
our website (www.tataaig.com).
Policy Schedule means the Policy Schedule Treatment normally taken on out-patient
attached to and forming part of Policy. basis is not included in the scope of this
cover.
5. Policy year B5. Organ Donor
We will cover for Medical and surgical
Policy Year means a period of twelve
months beginning from the date of Expenses of the organ donor for harvesting
commencement of the Policy period the organ where an Insured Person is the
and ending on the last day of such recipient provided that:
twelve-month period. For the purpose of i. The organ donor is any person whose
subsequent years, policy year shall mean organ has been made available
a period of twelve months commencing in accordance and in compliance
from the end of the previous policy year with The Transplantation of Human
and lapsing on the last day of such twelve- Organs (Amendment) Bill, 2011 and
month period, till the Policy Expiry date. the organ donated is for the use of
the Insured Person, and
Section 2 – Benefits ii. We have accepted an inpatient
The following benefits are payable subject to Hospitalization claim for the
Terms and Conditions of the policy: insured member under In Patient
B1. In-Patient Treatment Hospitalization Treatment (section
We w ill c o v e r fo r e xp e ns e s fo r B1).
hospitalization due to disease/illness/Injury B6. Domiciliary Treatment
during the policy period that requires an We will cover for expenses related to
Insured Person’s admission in a hospital Domiciliary Hospitalization of the insured
as an inpatient. person if the treatment exceeds beyond
Medical expenses directly related to the three days. The treatment must be for
hospitalization would be payable. management of an illness and not for
B2. Pre-Hospitalization expenses enteral feedings or end of life care.
We will cover for expenses for Pre- At the time of claiming under this benefit,
Ho s p i t a l i z a t i o n co ns u l t a t i o ns , we shall require certification from the
investigations and medicines incurred treating doctor fulfilling the conditions as
upto 60 days before the date of admission mentioned under the general definitions

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 (Section 1) of this Policy. B10. Consumables Benefit
B7. AYUSH Benefit We will pay for expenses incurred, for
We will cover Medical Expenses incurred specified consumables listed in ‘Annexure
for treatment as In-Patient or Day Care I – List I of Optional Items (Consumables
Treatment in an AYUSH Hospital/ AYUSH Benefit)’ which are consumed during
day care centre. the period of hospitalization directly
related to the insured’s medical or surgical
This benefit shall also cover Pre- treatment of illness/disease/injury.
Hospitalization medical expenses for a Details of Annexure I-List I-Optional items
period of upto 60 days before the date of (Consumables Benefit) are available on our
admission to the AYUSH hospital/AYUSH website (www.tataaig.com).
day care centre and Post-Hospitalization
Medical Expenses for a period upto 90 days, However the following items shall be
subject to AYUSH In-Patient hospitalization excluded from scope of this coverage:
or AYUSH day care treatment claim being • Items of personal comfort, toiletries,
admissible under this benefit. cosmetics and convenience shall be
Claims under this section shall be assessed excluded from scope of this coverage.
as per the applicable insurance guidelines • External durable devices like Bilevel
related to AYUSH and benchmark rates Positive Airway Pressure (BIPAP)
as available on Ministry of AYUSH website machine, Continuous Positive Airway
(https://ayushnext.ayush.gov.in/site/ Pressure (CPAP) machine, Peritoneal
insurance-guidelines-related-to-ayush). Dialysis (PD) equipment and supplies,
For your reference, the document has been Nimbus/water/air bed, dialyzer and
uploaded on Our website under “Annexure other medical equipments.
B for AYUSH Benefit” (www.tataaig.com). • Any item which is neither a medical
B8. Ambulance Cover consumable nor medically necessary
We will cover for expenses incurred on nor prescribed by doctor.
transportation of Insured Person in a For this claim to be paid, the main
registered ambulance to a Hospital for claim must be admissible under
admission in case of an Emergency or from section B1 or B4 of this policy.
one hospital to another hospital for better
B11. In-Patient Treatment - Dental
medical facilities and treatment, subject to
Rs. 3000 per Hospitalization. We will cover for medical expenses
incurred towards hospitalization for dental
For this claim to be paid, the claim must be
treatment under anesthesia necessitated
admissible under section B1 or B4 of this
due to an accident/injury/illness.
policy.
B12. Second Opinion
B9. Health Checkup
We will provide You a second opinion from
We will cover for expenses for a Preventive
Network Provider or Medical Practitioner,
Health Check-up upto 1% of previous
if an Insured Person is diagnosed with
sum insured subject to a maximum of
the below mentioned Illnesses during the
Rs. 10,000/- per policy. The limit is the
Policy Period. The expert opinion would be
maximum per policy and more than one
directly sent to the Insured Person.
insured can utilize the amount.
i. Cancer
The benefit is payable once after block
of every two continuous claim free policy ii. Kidney Failure
years with us. This benefit has a separate iii. Myocardial Infarction
limit (over and above base sum insured)
iv. Angina
and does not affect cumulative bonus.
Deductible shall not be applicable for this v. Coronary bypass surgery
benefit. vi. Stroke/Cerebral hemorrhage

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 vii. Organ failure requiring transplant Year. There will be no impact on
viii. Heart Valve replacement the Inpatient Sum Insured, only the
accrued Cumulative Bonus will be
ix. Brain tumors decreased.
This benefit can be availed by an Insured
iii. In policies with a tenure of more than
Person once during a Policy Year. one year, the above guidelines of
B13. Global Cover (Optional Cover) Cumulative Bonus shall be applicable
We will cover for Medical Expenses of the post completion of each policy year.
Insured Person incurred outside India, iv. In relation to a Family Floater, the
upto the sum insured, provided that the Cumulative Bonus so applied will
diagnosis was made in India and the only be available in respect of those
insured travels abroad for treatment. Insured Persons who were Insured
The Medical Expenses payable shall Persons in the claim free Policy Year
be limited to Inpatient and daycare and continue to be Insured Persons
Hospitalization only on reimbursement in the subsequent Policy Year.
basis. Cashless facility may be arranged
v. Cumulative Bonus shall not be
on case to case basis. Insured person can
applicable for newly added members
contact us for any claim assistance.
in the year of addition.
The payment of any claim under this
benefit will be in Indian Rupees based vi. For purpose of computation of
on the rate of exchange as on the date Cumulative Bonus, the percentage
of invoice, published by Reserve Bank of (%) of Cumulative Bonus will be
India (RBI) and shall be used for conversion applied on the Inpatient Sum Insured
of foreign currency into Indian Rupees only.
for claims payment. If these rates are vii. Cumulative Bonus shall be provided
not published on the date of invoice, the only if No Claim Discount has not
exchange rate next published by RBI shall been availed for the claim free
be considered for conversion. previous Policy Year.
We shall require the following additional Section 3 – Exclusions
documents of the insured person for
supporting the claim under this benefit: We will neither be liable nor make any payment
for any claim in respect of any Insured Person
• Proof of diagnosis in India which is caused by, arising from or in any way
• Insured’s Passport and Visa attributable to any of the following exclusions,
unless expressly stated to the contrary in this
B14. Cumulative Bonus
Policy.
i. 50% cumulative bonus will be applied i. Standard Exclusions
on the Sum Insured for next policy
year under the Policy after every 1. Exclusions with waiting periods
claim free Policy Year, provided i. Pre-existing Diseases Waiting
that the Policy is renewed with Us Period (Code- Excl 01):
and without a break. The maximum a. E xpe nse s rel ate d to the
cumulative bonus shall not exceed treatment of a pre-existing
100% of the Sum Insured in any Policy Disease (PED) and its direct
Year. complications shall be excluded
ii. If a Cumulative Bonus has been until the expiry of 36 months of
applied and a claim is made, then continuous coverage after the
in the subsequent Policy Year We date of inception of the first
will automatically decrease the policy with us.
Cumulative Bonus by 50% of the b. In case of enhancement of sum
Sum Insured in that following Policy insured the exclusion shall

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 apply afresh to the extent of coverage.
sum insured increase. f. List of Specific Diseases/
c. I f the I nsured Person i s procedures as furnished below:
continuously covered without I. Tumors, Cysts, polyps
any break as defined under including breast lumps
the portability norms of the (benign)
extant IRDAI (Health Insurance)
II. Polycystic ovarian disease
Regulations, then waiting period
for the same would be reduced III. Fibromyoma
to the extent of prior coverage. IV. Adenomyosis
d. Coverage under the policy after V. Endometriosis
the expiry of 36 months for any VI. Prolapsed Uterus
pre-existing disease is subject
to the same being declared VII. Non-infective arthritis
at the time of application and VIII. Gout and Rheumatism
accepted by us. IX. Osteoporosis
ii. Specified Disease/Procedure X. Ligament, Tendon or
Waiting Period (Code- Excl 02): Meniscal tear (due to
a. E xpe nse s rel at ed to the injury or otherwise)
t r e at m e n t of t he l is t e d XI. Prolapsed Inter Vertebral
C o nd i t i o ns , s ur ge r ie s / Disc (due to injury or
treatments shall be excluded otherwise)
until the expiry of 24 months
XII. Cholelithiasis
of continuous coverage after
the date of inception of the first XIII. Pancreatitis
policy with us. This exclusion XIV. Fissure/fistula in anus,
shall not be applicable for claims haemorrhoids, pilonidal
arising due to an accident. sinus
b. In case of enhancement of sum XV. Ulcer & erosion of stomach
insured the exclusion shall & duodenum
apply afresh to the extent of XVI. Gastro Esophageal Reflux
sum insured increase.
Disorder (GERD)
c. If any of the specified disease/
XVII. Liver Cirrhosis
procedure falls under the
waiting period specified for XVIII. Perineal Abscesses
pre-Existing diseases, then XIX. Perianal / Anal Abscesses
the longer of the two waiting XX. Calculus diseases of
periods shall apply. Urogenital system
d. The waiting period for listed Example: Kidney stone,
conditions shall apply even if Urinary bladder stone.
contracted after the policy or XXI. Benign Hyperplasia of
declared and accepted without
a specific exclusion. prostate
XXII. Varicocele
e. I f the Insured Person i s
continuously covered without XXIII. Cataract
any break as defined under the XXIV. Retinal detachment
applicable norms on portability XXV. Glaucoma
stipulated by IRDAI, then waiting
period for the same would be XXVI. C o ng e n i t a l I nt e r na l
reduced to the extent of prior Diseases

10

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 The following treatments are covered a. Expenses related to any
after a waiting period of two years a d m is s io n p r im a r ily fo r
irrespective of the illness for which it diagnostics and evaluation
is done: purposes only are excluded.
XXVII. Adenoidectomy b. Any diagnostic expenses which
XXVIII. Mastoidectomy are not related or not incidental
to the current diagnosis and
XXIX. Tonsillectomy treatment are excluded.
XXX. Tympanoplasty ii. Rest cure, rehabilitation and
XXXI. Surgery for nasal septum respite care (Code- Excl 05):
deviation a. Expenses related to any
XXXII. Nasal concha resection a d m is s io n p r im a r ily fo r
XXXIII. Surgery for Turbinate enforced bed rest and not for
hypertrophy receiving treatment. This also
includes:
XXXIV. Hysterectomy
i. Custodial care either
XXXV. Joint replacement surgeries at home or in a nursing
Eg: Knee replacement, Hip facility for personal care
replacement such as help with activities
XXXVI. Cholecystectomy of daily living such as
XXXVII. H e r n i o p l a s t y o r bathing, dressing, moving
Herniorraphy around either by skilled
nurses or assistant or non-
XXXVIII. S u r g e r y / p r o c e d u re
skilled persons.
f or Ben i gn p r os t at e
enlargement ii. Any services for people
who are terminally ill to
XXXIX. Surgery for Hydrocele/
address physical, social,
Rectocele emotional and spiritual
XL. Surgery of varicose veins needs.
and varicose ulcers iii. Obesity/ Weight Control (Code-
iii. 30 Days Waiting Period (Code- Excl 03): Excl 06)
a. E xpe nse s r el ate d to the Expenses related to surg ical
treatment of any illness within treatment of obesity that does not
30 days from the first policy fulfil the below conditions:
commencement date shall be a. Surgery to be conducted is upon
excluded except claims arising the advice of the Doctor;
due to an accident, provided the
same are covered. b. Th e su r g e r y / P r o c e d u re
conducted should be supported
b. This exclusion shall not, however, by clinical protocols;
apply if the Insured Person has
Continuous Coverage for more c. The member has to be 18 years
than twelve months. of age or older and
c. The within referred waiting d. Body Mass Index (BMI);
period is made applicable to the i. greater than or equal to 40
enhanced sum insured in the or
event of granting higher sum
ii. greater than or equal to
insured subsequently.
35 in conjunction with any
2. Medical Exclusions of the following severe
i. Investigation and evaluation co-morbidities following
(Code- Excl 04): failure of less invasive

11

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 methods of weight loss: for correction of eye sight due to
1. O be s i t y - r e la te d refractive error less than 7.5 dioptres
cardiomyopathy x. Unproven treatments (Code- Excl
2. Co ronary heart 16):
disease Expenses related to any unproven
3. Severe Sleep Apnea treatment, services and supplies for
4. Uncontrolled Type2 or in connection with any treatment.
Diabetes Unproven treatments are treatments,
procedures or supplies that lack
iv. Change-of-Gender treatments significant medical documentation
(Code- Excl 07) : to support their effectiveness.
Expenses related to any treatment, xi. Sterility and Infertility (Code- Excl
including surgical management, to 17):
change characteristics of the body to
those of the opposite sex. Expenses related to Sterility and
infertility. This includes:
v. Cosmetic or Plastic Surgery (Code-
i. Any type of contraception,
Excl 08):
sterilization
Expenses for cosmetic or plastic
ii. Assisted Reproduction services
surgery or any treatment to change
including artificial insemination
appearance unless for reconstruction
and advanced reproductive
following an Accident, Burn(s) or
technologies such as IVF, ZIFT,
Cancer or as part of medically
GIFT, ICSI
necessary treatment to remove a
direct and immediate health risk to iii. Gestational Surrogacy
the insured. For this to be considered iv. Reversal of sterilization
a medical necessity, it must be xii. Maternity (Code - Excl 18) :
certified by the attending Medical
Practitioner. a. Medical treatment expenses
traceable to childbirth (including
vi. Treatment for, Alcoholism, drug or complicated deliveries and
substance abuse or any addictive caesarean sections incurred
condition and consequences thereof. during hospitalization) except
(Code- Excl 12) ectopic pregnancy;
vii. Treatments received in heath b. Expenses towards miscarriage
hydros, nature cure clinics, spas or (unless due to an accident) and
similar establishments or private lawful medical termination of
beds registered as a nursing home pregnancy during the policy
attached to such establishments or period.
where admission is arranged wholly
or partly for domestic reasons. 3. Non-Medical Exclusions
(Code -Excl13) i. Hazardous or Adventure Sports
viii. Dietary supplements and substances (Code- Excl 09):
that can be purchased without Expenses related to any treatment
prescription, including but not limited necessitated due to participation
to Vitamins, minerals and organic as a professional in hazardous or
substances unless prescribed by adventure sports, including but
a medical practitioner as part of not limited to, para-jumping, rock
hospitalization claim or day care climbing, mountaineering, rafting,
procedure. (Code- Excl14) motor racing, horse racing or scuba
ix. Refractive error (Code- Excl 15): diving, hand gliding, sky diving, deep-
sea diving.

Expenses related to the treatment 12

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 ii. Breach of law (Code- Excl 10): natural teeth and also requiring
Expenses for treatment directly hospitalization & any dental
arising from or consequent upon treatment other than specified
any Insured Person committing or in ‘Inpatient Treatment – Dental’;
attempting to commit a breach of law x. Any existing disease specifically
with criminal intent. mentioned as Permanent
iii. Excluded Providers (Code-Excl 11): exclusion in the Policy Schedule.
Expenses incurred towards treatment 2. Non-Medical Exclusions
in any hospital or by any Medical i. War or any act of war, invasion,
Practitioner or any other provider act of foreign enemy, civil
specifically excluded by the Insurer war, public defence, rebellion,
and disclosed in its website / r e v o l ut i o n , i n s u r re c ti o n ,
notified to the policyholders are not military or usurped acts, nuclear
admissible. However, in case of life weapons/materials, chemical
threatening situations or following an and biological weapons, ionising
accident, expenses up to the stage of radiation.
stabilization are payable but not the
complete claim. ii. A n y I n s u r e d P e r s o n ’ s
participation or involvement
ii. Specific Exclusions (Exclusions other in naval, military or air force
than as mentioned under Section 3 (i) operation.
above)
iii. Intentional self- injury or
1. Medical Exclusions
attempted suicide while sane
i. Alcoholic pancreatitis; or insane.
ii. Congenital External Diseases, iv. Items of personal comfort and
defects or anomalies; convenience like television
iii. Stem cell therapy; however (wherever specifically charged
hematopoietic stem cells for for), charges for access to
bone marrow transplant for telephone and telephone calls,
haematological conditions will internet, foodstuffs (except
be covered under benefit B1 patient’s diet), cosmetics,
or B4 of this policy; hygiene articles, body care
iv. Growth hormone therapy; products and bath additive,
barber or beauty service, guest
v. Sleep-apnoea; service.
vi. Ad m is s io n p r im a r ily fo r v. Treatment rendered by a
administration of Intra-articular Medical Practitioner which is
or intra-lesional injections or outside his discipline.
Intravenous immunoglobulin
infusion or supplementary vi. Doctor’s fees charged by the
medications like Zolendronic Medical Practitioner sharing the
Acid; same residence as an Insured
Person or who is an immediate
vii. Venereal disease, sexually
relative of an Insured Person’s
transmitted disease or illness; family.
viii. All preventive care, vaccination
vii. Provision or fitting of hearing
including inoculation and
aids, spectacles or contact
immunisations;
lenses including optometric
ix. Dental treatment or surgery therapy.
of any kind unless as a result
viii. Any treatment and associated
of Accidental Bodily Injury to
e xpe ns e s fo r a lo pe c ia ,

13

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 baldness, wigs, or toupees, 3. Claim Settlement (provision for Penal
medical supplies including Interest)
elastic stockings, diabetic test i. The Company shall settle or reject a
strips, and similar products. claim, as the case may be, within 15
ix. Any treatment or part of a days from the date of receipt of last
t re at men t that is not of necessary document.
a reasonable charge, not ii. In the case of delay in the payment of
medically necessary; drugs a claim, the Company shall be liable
or treatments which are not to pay interest to the policyholder
supported by a prescription. from the date of receipt of last
x. Crutches or any other external necessary document to the date of
appliance and/or device used payment of claim at a rate 2% above
for diagnosis or treatment the bank rate.
(except when used intra- iii. However, where the circumstances
operatively and explicitly stated of a claim warrant an investigation
and covered in the policy). in the opinion of the Company, it
xi. Any illness diagnosed or injury shall initiate and complete such
sustained or where there is investigation at the earliest, in any
change in health status of the case not later than 30 days from
member after date of proposal the date of receipt of last necessary
and before commencement document. In such cases, the
of policy and the same is not Company shall settle or reject the
claim within 45 days from the date of
communicated and accepted
receipt of last necessary document.
by us.
iv. In case of delay beyond stipulated
xii. Any claim within the deductible
45 days, the Company shall be liable
limit as specified in the policy
to pay interest to the policyholder at
schedule.
a rate 2% above the bank rate from
Section 4 – General Terms and Clauses the date of receipt of last necessary
Standard General Terms and Clauses: document to the date of payment of
claim.
1. Disclosure of Information
(Explanation: “Bank rate” shall mean
The policy shall be void and all premium
the rate fixed by the Reserve Bank
paid thereon shall be forfeited to the
of India (RBl) at the beginning of
Company in the event of established the financial year in which claim has
fraud, misrepresentation, misdescription fallen due).
or non-disclosure of any material fact by
the policyholder. 4. Complete Discharge
(Explanation: “Material facts” for the Any payment to the policyholder, insured
purpose of this policy shall mean all person or his/ her nominees or his/ her
relevant information sought by the legal representative or assignee or to
company in the proposal form and other the Hospital, as the case may be, for any
connected documents to enable it to benefit under the policy shall be a valid
take informed decision in the context of discharge towards payment of claim by the
underwriting the risk.) Company to the extent of that amount for
2. Condition Precedent to Admission of the particular claim.
Liability 5. Multiple Policies
The terms and conditions of the policy i. In case of multiple policies taken by an
must be fulfilled by the insured person insured person during a period from
for the Company to make any payment for one or more insurers to indemnify
claim(s) arising under the policy.

14

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 treatment costs, the insured person For the purpose of this clause, the
shall have the right to require a expression “fraud” means any of the
settlement of his/her claim in terms following acts committed by the insured
of any of his/her policies. In all such person or by his agent or the hospital/
cases the insurer chosen by the doctor/any other party acting on behalf of
insured person shall be obliged to the insured person, with intent to deceive
settle the claim as long as the claim the insurer or to induce the insurer to issue
is within the limits of and according an insurance policy:
to the terms of the chosen policy. a) the suggestion, as a fact of that which
ii. Insured person having multiple is not true and which the insured
policies shall also have the right to person does not believe to be true;
prefer claims under this policy for b) the active concealment of a fact by the
the amounts disallowed under any insured person having knowledge or
other policy / policies even if the sum belief of the fact;
insured is not exhausted. Then the c) any other act fitted to deceive; and
insurer shall independently settle
the claim subject to the terms and d) any such act or omission as the law
conditions of this policy. specially declares to be fraudulent.
The Company shall not repudiate the
iii. If the amount to be claimed exceeds
claim and / or forfeit the policy benefits
the Sum Insured under a single
on the ground of Fraud, if the insured
Policy, the Insured Person shall
person / beneficiary can prove that the
have the right to choose Insurer
misstatement was true to the best of his
from whom he/she wants to claim
knowledge and there was no deliberate
the balance amount and we will assist
intention to suppress the fact or that
the insured person in facilitating the
such misstatement of or suppression of
same.
material fact are within the knowledge of
iv. Where an insured person has policies the insurer.
from more than one insurer to 7. Cancellation
cover the same risk on indemnity
basis, the insured person shall only i. The policyholder may cancel this
be indemnified the treatment costs policy by giving 7 days written notice
in accordance with the terms and and in such an event, the Company
conditions of the chosen policy. shall refund proportionate premium
for the unexpired policy period. No
6. Fraud refunds of premium shall be made
If any claim made by the insured person, in respect of Cancellation where
is in any respect fraudulent, or if any false any claim has been admitted or has
statement, or declaration is made or used been lodged or any benefit under
in support thereof, or if any fraudulent this Policy has been availed by the
means or devices are used by the insured Insured Person.
person or anyone acting on his/her behalf ii. The Company may cancel the policy
to obtain any benefit under this policy, all at any time on grounds of established
benefits under this policy and the premium fraud, misrepresentation or non-
paid shall be forfeited. disclosure of material facts by the
Any amount already paid against claims Policyholder/Insured Person by
made under this policy but which are giving 15 days’ written notice. There
found fraudulent later shall be repaid by all would be no refund of premium on
recipient(s)/policyholder(s), who has made cancellation on established fraud,
that particular claim, who shall be jointly misrepresentation or non-disclosure
and severally liable for such repayment to of material facts.
the insurer. 8. Migration

15

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 Reg/8/202/2024 dated 20th March, 2024
The insured person will have the option and Master Circular on IRDAI (Insurance
to migrate the policy to other health Products) Regulations 2024- Health
insurance products/plans offered by the Insurance Ref: IRDAI/HLT/CIR/PRO/84/5/
company by applying for migration of the 2024 dated 29th May 2024 and their
policy at least 30 days before the policy subsequent amendments thereof.
renewal date as per IRDAI guidelines. lf
such person is presently covered and
has been continuously covered without Renewal of Policy
any lapses under any health insurance The policy shall ordinarily be renewable
product/plan offered by the company, except on grounds of established fraud,
the insured person will get the accrued non-disclosure or misrepresentation.
continuity benefits to the extent of the i. Renewal shall not be denied on the
Sum Insured, No Claim Bonus, Specific ground that the insured person
Waiting periods, waiting period for pre- had made a claim or claims in the
existing diseases, Moratorium period etc. preceding policy years.
in the previous policy to the migrated
ii. Request for renewal along with
policy, as applicable.
requisite premium shall be received
by the Company before the end of
the policy period.
For Detailed Guidelines on Migration,
kindly refer Insurance Regulatory and iii. Single premium payment mode
Development Authority of India (Insurance Policy can be renewed within the
Products) Regulations, 2024 F. No. IRDAI/ Grace Period of 30 days to maintain
Reg/8/202/2024 dated 20th March, 2024 continuity of benefits without break
and Master Circular on IRDAI (Insurance in policy. Coverage is not available
Products) Regulations 2024- Health during the grace period after the end
Insurance Ref: IRDAI/HLT/CIR/PRO/84/5/ of the policy period. If not renewed
2024 dated 29th May 2024 and subsequent under the Grace Period, the Policy
amendments thereof. shall terminate at the end of the
Grace period.
9. Portability
iv. The grace period for payment of the
The insured person will have the option premium during the Policy Period, for
to port the policy to other insurers by instalment premium shall be fifteen
applying to such insurer to port the entire days where premium payment mode
policy along with all the members of the is monthly and thirty days in all other
family, if any, at least 30 days before, but cases (Anually/ Half-Yearly/Quarterly/
not earlier than 60 days from the policy Limited Premium Payment Term).
renewal date as per IRDAI guidelines. If
such person is presently covered and v. Coverage during such grace period
has been continuously covered without (in case of instalment premium):
any lapses under any health insurance a. Within the policy period -
policy with an Indian General/Health coverage will be available from
insurer, the proposed insured person the due date of instalment
will get the accrued continuity premium till the date of receipt
benefits to the extent of the Sum of premium by Company within
Insured, No Claim Bonus, specific waiting the grace period.
periods, waiting period for pre-existing
b. At the end of the policy period
disease , Moratorium period etc from the
Existing Insurer to the Acquiring Insurer - the policy shall terminate
in the previous policy, as applicable. and can be renewed within
the Grace Period of 30 days
to maintain continuity of
For Detailed Guidelines on Portability, benefits without break in policy.
kindly refer Insurance Regulatory and Coverage is not available during
Development Authority of India (Insurance the grace period after the end
Products) Regulations, 2024 F. No. IRDAI/ of the policy period.
16

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 c. The insured person will get the free look period of thirty days beginning
accrued continuity benefit to from the date of receipt of the policy
document, whether received electronically
the extent of Sum Insured, No
or otherwise, to review the terms and
Claim Bonus, Specified Waiting conditions of the policy, and to return the
Periods, waiting periods for same if not acceptable.
pre-existing diseases, If the insured has not made any claim
Moratorium period, as during the Free Look Period, the insured
applicable, in the event of shall be entitled to
payment of premium within i. a refund of the premium paid subject
the stipulated grace Period. to deduction of proportionate risk
vi. No loading shall apply on renewals premium for the period of cover
based on individual claims experience. and the expenses, if any, incurred
by Us on medical examination of the
10. Withdrawal of Policy proposer and stamp duty charges.
i. In the likelihood of this product being 14. Redressal of Grievance
withdrawn in future, the Company
will intimate the insured person At TATA AIG, we strive to provide
about the same 90 days prior to the best service to our customers. If
expiry of the policy. you’re not satisfied and wish to lodge a
complaint, please call our 24/7 toll-free
ii. Insured Person will have the option
number 022 6489 8282/ 1800 22 9966
to migrate to similar health insurance
(For Senior Citizens) or 022-66939500
product available with the Company
(toll charges apply), or email us at
at the time of renewal with all the
customersupport@tataaig.com. We
accrued continuity benefits such as
will investigate and respond within the
cumulative bonus, waiver of waiting
regulatory turnaround time (TAT).
period as per IRDAI guidelines,
provided the policy has been Escalation Level 1
maintained without a break. I f you do not receive a r esponse
11. Moratorium Period o r ar e no t s a t i s f ie d w i t h t h e
After completion of five continuous years r e s o l ut io n, please conta ct us at
of coverage (including portability and manager.customersupport@tataaig.com.
migration) in health insurance policy, no Escalation Level 2
policy and claim shall be contestable by If you still need assistance, reach out
the insurer on grounds of non-disclosure, to the Head of Customer Services at
misrepresentation, except on grounds of head.customerservices@tataaig.com.
established fraud. This continuous period We will provide our final response within
of five years is called as moratorium period. the regulatory TAT.
The moratorium would be applicable
for the sums insured of the first policy. If you’re still not satisfied after this
Wherever the sum insured is enhanced, process, you may approach the Insurance
completion of five continuous years Ombudsman of concerned jurisdiction.
would be applicable from the date of You can also lodge a grievance on the
enhancement of sums insured only on the Bima Bharosa Grievance Redressal Portal:
enhanced limits. https://bimabharosa.irdai.gov. in
12. Possibility of Revision of Terms of the The name and address of the Insurance
Policy Including the Premium Rates Ombudsman of competent jurisdiction is
The Company may revise or modify the provided under Annexure A of this Policy.
terms of the Policy including the premium 15. Nomination
rates. The Insured Person shall be notified
The policyholder is required at the inception
three months before the changes are
of the policy to make a nomination for
affected.
the purpose of payment of claims under
13. Free look period
The insured person shall be provided a

17

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 the policy in the event of death of the medical condition and an overall risk
policyholder. Any change of nomination loading of over 150% of premium per
shall be communicated to the company in person.
writing and such change shall be effective iii. The loading shall only be applied
only when an endorsement on the policy basis an outcome of Our medical
is made. In the event of death of the underwriting.
policyholder, the Company will pay the
iv. These loadings are applied from
nominee {as named in the Policy Schedule/
Commencement Date of the Policy
Policy Certificate/Endorsement (if any)} and
including subsequent renewal(s) with
in case there is no subsisting nominee, to
Us or on the receipt of the request
the legal heirs or legal representatives of
of increase in Sum Insured (for the
the policyholder whose discharge shall be
increased Sum Insured).
treated as full and final discharge of its
liability under the policy. a. We will inform You about the
applicable risk loading through
ii. Specific terms and clauses
a counter offer letter.
(terms and clauses other than those
mentioned under Section 4 (i) above) b. You need to revert to Us
with consent and additional
16. Premium Payment
premium (if any), within 15 days
i. Premium to be paid for the Policy Period of the issuance of such counter
before Policy Commencement date as offer letter.
opted by You in the proposal form.
c. In case, you neither accept the
ii. Long term premium discount of 5% counter offer nor revert to Us
and 10% is applicable for policy with within 15 days, We shall cancel
tenure of 2 and 3 years respectively. Your application and refund the
17. Insured Person premium paid within next 10
i. Only those persons named as an days subject to deduction of the
Insured Person in the Schedule shall Pre-Policy Check up charges, as
be covered under this Policy. applicable.
ii. Any person may be added during v. Please note that We will issue Policy
the Policy Period after his application only after getting Your consent.
has been accepted by Us, additional 19. Entire Contract
premium has been paid and We have i. T h i s P o l i c y , i t s Sc he d u l e ,
issued an endorsement confirming endorsement(s), proposal constitutes
the addition of such person as an the entire contract of insurance. No
Insured Person. change in this policy shall be valid
iii. We will be offering continuous unless approved by Us and such
renewal with no exit age subject approval be endorsed hereon.
to regular premium payment and ii. This Policy and the Schedule shall be
compliance with all provisions and read together as one contract and
terms & conditions of this policy by any word or expression to which a
the Insured Person. specific meaning has been attached
18. Loadings in any part of this Policy or of the
i. We may apply a risk loading on the Schedule shall bear such meaning
premium payable (based upon the wherever it may appear.
declarations made in the proposal 20. Sum Insured Enhancement and Change
form and the health status of the in deductible
persons proposed for insurance). i. Sum Insured and/or Deductible
ii. The maximum risk loading applicable can be changed only at the time
for an individual shall not exceed of renewal subject to underwriting
100% of premium per diagnosis / guidelines of the company.

18

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 ii. In case of increase in the Sum Insured a. Any Insured Person, then it shall
waiting period and exclusions will be sent to You at Your address
apply afresh in relation to the amount specified in the Schedule to
by which the Sum Insured has been this Policy and You shall act for
enhanced. For claims arising in all Insured Persons for these
respect of accident, injury or illness purposes.
contracted or suffered during a b. Us, it shall be delivered to
preceding Policy period, liability of Our address specified in the
the Company shall be only to the Schedule to this Policy. No
extent of the Sum Insured under the insurance agents, brokers
Policy in force at the time when it was or other person or entity is
contracted or suffered. authorised to receive any
21. Change of Policyholder notice, direction or instruction
The change of Policyholder is permitted on Our behalf unless We have
only at the time of renewal. expressly stated to the contrary
in writing.
If the Insured Person is no longer eligible on
grounds of age or dependency, the insured Section 5 – Claims Procedure and Claims
member will be eligible to apply for a new Payment
policy and enjoy continuity benefits upto
Sum Insured. This section explains about the procedures
involved to file a valid claim by the insured
22. Notices member and processes related in managing
i. Any notice, direction or instruction the claim by TPA or Us. All the procedures and
under this Policy shall be in writing processes such as notification of claim, availing
and if it is to: cashless service, supporting claim documents
and related claim terms of payment are
explained in this section.
1. Notification of Claim
Treatment, Consultation or We or Our TPA* must be informed:
Procedure:
1 If any treatment for which a claim may At least 48 hours prior to the Insured Person’s
be made and that treatment requires admission.
planned Hospitalisation:
2 If any treatment for which a claim may Within 24 hours of the Insured Person’s
be made and that treatment requires admission to Hospital.
emergency Hospitalisation
Failure to furnish such intimation within the time required shall not invalidate nor reduce any
claim if You can satisfy us that it was not reasonably possible for You to give proof of such
delay within such time. The Company may relax these timelines only in special circumstances
and for the reasons beyond the control of the insured.
*TPA as mentioned in the policy schedule
2. Cashless Service
T r e a t m e n t , T r e a t m e n t , Cashless Service is We must be given
C o ns u l t a t i o n o r C o ns u l t a t i o n o r Available: notice that the Insured
Procedure: Procedure Taken at: Person wis hes to
take advantage of
the cashless service
accompanied by full
particulars:

19

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 If a ny p l a n n e d Network Hospital We w i l l p r o v id e At least 48 hours
t r e a t m e n t , cashless service by before the planned
co n s u l t a t i o n or making payment to t reat men t or
procedure for which the extent of Our Hospitalisation
a claim may be made: liability directly to the
Network Hospital.

If any treatment, Network Hospital We w i l l p r o v id e Within 24 hours after

co n s u l t a t i o n or cashless service by t h e t reat men t or
procedure for which making payment to Hospitalisation
a claim may be made, the extent of Our
requiring emergency liability directly to the
hospitalisation Network Hospital.

3. Procedure for Cashless Service covered under the policy, the

i. Cashless Service is only available at same shall be communicated
Network Hospitals. to the Hospital/You by TPA/Us.
ii. In order to avail of cashless treatment, f. In case the ailment /treatment
the following procedure must be is not covered under the policy
followed by You: or cashless is rejected due
to insufficient documents
a. Prior to taking treatment and/ submitted, a rejection letter
or incurring Medical Expenses would be sent to the Hospital/
at a Network Hospital, You must You by TPA/Us
notify our designated TPA/Us
and request pre-authorization. • We/TPA will respond
within TAT as prescribed
b. For any emergency by the Regulator under
Hospitalisation, our designated the Ma s te r C ir cula r
TPA/We must be informed on IRDAI ( I ns u r a nc e
no later than 24 hours of the Products) Regulations
start of Your hospitalization/ 2024- Health Insurance
treatment. Ref : I R D A I / HL T/ CI R /
c. For any planned hospitalization, PRO/84/5/ 2024 and its
our designated TPA/We must subsequent amendments
be informed atleast 48 hours thereof.
prior to the start of your g. Rejection of cashless in no way
hospitalization/treatment. indicates rejection of the claim.
d. Our designated TPA/We will You are required to submit
check your coverage as per the claim along with required
the eligibility and send an documents for us to decide on
authorization letter to the the admissibility of the claim.
provider. You have to provide h. If the cashless is approved,
the ID card issued to You along the original bills and evidence
with any other information of treatment in respect of the
or documentation that is same shall be left with the
requested by the TPA/Us to Network Hospital.
the Network Hospital.
i. Pre-authorization does not
e. In case of deficiency in the guarantee that all costs and
documents sent to TPA/Us expenses will be covered. We
for cashless authorization or reserve the right to review each
the ailment /treatment is not claim for Medical Expenses and

20

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 accordingly coverage will be papers (in reimbursement
determined according to the cases, if available), discharge
terms and conditions of this summaries.
Policy. d. A precise diagnosis of the
4. S u pp o r t i n g D o c u m e n t a t i o n & treatment for which a claim is
Examination made.
i. We or Our TPA may require e. A detailed list of the individual
documentation, medical records medical services and treatments
and information to establish the provided and a unit price for
circumstances of the claim, its each in case not available in the
quantum or Our liability for the submitted hospital bill.
claim within 15 days or earlier of f. Prescriptions that name the
Our request or the Insured Person’s Insured Person and in the
discharge from Hospitalization or case of drugs: the drugs
completion of treatment. prescribed, their price and a
ii. In case the delay is at Your end, failure receipt for payment. In case of
to furnish such evidence within the pre/post hospitalization claim
time required shall not invalidate nor Prescriptions must be submitted
reduce any claim if You can satisfy Us with the corresponding Doctor/
that it was not reasonably possible hospital invoice.
for You to give proof within such time g. All pre and post investigation,
iii. We may accept claims where treatment and follow up
documents have been provided ( c o ns u l t a t i o n) r e co r ds
after a delayed interval only in special pertaining to the present
circumstances and for the reasons ailment for which claim is being
beyond the control of the Insured made, if and where applicable.
Person. h. Treating doctor’s certificate
iv. Such documentation will include regarding missing information
the following: i n c a s e h i st o r i es e . g .
Circumstance of injury and
a. Our claim form, duly completed Alcohol or drug influence at the
and signed for on behalf of the time of accident, if available.
Insured Person.
i. Stickers and invoice of implants
We, upon receipt of a notice
used during surgery.
of claim, will furnish Your
representativ e with such j. Copy of MLC (Medico legal case)
forms as We may require for records, if carried out and FIR
filing proofs of loss or you may (First information report), if
download the claim form from registered, in case of claims
our Web site. arising out of an accident and
available with the claimant.
b. O r ig in al Bills ( ph a rmacy
purchase bill, consultation k. Regulatory requirements as
bill, diagnostic bill) and any amended from time to time,
attachments thereto like currently mandatory NEFT (to
receipts or prescriptions in enable direct credit of claim
support of any amount claimed amount in bank account) and
which will then become Our KYC (recent ID/Address proof
property. and photograph) requirements.
c. All medical reports, case l. Legal heir/succession certificate,
histories, investigation reports, if required;
indoor case papers/ treatment

21

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 m. PM report (wherever applicable iii. This Policy only covers medical
and conducted); treatment taken within India (except
n. If the original claim documents in case of benefit B13- Global cover,
mentioned above are submitted if opted), and payments under this
to any other insurer, we would Policy shall only be made in Indian
require: Rupees within India.
• Self –attested copies of the Your claim will be processed including
claim documents cashless and final bill authorization
as prescribed by the Regulator
• C e r t i f i c a te / C la im
under the Master Circular on IRDAI
settlement letter from
(Insurance Products) Regulations
other insurer or TPA
2024- Health Insurance Ref: IRDAI/
v. Note: In case You are claiming for HLT/CIR/PRO/84/5/ 2024 and its
the same event under an indemnity- subsequent amendments thereof.
based Policy with Us and with
another Insurer and are required Section 6 - Dispute Resolution
to submit the original documents 1. Dispute Resolution Clause
related to Your treatment with that
Any and all disputes or differences
particular Insurer, then We will
under or in relation to this Policy shall
require the attested copies of such
be determined by the Indian Courts and
documents along with a declaration
subject to Indian law.
from the particular Insurer specifying
the availability of the original copies
of the specified treatment documents
with it.
vi. We at our own expense, shall
have the right and opportunity to
examine insured persons through
an independent Medical Practitioner
whose details will be notified to
insured person when and as often
as We may reasonably require during
the pendency of a claim hereunder.
5. Claims Payment
i. We shall be under no obligation
to make any payment under this
Policy unless We have received all
premium payments in full in time
and We have been provided with
the documentation and information
We or Our TPA has requested to
establish the circumstances of the
claim, its quantum or Our liability for
it, and unless the Insured Person has
complied with his obligations under
this Policy.
ii. Medical Expenses incurred for AYUSH
treatment shall be assessed only
under benefit B7 of this policy and
shall be admissible only if incurred
within India.^

22

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
Annexure A
NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

Jurisdiction of Office
SN Centre Address & Contact
Union Territory, District

Office of the Insurance Ombudsman, Jeevan

Prakash Building, 6th floor, Tilak Marg,
Gujarat, Dadra & Nagar
1 Ahemdabad Relief Road, Ahemdabad – 380 001.
Haveli, Daman and Diu
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in

Office of the Insurance Ombudsman,

Jeevan Soudha Building, PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road,
2 Bengaluru Karnataka
JP Nagar, Ist Phase, Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in

Office of the Insurance Ombudsman,

1st floor,”Jeevan Shikha”, 60-B,Hoshangabad
Road, Opp. Gayatri Mandir, Bhopal – 462 Madhya Pradesh,
3 Bhopal
011. Chhattisgarh
Tel.: 0755 - 2769201 / 2769202
Email: bimalokpal.bhopal@cioins.co.in

Office of the Insurance Ombudsman,

62, Forest park, Bhubaneswar – 751 009.
4 Bhubaneswar Odisha
Tel.: 0674 - 2596461 /2596455
Email: bimalokpal.bhubaneswar@cioins.co.in
Punjab, Haryana
Office Of The Insurance Ombudsman, (excluding Gurugram,
Jeevan Deep Building SCO 20-27, Faridabad, Sonepat
Ground Floor Sector- 17 A, and Bahadurgarh),
5 Chandigarh
Chandigarh – 160 017. Himachal Pradesh, Union
Tel.: 0172 - 4646394 / 2706468 Territories of Jammu
Email: bimalokpal.chandigarh@cioins.co.in & Kashmir,Ladakh &
Chandigarh

Office of the Insurance Ombudsman, Fatima

Tamil Nadu,
Akhtar Court, 4th Floor, 453,
PuducherryTown and
6 Chennai Anna Salai, Teynampet,CHENNAI – 600 018. Karaikal (which are part of
Tel.: 044 - 24333668 / 24333678 Puducherry)
Email: bimalokpal.chennai@cioins.co.in
Office of the Insurance Ombudsman, 2/2 A, Delhi & following Districts
Universal Insurance Building, Asaf Ali Road, of Haryana - Gurugram,
7 Delhi
New Delhi – 110 002. Tel.: 011 - 23237539 Faridabad, Sonepat &
Email: bimalokpal.delhi@cioins.co.in Bahadurgarh

23

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 Jurisdiction of Office
SN Centre Address & Contact
Union Territory, District

Office of the Insurance Ombudsman, Jeevan

Assam, Meghalaya,
Nivesh, 5th Floor, Nr. Panbazar over bridge,
Manipur, Mizoram,
8 Guwahati S.S. Road, Guwahati – 781001 (ASSAM). Tel.: Arunachal Pradesh,
0361 - 2632204 / 2602205 Nagaland and Tripura
Email: bimalokpal.guwahati@cioins.co.in

Office of the Insurance Ombudsman,

6-2-46, 1st floor, “Moin Court”, Lane Andhra Pradesh,
Opp. Saleem Function Palace, A. C. Guards, Telangana, Yanam and
9 Hyderabad
Lakdi-Ka-Pool, Hyderabad - 500 004. part of Union Territory of
Tel.: 040 - 23312122 Puducherry
Email: bimalokpal.hyderabad@cioins.co.in

Office of the Insurance Ombudsman, Jeevan

Nidhi – II Bldg., Gr. Floor, Bhawani Singh
10 Jaipur Marg, Jaipur - 302 005. Rajasthan
Tel.: 0141- 2740363/2740798
Email: bimalokpal.jaipur@cioins.co.in

Office of the Insurance Ombudsman,

10th Floor, Jeevan Prakash,LIC Building,
Kerala, Lakshadweep,
Opp to Maharaja’s College Ground,
11 Kochi Mahe-a part of Union
M.G.Road, Kochi - 682 011.
Territory of Puducherry
Tel.: 0484 - 2358759
Email: bimalokpal.ernakulam@cioins.co.in

Office of the Insurance Ombudsman,

Hindustan Bldg. Annexe, 7th Floor, 4, C.R. West Bengal, Sikkim,
12 Kolkata Avenue, KOLKATA - 700 072. Andaman & Nicobar
Tel.: 033 - 22124339 / 22124341 Email: Islands
bimalokpal.kolkata@cioins.co.in

24

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 Jurisdiction of Office
SN Centre Address & Contact
Union Territory, District

Districts of Uttar Pradesh

: Lalitpur, Jhansi, Mahoba,
Hamirpur, Banda,
Chitrakoot, Allahabad,
Mirzapur, Sonbhabdra,
Fatehpur, Pratapgarh,
Jaunpur,Varanasi, Gazipur,
Office of the Insurance Ombudsman, 6th Jalaun, Kanpur, Lucknow,
Floor, Jeevan Bhawan, Phase-II, Nawal Unnao, Sitapur, Lakhimpur,
Kishore Road, Hazratganj, Bahraich, Barabanki,
13 Lucknow
Lucknow - 226 001. Raebareli, Sravasti,
Tel.: 0522 - 4002082 / 3500613 Gonda, Faizabad, Amethi,
Email: bimalokpal.lucknow@cioins.co.in Kaushambi, Balrampur,
Basti, Ambedkarnagar,
Sultanpur, Maharajgang,
Santkabirnagar, Azamgarh,
Kushinagar, Gorkhpur,
Deoria, Mau, Ghazipur,
Chandauli, Ballia,
Sidharathnagar

Office of the Insurance Ombudsman,

Goa, Mumbai
3rd Floor, Jeevan Seva Annexe,
Metropolitan Region
14 Mumbai S. V. Road, Santacruz (W), Mumbai - 400 054.
(excluding Navi Mumbai
Tel.: 022 - 69038800/27/29/31/32/33 Email:
& Thane)
bimalokpal.mumbai@cioins.co.in

State of Uttarakhand
and the following
Districts of Uttar
Pradesh: Agra, Aligarh,
Bagpat, Bareilly, Bijnor,
Budaun, Bulandshehar,
Etah, Kannauj,
Office of the Insurance Ombudsman,
Mainpuri, Mathura,
Bhagwan Sahai Palace
Meerut, Moradabad,
4th Floor, Main Road, Naya Bans, Sector 15,
15 Noida Muzaffarnagar, Oraiyya,
Distt: Gautam Buddh Nagar, U.P-201301.
Pilibhit, Etawah,
Tel.: 0120-2514252 / 2514253
Farrukhabad, Firozbad,
Email: bimalokpal.noida@cioins.co.in Gautam Buddh nagar,
Ghaziabad, Hardoi,
Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj,
Sambhal, Amroha,
Hathras, Kanshiramnagar,
Saharanpur
R1/PW/MC+/Mar 24

25

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924
 Jurisdiction of Office
SN Centre Address & Contact
Union Territory, District

Office of the Insurance Ombudsman, 2nd

Floor, Lalit Bhawan, Bailey Road,
16 Patna Bihar, Jharkhand
Patna 800 001. Tel.: 0612-2547068
Email: bimalokpal.patna@cioins.co.in
Office of the Insurance Ombudsman, Jeevan
Maharashtra, Areas of
Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to
Navi Mumbai and Thane
17 Pune 198, N.C. Kelkar Road, Narayan Peth,
(excluding Mumbai
Pune – 411 030. Tel.: 020-24471175
Metropolitan Region)
Email: bimalokpal.pune@cioins.co.in

For updated list and details of Insurance or property in India, any rebate of the
Ombudsman Offices, please visit website http:// whole or part of the commission payable
www.cioins.co.in/ombudsman.html or any rebate of the premium shown on
the policy, nor shall any person taking out
Prohibition of Rebates - Section 41 of the
or renewing or continuing a policy accept
Insurance Act, 1938 as amended by Insurance
any rebate, except such rebate as may be
Laws (Amendment) Act, 2015.
allowed in accordance with the published
1. No person shall allow or offer to allow, prospectuses or tables of the insurer.
either directly or indirectly, as an 2. Any person making default in complying
inducement to any person to take out with the provisions of this section shall be
or renew or continue an insurance in liable for a penalty which may extend to
respect of any kind of risk relating to lives ten lakh rupees.

26

Registered Office: Peninsula Business Park, Tower A, 15th Floor, G. K. Marg, Lower Parel,
Mumbai- 400013, Maharashtra, India • 24x7 Toll Free No. 1800 266 7780 or 1800 22 9966 (Senior Citizen)
Visit us at www.tataaig.com | IRDA of India Registration No.:108 | CIN: U85110MH2000PLC128425
UIN: TATHLIP21253V022021 | REG-IMP-V1-300924