Medicare Premier Prospectus

Prospectus
1. Suitability:
a. This policy covers persons in the age group 5 years onwards (Dependent children between 91 days and 5
years can be insured only when both parents are getting insured). The maximum entry age is 65 years.
b. There is no maximum cover ceasing age under this policy.
c. The policy will be issued for a period 1/2/3 years.
d. This policy can be issued to an individual and/or family.
e. The family includes spouse and economically dependent children and parents/parents-in-law.
f. The policy offers coverage on family floater basis.
g. Maximum 7 members of a family are covered in one Individual Plan Policy (Self, spouse, 3 dependent
children, 2 parents and 2 parent-in-laws ).
h. Maximum 7 members are covered in one Family Floater Plan policy (Self, spouse, 3 dependent children
(Up to the age of 25 Years), 2 parents and 2 parent-in-laws). In case of family floater, where age of the
dependent child is crossing 25 years, the child can be covered under a separate policy with eligible
continuity benefit.
2. Key Benefits:
a. Range of benefits: Indemnity based health insurance cover with range of benefits without any sub-limit
unless otherwise mentioned.
b. Network of hospitals: We are equipped to offer you quality health care with our strong network of
7000+ hospitals across India.
c. Lifelong renewal: We offer you a lifelong renewal for your policy provided premium is paid without any
break.
d. Global Cover for Planned Hospitalization: We will cover Medical Expenses of the Insured Person
incurred outside India upto the sum insured provided that the diagnosis was made in India and the
insured travels abroad for treatment. In case the Insured Person has opted for Sum Insured above Rs. 50
Lacs, then reasonable and customary expenses incurred towards obtaining visa for medical treatment of
the insured person will be covered.
e. Bariatric Surgery Cover - We will Cover reasonable and customary expenses for Bariatric surgery if the
insured fulfills conditions as listed in the policy.
f. Sum Insured Restore Benefit: If Your Sum Insured including cumulative bonus is insufficient to pay
a claim during a policy year, an additional amount equivalent to the base Sum Insured will be restored
once during the policy year and can also be used for admissions due to related illness/diseases after 45
days from the date of discharge of the earlier claim. This benefit cannot be carried forward to subsequent
renewals.
g. High End Diagnostics - We will pay the insured for the listed diagnostic tests on OPD basis if required as
part of a treatment subject to coverage sum insured.
h. Emergency Air Ambulance Cover - We will pay for ambulance transportation of the insured person in
an airplane or helicopter subject to coverage sum insured.
i. Maternity Cover - We will cover Maternity Expenses subject to coverage sum insured.
1
Tata AIG General Insurance Company Limited
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) • Email: [email protected] • Website: www.tataaig.com
IRDA of India Registration No.: 108 • CIN: U85110MH2000PLC128425 • Tata AIG MediCare Premier UIN: TATHLIP23167V032223
j. Consumables Benefit - We will pay for expenses incurred, for specified consumables which are listed in
‘annexure 1 – List 1 as optional items’ under ‘Guidelines on Standardization in Health Insurance, 2016’ &
its amendments, which are consumed during the period of hospitalization directly related to the insured’s
medical or surgical treatment of illness/disease/injury. Details of Annexure I-List I-Optional items are
available on our website (www.tataaig.com).
k. Cumulative bonus: 50% increase in cumulative bonus for every claim free year. In the case a claim is
made during the policy year, the cumulative bonus would reduce by 50% in the following year.
l. Home Care Treatment Cover (Applicable only for Sum Insured `75 Lakhs and above) - We will
cover for reasonable and customary medical expenses incurred for treatment taken at home for below
specified conditions/ illness:
• Dialysis at home
• Chemotherapy at home
• Pandemic Care at home for a maximum period of 15 days and maximum upto 25% of the base sum
insured excluding cumulative bonus
m. Wellness Services - We / our Empanelled Service Provider will provide below mentioned wellness
services:
a. Teleconsultation - General
b. Teleconsultation – Specialty
c. Ambulance Booking facility
d. Emergency Help me feature
e. Redeemable voucher/Discount on services
f. Health Condition Management
n. Wellness Program - We / our empanelled service provider will provide a wellness program designed to
promote wellness and fitness amongst the insured persons through:
a. Health risk assessment
b. Wellness Rewards: Wellness Reward accumulated through fitness activities can be converted into
monetary value and can be utilized towards the payment of services/items under below categories,
available through our Network/ empanelled service provider:
• OPD consultation/ treatment
• Pharmaceuticals
• Health-check-ups/ diagnostics
• Health Supplements
• Coverage of cost of treatment of any admissible claim in respect of non-payable items that are
specified under the terms and conditions of the base policy
o. Tax Benefit: The premium amount paid under this policy qualifies for deduction under Section 80D of
the Income Tax Act.
3. Discounts on premium:
a. 10% long term discount on premium in case insured opts policy term of 3 years
b. 5% long term discount on premium in case insured opts policy term of 2 years
2
c. Family floater discount on premium:
• 2 members -20%
• 3 members -28%
• > 3 members-32%
4. Salient Features: (Please refer Benefit Table for coverage limits)
1. In-patient Treatment: We will cover expenses for hospitalization due to disease/illness/Injury during the
policy period that requires an Insured Person’s admission in a hospital as an inpatient. Medical expenses
directly related to the hospitalization would be payable
2. Pre-Hospitalisation: The Medical Expenses incurred in 60 days immediately before the Insured Person
was hospitalized.
3. Post-Hospitalisation: The Medical Expenses incurred for specified number of days immediately after
the Insured Person was discharged post Hospitalisation.
4. Day Care Procedures: We will cover expenses for Day Care Treatment due to disease/illness/Injury
during the policy period taken at a hospital or a Day Care Centre.
5. Organ Donor: The Medical and surgical Expenses of the organ donor for harvesting the organ where an
insured person is the recipient.
6. Domiciliary Treatment: The Medical Expenses incurred by an Insured Person for availing medical
treatment at his home which would otherwise have required Hospitalisation. We will also cover pre and
post hospitalization expenses in case of domiciliary hospitalization
7. Global Cover for Planned Hospitalization: We will cover Medical Expenses of the Insured Person
incurred outside India, upto the sum insured provided that the diagnosis was made in India and the
insured travels abroad for treatment. The Medical Expenses payable shall be limited to Inpatient and
daycare Hospitalization only on reimbursement basis. In case the Insured Person has opted for Sum
Insured above Rs. 50 Lacs, then reasonable and customary expenses incurred towards obtaining visa for
medical treatment of the insured person will be covered.
8. Bariatric Surgery Cover - Covers reasonable and customary expenses for Bariatric surgery if the insured
fulfills:
i. Surgery to be conducted upon the advice of the Doctor
ii. The member has to be 18 years of age or older and
iii. BMI greater than or equal to 40 or
iv. BMI greater than or equal to 35 in conjunction with any of the following severe comorbidities following
failure of less invasive methods of weight loss:
a) Obesity-related cardiomyopathy,
b) Severe sleep apnea,
c) Uncontrolled Type2 Diabetes, or
d) Coronary heart disease
9. In-patient Dental Treatment - Covers expenses incurred towards hospitalization for dental treatment
under anesthesia necessitated due to an accident/injury/illness.
10. Restore benefit - Automatically restore the Basic Sum Insured upon exhaustion of the Sum Insured and
accrued Cumulative Bonus, during the policy year.
3
11. AYUSH benefit - Medical Expenses incurred for In-patient treatment taken in an AYUSH hospital.
12. Ambulance cover – For utilizing ambulance service for transporting insured person to hospital in case of
an emergency.
13. Maternity Cover - We will cover Maternity Expenses subject to a waiting period of 4 years of continuous
coverage under this policy.
14. Delivery Complications Cover - We will cover medical expenses incurred for the medically necessary
treatment of the new born baby for complications related to delivery. This benefit will trigger only in case
where we have admitted the maternity claim.
15. First year Vaccinations - We will pay for vaccination expenses for up to one year after the birth of the
child provided the child is covered with us. This benefit will trigger only in case where we have admitted
the maternity claim.
16. Health Check-up - We will pay for expenses for a Preventive Health Check-up
17. Second Opinion - We will provide You a second opinion from Network Provider or Medical Practitioner,
if an Insured Person is diagnosed with the mentioned Illnesses during the Policy Period.
18. Vaccination cover - We will cover for expenses related to the cost of the following vaccines only:
Basic Sum Insured Vaccines covered

Up to `50 Lakhs Without any waiting period:
• Anti-rabies vaccine following an animal bite
• Typhoid vaccination
After 2 years of continuous coverage with Us:
• Human Papilloma Virus (HPV) vaccine
• Hepatitis B Vaccine
`75 Lakhs to `3 Crore. Without any waiting period:
• Anti-rabies vaccine following an animal bite
• Typhoid vaccination
After 2 years of continuous coverage with Us:
• Human Papilloma Virus (HPV) vaccine
• Hepatitis A Vaccine
• Hepatitis B Vaccine
• Tetanus, Diphtheria, Pertussis
• Pneumococcal
19. Hearing Aid - We will cover reasonable charges for hearing aid every third year.
20. Daily cash for choosing shared accommodation - We will pay a fixed amount per day if the Insured
Person is Hospitalized in Shared Accommodation in a Network Hospital for each continuous and
completed period of 24 hours.
21. Daily cash for accompanying an insured child - We will pay a fixed amount per day if the Insured
Person Hospitalized is a child Aged 12 years or less, for one accompanying adult for each complete period
of 24 hours.
22. Prolonged hospitalization benefit - We will pay a fixed amount in the event of insured hospitalized for
a disease/illness/injury for a continuous period exceeding 10 days.
23. High End Diagnostics - We will pay the insured for the following diagnostic tests on OPD basis if required
as part of a treatment:
a. Brain Perfusion imaging
b. CT guided Biopsy
c. CT Urography
4
d. Digital Subtraction Angiography (DSA)
e. Liver Biopsy
f. Magnetic Resonance Cholangiography Scan
g. PET CT
h. PET MRI
i. Renogram
24. OPD Treatment - Once the insured has completed two years of continuous coverage with us, we will pay
for expenses related to consultations and pharmacy subject to policy terms and conditions.
25. OPD Treatment-Dental - Once the insured has completed two years of continuous coverage with us, we
will pay for expenses related to the following dental treatments only.
a. Root Canal Treatment (single or multiple sittings)
b. Tooth extraction(s)
c. Filling
26. Emergency Air Ambulance Cover - We will pay for ambulance transportation of the insured person in
an airplane or helicopter, for emergency life threatening health conditions which require immediate and
rapid ambulance transportation to the hospital/medical centre for further medical management.
27. Compassionate travel-
a) Domestic
In the event the Insured Person is Hospitalized in India for more than Five consecutive days in a
place where no adult member of his immediate family is present, we will cover for expenses related
to a round trip economy class air ticket, or first-class railway ticket, to allow the Immediate Family
Member be at his bedside for the duration of his stay in the hospital. The benefit shall be payable if
an inpatient Hospitalization claim for the insured member is admissible under In-patient Treatment
cover of this policy.
b) Global (Applicable for sum insured above `50 Lakhs):
In the event the Insured person is hospitalized outside India and claim is admissible under Global
cover for Planned Hospitalization, We will cover expenses related to round trip economy class air
ticket, to allow the Immediate Family Member to accompany the Insured person for the purpose of
planned treatment outside India.
28. Accidental Death Benefit - If an Insured Person suffers an accident during the policy period and this is
the sole and direct cause of his death within 365 days from the date of accident, then we will pay a fixed
amount.
29. Consumables Benefit - We will pay for expenses incurred, for specified consumables which are listed in
‘annexure 1 – List 1 as optional items’ under ‘Guidelines on Standardization in Health Insurance, 2016’ &
its amendments, which are consumed during the period of hospitalization directly related to the insured’s
medical or surgical treatment of illness/disease/injury. Details of Annexure I-List I-Optional items are
available on our website (www.tataaig.com).
30. Home care treatment cover (Applicable only for sum insured Rs. 75 Lacs and above) - We will cover
for reasonable and customary medical expenses incurred for treatment taken at home for mentioned
conditions/ illness.
31. Wellness Services - We / our Empanelled Service Provider will provide wellness services designed to
assist insured persons in maintaining and improving good health and fitness.
5
32. Wellness Program - We / our empanelled service provider will provide a wellness program designed to
promote wellness and fitness amongst the insured persons through:
a. Health risk assessment
b. Wellness Rewards
5. Sum Insured options (`) :
• 5 Lakhs
• 10 Lakhs
• 15 Lakhs
• 20 Lakhs
• 25 Lakhs
• 50 Lakhs
• 75 Lakhs
• 100 Lakhs
• 200 Lakhs
• 300 Lakhs
6. Renewal Incentives:
a. Cumulative Bonus: We will offer Cumulative Bonus of 50% of the Sum Insured for every claim free year
accumulating up to 100% of sum insured. In the event of a claim, the cumulative bonus shall be reduced
by 50% at the time of renewal.
7. Portability:
The insured person will have the option to port the policy to other insurers by applying to such insurer to port
the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than
60 days from the policy renewal date as per IRDAI guidelines related to portability. If such person is presently
covered and has been continuously covered without any lapses under any health insurance policy with an
Indian General/Health insurer, the proposed insured person will get the accrued continuity benefits in waiting
periods as per IRDAI guidelines on portability.
For Detailed Guidelines on Portability, kindly refer Guidelines issued IRDAI (Insurance Regulatory and
Development Authority of India) on Migration and Portability of Health Insurance policies – Ref: IRDAI/HLT/
REG/CIR/194/07/2020) dated 22nd July 2020 and subsequent amendments thereof.
8. Free Look Period:
The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or
at the time of porting/migrating the policy.
The insured person shall be allowed free look period of fifteen days from date of receipt of the policy document
to review the terms and conditions of the policy, and to return the same if not acceptable.
If the insured has not made any claim during the Free Look Period, the insured shall be entitled to
i. a refund of the premium paid less any expenses incurred by the Company on medical examination of the
insured person and the stamp duty charges or
ii. where the risk has already commenced and the option of return of the policy is exercised by the insured
person, a deduction towards the proportionate risk premium for period of cover or
6
iii. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate
with the insurance coverage during such period
9. Waiting Period:
i. 30 Days Waiting Period (Code-Excl03):
a. Expenses related to the treatment of any illness within 30 days from the first policy commencement
date shall be excluded except claims arising due to an accident, provided the same are covered.
b. This exclusion shall not, however, apply if the Insured Person has Continuous
Coverage for more than twelve months.
c. The within referred waiting period is made applicable to the enhanced sum insured in the event of
granting higher sum insured subsequently.
ii. Specified Disease/Procedure Waiting Period (Code- Excl02):
a. Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded
until the expiry of 24 months of continuous coverage after the date of inception of the first policy
with us. This exclusion shall not be applicable for claims arising due to an accident.
b. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured
increase.
c. If any of the specified disease/procedure falls under the waiting period specified for pre-Existing
diseases, then the longer of the two waiting periods shall apply.
d. The waiting period for listed conditions shall apply even if contracted after the policy or declared and
accepted without a specific exclusion.
e. If the Insured Person is continuously covered without any break as defined under the applicable
norms on portability stipulated by IRDAI, then waiting period for the same would be reduced to the
extent of prior coverage.
f. List of Specific Diseases/Procedures furnished below:
I. Tumors, Cysts, polyps including breast lumps (benign)
II. Polycystic ovarian disease
III. Fibromyoma
IV. Adenomyosis
V. Endometriosis
VI. Prolapsed Uterus
VII. Non-infective arthritis
VIII. Gout and Rheumatism
IX. Osteoporosis
X. Ligament, Tendon or Meniscal tear
XI. Prolapsed Inter Vertebral Disc
XII. Cholelithiasis
XIII. Pancreatitis
7
XIV. Fissure/fistula in anus, haemorrhoids, pilonidal sinus
XV. Ulcer & erosion of stomach & duodenum
XVI. Gastro Esophageal Reflux Disorder (GERD)
XVII. Liver Cirrhosis
XVIII. Perineal Abscesses
XIX. Perianal / Anal Abscesses
XX. Calculus diseases of Urogenital system Example: Kidney stone, Urinary bladder stone.
XXI. Benign Hyperplasia of prostate
XXII. Varicocele
XXIII. Cataract
XXIV. Retinal detachment
XXV. Glaucoma
XXVI. Congenital Internal Diseases
The following treatments are covered after a waiting period of two years irrespective of the illness for
which it is done:
XXVII. Adenoidectomy
XXVIII. Mastoidectomy
XXIX. Tonsillectomy
XXX. Tympanoplasty
XXXI. Surgery for nasal septum deviation
XXXII. Nasal concha resection
XXXIII. Surgery for Turbinate hypertrophy
XXXIV. Hysterectomy
XXXV. Joint replacement surgeries Eg: Knee replacement, Hip replacement
XXXVI. Cholecystectomy
XXXVII. Hernioplasty or Herniorraphy
XXXVIII. Surgery/procedure for Benign prostate enlargement
XXXIX. Surgery for Hydrocele/ Rectocele
XL. Surgery of varicose veins and varicose ulcers
iii. Pre-existing Diseases Waiting Period (Code-Excl01)
a. Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall
be excluded until the expiry of 24 months of continuous coverage after the date of inception of the
first policy with us.
b. In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured
increase.
8
c. If the Insured Person is continuously covered without any break as defined under the portability
norms of the extant IRDAI (Health Insurance) Regulations, then waiting period for the same would be
reduced to the extent of prior coverage.
d. Coverage under the policy after the expiry of 24 months for any pre-existing disease is subject to the
same being declared at the time of application and accepted by us.
10. 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, unless expressly stated
to the contrary in this Policy.
Medical Exclusions:
i. Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof
.(Code-Excl12)
ii. Alcoholic pancreatitis
iii. Expenses related to surgical treatment of obesity that does not fulfil the below conditions (Code-Excl06):
a. Surgery to be conducted is upon the advice of the Doctor
b. The surgery/Procedure conducted should be supported by clinical protocols
c. The member has to be 18 years of age or older and
d. Body Mass Index (BMI);
i. greater than or equal to 40 or
ii. greater than or equal to 35 in conjunction with any of the following severe co-morbidities
following failure of less invasive methods of weight loss:
1. Obesity-related cardiomyopathy
2. Coronary heart disease
3. Severe Sleep Apnea
4. Uncontrolled Type2 Diabetes
iv. Congenital External Diseases, defects or anomalies;
v. Stem cell therapy; however hematopoietic stem cells for bone marrow transplant for haematological
conditions will be covered under benefit In-Patient Treatment or Day Care Procedures of this policy;
vi. Growth hormone therapy;
vii. Sleep-apnoea
viii. Admission primarily for administration of Intra-articular or intra-lesional injections or Intravenous

immunoglobulin infusion or supplementary medications like Zolendronic Acid
ix. Investigation and evaluation (Code-Excl04):
a. Expenses related to any admission primarily for diagnostics and evaluation purposes only are
excluded.
b. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment
are excluded.
x. Venereal disease, sexually transmitted disease or illness;
9
xi. Expenses related to Sterility and infertility (Code-Excl17). This includes:
i. Any type of contraception, sterilization
ii. Assisted Reproduction services including artificial insemination and advanced reproductive
technologies such as IVF, ZIFT, GIFT, ICSI
iii. Gestational Surrogacy
iv. Reversal of sterilization
xii. Refractive error (Code -Excl15): Expenses related to the treatment for correction of eye sight due to
refractive error less than 7.5 dioptres.
xiii. 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
xiv. Cosmetic or Plastic Surgery (Code – Excl08): Expenses for cosmetic or plastic surgery or any treatment
to change appearance unless for reconstruction following an Accident, Burn(s) or Cancer or as part of
medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be
considered a medical necessity, it must be certified by the attending Medical Practitioner.
xv. Rest cure, rehabilitation and respite care (Code-Excl05):
a. Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This
also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of
daily living such as bathing, dressing, moving around either by skilled nurses or assistant or non-skilled
persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
xvi. All preventive care, vaccination including inoculation and immunisations (except in case of post- bite
treatment and other vaccines explicitly covered);
xvii. Unproven treatments (Code-Excl16) : Expenses related to any unproven treatment, services and supplies
for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies
that lack significant medical documentation to support their effectiveness.
xviii. Dental treatment or surgery of any kind except as specified in ‘Inpatient Treatment – Dental’.
xix. Maternity (Code - Excl18):
a. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean
sections incurred during hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy
during the policy period
xx. Treatments received in heath hydros, nature cure clinics, spas or similar establishments or private beds
registered as a nursing home attached to such establishments or where admission is arranged wholly or
partly for domestic reasons. (Code -Excl13)
xxi. Dietary supplements and substances that can be purchased without prescription, including but not
limited to Vitamins, minerals and organic substances unless prescribed by a medical practitioner as part
of hospitalization claim or day care procedure. (Code -Excl14)
xxii. Any existing disease specifically mentioned as Permanent exclusion in the Policy Schedule
Non-Medical Exclusions:
I. War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or
10
not or caused during service in the armed forces of any country), civil war, public defence, rebellion,
revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological
weapons, ionising radiation.
II. Any Insured Person’s participation or involvement in naval, military or air force operation,
III. Hazardous or Adventure Sports (Code Excl09) : Expenses related to any treatment necessitated due
to participation as a professional in hazardous or adventure sports, including but not limited to, para-
jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding,
sky diving, deep-sea diving
IV. Breach of law (Code Excl10): Expenses for treatment directly arising from or consequent upon any Insured
Person committing or attempting to commit a breach of law with criminal intent.
V. Intentional self-injury or attempted suicide while sane or insane.
VI. Items of personal comfort and convenience like television (wherever specifically charged for), charges for
access to telephone and telephone calls, internet, foodstuffs (except patient’s diet), cosmetics, hygiene
articles, body care products and bath additive, barber or beauty service, guest service
VII. Treatment rendered by a Medical Practitioner which is outside his discipline
VIII. Doctor’s fees charged by the Medical Practitioner sharing the same residence as an Insured Person or
who is an immediate relative of an Insured Person’s family.
IX. Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy unless
explicitly stated and covered in the policy,
X. Any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies
including elastic stockings, diabetic test strips, and similar products.
XI. Any treatment or part of a treatment that is not of a reasonable charge, not medically necessary; drugs
or treatments which are not supported by a prescription.
XII. Crutches or any other external appliance and/or device used for diagnosis or treatment (except when
used intra-operatively and explicitly stated and covered in the policy).
XIII. 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
XIV. Excluded Providers (Code-Excl11):Expenses incurred towards treatment in any hospital or by any Medical
Practitioner or any other provider specifically excluded by the Insurer and disclosed in its website / notified
to the policyholders are not admissible. However, in case of life threatening situations or following an
accident, expenses up to the stage of stabilization are payable but not the complete claim.
11. Claim Procedure:
The final decision on all claims is taken by Tata AIG General Insurance Company Limited.
a. Intimation & Assistance:
Please contact our designated TPA/Us atleast 48 hours prior to an event which might give rise to a claim.
For any emergency situations, kindly contact our TPA within 24 hours of the event.
b. Claim Related Information:
For any claim related query, intimation of claim and submission of claim related documents, You can
contact us through:
• Name of Claims Administrator: TAGIC Health Claims
11
• Website : www.tataaig.com
• Email : [email protected]
• Toll Free : 1800 266 7780
: 1800 229 966 (for Senior Citizens)
• Submit claim: Tata AIG General Insurance Company Limited, 5th and 6th Floor, Imperial Towers, H.No
7-1-6-617/A, GHMC No - 615,616, Ameerpet, Hyderabad – 500016, Telangana, Phone-040-66864900
c. Procedure for reimbursement claims:
• Our TPA/We must be informed within 7 days of completion of such treatment, consultation or
procedure using the Claim Intimation Form.
• Please send the duly signed claim form and all the information/documents mentioned therein to our
TPA/Us within 15 days of the occurrence of the Incident.
• Please refer to claim form for complete documentation.
• If there is any deficiency in the documents/information submitted by you, our TPA/We will send the
deficiency letter within 7 working days of receipt of the claim documents.
• On receipt of the complete set of claim documents, We will send the payment for the admissible
amount, along with a settlement statement within 30 days.
• The payment will be sent in the name of the proposer/ Nominee in case of death of Proposer.
d. Procedure for availing cashless facility:
• For any emergency Hospitalisation, our TPA/We must be informed within 24 hours after hospitalization.
• For any planned hospitalization, kindly seek cashless authorization from our TPA/Us atleast 48 hours
prior to the hospitalization.
• TPA/We will check your coverage as per the eligibility and send an authorization letter to the provider.
In case there is any deficiency in the documents sent, the same shall be communicated to the hospital
within 6 hours of receipt of documents.
• In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the
provider within 6 hours.
Note:
• Insured person is entitled for cashless coverage only in our empanelled hospitals.
• Please refer to our website(www.tataaig.com) or call us on our toll free number at <<1800-266-7780>> for
empaneled hospital list.
• Rejection of cashless facility in no way indicates rejection of the claim.
e. Claim Settlement (provision for Penal Interest)
i. The Company shall settle or reject a claim, as the case may be, within 30 days from the date of receipt
of last necessary document.
ii. In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the
policyholder from the date of receipt of last necessary document to the date of payment of claim at
a rate 2% above the bank rate.
iii. However, where the circumstances of a claim warrant an investigation in the opinion of the Company,
it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from
12
the date of receipt of last necessary document. In such cases, the Company shall settle or reject the
claim within 45 days from the date of receipt of last necessary document.
iv. In case of delay beyond stipulated 45 days, the Company shall be liable to pay interest to the
policyholder at a rate 2% above the bank rate from the date of receipt of last necessary document to
the date of payment of claim.
(Explanation: “Bank rate” shall mean the rate fixed by the Reserve Bank of India (RBl) at the beginning
of the financial year in which claim has fallen due) . The Clause shall be suitably modified by the
insurer based on the amendment(s), if any to the relevant provisions of Protection of Policyholder’s
Interests Regulations, 2017)
f. Claim procedure and management of Wellness Services & Wellness Program
i. Utilise Wellness Points:
Utilisation of Wellness points is only available at network service providers. To avail products or
services, Insured Person must visit our Customer application and buy the required product/ services.
On successful purchase, an amount equivalent to the monetary value of the Earned Wellness points
will be deducted from Your policy.
ii. Avail services under Benefits:
Services are only available at network. To avail the same, following procedure must be followed:
• Teleconsultation:
Insured person can gain access to tele/video/digital consultation with a general physician/
specialist/psychiatrist, using our digital customer application.
• Ambulance booking facility:
Insured person can use our digital customer application to book an ambulance. This service will
be offered on best effort basis and does not have a legal binding on us.
• Emergency - Help me feature:
In case of an emergency, insured person can use Our Customer application to alert designated
caregiver, at a push of a button. An alert message will be sent to the designated caregiver,
informing him/her about the emergency. By opting this feature, the insured person authorizes
us/our empanelled service provider to share their geo-location with the designated caregiver.
This service will be offered on best effort basis and does not have a legal binding on us.
12. Renewal of Policy:
The policy shall ordinarily be renewable except on grounds of fraud, misrepresentation by the insured person.
i. The Company shall endeavor to give notice for renewal. However, the Company is not under obligation
to give any notice for renewal.
ii. Renewal shall not be denied on the ground that the insured person had made a claim or claims in the
preceding policy years.
iii. Request for renewal along with requisite premium shall be received by the Company before the end of
the policy period.
iv. At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of
30 days to maintain continuity of benefits without break in policy. Coverage is not available during the
grace period.
v. No loading shall apply on renewals based on individual claims experience
13
13. Possibility of Revision of Terms of the Policy Including the Premium Rates
The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy including the premium
rates. The Insured Person shall be notified three months before the changes are effected.
14. Migration:
• The insured person will have the option to migrate the policy to other health insurance products/plans
offered by the company by applying for migration of the policy at least 30 days before the policy renewal
date as per IRDAI guidelines on Migration. lf such person is presently covered and has been continuously
covered without any lapses under any health insurance product/plan offered by the company, the insured
person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on migration.
• For Detailed Guidelines on Migration, kindly refer Guidelines issued by IRDAI(Insurance Regulatory and
Development Authority of India) on Migration and Portability of Health Insurance policies – Ref: IRDAI/
HLT/REG/CIR/194/07/2020) dated 22nd July 2020 and subsequent amendments thereof.
15. Withdrawal of the policy:
a. In the likelihood of this product being withdrawn in future, the Company will intimate the insured person
about the same 90 days prior to expiry of the policy.
b. Insured Person will have the option to migrate to similar health insurance product available with the
Company at the time of renewal with all the accrued continuity benefits such as cumulative bonus, waiver
of waiting period as per IRDAI guidelines, provided the policy has been maintained without a break.
16. Moratorium Period
After completion of eight continuous years under the policy no look back to be applied. This period of eight
years is called as moratorium period. The moratorium would be applicable for the sums insured of the first
policy and subsequently completion of 8 continuous years would be applicable from date of enhancement of
sums insured only on the enhanced limits. After the expiry of Moratorium Period no health insurance claim
shall be contestable except for proven fraud and permanent exclusions specified in the policy contract. The
policies would however be subject to all limits, sub limits, co-payments, deductibles as per the policy contract.
17. Nomination:
The policyholder is required at the inception of the policy to make a nomination for the purpose of payment
of claims under the policy in the event of death of the policyholder. Any change of nomination shall be
communicated to the company in writing and such change shall be effective only when an endorsement on
the policy is made. In the event of death of the policyholder, the Company will pay the nominee {as named
in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no subsisting nominee, to
the legal heirs or legal representatives of the policyholder whose discharge shall be treated as full and final
discharge of its liability under the policy.
18. Requirement:
• Completed proposal form,
• Supporting Medical papers (wherever applicable),
• Previous policy copies, IRDAI portability form (as applicable)
19. Pre-policy medical check-up:
Pre-Policy Check-up at our network may be required based upon the age and/or 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 Checkup.
14
Pre-policy medical examination gird:
Age(Yrs)/Sum Insured Sum Insured up to `50 Lakhs Sum Insured above `50 Lakhs
Upto age 45 Tele MER (only if positive medical Tele MER
declaration)
46-55 Tele MER Tele MER
56 to 65 Tele MER *MER, Urine Routine, CBC with
ESR, LFT, RFT, Lipid Profile, TMT/
(2D Echo+ECG), USG Abdomen &
Pelvis, Hba1c, HBsAg, X ray chest,
Sonomammography (female), PSA
(male)
- In case of adverse medical declaration, we may call for TeleMER/additional medical tests
- Tele-MER means Tele Medical Examination Reporting.
- 100% of TeleMER 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
20. Premium Rates & Payment Zones:
a. The premium will be charged on the completed age of the Insured Person.
b. Premium rates are subject to change with prior approval from IRDAI.
c. The premium for the policy will remain the same for the policy period as mentioned in the policy schedule.
d. For family floater, premium is calculated by adding the premium of respective individual members and
applying family floater discount.
e. Monthly instalment option would be allowed and following loadings shall be applicable:
Term of Policy Loading%

1 year Policy 5%
2 year Policy 9%
3 year Policy 13%
If the insured person has opted for Payment of Premium on an installment basis i.e. Monthly, as mentioned
in the policy Schedule, the following Conditions shall apply (notwithstanding any terms contrary elsewhere in
the policy)
I. Grace Period of 15 days would be given to pay the installment premium due for the policy.
II. During such grace period, coverage will not be available from the due date of installment premium till the
date of receipt of premium by Company.
III. The insured person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific
Waiting Periods” in the event of payment of premium within the stipulated grace Period.
IV. No interest will be charged lf the installment premium is not paid on due date
V. In case of installment premium due not received within the grace period, the policy will get cancelled.
VI. In the event of a claim, all subsequent premium instalments shall immediately become due and payable.
15
VII. The company has the right to recover and deduct all the pending installments from the claim amount due
under the policy.
Premium Payment Zones:
For the purpose of premium computation, the country is divided into following three Zones and premium
payable under the policy will be computed based on the residential location/address as provided by the
proposer/insured person in the proposal form:
a. Zone A: Mumbai including MMR/ Thane, Delhi NCR/Faridabad/Ghaziabad, Ahmedabad, Surat and Baroda
b. Zone B: Hyderabad, Bengaluru, Kolkata, Indore, Chennai, Chandigarh/ Mohali/ Punchkula/Zirakpur, Pune/
Pimpri Chinchwad and Rajkot
c. Zone C: Rest of India
Zone A (Annual)Per Person Rates(Rs.) (Exclusive of taxes)
Age\
5 10 15 20 25 50 75 100 200 300
Sum
Lakhs Lakhs Lakhs Lakhs Lakhs Lakhs Lakhs Lakhs Lakhs Lakhs
Insured
0-17yrs 7,205 7,947 8,730 9,016 9,300 10,467 12,688 14,198 18,791 22,984
18-35yrs 10,227 11,579 12,983 13,871 14,575 17,218 20,685 22,681 29,136 34,942
36-45yrs 12,820 13,876 15,427 16,530 17,318 20,056 25,377 28,119 36,413 43,727
46-50yrs 18,090 20,363 22,882 24,004 25,084 29,804 36,379 40,510 53,217 64,529
51-55yrs 22,092 24,799 27,831 29,153 30,426 35,964 45,015 50,323 66,685 81,314
56-60yrs 29,199 32,592 36,570 38,248 39,855 46,801 58,532 65,454 87,139 1,06,626
61-65yrs 38,235 42,525 47,819 50,002 52,094 61,092 77,767 87,135 1,17,174 1,44,354
66-70yrs 60,573 66,608 74,834 78,120 81,260 94,680 1,20,700 1,35,113 1,82,519 2,25,984
71+yrs 74,264 80,995 91,110 95,102 98,900 1,15,106 1,46,261 1,63,305 2,20,515 2,73,069
Zone B (Annual)Per Person Rates(Rs.) (Exclusive of taxes)
Age\
5 10 15 20 25 50 75 100 200 300
Sum
Insured
0-17yrs 6,306 6,961 7,629 7,873 8,116 9,116 11,161 12,526 16,583 20,278
18-35yrs 8,868 10,092 11,448 12,131 12,797 15,239 18,340 20,105 25,709 30,724
36-45yrs 10,869 12,282 13,654 14,630 15,329 17,750 22,707 25,186 32,505 38,914
46-50yrs 15,896 17,963 20,176 21,185 22,157 26,435 32,371 36,100 47,320 57,251
51-55yrs 19,425 21,881 24,539 25,721 26,862 31,853 40,001 44,799 59,276 72,153
56-60yrs 24,919 27,911 31,283 32,732 34,125 40,179 50,441 56,532 75,140 91,767
61-65yrs 32,557 36,317 40,790 42,664 44,463 52,247 66,678 74,887 1,00,626 1,23,809
66-70yrs 51,511 56,732 63,656 66,452 69,131 80,626 1,03,076 1,15,656 1,56,258 1,93,399
71+yrs 62,944 68,748 77,249 80,636 83,866 97,693 1,24,446 1,39,230 1,88,049 2,32,810
Zone C (Annual)Per Person Rates(Rs.) (Exclusive of taxes)
Age\
5 10 15 20 25 50 75 100 200 300
Sum
Insured
0-17yrs 5,430 5,995 6,545 6,746 6,947 7,775 9,588 10,803 14,306 17,486
18-35yrs 7,525 8,617 9,785 10,397 10,996 13,703 15,933 17,460 22,184 26,382
36-45yrs 9,620 11,043 12,424 13,118 13,792 16,821 19,747 21,929 28,157 33,550
16
46-50yrs 13,519 15,357 17,233 18,114 18,967 22,749 27,920 31,197 40,748 49,127
51-55yrs 16,524 18,701 20,944 21,970 22,962 27,340 34,424 38,649 51,002 61,902
56-60yrs 21,148 23,784 26,616 27,862 29,063 34,321 43,219 48,566 64,422 78,486
61-65yrs 27,507 30,794 34,536 36,134 37,673 44,370 56,792 63,962 85,849 1,05,447
66-70yrs 43,448 47,944 53,709 56,069 58,336 68,110 87,362 98,301 1,32,809 1,64,283
71+yrs 52,873 57,852 64,918 67,765 70,487 82,189 1,05,003 1,17,765 1,59,073 1,96,855
21. Loadings:
i. We may apply a risk loading on the premium payable (based upon the declarations made in the proposal
form and the health status of the persons proposed for insurance).
ii. The maximum risk loading applicable for an individual shall not exceed 100% of premium per diagnosis /
medical condition and an overall risk loading of over 150% of premium per person.
iii. The loading shall only be applied basis an outcome of Our medical underwriting.
iv. These loadings are applied from Commencement Date of the Policy including subsequent renewal(s) with
Us or on the receipt of the request of increase in Sum Insured (for the increased Sum Insured).
a. We will inform You about the applicable risk loading through a counter offer letter.
b. You need to revert to Us with consent and additional premium (if any), within 15 days of the issuance
of such counter offer letter.
c. In case, you neither accept the counter offer nor revert to Us within 15 days, We shall cancel Your
application and refund the premium paid within next 10 days subject to deduction of the Pre-Policy
Check up charges, as applicable.
v. Please note that We will issue Policy only after getting Your consent.
22. Cancellation:
i. The policyholder may cancel this policy by giving 15 days written notice and in such an event, the Company
shall refund premium for the unexpired policy period as detailed below.
Year
Length of time Policy in force
1 2 3
Upto 1 Month 75% 87.5% 91.5%
>1 month & Upto 3 Months 50% 75% 88.5%
>3 months & Upto 6 Months 25% 62.5% 75%
>6 months & Upto 12
Nil 50% 66.5%
Months
>12 months & Upto 15
NA 25% 50%
Months
NA 12.5% 41.5%
Months
NA Nil 33%
months
NA NA 8%
months
Exceeding 30 months NA Nil
Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of
Cancellation where, any claim has been admitted or has been lodged or any benefit (including those provided
under Wellness Services/ Wellness Program) has been availed by the insured person under the policy.
17
ii. The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure of
material facts, fraud by the insured person by giving 15 days’ written notice. There would be no refund of
premium on cancellation on grounds of misrepresentation, non-disclosure of material facts or fraud.
23. Redressal of Grievance:
In case of any grievance the insured person may contact the company through
• Website: www.tataaig.com
• Toll Free: 1800 266 7780 or 1800 229 966 (only for Senior Citizen policyholders)
• Email: [email protected]
• Courier: Customer Support, Tata AIG General Insurance Company Limited, 7th and 8th Floor, Romell Tech
Park, Cama Industrial Estate, Western Express Highway, Goregaon(E), Mumbai, Maharashtra 400063
Insured person may also approach the grievance cell at any of the company’s branches with the details of grievance.
If Insured person is not satisfied with the redressal of grievance through one of the above methods, insured
person may contact the grievance officer at [email protected].
For updated details of grievance officer, kindly refer the link (https://www.tataaig.com/grievance-redressal-policy)
lf Insured person is not satisfied with the redressal of grievance through above methods, the insured person
may also approach the office of Insurance Ombudsman of the respective area/region (details as mentioned
in the Annexure A of this policy) for redressal of grievance as per Insurance Ombudsman Rules 2017.
Grievance may also be lodged at IRDAI Integrated Grievance Management System (https://igms.irda.gov.in/)
24. Section 41 of Insurance Act1938 (Prohibition of Rebates):
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to
take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in
India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the
policy, nor shall any person taking out or renewing or continuing a policy accept any rebate, except such
rebate as may be allowed in accordance with the prospectus or tables of the insurer.
2. Any person making default in complying with the provision of this section shall be liable for penalty which
may extend to ten lakh rupees.
IRDAI REGULATION: This policy is subject to IRDAI (Protection of Policyholder’s Interests) Regulations,2017.
Note: Policy Term and Conditions & Premium rates are subject to change with prior approval from IRDAI.
Disclaimer:
This is only a summary of the product features. The actual benefits available are as described in the policy,
and will be subject to the policy terms, conditions and exclusions. Please seek the advice of your insurance
advisor if you require any further information or clarification.
“Insurance is the subject matter of the solicitation”. For more details on benefits, exclusions, limitations, terms
& conditions, please refer sales brochure/ policy wordings carefully, before concluding a sale.”
Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance
Company Limited.
18
Benefit Table:
Coverage
Cover/ SI (in `)
Up to 50 Lakhs 75 Lakhs 100 Lakhs 200 Lakhs 300 Lakhs
In-patient
Upto Sum Insured
Treatment
Pre-
Hospitalization Upto 60 days
expenses
Post-
Hospitalization Upto 90 days Upto 200 days Upto 200 days Upto 200 days Upto 200 days
expenses
Day Care
procedures
Organ Donor
Domiciliary Upto Sum Insured
Treatment
Restore benefit
AYUSH benefit
Upto Upto ` Upto `
Ambulance Upto `5000 per Upto `7500 per
`10000 per 20000 per 30000 per
cover Hospitalization Hospitalization
Hospitalization Hospitalization Hospitalization
Upto 1% of Upto 1% of Upto 1% of Upto 1% of Upto 1% of
Sum Insured; Sum Insured; Sum Insured; Sum Insured; Sum Insured;
Health Check-
maximum maximum maximum maximum maximum
up
`10,000 per `15,000 per `20,000 per `25,000 per `25,000 per
policy policy policy policy policy
Compassionate Upto `20,000 Upto `50,000 Upto `50,000 Upto `50,000 Upto `50,000
travel per policy year per policy year per policy year per policy year per policy year
Consumables
Benefit
Global Cover
for Planned
Hospitalization
Bariatric
Upto Sum Insured
Surgery Cover
In-patient
Treatment -
Dental
Vaccination
cover
Hearing Aid 50% of actuals; maximum `10,000 per policy
Daily cash for
choosing shared
accommodation
0.25% of base Sum Insured; maximum `2000 per day
Daily cash for
accompanying
an insured child
Second Opinion Covered
`1,00,000 `1,00,000 `1,00,000 `1,00,000
`50,000 (Rs.
(`1,20,000 for (`1,20,000 for (`1,20,000 for (`1,20,000 for
Maternity Cover 60,000 for birth
birth of girl birth of girl birth of girl birth of girl
of girl child)
child) child) child) child)
19
Delivery
Complications Up to `10000 Up to `25000 Up to `25000 Up to `25000 Up to `25000
Cover
First year
Upto `10000 (`15000 for girl child)
Vaccinations
Prolonged
Hospitalization 1% of Sum Insured
Benefit
High End Upto `25,000 Upto `50,000 Upto `50,000 Upto `50,000 Upto `50,000
Diagnostics per policy year per policy year per policy year per policy year per policy year
OPD Treatment Upto `5,000 Upto `7500 Upto `10,000 Upto `15,000 Upto `20,000
OPD Treatment
Upto `10,000 Upto `12,500 Upto `15,000 Upto `20,000 Upto `25,000
- Dental
Up to `500,000 Up to `500,000 Up to `500,000 Up to `500,000
for out of for out of for out of for out of
Emergency Air
Network Network Network Network
Ambulance Upto `5,00,000
Upto Sum Upto Sum Upto Sum Upto Sum
Cover
Insured within Insured within Insured within Insured within
our Network our Network our Network our Network
Accidental 100% of base
`50,00,000 `50,00,000 `50,00,000 `50,00,000
Death Benefit Sum Insured
Upto Sum Upto Sum Upto Sum Upto Sum
Insured for Insured for Insured for Insured for
a) Dialysis at a) Dialysis at a) Dialysis at a) Dialysis at
home home home home
b) b) b) b)
Chemotherapy Chemotherapy Chemotherapy Chemotherapy
Home care at home at home at home at home
-
treatment cover c) Up to 25% of c) Up to 25% of c) Up to 25% of c) Up to 25% of
Sum Insured Sum Insured Sum Insured Sum Insured
for Pandemic for Pandemic for Pandemic for Pandemic
Care at home, Care at home, Care at home, Care at home,
max up to 15 max up to 15 max up to 15 max up to 15
days in a policy days in a policy days in a policy days in a policy
year year year year
Cumulative 50% increase in cumulative bonus for every claim free year. In the case a claim is made
Bonus during the policy year, the cumulative bonus would reduce by 50% in the following year.
i. Unlimited Teleconsultation General
ii. Unlimited Teleconsultation – Specialist
iii. Health Condition Management
Wellness a. Diet & Weight Management Program
Services b. Stress Management Program
iv Redeemable voucher/Discount on services
v Ambulance Booking facility
vi Emergency Help me feature
Wellness
Available
Program
20

Medicare Premier Prospectus

Uploaded by

Copyright:

Available Formats

Medicare Premier Prospectus

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Medicare Premier Prospectus

Uploaded by

Copyright:

Available Formats

Prospectus

b. There is no maximum cover ceasing age under this policy.

c. The policy will be issued for a period 1/2/3 years.

d. This policy can be issued to an individual and/or family.

f. The policy offers coverage on family floater basis.

c. Ambulance Booking facility

d. Emergency Help me feature

e. Redeemable voucher/Discount on services

f. Health Condition Management

a. Health risk assessment

• OPD consultation/ treatment

4. Salient Features: (Please refer Benefit Table for coverage limits)

i. Surgery to be conducted upon the advice of the Doctor

ii. The member has to be 18 years of age or older and

iii. BMI greater than or equal to 40 or

b) Severe sleep apnea,

c) Uncontrolled Type2 Diabetes, or

d) Coronary heart disease

Basic Sum Insured Vaccines covered

a. Brain Perfusion imaging

f. Magnetic Resonance Cholangiography Scan

a. Root Canal Treatment (single or multiple sittings)

27. Compassionate travel-

b) Global (Applicable for sum insured above `50 Lakhs):

a. Health risk assessment

5. Sum Insured options (`) :

8. Free Look Period:

i. 30 Days Waiting Period (Code-Excl03):

Coverage for more than twelve months.

ii. Specified Disease/Procedure Waiting Period (Code- Excl02):

f. List of Specific Diseases/Procedures furnished below:

I. Tumors, Cysts, polyps including breast lumps (benign)

II. Polycystic ovarian disease

VI. Prolapsed Uterus

VII. Non-infective arthritis

VIII. Gout and Rheumatism

X. Ligament, Tendon or Meniscal tear

XI. Prolapsed Inter Vertebral Disc

XV. Ulcer & erosion of stomach & duodenum

XVI. Gastro Esophageal Reflux Disorder (GERD)

XVII. Liver Cirrhosis

XVIII. Perineal Abscesses

XIX. Perianal / Anal Abscesses

XXI. Benign Hyperplasia of prostate

XXIV. Retinal detachment

XXVI. Congenital Internal Diseases

XXXI. Surgery for nasal septum deviation

XXXII. Nasal concha resection

XXXIII. Surgery for Turbinate hypertrophy

XXXV. Joint replacement surgeries Eg: Knee replacement, Hip replacement

XXXVII. Hernioplasty or Herniorraphy

XXXVIII. Surgery/procedure for Benign prostate enlargement

XXXIX. Surgery for Hydrocele/ Rectocele

XL. Surgery of varicose veins and varicose ulcers

iii. Pre-existing Diseases Waiting Period (Code-Excl01)

10. General Exclusions:

ii. Alcoholic pancreatitis

a. Surgery to be conducted is upon the advice of the Doctor

b. The surgery/Procedure conducted should be supported by clinical protocols

c. The member has to be 18 years of age or older and