TATA AIG Individual Accident & Sickness Hospital Cash Policy

Eligibility of Individual Accident & Sickness Hospital Cash Policy Premier health Plan

• Entry age is 6 months up to 65 years for the proposer.
• The policy will be issued for a period 1 year.
• This policy can be issued to an individual and/or family

Features of Tata AIG Individual Accident and Sickness Hospital Cash policy Insurance

• A Daily benefit hospitalization for Accident & Sickness.
• No Pre-policy check up required
• Hospitalisation Cash upto 180 days in case of Accidents or Sickness
• Tax Benefits-Get tax benefits for premium paid on policies as per section 80D of the Income Tax Act.Tax benefits are subject to changes in tax laws.
• Flexibility in choosing options-5 different levels .
• We offer life-long renewal subject to application for renewal
• Free Look Period –You have a period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy.
• Grace Period of 30 days for renewing the Policy is provided under this Policy.
• Sum Insured Enhancement – Sum Insured can be enhanced only at the time of renewal.
• Any revision / modification in the product will be done with the approval of the Insurance Regulatory and Development Authority and will be intimated to you atleast 3 months in advance

Benefits of Tata AIG Individual Accident and Sickness Hospital Cash policy Insurance

• In-hospital Indemnity For Accidents – Pays for Daily Benefit for each Day for Inpatient Hospitalisation due to Injury or Accidents upto 180 days.
• In-hospital Indemnity For Sickness - Pays for Daily Benefit for each Day for Inpatient Hospitalisation due to Illness ,Disease or Sickness upto 180 days.
• Accident Medical Expense Reimbursement – We will pay the Reasonable Charges, subject to the Deductible shown in the Policy Schedule, for Covered Medical Expenses that occurs within the Republic of India, for medical services which are not due to a Pre¬existing Condition up to the maximum amount and benefit period stated in the Policy Schedule for the treatment of an Injury sustained by you.
• 1 day deductible and 90 days waiting period for under Hospital Indemnity for Sickness
• Deductible of 5% of benefit amount under Accident Medical expense reimbursement
• Coverage will be 100% of the Coverage amount in case of Insured and Spouse, 50% in case of each child

Tata AIG health insurance claims

Claim Related Information:

For any claim related query, intimation of claim and submission of claim related documents, you can contact Your TPA through:

• Name of TPA : Family Health Plan Insurance TPA Ltd (FHPL)
• Website : www.fhpl.net
• Email
  • info@fhpl.net
  • seniorcitizensdesk@fhpl.net (for Senior Citizens)
• Toll Free
  • 1800-425-4033
  • 040- 23552899 (for Senior Citizens)
• Fax : +91-40-23541400
• Submit claim
  • Claims Department, Family Health Plan Insurance (TPA) Ltd, Srinilaya – Cyber Spazio Suite # 101,102,109 & 110, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, 500 034.

Procedure for Reimbursement of Medical Expenses

• The TPA (Third Party Administrator) must be informed no later than 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 your designated TPA 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 the insured, the TPA will send the deficiency letter within 7 days of receipt of the claim documents.
• On receipt of the complete set of claim documents, Tata AIG 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.

(Note: Payment will only be made for items covered under your policy and upto the limits therein.)

Procedure to avail Cashless Treatment

• For any emergency Hospitalisation, the designated TPA must be informed no later than 24 hours after hospitalization.
• For any planned hospitalization, kindly seek cashless authorization from the designated TPA atleast 48 hours prior to the hospitalization.
• TPA 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.
• Please pay the non-medical and expenses not covered to the hospital prior to the discharge.
• In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the provider within 6 hours.

(Note: n Insured person is entitled for cashless coverage only in our empanelled hospitals.)

Grievance Redressal Procedure

Tata AIG is committed to extend the best possible services to the insured. However, if you are not satisfied with our services and wish to lodge a complaint, please call our 24X7 Toll free number 1800266-7780 or 022-66939500 (toll number) or 1800 22 9966 (For Senior Citizens) or you may email to the customer service desk at customersupport@tataaig.com.

After examining the issue and subsequent closure, Tata AIG will send our response within 10 days from the date of receipt of the complaint by them. In case the resolution is likely to take a longer time, we will inform you of the same through an interim reply.

Escalation Level 1
In case you do not receive a resolution within 10 days or if the resolution still does not meet your expectations, you can write to manager.customersupport@tataaig.com . After analysing the matter internally and subsequent closure, we will send our response within a period of 8 days from the date of receipt at this email id.

Escalation Level 2
In case you do not receive a resolution within 8 days or if the resolution still does not meet your expectations, you can write to Head - Customer Services at head.customerservices@tataaig.com . After examining the matter, we will send you our final response within 7 days from the date of receipt of your complaint on this email id.

Exclusions under the Individual Accident and Sickness Hospital Cash policy Health product

• Intentionally self-inflicted Injury or illness;
• Conditions related to or arising out of HIV;
• AIDS; War; Congenital anomalies;
• Pregnancy and all related conditions; Abuse of drugs and alcohol and addiction or overdose etc.

Note: Please refer to policy wordings for the list of exclusions.