TATA AIG Group Accident & Sickness hospital cash policy

Tata AIG Group Accident & Sickness hospital cash policy insurance benefits

• Eligibility of Group Accident & Sickness hospital cash policy health plan

  • Entry age for the proposer is 6 months to 65 years.
  • The issued policy is for a period of one year.

• Features of Tata AIG Group Accident & Sickness hospital cash policy insurance

  • A daily benefit hospitalization expenses for accident and sickness.
  • Pre-policy check-up is not required under this policy.
  • Hospitalization cash up to 180 can be used for expenses in case of accidents or sickness.
  • Under Section 80D of Income Tax Act, Health insurance premium qualifies for tax deduction. These tax benefits are subject to changes in tax laws by the Government of India.
  • You have the flexibility to choose five different levels.
  • Lifelong renewals offered subject to application for renewal.
  • Free look period of 15 days ( For the new business only )
  • Insured will get a grace period of 30 days to pay the renewal premium.
  • Sum Insured Enhancement – Enhancement of sum insured is available only at the time of renewal.
  • In case of any revision/modification, the company will notify the policyholders 3 months in advance.

• Benefits of Tata AIG Group Accident & Sickness hospital cash policy insurance

  • In-hospital Indemnity For Accidents – The policy will pay a Daily Benefit for each day if you are an Inpatient in a hospital due to illness, disease or Sickness.
  • In-hospital Indemnity For Sickness - The insurance will pay a Daily Benefit for each day if you are an Inpatient in a hospital due to Injury or Accident.
  • Accident Medical Expense Reimbursement – The policy will reimburse Reasonable and Customary charges up to the maximum shown in your policy schedule.
  • Covered Medical Expenses incurred in the Republic of India by the insured 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 the insured.
  • A deductible of one day and waiting period for Indemnity of Sickness of 90 days
  • 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 Group Accident & Sickness Hospital cash policy health product

  • Pre-existing Condition, any complication arising from it
  • Intentionally self-inflicted Injury or illness;
  • Conditions related to or arising out of HIV;
  • AIDS; War; Congenital anomalies;
  • participation in an actual or attempted felony, riot, crime, misdemeanor, (excluding traffic violations) or civil commotion
  • operating or learning to operate any aircraft, or performing duties as a member of the crew on any aircraft; or Scheduled Aircraft.
  • any loss, damage cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any Act of Terrorism regardless of any other cause or event contributing concurrently or in any other sequence to the loss
  • the intentional use of military force to intercept, prevent, or mitigate any known or suspected Terrorist Act
  • ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from burning nuclear fuel
  • the radioactive, toxic, explosive or other dangerous properties of any explosive nuclear equipment or any part of that equipment
  • congenital anomalies or any complications or conditions arising therefrom
  • participation in winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters (2 miles), participation in any Professional Sport, any bodily contact sport or any other hazardous or potentially dangerous sport for which you are trained or untrained
  • any loss resulting directly or indirectly, contributed or aggravated or prolonged by childbirth or from pregnancy.
  • for any loss of which a contributing cause was Your actual or attempted commission of, or willful participation in, an illegal act or any violation or attempted violation of the law or Your resistance to arrest
  • if You are admitted to a Hospital within 90 days immediately following the Effective Date of Coverage stated in the Schedule, unless hospitalization is caused by Injury
  • If You are admitted to a Hospital during the first 3 months immediately following the Policy Effective Date as a result of cataract(s), benign prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, fistula in anus, piles, sinusits and related disorders