{"uin":"TATHLGP14004V011314","name":"Group Mediprime","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314","insurer":{"slug":"tata-aig-general-insurance","name":"Tata AIG General Insurance Company Limited","url":"https://indiainsurances.com/insurer/tata-aig-general-insurance"},"line":"health","category":"group-health","category_name":"Group health","irdai_type":null,"kind":"product","status":"active","approved_on":"2014-07-14","withdrawn_on":null,"summary":"Group MediPrime is a group health indemnity policy offered to employees and non-employer groups, issued for a 1 year period with cover within India. The base policy has a 30 days initial waiting period, a 12 months waiting period for listed conditions, and optional endorsements including family floater, maternity, newborn, OPD, AYUSH and co-payment or deductible.","analysis":{"state":"machine","analysed_at":"2026-10-19 23:00:25.390099+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"The documents mention individual and family floater sum insured bases, but do not name plans inside the product.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"The policy is issued for a 1 year period.","display":"1 year period","note":null,"quote":"The policy will be issued for a 1 year period.","sources":[{"clause":"5","heading":null,"page":1,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17003#c-5"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For planned hospitalisation, the insurer or TPA must be informed immediately and at least 48 hours before admission. For emergency hospitalisation, intimation must be within 24 hours of admission; for cashless service, planned treatment requires notice at least 48 hours before and emergency treatment within 24 hours after treatment or hospitalisation.","display":"Planned hospitalisation: at least 48 hours prior; emergency: within 24 hours of admission. Cashless planned: at least 48 hours before; cashless emergency: within 24 hours after.","note":null,"quote":"Immediately and in any event at least 48 hours prior to the Insured Person’s admission. ... Within 24 hours of the Insured Person’s admission to Hospital. ... At least 48 hours before the planned treatment or Hospitalisation ... Within 24 hours after the treatment or Hospitalisation","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Our claim form, duly completed and signed","Original Bills","All reports","A precise diagnosis","A detailed list of the individual medical services and treatments provided and a unit price for each","Prescriptions"],"display":"Claim form, original bills, reports, diagnosis, detailed list of services and unit prices, and prescriptions.","note":"The insured must provide requested documentation within 30 days or earlier of the insurer's request or discharge/completion of treatment.","quote":"Our claim form, duly completed and signed for on behalf of the Insured Person. ... Original Bills (including but not limited to pharmacy purchase bills, consultation bills, diagnostic bills) ... All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries. ... A precise diagnosis of the treatment for which a claim is made. ... A detailed list of the individual medical services and treatments provided and a unit price for each. ... Prescriptions that name the Insured Person","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"An admitted payable claim is to be paid within 30 days of submission of all necessary documents, information and additional information required for settlement. Delay beyond the prescribed period attracts interest at 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed.","display":"Within 30 days of submission of all necessary documents / information and additional information; delay interest at 2% above bank rate.","note":null,"quote":"We shall make the payment of claim that has been admitted as payable by Us under the Policy terms and conditions within 30 days of submission of all necessary documents / information and any other additional information required for the settlement of the claim. ... we shall pay interest at a rate which is 2% above the bank rate prevalent at the beginning of the financial year in which the claim is reviewed by Us.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["30 days Waiting Period","First year Waiting Period","Pre-existing Condition","War or any act of war","breach of law with criminal intent, or intentional self injury or attempted suicide","racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing","abuse of intoxicants or hallucinogenic substances","Treatment of Obesity and any weight control program","Psychiatric or mental disorders","AIDS and/or infection with HIV","Pregnancy, maternity or birth","Sterility, treatment whether to effect or to treat infertility","Dental treatment and surgery of any kind","Any non-allopathic treatment","Non medical expenses as per Appendix III"],"display":"30 days waiting period; 12 months first-year waiting period; pre-existing conditions; war; criminal breach/self-injury; hazardous activities; substance abuse; obesity; psychiatric or mental disorders; HIV/AIDS; pregnancy/maternity; infertility; dental; non-allopathic treatment; non-medical expenses.","note":"Some waiting-period and pre-existing disease exclusions may be deleted by optional endorsements if opted.","quote":"A waiting period of 30 days (or longer if specified in any benefit) will apply to all claims ... A waiting period of 12 months shall apply to the treatments, whether medical or surgical, of the disease/conditions mentioned below. ... We will not make any payment for any claim in respect of any Insured Person directly or indirectly for, caused by, arising from or in any way attributable to any Pre-existing Condition ... War or any act of war ... breach of law with criminal intent, or intentional self injury or attempted suicide ... racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing ... The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances ... Treatment of Obesity and any weight control program,. ... Psychiatric or mental disorders ... “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV ... Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth ... Sterility, treatment whether to effect or to treat infertility ... Dental treatment and surgery of any kind ... Any non-allopathic treatment. ... Non medical expenses as per Appendix III","sources":[{"clause":null,"heading":"30 days Waiting Period","page":4,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-30-days-waiting-period"},{"clause":null,"heading":"First year Waiting Period","page":4,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-first-year-waiting-period"},{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"First complain to the company by calling 1-800-119966, 022-66939500, 1800 22 9966 for senior citizens, or emailing customersupport@tata-aig.com. If there is no response or the resolution does not meet expectations, escalate to manager.customersupport@tata-aig.com and then the Head - Customer Services at head.customerservices@tata-aig.com before approaching the Insurance Ombudsman.","display":"First: customer service phone/email; then manager.customersupport@tata-aig.com; then head.customerservices@tata-aig.com.","note":null,"quote":"if you are not satisfied with our services and wish to lodge a complaint, please feel free to call our 24X7 Toll free number 1-800-119966 or 022-66939500 (tolled) or 1800 22 9966 (only for senior citizen policy holders) or you may email to the customer service desk at customersupport@tata-aig.com. ... For lack of a response or if the resolution still does not meet your expectations, you can write to manager.customersupport@tata-aig.com. ... For lack of a response or if the resolution still does not meet your expectations, you can write to the Head\n- Customer Services at head.customerservices@tata-aig.com","sources":[{"clause":null,"heading":"Section . 6 : Grievance Redressal Procedure","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-section-6-grievance-redressal-procedure"},{"clause":null,"heading":"Escalation Level 1","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-escalation-level-1"},{"clause":null,"heading":"Escalation Level 2","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-escalation-level-2"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"quote-verified","value":"Sum insured would range from Rs. 25,000.00 to Rs. 10, 00,000.00 and can be on individual basis as well as family floater basis.","display":"Rs. 25,000.00 to Rs. 10, 00,000.00","note":"From the prospectus.","quote":"Sum Insured would Range from Rs. 25,000.00 to Rs. 10, 00,000.00.The sum insured can be on individual basis as well as family floater basis","sources":[{"clause":null,"heading":"Continuity","page":7,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17003#c-continuity"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply to accidents.","quote":"A waiting period of 30 days (or longer if specified in any benefit) will apply to all claims unless the Insured Person has been insured under a Group MediPrime Policy continuously and without any break in the previous Policy Year.","sources":[{"clause":null,"heading":"30 days Waiting Period","page":4,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-30-days-waiting-period"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"not-applicable","value":null,"display":null,"note":"The base policy excludes pre-existing conditions unless expressly stated to the contrary; it does not give a waiting period after which they are covered.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"quote-verified","value":{"unit":"months","amount":12},"display":"12 months","note":"The 12 months waiting period also applies to all surgical procedures listed in the table, irrespective of the disease/condition for which the surgery is done, except claims payable due to cancer.","quote":"A waiting period of 12 months shall apply to the treatments, whether medical or surgical, of the disease/conditions mentioned below.","sources":[{"clause":null,"heading":"First year Waiting Period","page":4,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-first-year-waiting-period"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"not-stated","value":null,"display":null,"note":"The wording mentions migration to Tata AIG individual health insurance plans if the group policy is discontinued or the insured member leaves the group, but does not state portability to another insurer with waiting-period credit.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"quote-verified","value":true,"display":"Ordinarily renewable for life","note":null,"quote":"This Policy is ordinarily renewable for life unless the policy holder or the insured person oe anyone acting on behalf of the policyholder or the insured person has acted in an improper, dishonest or fraudulent manner or there has been any misrepresentation under or in relation to this Policy or the renewal of the Policy poses a moral hazard.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"Loading of premium or discounts will be based on the incurred claim experience of the proposer.","display":"Loading of Premium / discounts based on Incurred claim experience of Proposer","note":"From the prospectus.","quote":"Loading of Premium / discounts will be based on Incurred claim experience of Proposer.","sources":[{"clause":"7(b)(ii)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17003#c-7-b-ii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"quote-verified","value":["War or any act of war","breach of law with criminal intent, or intentional self injury or attempted suicide","naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing","abuse of intoxicants or hallucinogenic substances","Treatment of Obesity and any weight control program","Psychiatric or mental disorders (including mental health treatments), Parkinson and Alzheimer’s disease","Venereal disease, sexually transmitted disease or illness; “AIDS”","Pregnancy, maternity or birth","Sterility, treatment whether to effect or to treat infertility","Dental treatment and surgery of any kind","Experimental, investigational or unproven treatment","Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures","Any non-allopathic treatment","Items of personal comfort and convenience","Non medical expenses as per Appendix III"],"display":"War; criminal breach/self-injury; hazardous activities; substance abuse; obesity; psychiatric/mental disorders; venereal disease/HIV/AIDS; pregnancy/maternity; infertility; dental; experimental/unproven treatment; convalescence/rest/rehabilitation; non-allopathic treatment; personal comfort items; non-medical expenses.","note":"The wording also allows any specific time-bound or lifetime exclusions mentioned in the Schedule and accepted by the policyholder.","quote":"War or any act of war ... breach of law with criminal intent, or intentional self injury or attempted suicide ... naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing ... The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances ... Treatment of Obesity and any weight control program,. ... Psychiatric or mental disorders (including mental health treatments), Parkinson and Alzheimer’s disease ... Venereal disease, sexually transmitted disease or illness; “AIDS” ... Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth ... Sterility, treatment whether to effect or to treat infertility ... Dental treatment and surgery of any kind ... Experimental, investigational or unproven treatment ... Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures ... Any non-allopathic treatment. ... Items of personal comfort and convenience ... Non medical expenses as per Appendix III","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"You may terminate the policy by written notice. If no claim has been made, refund is 75% up to 1 month, 50% up to 3 months, 25% up to 6 months and 0% after 6 months.","display":"75% up to 1 month; 50% up to 3 months; 25% up to 6 months; 0% exceeding 6 months, if no claim.","note":null,"quote":"You may terminate this Policy at any time by giving Us written notice, and the Policy shall terminate when such written notice is received. If no claim has been made under this Policy, then We will refund premium in accordance with the table below:\nLength of time Policy in force | Refund of premium\nup to 1 month | 75%\nup to 3 months | 50%\nup to 6 months | 25%\nexceeding 6 months | 0%","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"This policy only covers medical treatment taken within India, and payments are made in Indian Rupees within India.","display":"Within India only","note":null,"quote":"This Policy only covers medical treatment taken within India. All payments under this Policy will only be made in Indian Rupees within India.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":15},"display":"15 days","note":"Free look cancellation is available only if no claims have been made and is not applicable at renewal.","quote":"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.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":null,"quote":"However a grace period delay in payment up to 30 days from the premium due date is allowed where you can still pay your premium and continue your policy.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"Entry age is 91 days with no limitation on maximum entry age.","display":"91 days; no maximum entry age","note":null,"quote":"For the purpose of this policy, the entry age is 91 days with no limitation on maximum entry age.","sources":[{"clause":"Def. 2","heading":"Age or Aged","page":12,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-def-2"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"The prospectus says premium can be paid in full or installment, but does not specify yearly, half-yearly, quarterly or monthly modes.","quote":null,"sources":[],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Inclusion of Primary Insured’s Dependents","Family Floater","Pre-existing Disease Exclusion Waiver","Deletion of 30 days waiting Period","Deletion of First Year waiting Period","Limitation on Room & Boarding expense","Reduction of Pre/Post Hospitalisation","Hospital Daily Cash","Dental Benefit","External Aids and Appliances","Co-payment/Deductible","Health Check-up Benefit","Ayush Benefit","Critical Illness Benefit","Maternity Benefit (with pre/post natal)","New Born Cover from Day 1","Corporate Floater","Outpatient Treatment Costs"],"display":"Dependents, family floater, PED waiver, deletion of 30 days waiting, deletion of first year waiting, room/boarding limit, reduced pre/post hospitalisation, hospital daily cash, dental, external aids, co-payment/deductible, health check-up, AYUSH, critical illness, maternity, newborn, corporate floater, OPD.","note":"These apply only upon endorsement and additional premium.","quote":"shall become applicable only upon endorsement and after Our receipt of requisite additional premium. ... Endorsement No. 1. Inclusion of Primary Insured’s Dependents ... Endorsement No. 2. Family Floater ... Endorsement No. 3. Pre-existing Disease Exclusion Waiver ... Endorsement No. 4. Deletion of 30 days waiting Period ... Endorsement No. 5. Deletion of First Year waiting Period ... Endorsement No. 6. Limitation on Room & Boarding expense ... Endorsement No. 7. Reduction of Pre/Post Hospitalisation ... Endorsement No. 8. Hospital Daily Cash ... Endorsement No. 9. Dental Benefit ... Endorsement No. 10. External Aids and Appliances ... Endorsement No. 11. Co-payment/Deductible ... Endorsement No. 12. Health Check-up Benefit ... Endorsement No. 13. Ayush Benefit ... Endorsement No. 14. Critical Illness Benefit ... Endorsement No. 15. Maternity Benefit (with pre/post natal) ... Endorsement No. 16. New Born Cover from Day 1 ... Endorsement No. 17. Corporate Floater ... Endorsement No. 18. Outpatient Treatment Costs","sources":[{"clause":"Appendix II","heading":"Endorsements – Optional Covers","page":25,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-appendix-ii"},{"clause":null,"heading":"Endorsement No. 1. Inclusion of Primary Insured’s Dependents","page":25,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-1-inclusion-of-primary-insureds-d"},{"clause":null,"heading":"Endorsement No. 2. Family Floater","page":25,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-2-family-floater"},{"clause":null,"heading":"Endorsement No. 3. Pre-existing Disease Exclusion Waiver","page":25,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-3-pre-existing-disease-exclusion"},{"clause":null,"heading":"Endorsement No. 4. Deletion of 30 days waiting Period","page":25,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-4-deletion-of-30-days-waiting-per"},{"clause":null,"heading":"Endorsement No. 5. Deletion of First Year waiting Period","page":25,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-5-deletion-of-first-year-waiting"},{"clause":null,"heading":"Endorsement No. 6. Limitation on Room & Boarding expense","page":25,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-6-limitation-on-room-boarding-exp"},{"clause":null,"heading":"Endorsement No. 7. Reduction of Pre/Post Hospitalisation","page":26,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-7-reduction-of-pre-post-hospitali"},{"clause":null,"heading":"Endorsement No. 8. Hospital Daily Cash","page":26,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-8-hospital-daily-cash"},{"clause":null,"heading":"Endorsement No. 9. Dental Benefit","page":26,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-9-dental-benefit"},{"clause":null,"heading":"Endorsement No. 10. External Aids and Appliances","page":27,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-10-external-aids-and-appliances"},{"clause":null,"heading":"Endorsement No. 11. Co-payment/Deductible","page":27,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-11-co-payment-deductible"},{"clause":null,"heading":"Endorsement No. 12. Health Check-up Benefit","page":27,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-12-health-check-up-benefit"},{"clause":null,"heading":"Endorsement No. 13. Ayush Benefit","page":27,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-13-ayush-benefit"},{"clause":null,"heading":"Endorsement No. 14. Critical Illness Benefit","page":27,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-14-critical-illness-benefit"},{"clause":null,"heading":"Endorsement No. 15. Maternity Benefit (with pre/post natal)","page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-15-maternity-benefit-with-pre-pos"},{"clause":null,"heading":"Endorsement No. 16. New Born Cover from Day 1","page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-16-new-born-cover-from-day-1"},{"clause":null,"heading":"Endorsement No. 17. Corporate Floater","page":31,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-17-corporate-floater"},{"clause":null,"heading":"Endorsement No. 18. Outpatient Treatment Costs","page":31,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-18-outpatient-treatment-costs"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage is not available for the period for which no premium has been received during the grace period.","display":"Coverage would not be available for the period for which no premium has been received.","note":null,"quote":"Coverage would not be available for the period for which no premium has been received.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"Daily room limit, if any.","status":"not-stated","value":null,"display":null,"note":"The base benefit includes room rent and boarding expenses, but the actual per-day limit is not stated in the wording provided. An optional room and boarding expense endorsement uses [X]% placeholders.","quote":null,"sources":[],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Childbirth cover and any waiting period.","status":"quote-verified","value":"Pregnancy, maternity or birth, including caesarean section, are excluded in the base policy except ectopic pregnancy for inpatient treatment only. If the optional maternity endorsement applies, delivery including caesarean section is covered for the first two living children, with a 9 months waiting period for later-enrolled primary insured and dependents or no waiting period, and sub-limits as specified in the schedule.","display":"Excluded in base except ectopic pregnancy for inpatient treatment; optional maternity benefit has 9 months or no waiting period and schedule sub-limits.","note":"Maternity cover is an optional endorsement and is available only for the Primary Insured or Primary Insured’s Spouse if covered.","quote":"Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth (including caesarean section) except in the case of ectopic pregnancy for inpatient treatment only. ... We will reimburse the Medical Expenses of any Insured Person for a delivery (including caesarean section) while Hospitalised during the Policy Period ... A waiting period of 9 months shall apply to the Primary Insured and his Dependents enrolled subsequent to the Commencement Date, and OR There shall be no waiting period in respect of this benefit.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"},{"clause":null,"heading":"Endorsement No. 15. Maternity Benefit (with pre/post natal)","page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-endorsement-no-15-maternity-benefit-with-pre-pos"},{"clause":"3(c)","heading":null,"page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-3-c"}],"law":[]},{"key":"ped_cover_group","label":"Pre-existing diseases","section":"Waiting periods","meaning":"Whether pre-existing diseases are covered from day one for the group.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless service is available at a Network Hospital; the insurer pays the network hospital directly to the extent of its liability.","display":"Available at Network Hospital; payment directly to the Network Hospital.","note":"Planned cashless notice is at least 48 hours before; emergency cashless notice is within 24 hours after treatment or hospitalisation.","quote":"Network Hospital | We will provide cashless service by making payment to the extent of Our | At least 48 hours before the planned treatment or Hospitalisation ... Network Hospital | We will provide cashless service by making payment to the extent of Our liability directly to the Network Hospital.","sources":[{"clause":null,"heading":"Pre-existing Conditions","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-pre-existing-conditions"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims are processed through a duly licensed TPA, Family Health Plan (TPA) Ltd, for claim queries, intimation and document submission. The prospectus says the specified TPA processes and settles claims on behalf of Tata AIG, with the final decision resting with Tata AIG General Insurance Company Limited.","display":"TPA: Family Health Plan (TPA) Ltd; final decision with Tata AIG.","note":null,"quote":"For any claim related query, intimation of claim and submission of claim related documents, You can contact our duly licensed TPA through: ... Family Health Plan (TPA) Ltd ... Specified Third Party Administrator (TPA) duly licensed by IRDA will process and settle all claims under this policy on behalf of TATA AIG General Insurance Company Limited. The final decision on any claim solely rests with TATA AIG General Insurance Company Limited.","sources":[{"clause":null,"heading":"Section . 5 : Claim Related Information","page":17,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174#c-section-5-claim-related-information"},{"clause":null,"heading":"Basic Group Tariff","page":7,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17003#c-basic-group-tariff"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, individual/family floater sum insured basis","note":"From the prospectus.","quote":"The policy can be issued on individual/family floater sum insured basis. ... In a family floater option a single sum insured would be applicable to the entire family and the same can be utilized by any of the insured family member.","sources":[{"clause":"6","heading":null,"page":1,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17003#c-6"},{"clause":"7","heading":null,"page":1,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17003#c-7"}],"law":[]}],"documents":[{"kind":"wording","label":"Policy wording","pages":42,"fetched_at":"2026-10-17 20:23:02+00","source_url":"https://www.tataaig.com/s3/group_mediprime_policy_wordings_016de5c669.pdf","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17174"},{"kind":"wording","label":"Group MediPrime (IRDAI copy)","pages":43,"fetched_at":"2026-10-20 02:22:42+00","source_url":"https://irdai.gov.in/documents/37343/931203/Group+MediPrime_2014-2015.pdf/fe178b7f-59be-683b-cc74-dd0c9bb06349?version=1.1&t=1668239121532&download=true","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/28163"},{"kind":"prospectus","label":"Prospectus","pages":16,"fetched_at":"2026-10-17 20:12:50+00","source_url":"https://www.tataaig.com/s3/group_mediprime_prospectus_e49471a9a4.pdf","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314/document/17003"}],"versions":[{"uin":"IRDA/NL-HLT/TAGI/P-H/V.I/276/13-14","version":null,"approved_on":null},{"uin":"TATHLGP14004V011314","version":null,"approved_on":null}],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"Tata AIG General Insurance official website","url":"https://www.tataaig.com/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claims process","url":"https://www.tataaig.com/claims-process","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal policy","url":"https://www.tataaig.com/grievance-redressal-policy","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Group Mediprime (UIN TATHLGP14004V011314), IndiaInsurances, https://indiainsurances.com/policy/tata-aig-general-insurance/group-mediprime-tathlgp14004v011314"}