{"uin":"TATHLIP27060V012627","name":"TATA AIG MediCare Platinum","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627","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":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"TATA AIG MediCare Platinum is a one-year indemnity health policy for individuals or families with sum insured options of Rs. 35, 50, 75 or 100 lakh and lifelong renewal. It has a 30-day initial wait, 24-month waits for pre-existing and specified diseases, a once-a-year restore of the base sum insured, OPD cover up to Rs. 25,000 and planned treatment abroad for listed critical illnesses.","analysis":{"state":"extracted","analysed_at":"2026-10-19 17:40:49.78488+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"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":"No named plans are printed. The prospectus offers one product with 'Individual/Family floater' coverage options and sum insured choices.","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":"cross-checked","value":"One year.","display":"1 year","note":"The prospectus instalment loading table also shows columns for '2 Year Policy' and '3 Year Policy', though the policy term is printed as 1 year.","quote":"Policy Term | 1 Year ... with an option of policy tenure 1year","sources":[{"clause":"1","heading":"Suitability","page":1,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-1"},{"clause":"Section 4(ii)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-section-4-ii"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Planned hospitalisation: at least 48 hours before admission. Emergency hospitalisation: within 24 hours of admission.","display":"At least 48 hours before a planned admission; within 24 hours of an emergency admission","note":"For reimbursement claims the prospectus and CIS add: inform within 7 days of completion of treatment and send the claim form and documents within 15 days of the incident.","quote":"At least 48 hours prior to the Insured Person’s admission. ... Within 24 hours of the Insured Person’s admission to Hospital. ... 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.","sources":[{"clause":"1","heading":"Notification of Claim","page":33,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-5"},{"clause":"11(c)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-11-c"}],"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":"cross-checked","value":["Claim form, duly completed and signed","Original bills and receipts or prescriptions","Medical reports, case histories, investigation reports, discharge summaries","A precise diagnosis","Detailed list of medical services with unit prices","Prescriptions naming the Insured Person","Pre and post investigation, treatment and follow up records","Treating doctor's certificate on missing information","Copy of settlement letter from other insurer or TPA","Stickers and invoice of implants","MLC and FIR copies for accident claims","NEFT and KYC details","Legal heir/succession certificate, if required","PM report (wherever applicable)"],"display":"Claim form, original bills, medical reports and discharge summary, prescriptions, implant invoices, MLC/FIR for accidents, NEFT and KYC, and others","note":"Global Planned Hospitalization claims also need proof of diagnosis in India and the insured's passport and visa. The company reserves the right to call for additional documents.","quote":"a) Our claim form, duly completed and signed for on behalf of the Insured Person. ... b) Original Bills (pharmacy purchase bill, consultation bill, diagnostic bill) and any attachments thereto like receipts or prescriptions ... c) All medical reports, case histories, investigation reports, indoor case papers/ treatment papers (in reimbursement cases, if available), discharge summaries. ... d) A precise diagnosis of the treatment for which a claim is made. ... e) A detailed list of the individual medical services and treatments provided and a unit price for each ... f) Prescriptions that name the Insured Person ... g) All pre and post investigation, treatment and follow up (consultation) records ... h) Treating doctor’s certificate regarding missing information ... i) Copy of settlement letter from other insurance company or TPA ... j) Stickers and invoice of implants used during surgery ... k) Copy of MLC (Medico legal case) records, if carried out and FIR (First information report) if registered, in case of claims arising out of an accident ... currently mandatory NEFT (to enable direct credit of claim amount in bank account) and KYC ... m) Legal heir/succession certificate, if required ... n) PM report (wherever applicable) ... Proof of diagnosis in India ... Insured’s Passport and Visa ... o) The company reserves the right to call for additional documents wherever required.","sources":[{"clause":"4","heading":"Supporting Documentation & Examination","page":34,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-4-3"},{"clause":null,"heading":"B12. Global Planned Hospitalization for Specified Illnesses","page":12,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b12-global-planned-hospitalization-for-specified"}],"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":"cross-checked","value":"Settled or rejected within 15 days of receipt of the last necessary document; interest at 2% above bank rate for delay.","display":"Within 15 days of the last necessary document","note":null,"quote":"The Company shall settle or reject a claim, as the case may be, within 15 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 intimation to the date of payment of claim at a rate 2% above the bank rate.","sources":[{"clause":"3","heading":"Claim Settlement (provision for Penal Interest)","page":26,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-3-3"}],"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":"cross-checked","value":["Illness in the first 30 days (Code-Excl03), except accidents","Specified diseases/procedures for 24 months (Code-Excl02)","Pre-existing diseases for 24 months (Code-Excl01)","Investigation and evaluation (Code-Excl04)","Rest cure, rehabilitation and respite care (Code-Excl05)","Change-of-Gender treatments (Code- Excl 07)","Cosmetic or Plastic Surgery (Code – Excl08)","Hazardous or Adventure Sports (Code Excl09)","Breach of law (Code Excl10)","Alcoholism, drug or substance abuse (Code - Excl12)","Unproven treatments (Code-Excl16)","Sterility and infertility (Code-Excl17)","Maternity (Code - Excl18)","Alcoholic pancreatitis","Growth hormone therapy","Sleep-apnoea and Sleeping disorder","War, nuclear, chemical or biological attack","Intentional self-injury or attempted suicide"],"display":"30-day illness wait, 24-month specified disease and PED waits, investigation, rest cure, gender change, cosmetic surgery, adventure sports, breach of law, alcoholism, unproven treatment, infertility, maternity, alcoholic pancreatitis, growth hormone, sleep apnoea, war, self-injury","note":"Obesity/Weight Control (Code - Excl 06) is still printed in the wording, prospectus and CIS, but the wording's Bariatric Surgery Cover (B13) says the exclusion 'stands deleted': a contradiction inside the documents. Bariatric surgery meeting the BMI conditions is covered, after the 24-month specified-procedure wait.","quote":"30 Days Waiting Period (Code-Excl03) ... except claims arising due to an accident ... Specified Disease/Procedure Waiting Period (Code-Excl02) ... 24 months of continuous coverage ... Pre-existing Diseases Waiting Period (Code-Excl01) ... Investigation and evaluation (Code-Excl04) ... Rest cure, rehabilitation and respite care (Code-Excl05) ... Change-of-Gender treatments (Code- Excl 07) ... Cosmetic or Plastic Surgery (Code – Excl08) ... Alcoholism, drug or substance abuse ... (Code - Excl12) ... Unproven treatments (Code-Excl16) ... Sterility and infertility (Code-Excl17) ... Maternity (Code - Excl18) ... Hazardous or Adventure Sports (Code Excl09) ... Breach of law (Code Excl10) ... Alcoholic pancreatitis ... Growth hormone therapy ... Sleep-apnoea and Sleeping disorder ... War or any act of war ... Nuclear, chemical or biological attack ... Intentional self-injury or attempted suicide ... In view of this coverage getting extended, exclusion code (Code-Excl 06) of this policy stands deleted.","sources":[{"clause":"1","heading":"Exclusions with waiting periods","page":20,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-3"},{"clause":"2","heading":"Medical Exclusions","page":22,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-3"},{"clause":"2(d)(ii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-d-ii"},{"clause":"2(d)(iv)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-d-iv"},{"clause":"3","heading":"Non-Medical Exclusions","page":23,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-3-2"},{"clause":null,"heading":"1. Medical Exclusions","page":24,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-medical-exclusions"},{"clause":null,"heading":"2. Non-Medical Exclusions","page":24,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-non-medical-exclusions"},{"clause":"Row 2(d)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-row-2-d"}],"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":"cross-checked","value":"Call 022 6489 8282 or 1800 267 1955 (senior citizens) or email customersupport@tataaig.com; escalate to manager.customersupport@tataaig.com, then the Head of Customer Services at head.customerservices@tataaig.com, then the Insurance Ombudsman or Bima Bharosa portal.","display":"TATA AIG customer support (022 6489 8282, customersupport@tataaig.com), then two escalation levels, then the Ombudsman","note":null,"quote":"please call our 24*7 customer support number 022 6489 8282/1800 267 1955 (For Senior Citizen), or email us at customersupport@tataaig.com ... please contact us at manager.customersupport@tataaig.com. ... reach out to the Head of Customer Services at head.customerservices@tataaig.com ... you may approach the Insurance Ombudsman of concerned jurisdiction. You can also lodge a grievance on the Bima Bharosa Grievance Redressal Portal","sources":[{"clause":"15","heading":"Redressal of Grievance","page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-15-2"},{"clause":null,"heading":"Escalation Level 1","page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-escalation-level-1"},{"clause":null,"heading":"Escalation Level 2","page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#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":"cross-checked","value":"Rs. 35 lakh, 50 lakh, 75 lakh or 100 lakh.","display":"Rs. 35 Lacs, 50 Lacs, 75 Lacs, 100 Lacs","note":null,"quote":"Sum Insured options (Rs.) ... 35 Lacs ... 50 Lacs ... 75 Lacs ... 100 Lacs","sources":[{"clause":"5","heading":"Sum Insured options (Rs.)","page":4,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-5"}],"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":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (accidents covered)","note":"Does not apply if the Insured Person has Continuous Coverage for more than twelve months; applies afresh to an enhanced sum insured.","quote":"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","sources":[{"clause":"1","heading":"Exclusions with waiting periods","page":20,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-3"}],"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":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months","note":"Reduced by prior continuous coverage under portability; applies afresh to an enhanced sum insured; cover after 24 months subject to the PED being declared and accepted.","quote":"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","sources":[{"clause":"1","heading":"Exclusions with waiting periods","page":20,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-3"}],"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":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months","note":"Not applicable to accident claims. If a listed condition is also a PED, the longer waiting period applies.","quote":"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.","sources":[{"clause":"1","heading":"Exclusions with waiting periods","page":20,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-3"}],"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":"cross-checked","value":["Tumors, Cysts, polyps including breast lumps (benign)","Polycystic ovarian disease, Fibromyoma, Adenomyosis, Endometriosis","Prolapsed Uterus","Gout and Rheumatism, Rheumatoid arthritis, Non-infective arthritis","Ligament, Tendon or Meniscal tear","Prolapsed Inter-Vertebral Disc and Spinal Diseases","Cholelithiasis","Pancreatitis","Fissure/fistula in anus, haemorrhoids, pilonidal sinus","Ulcer & erosion of stomach & duodenum","Gastro Esophageal Reflux Disorder (GERD)","Liver Cirrhosis","Perineal Abscesses","Perianal / Anal Abscesses","Calculus diseases of Urogenital system","Benign Hyperplasia of prostate","Varicocele","Cataract, Retinal detachment, Glaucoma","Congenital Internal Diseases","Osteoarthritis and osteoporosis","Systemic connective tissue disorders, inflammatory polyarthropathies","Adenoidectomy","Mastoidectomy","Tonsillectomy","Tympanoplasty","Surgery for nasal septum deviation and Nasal concha resection","Surgery for Turbinate hypertrophy","Hysterectomy","Joint replacement","Cholecystectomy","Hernioplasty or Herniorraphy","Surgery/procedure for Benign prostate enlargement","Surgery for Hydrocele/ Rectocele/Spermatocele","Surgery of varicose veins and varicose ulcers","Obesity / Weight control procedures including Gastric bypass surgeries"],"display":"Benign tumours and cysts, gynaecological conditions, arthritis, spinal disc disease, gallstones, piles and fistula, kidney stones, prostate, cataract, joint replacement, hernia, hysterectomy and others","note":null,"quote":"I) Tumors, Cysts, polyps including breast lumps (benign) ... II) Polycystic ovarian disease (garbhashaya granthi), Fibromyoma ... Adenomyosis, Endometriosis ... III) Prolapsed Uterus ... IV) Gout and Rheumatism, ... Rheumatoid arthritis, Non-infective arthritis ... V) Ligament, Tendon or Meniscal tear ... VI) Prolapsed Inter-Vertebral Disc ... and Spinal Diseases ... VII) Cholelithiasis ... VIII) Pancreatitis IX) Fissure/fistula in anus, haemorrhoids, pilonidal sinus ... X) Ulcer & erosion of stomach & duodenum XI) Gastro Esophageal Reflux Disorder (GERD) ... XII) Liver Cirrhosis XIII) Perineal Abscesses ... XIV) Perianal / Anal Abscesses XV) Calculus diseases of Urogenital system ... XVI) Benign Hyperplasia of prostate ... XVII) Varicocele ... XVIII. Cataract (avrana Shukla), Retinal detachment, Glaucoma ... XIX. Congenital Internal Diseases ... XX. Osteoarthritis and osteoporosis ... XXI. Systemic connective tissue disorders, inflammatory polyarthropathies ... XXII. Adenoidectomy XXIII. Mastoidectomy ... XXIV. Tonsillectomy ... XXV. Tympanoplasty ... XXVI. Surgery for nasal septum deviation and Nasal concha resection XXVII. Surgery for Turbinate hypertrophy XXVIII. Hysterectomy ... XXIX. Joint replacement ... XXX. Cholecystectomy ... XXXI. Hernioplasty or Herniorraphy XXXII. Surgery/procedure for Benign prostate enlargement XXXIII. Surgery for Hydrocele/ Rectocele/Spermatocele XXXIV. Surgery of varicose veins and varicose ulcers ... XXXV. Obesity / Weight control procedures including Gastric bypass surgeries","sources":[{"clause":"1","heading":"Exclusions with waiting periods","page":20,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-3"}],"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":"cross-checked","value":{"unit":"years","amount":5},"display":"5 continuous years","note":"Counted from the date of enhancement for any increase in sum insured.","quote":"After completion of five continuous years of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of nondisclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":"12","heading":"Moratorium Period","page":29,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-12-2"}],"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":"cross-checked","value":"Yes. Apply to the new insurer at least 30 days but not earlier than 60 days before renewal; credit for waiting periods, PED wait, sum insured, No Claim Bonus and moratorium carries over.","display":"Yes, with waiting-period credit; apply 30 to 60 days before renewal","note":null,"quote":"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 30 days before, but not earlier than 60 days from the policy renewal date ... the proposed insured person will get the accrued continuity benefits to the extent of the Sum Insured, No Claim Bonus, specific waiting periods, waiting period for pre-existing disease, Moratorium period etc","sources":[{"clause":"9","heading":"Portability","page":28,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-9-2"}],"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":"cross-checked","value":true,"display":"Yes, continuous renewal with no exit age","note":"Renewal can be refused on grounds of established fraud, non-disclosure or misrepresentation.","quote":"We will be offering continuous renewal with no exit age subject to regular premium payment","sources":[{"clause":"Section 4(iii)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-section-4-iii"}],"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":"cross-checked","value":"No. No loading applies at renewal based on individual claims, and renewal is not denied because of claims.","display":"No claim-based loading at renewal","note":"Risk loading may be applied at issue based on health declarations and medical underwriting.","quote":"Renewal shall not be denied on the ground that the insured person had made a claim or claims in the preceding policy periods. ... vii. No loading shall apply on renewals based on individual claims experience","sources":[{"clause":"10(i)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-10-i"},{"clause":"10(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-10-b"}],"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":"cross-checked","value":["Investigation and evaluation (Code-Excl04)","Rest cure, rehabilitation and respite care (Code-Excl05)","Change-of-Gender treatments (Code- Excl 07)","Cosmetic or Plastic Surgery (Code – Excl08)","Hazardous or Adventure Sports (Code Excl09)","Breach of law (Code Excl10)","Excluded Providers (Code-Excl11)","Alcoholism, drug or substance abuse (Code - Excl12)","Health hydros, nature cure clinics, spas (Code -Excl13)","Dietary supplements (Code -Excl14)","Refractive error less than 7.5 dioptres (Code- Excl 15)","Unproven treatments (Code-Excl16)","Sterility and infertility (Code-Excl17)","Maternity (Code - Excl18)","Alcoholic pancreatitis","Congenital External Diseases, defects or anomalies","Stem cell therapy (except hematopoietic stem cells for bone marrow transplant)","Growth hormone therapy","Sleep-apnoea and Sleeping disorder","Admission primarily for intra-articular or intra-lesional injections or IVIG","Venereal disease, sexually transmitted disease","All preventive care, vaccination","Dentures, dental implants and braces","Non-Allopathic treatment (except AYUSH Benefit)","Existing disease named as Permanent exclusion in the Policy Schedule","Non payable items in Annexure I","War, nuclear, chemical or biological attack","Armed forces operations","Intentional self-injury or attempted suicide","Items of personal comfort and convenience","Hearing aids, spectacles or contact lenses","Alopecia, wigs, elastic stockings, diabetic test strips","Crutches or other external appliances","Injury under the influence of intoxicants"],"display":"IRDAI standard exclusions Excl04 to Excl18 (Code-Excl 06 deleted), plus product exclusions such as alcoholic pancreatitis, growth hormone, sleep apnoea, STDs, dental implants, non-allopathic treatment and war","note":"Obesity/Weight Control (Code - Excl 06) is printed in the wording, prospectus and CIS, but the wording's B13 Bariatric Surgery Cover says it 'stands deleted': a contradiction inside the documents.","quote":"Investigation and evaluation (Code-Excl04) ... Rest cure, rehabilitation and respite care (Code-Excl05) ... Change-of-Gender treatments (Code- Excl 07) ... Cosmetic or Plastic Surgery (Code – Excl08) ... (Code - Excl12) ... (Code -Excl13) ... (Code -Excl14) ... Refractive error (Code- Excl 15): Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. ... Unproven treatments (Code-Excl16) ... Sterility and infertility (Code-Excl17) ... Maternity (Code - Excl18) ... Hazardous or Adventure Sports (Code Excl09) ... Breach of law (Code Excl10) ... Excluded Providers (Code-Excl11) ... i. Alcoholic pancreatitis ii. Congenital External Diseases, defects or anomalies; iii. Stem cell therapy; however hematopoietic stem cells for bone marrow transplant for haematological conditions will be covered ... Growth hormone therapy; ... Sleep-apnoea and Sleeping disorder; ... Admission primarily for administration of Intra-articular or intra-lesional injections or Intravenous immunoglobulin infusion ... Venereal disease, sexually transmitted disease or illness; ... All preventive care, vaccination ... Cost of dentures, dental implants and braces ... Any form of Non-Allopathic treatment (except AYUSH Benefit) ... Any existing disease specifically mentioned as Permanent exclusion in the Policy Schedule ... Non payable items as mentioned in Annexure I ... War or any act of war ... Nuclear, chemical or biological attack ... participation or involvement in armed forces ... Intentional self-injury or attempted suicide ... Items of personal comfort and convenience ... hearing aids, spectacles or contact lenses ... alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips ... Crutches or any other external appliance ... under the influence of intoxicants ... In view of this coverage getting extended, exclusion code (Code-Excl 06) of this policy stands deleted.","sources":[{"clause":"Row 2(d)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-row-2-d"},{"clause":"2","heading":"Medical Exclusions","page":22,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-3"},{"clause":"2(d)(ii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-d-ii"},{"clause":"2(d)(iv)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-d-iv"},{"clause":"3","heading":"Non-Medical Exclusions","page":23,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-3-2"},{"clause":null,"heading":"1. Medical Exclusions","page":24,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-medical-exclusions"},{"clause":null,"heading":"2. Non-Medical Exclusions","page":24,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-non-medical-exclusions"}],"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":"cross-checked","value":"On 7 days written notice, proportionate premium for the unexpired period is refunded; no refund if any claim has been admitted or lodged or any benefit availed.","display":"Proportionate refund for the unexpired period, none if a claim was made or a benefit used","note":"No refund when the insurer cancels for established fraud, misrepresentation or non-disclosure (15 days notice).","quote":"The policyholder may cancel this policy by giving 7 days written notice and in such an event, the Company shall refund proportionate premium for the unexpired policy period. No refunds of premium shall be made in respect of Cancellation where any claim has been admitted or has been lodged or any benefit under this Policy has been availed by the Insured Person. ... The Company may cancel the policy at any time on grounds of established fraud, misrepresentation or non-disclosure of material facts by the Policyholder/ Insured Person by giving 15 days' written notice. There would be no refund of premium on cancellation on grounds of established fraud, misrepresentation or non-disclosure of material facts.","sources":[{"clause":"7(I)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-7-i"},{"clause":"7(II)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-7-ii"}],"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":"cross-checked","value":"India only, except Global Planned Hospitalization for listed critical illnesses first diagnosed in India, paid on reimbursement abroad.","display":"India; abroad only for planned treatment of listed critical illnesses","note":"The global benefit is not available where the policyholder or any insured is a Foreign National, NRI or OCI (2% premium discount instead). It uses only the balance basic sum insured plus No Claim Bonus, not the restored sum insured.","quote":"All benefits under this Policy are restricted to the geography of India. ... This Policy only covers claims incurred within India (except in case of benefit B12- Global Planned Hospitalization for Specified Illnesses, wherever applicable) ... Only the balance basic sum insured along with No Claim Bonus can be used for this and not the restored sum insured. ... where either the policyholder or any of the Insured Person(s) is a Foreign National or their Residence Status at the time of proposal or anytime during the policy period/ renewal is: ... Discount in lieu of 2% where either the policyholder or any of the Insured Person(s) is a Foreign","sources":[{"clause":"Section 2","heading":"Benefits","page":9,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-section-2"},{"clause":"5(ii)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-5-ii-2"},{"clause":null,"heading":"B12. Global Planned Hospitalization for Specified Illnesses","page":12,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b12-global-planned-hospitalization-for-specified"},{"clause":"3","heading":"Discounts on premium","page":2,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-3"}],"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":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Refund less proportionate risk premium, medical examination expenses and stamp duty, if no claim was made.","quote":"The insured person shall be provided a free look period of thirty days beginning from the date of receipt of the policy document ... If the insured has not made any claim during the Free Look Period, the insured shall be entitled to a refund of the premium paid subject to deduction of proportionate risk premium for the period of cover and the expenses, if any, incurred by Us on medical examination of the proposer and stamp duty charges.","sources":[{"clause":"14","heading":"Free look period","page":30,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-14-2"}],"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":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for monthly instalments)","note":"15 days where premium is paid monthly.","quote":"The grace period for payment of the premium shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases.","sources":[{"clause":"18","heading":"Grace Period","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-18"}],"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":"cross-checked","value":"Children from 91 days to 25 years; adults from 18 to 65 years.","display":"Child 91 days to 25 years; adult 18 to 65 years","note":"Children between 91 days and 5 years only when both parents are insured. From the prospectus.","quote":"Entry Age: Minimum | Child- 91 days Dependent children between 91 days and 5 years can be insured only when both parents are getting insured. Adult- 18 years Entry Age: Maximum | Child- 25 years Adult- 65 years","sources":[{"clause":"1","heading":"Suitability","page":1,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Full premium upfront (lumpsum)","Monthly","Quarterly","Half-Yearly","Limited Premium paying term"],"display":"Lumpsum, monthly, quarterly, half-yearly, or limited premium paying term instalments","note":"Instalments carry a loading, e.g. 5.00% monthly, 4.00% quarterly, 2.50% half-yearly for a 1 year policy (prospectus).","quote":"If you have opted to pay premium in full (lumpsum) upfront ... Monthly/Quarterly/Half-Yearly/ Limited Premium paying term instalment option would be allowed ... Monthly | 5.00% | 9.00% | 13.00% ... Quarterly | 4.00% | 8.00% | 12.00% ... Half-Yearly | 2.50% | 7.00% | 11.00%","sources":[{"clause":"Section 4(ii)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-section-4-ii"},{"clause":"20","heading":"Premium Rates & Payment Zones","page":16,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-20"},{"clause":null,"heading":"Loading %","page":16,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-loading"}],"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":"not-stated","value":null,"display":null,"note":"No optional cover bought for extra premium is listed. B12 critical illnesses apply 'provided the same has been specifically covered under the Policy Schedule'; NRI/OCI policyholders get a 2% discount instead of B12.","quote":null,"sources":[],"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":"cross-checked","value":"For instalment premiums within the policy period, cover continues during the grace period; at the end of the policy period, there is no cover during the grace period.","display":"Yes for instalments within the policy year; no after the policy period ends","note":null,"quote":"Within the policy period - coverage will be available from the due date of instalment premium till the date of receipt of premium by Company within the grace period. ... Coverage is not available during the grace period after the end of the policy period.","sources":[{"clause":"10(a)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-10-a"},{"clause":"10(b)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-10-b"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"not-stated","value":null,"display":null,"note":"No room rent limit is printed (only the Room Rent definition). The prospectus says benefits are 'without any sub-limit unless otherwise mentioned' and its table shows In-Patient Treatment 'Up to Sum Insured'; the CIS refers to the Policy Schedule for limits.","quote":null,"sources":[],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-stated","value":null,"display":null,"note":"No room category is printed in the wording, prospectus or CIS.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"not-stated","value":null,"display":null,"note":"No ICU limit or ICU charge rule is printed.","quote":null,"sources":[],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"not-stated","value":null,"display":null,"note":"No proportionate deduction clause is printed; no room rent limit is printed either.","quote":null,"sources":[],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"not-stated","value":null,"display":null,"note":"No co-payment is printed. The CIS co-payment row is an empty template (it only defines co-payment and lists ambulance and other limits); the moratorium clause only says policies stay subject to 'co-payments, deductibles as per the policy contract'.","quote":null,"sources":[],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"not-stated","value":null,"display":null,"note":"No deductible is printed. The CIS deductible row is an empty template (it only defines a deductible).","quote":null,"sources":[],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["None: benefits without any sub-limit unless otherwise mentioned"],"display":"No disease-wise sub-limits","note":"No named treatment (cataract, joint replacement...) carries a cap. Benefit limits that do apply: ambulance Rs. 10,000 per hospitalisation and OPD Rs. 25,000 a policy period. The CIS sub-limit row says 'For limits applicable to you, please refer your Policy Schedule'.","quote":"Indemnity based health insurance cover with range of benefits without any sub-limit unless otherwise mentioned. ... Ambulance Cover – Upto Rs. 10,000 per Hospitalization ... OPD Treatment – Upto Rs. 25,000 in a Policy Period (over and above base sum insured)","sources":[{"clause":"2","heading":"Key Benefits","page":1,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-2"},{"clause":"Row 8","heading":"i. Financial limits of coverage","page":2,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1084#c-row-8"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":null,"quote":"We will cover for expenses for Pre-Hospitalization consultations, investigations and medicines incurred upto 60 days before the date of admission to the hospital.","sources":[{"clause":null,"heading":"B2. Pre-Hospitalization expenses","page":9,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b2-pre-hospitalization-expenses"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":90},"display":"90 days","note":null,"quote":"We will cover for expenses for Post-Hospitalization consultations, investigations and medicines incurred upto 90 days after discharge from the hospital.","sources":[{"clause":null,"heading":"B3. Post-Hospitalization expenses","page":9,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b3-post-hospitalization-expenses"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"All day care treatments are covered up to the sum insured.","display":"All day care treatments, up to sum insured","note":"Treatment normally taken on an out-patient basis is not included.","quote":"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. Treatment normally taken on out-patient basis is not included in the scope of this cover. ... Day Care Procedures | All Day Care Treatments, Upto Sum Insured","sources":[{"clause":null,"heading":"B4. Day Care Procedures","page":10,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b4-day-care-procedures"},{"clause":"24","heading":"Section 41 of Insurance Act1938 (Prohibition of Rebates), as amended by","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-24"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Covered up to the sum insured if the home treatment exceeds three days; not for enteral feeding or end of life care.","display":"Covered if treatment exceeds three days, up to sum insured","note":null,"quote":"We will cover for expenses related to Domiciliary Hospitalization of the insured person if the treatment exceeds beyond three days. The treatment must be for management of an illness and not for enteral feedings or end of life care. ... Domiciliary Treatment | Up to Sum Insured","sources":[{"clause":null,"heading":"B7. Domiciliary Treatment","page":11,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b7-domiciliary-treatment"},{"clause":"24","heading":"Section 41 of Insurance Act1938 (Prohibition of Rebates), as amended by","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-24"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"In-patient or day care treatment in an AYUSH hospital or day care centre, up to the sum insured, with 60 days pre and 90 days post hospitalisation.","display":"Covered up to sum insured, with 60/90 days pre/post","note":null,"quote":"We will cover Medical Expenses incurred for treatment as In-Patient or Day Care Treatment in an AYUSH Hospital/ AYUSH day care centre. This benefit shall also cover Pre-Hospitalization medical expenses for a period of upto 60 days ... Post-Hospitalization Medical Expenses for a period upto 90 days ... AYUSH Benefit | Upto Sum Insured","sources":[{"clause":null,"heading":"B9. AYUSH Benefit","page":11,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b9-ayush-benefit"},{"clause":"24","heading":"Section 41 of Insurance Act1938 (Prohibition of Rebates), as amended by","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-24"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"cross-checked","value":"Covered up to the sum insured: uterine artery embolization and HIFU, balloon sinuplasty, deep brain stimulation, oral chemotherapy, immunotherapy, intra vitreal injections, robotic surgery, stereotactic radiosurgery, bronchial thermoplasty, prostate vaporisation, IONM and stem cell therapy for haematological conditions.","display":"Covered up to sum insured","note":"Each claim needs written justification from the treating medical practitioner.","quote":"A. Uterine Artery Embolization and HIFU B. Balloon Sinuplasty C. Deep Brain stimulation D. Oral chemotherapy E. Immunotherapy-Monoclonal Antibody to be given as injection F. Intra vitreal injections G. Robotic surgeries H. Stereotactic radiosurgeries ... I) Bronchical Thermoplasty J. Vaporisation of the prostrate ... K. IONM - (Intra Operative Neuro Monitoring) L. Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions ... Modern Treatment Methods and Advancement in Technologies | Up to Sum Insured","sources":[{"clause":null,"heading":"B5. Modern Treatment Methods and Advancement in Technologies","page":10,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b5-modern-treatment-methods-and-advancement-in-t"},{"clause":"Section 2(I)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-section-2-i"},{"clause":"24","heading":"Section 41 of Insurance Act1938 (Prohibition of Rebates), as amended by","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-24"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"cross-checked","value":"Yes, the donor's medical and surgical expenses for harvesting the organ, up to the sum insured, if the recipient's in-patient claim is accepted.","display":"Yes, up to sum insured","note":"Only if an in-patient claim for the insured recipient is accepted under B1.","quote":"We will cover for Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient ... Organ Donor | Up to Sum Insured ... ii) We have accepted an inpatient Hospitalization claim for the insured member under section B1 of this policy.","sources":[{"clause":null,"heading":"B6. Organ Donor","page":10,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b6-organ-donor"},{"clause":"24","heading":"Section 41 of Insurance Act1938 (Prohibition of Rebates), as amended by","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-24"},{"clause":"Section 2(ii)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-section-2-ii"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Registered ambulance to hospital in an emergency or between hospitals, up to Rs. 10,000 per hospitalisation.","display":"Up to Rs. 10,000 per hospitalisation","note":"Claim must be admissible under in-patient or day care. Air ambulance is not mentioned.","quote":"We will cover for expenses incurred on transportation of Insured Person in a registered ambulance to a Hospital for admission in case of an Emergency or from one hospital to another hospital for better medical facilities and treatment, subject to maximum upto Rs. 10,000 per Hospitalization.","sources":[{"clause":null,"heading":"B10. Ambulance Cover","page":12,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b10-ambulance-cover"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"cross-checked","value":"Basic sum insured restored once a policy period when the sum insured and cumulative bonus are insufficient; usable for unrelated illness, and for a related illness after 45 days from discharge. Not on the first claim and not carried forward.","display":"100% of base sum insured, once a year","note":"Not available for the Global Planned Hospitalization benefit (B12). A single hospitalisation cannot exceed the sum insured.","quote":"We will automatically restore the Basic Sum Insured if the Sum Insured and accrued Cumulative Bonus is insufficient to pay a claim during the policy period. This benefit can be availed once during the policy period ... for admissions after 45 days from the date of discharge of the earlier claim. ... c) The unutilized restored sum insured cannot be carried forward to the next policy period. d) Restore will not trigger for the first claim under each policy period. ... Restore Benefit | 100% of the Base Sum Insured restored once in a Policy Year. ... Our maximum liability in aggregate of all claims arising out of a single Hospitalization shall not exceed the Sum Insured of the Policy. ... This benefit shall not be available for section B12 of this policy.","sources":[{"clause":null,"heading":"B8. Restore benefit","page":11,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b8-restore-benefit"},{"clause":"24","heading":"Section 41 of Insurance Act1938 (Prohibition of Rebates), as amended by","page":18,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-24"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"cross-checked","value":"Choose either a cumulative bonus of 20% of sum insured per claim-free year up to 100%, reduced by 20% after a claim, or a 1% renewal premium discount per claim-free year.","display":"20% a claim-free year, up to 100%; or 1% renewal discount","note":"The option is chosen at the first claim-free renewal and cannot be changed. The wording gives no terms for the renewal discount; the 1% figure is from the prospectus.","quote":"20% cumulative bonus will be applied on the Sum Insured of the expiring Policy, on each Renewal after every claim free Policy Period ... The maximum cumulative bonus shall not exceed 100% of the Sum Insured in any Policy Period. ... We will automatically decrease the Cumulative Bonus by 20% of the Sum Insured ... If you choose Discount in Renewal Premium, We will allow 1% discount on renewal premium for every claim free Policy Period ... Under this benefit, the Policyholder, at the time of first claim free Policy renewal, can opt for either Cumulative Bonus or Discount in Renewal Premium. Once opted, the option cannot be changed at subsequent renewals","sources":[{"clause":"1(i)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-i"},{"clause":"1(ii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-ii"},{"clause":"6(a)","heading":"Discount in Renewal Premium","page":5,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-6-a-2"},{"clause":null,"heading":"B16. No Claim Bonus","page":17,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b16-no-claim-bonus"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"not-stated","value":null,"display":null,"note":"Not addressed directly. The policy excludes 'Non payable items as mentioned in Annexure I - List I of optional items available on Our website', a list not printed in these documents, and 'medical supplies including elastic stockings, diabetic test strips, and similar products'.","quote":null,"sources":[],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not covered: childbirth, caesarean, miscarriage (unless accidental) and lawful termination are excluded (except ectopic pregnancy).","display":"Not covered","note":null,"quote":"Maternity (Code - Excl18): a) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;","sources":[{"clause":"2(d)(iv)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-2-d-iv"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"No newborn cover is printed; maternity is excluded and children can enter only from 91 days.","quote":null,"sources":[],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"In-patient mental illness cover is not mentioned. The prospectus lists teleconsultation with a psychiatrist under wellness services only.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"cross-checked","value":"A preventive health check-up for listed tests once a policy period, for the policyholder only, regardless of claims.","display":"Once a year, policyholder only","note":"Tests as listed in the TATA AIG mobile app; cashless at empanelled providers or at home. With instalment premium, available only after all instalments are paid.","quote":"The Health Checkup will be available only once in a Policy Period and only for the Policyholder ... The benefit is payable every year irrespective of claims under the policy. ... The health check-ups shall be arranged by Us on cashless basis at Our empanelled service providers or at Insured Person’s residence, as per availability. ... In case of premium payment in instalments, this benefit shall be available for utilization only after completion of all instalments.","sources":[{"clause":null,"heading":"B11. Health Checkup","page":12,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b11-health-checkup"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"In-person consultations, diagnostic tests and pharmacy for illness or injury up to Rs. 25,000 per policy period, over and above the sum insured, at most 2 claims a year.","display":"Up to Rs. 25,000 a year","note":"Intimate within 30 days of service; not for preventive care; with instalment premium, available only after all instalments are paid. The wording says 'per policy period', the prospectus table 'per Policy Year'.","quote":"We will cover the medical expenses for in-person consultations, diagnostic tests and pharmacy upto Rs. 25,000 per policy period ... Claim submission under this benefit shall be limited to a maximum of 2 times during a policy period. ... This benefit has a separate limit (over and above base sum insured) ... i) The Insured Person is suffering from an illness or injury and is not availing the services for preventive reasons; ... iv) Intimation of utilization under this benefit shall be made to Us within 30 days of date of service. ... v) In case of premium payment in instalments, this benefit shall be available for utilization only after completion of all instalments","sources":[{"clause":null,"heading":"B15. OPD Treatment","page":16,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b15-opd-treatment"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"The prospectus heading reads 'Premium Rates & Payment Zones' but no zones, zone-based premium or zone co-pay are described; premium depends on completed age.","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":"cross-checked","value":"Cashless at network hospitals only, with pre-authorisation.","display":"At network hospitals","note":"Global Planned Hospitalization is reimbursement only (cashless case to case). Notify 48 hours before planned or within 24 hours of emergency admission.","quote":"Cashless Service is only available at Network Hospitals. ... Any claim under this cover can be made only on reimbursement basis. Cashless facility may be arranged on case to case basis.","sources":[{"clause":"3","heading":"Procedure for Cashless Service","page":34,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-3-4"},{"clause":null,"heading":"B12. Global Planned Hospitalization for Specified Illnesses","page":12,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-b12-global-planned-hospitalization-for-specified"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"In-house: TATA AIG's own health claims unit (TAGIC Health Claims, Hyderabad) takes the final decision; a TPA applies only if named in the policy schedule.","display":"TATA AIG in-house (TAGIC Health Claims)","note":null,"quote":"The final decision on all claims is taken by TATA AIG General Insurance Company Limited. ... Name | TAGIC Health Claims ... *TPA as mentioned in the policy schedule, if any","sources":[{"clause":"11","heading":"Claim Procedure","page":11,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-11"},{"clause":null,"heading":"Claims Servicing Details","page":11,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-claims-servicing-details"},{"clause":"1","heading":"Notification of Claim","page":33,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-1-5"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes, individual or family floater","note":null,"quote":"Coverage Options | Individual/Family floater ... In case of family floater Policy, the Sum Insured & Cumulative Bonus, shall be available for all Insured Persons on an aggregate basis, on a per Policy Year basis.","sources":[{"clause":"1","heading":"Suitability","page":1,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083#c-1"},{"clause":"Section 2","heading":"Benefits","page":9,"url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082#c-section-2"}],"law":[]}],"documents":[{"kind":"wording","label":"TATA AIG MediCare Platinum (TATHLIP27060V012627)","pages":40,"fetched_at":"2026-10-19 17:40:49.599565+00","source_url":"https://www.tataaig.com/s3/tata_aig_medicare_platinum_policy_wordings_cdbc29ba86.pdf","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1082"},{"kind":"prospectus","label":"TATA AIG MediCare Platinum (TATHLIP27060V012627)","pages":20,"fetched_at":"2026-10-19 17:40:49.599565+00","source_url":"https://www.tataaig.com/s3/tata_aig_medicare_platinum_prospectus_6efe92bda1.pdf","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1083"},{"kind":"cis","label":"TATA AIG MediCare Platinum (TATHLIP27060V012627)","pages":5,"fetched_at":"2026-10-19 17:40:49.599565+00","source_url":"https://www.tataaig.com/s3/tata_aig_medicare_platinum_customer_information_sheet_6b0fed74d9.pdf","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/1084"},{"kind":"proposal","label":"TATA AIG MediCare Platinum (TATHLIP27060V012627)","pages":null,"fetched_at":"2026-10-17 20:16:44+00","source_url":"https://www.tataaig.com/s3/tata_aig_medicare_platinum_proposal_form_2186a9ad10.pdf","url":"https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627/document/31875"}],"versions":[],"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":"TATA AIG MediCare Platinum (UIN TATHLIP27060V012627), IndiaInsurances, https://indiainsurances.com/policy/tata-aig-general-insurance/tata-aig-medicare-platinum-tathlip27060v012627"}