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Tata AIG General Insurance Company Limitedadmissions due to unrelated illness/diseases. However, thisbenefit for related illness/diseases would be available, in case ofclaimed insured person(s), for admissions after 45 days from thedate of discharge of the earlier claim.b.In case of Family Floater policy, Reinstatement of Sum Insuredwill be available for all Insured Persons in the Policy on floaterbasisc.This benefit shall be applicable annually for policies with tenureof more than 1 year.d.The unutilized restored sum insured cannot be carried forward.This benefit shall not be applicable for Global Cover (section B13).B8. AYUSH BenefitWe will cover for expenses incurred on in-patient treatmenttaken under Ayurveda, Unani, Sidha and Homeopathy in any ofthe following:i.Government hospital or in any institute recognized by governmentand/or accredited by Quality Council of India / National AccreditationBoard for Hospitals and Healthcare Providers excluding centre forspas, massage and health rejuvenation procedures.ii.Teaching hospitals of AYUSH colleges recognised by CentralCouncil of Indian Medicine (CCIM) and Central Council ofHomeopathy (CCH).iii.AYUSH Hospitals having registration with a Government authorityunder appropriate Act in the State/UT and complies with thefollowing as minimum criteria:l has at least fifteen in-patient beds;l has minimum five qualified and registered AYUSH doctors;l has qualified paramedical staff under its employment round the clock;l has dedicated AYUSH therapy sections;l maintains daily records of patients and makes theseaccessible to the insurance company’s authorized personnel.B9. Ambulance CoverWe will cover for expenses incurred on transportation of InsuredPerson in a registered ambulance to a Hospital for admission incase of an Emergency or from one hospital to another hospitalfor better medical facilities and treatment, subject to Rs. 3000per Hospitalization.For this claim to be paid, the claim must be admissible undersection B1 or B4 of this policy.B10.Health CheckupWe will cover for expenses for a Preventive Health Check-up upto1% of previous sum insured subject to a maximum of Rs. 10,000/per policy. The limit is the maximum per policy and more than oneinsured can utilize the amount.B11.The benefit is payable after every two continuous claim free policyyears with us. This benefit has a separate limit (over and above basesum insured) and does not affect cumulative bonus.Compassionate travelIn the event the Insured Person is Hospitalized for more thanFive consecutive days in a place where no adult member of hisimmediate family is present, we will cover for expenses related toa round trip economy class air ticket, or first-class railway ticket,to allow the Immediate Family Member be at his bedside for theduration of his stay in the hospital.This benefit has a separate limit (over and above base sum insured)and does not affect cumulative bonus.We shall require the following additional documents (proof of travel)supporting the claim under this benefit: Boarding Pass, or Railwayticket or any other document to show proof of travelB12. Consumables BenefitWe will pay for expenses incurred, for consumables whichare listed in ‘Items for which optional cover may be offeredby insurers’ under ‘Guidelines on Standardization in HealthInsurance, 2016’, which are consumed during the period ofhospitalization directly related to the insured’s medical orsurgical treatment of illness/disease/injury.Following items shall be excluded from scope of this coverage:l Items of personal comfort, toiletries, cosmetics andconvenience shall be excluded from scope of this coverage.l External durable devices like Bilevel Positive Airway Pressure(BIPAP) machine, Continuous Positive Airway Pressure(CPAP) machine, Peritoneal Dialysis (PD) equipment andsupplies, Nimbus/water/air bed, dialyzer and other medicalequipments.For this claim to be paid, the main claim must be admissibleunder section B1 or B4 of this policy.B13.Global CoverWe will cover for Medical Expenses of the Insured Personincurred outside India, upto the sum insured, provided that thediagnosis was made in India and the insured travels abroad fortreatment.The Medical Expenses payable shall be limited to Inpatient anddaycare Hospitalization only on reimbursement basis. Cashlessfacility may be arranged on case to case basis. Insured personcan contact us for any claim assistance.The payment of any claim under this benefit will be in IndianRupees based on the rate of exchange as on the date of invoice,published by Reserve Bank of India (RBI) and shall be used forconversion of foreign currency into Indian Rupees for claimspayment. If these rates are not published on the date of invoice,the exchange rate next published by RBI shall be considered forconversion.Only basic sum insured along with Cumulative Bonus can beused for this and not the restored sum insured.We shall require the following additional documents supportingthe claim under this benefit:l Proof of diagnosis in Indial Insured’s Passport and VisaB14.Bariatric Surgery CoverWe will cover for reasonable and customary expenses forBariatric Surgery if the insured fulfills the following conditions:i.Surgery to be conducted is upon the advice of the Doctorii.The member has to be 18 years of age or older andiii.Body Mass Index (BMI) greater than or equal to 40iv.BMI greater than or equal to 35 in conjunction with any of thefollowing severe comorbidities following failure of less invasivemethods of weight loss:a. Obesity-related cardiomyopathyb. Coronary heart diseasec. Severe sleep apneaThe expenses must be incurred within India and shall not exceedRs. 20,000 during a policy year.d. Uncontrolled Type2 DiabetesThis benefit shall be payable if We have accepted an inpatientHospitalization claim for the insured member under In PatientHospitalization Treatment (Section B1).We will cover for medical expenses incurred towardshospitalization for dental treatment under anesthesianecessitated due to an accident/injury/illness.B15.In-Patient Treatment - DentalRegd Office: 15th Floor, Tower A, Peninsula Business Park, G. K. Marg, Lower Parel, Mumbai - 400 013 Toll Free No. (24x7): 1800 266 7780 Fax: 022 6693 8170 Email: [email protected] IRDA of India Registration No: 108 website: www.tataaig.comCIN: U85110MH2000PLC128425 UIN: TATHLIP18004V011819

Tata AIG General Insurance Company LimitedB16.Vaccination coverWe will cover for expenses related to the cost of the followingvaccines only:B21.Accidental Death Benefit (Optional Cover)If an Insured Person suffers an accident during the policy periodand this is the sole and direct cause of his death within 365 daysfrom the date of accident, then we will pay a fixed amount of100% of the base Sum Insured.Without any waiting period:l Anti-rabies vaccine following an animal bitel Typhoid vaccinationAfter 2 years of continuous coverage with Us:l Human Papilloma Virus (HPV) vaccinel Hepatitis B VaccineExpenses related to the doctor, nurse or any incidental expensesare not payable. This benefit has a separate limit (over andabove base sum insured) and does not affect cumulative bonus.This benefit is not applicable for dependent children covered inthe policy.Benefit under optional cover (if opted) shall be available to theinsured person, only if the particular benefit/optional cover isspecifically mentioned in the policy schedule.B22.i.50% cumulative bonus will be applied on the Sum Insured fornext policy year under the Policy after every claim free Policy Year,provided that the Policy is renewed with Us and without a break.The maximum cumulative bonus shall not exceed 100% of the SumInsured in any Policy Year.ii.If a Cumulative Bonus has been applied and a claim is made, thenin the subsequent Policy Year We will automatically decrease theCumulative Bonus by 50% of the Sum Insured in that followingPolicy Year. There will be no impact on the Inpatient Sum Insured,only the accrued Cumulative Bonus will be decreased.iii.In policies with a tenure of more than one year, the above guidelinesof Cumulative Bonus shall be applicable post completion of eachpolicy yeariv.In relation to a Family Floater, the Cumulative Bonus so applied willonly be available in respect of those Insured Persons who wereInsured Persons in the claim free Policy Year and continue to beInsured Persons in the subsequent Policy Year.v.For purpose of computation of Cumulative Bonus, the percentage(%) of Cumulative Bonus will be applied on the base Sum Insuredonly. Restored sum insured will not be taken into consideration.The maximum payable is actuals or Rs. 5,000/- per policy,whichever is lower.B17.Hearing AidWe will cover for reasonable charges for a hearing aid everythird year. The maximum amount payable is 50% of actual costor Rs. 10,000/- per policy, whichever is lower.The items must be prescribed by a specialized MedicalPractitioner as medically necessary. This benefit has a separatelimit (over and above base sum insured) and does not affectcumulative bonusB18.Daily Cash for choosing Shared AccommodationWe will pay a fixed amount per day as mentioned in the policyschedule if the Insured Person is Hospitalized in SharedAccommodation in a Network Hospital for each continuousand completed period of 24 hours. The benefit payable perday would be 0.25% of base sum insured and a maximum ofRs. 2000 per day. This benefit is applicable only for those caseswhere shared accommodation category is not opted by thepolicy holder in the policy.For this claim to be paid, the main claim must be admissibleunder section B1 of this policy. This benefit has a separatelimit (over and above base sum insured) and does not affectcumulative bonus.B19.Daily Cash for Accompanying an Insured ChildWe will pay a fixed amount per day, as mentioned in theschedule, if the Insured Person Hospitalized is a child Aged 12years or less, for one accompanying adult for each completeperiod of 24 hours. The benefit payable per day would be 0.25%of base sum insured and maximum of Rs.2000 per day.For this claim to be paid, the main claim must be admissibleunder section B1 of this policy. This benefit has a separatelimit (over and above base sum insured) and does not affectcumulative bonus.B20.Second OpinionWe will provide You a second opinion from Network Provider orMedical Practitioner, if an Insured Person is diagnosed with thebelow mentioned Illnesses during the Policy Period. The expertopinion would be directly sent to the Insured Person.i. Cancerii. Kidney Failureiii. Myocardial Infarctioniv. Anginav. Coronary bypass surgeryvi. Stroke/Cerebral hemorrhagevii. Organ failure requiring transplantviii. Heart Valve replacementxi. Brain tumorsThis benefit can be availed by an insured person once during aPolicy Year.Cumulative BonusSection 2 – General DefinitionsThe terms defined below and at other junctures in the PolicyWording have the meanings ascribed to them wherever theyappear in this Policy and, where appropriate, references to thesingular include references to the plural; references to the maleinclude the female and references to any statutory enactmentinclude subsequent changes to the same:1.2.3.4.AccidentAn accident means sudden, unforeseen and involuntary eventcaused by external, visible and violent means.Any one illnessAny one illness means continuous period of illness and includesrelapse within 45 days from the date of last consultation with theHospital/Nursing Home where treatment was taken.Cashless facilityCashless facility means a facility extended by the insurer to theinsured where the payments, of the costs of treatment undergoneby the insured in accordance with the policy terms and conditions,are directly made to the network provider by the insurer to theextent pre- authorization is approved.Congenital Anomaly:Congenital Anomaly means a condition which is present since birth,and which is abnormal with reference to form, structure or position.a. Internal Congenital AnomalyCongenital anomaly which is not in the visible and accessibleparts of the body.b. External Congenital AnomalyCongenital anomaly which is in the visible and accessibleparts of the bodyRegd Office: 15th Floor, Tower A, Peninsula Business Park, G. K. Marg, Lower Parel, Mumbai - 400 013 Toll Free No. (24x7): 1800 266 7780 Fax: 022 6693 8170 Email: [email protected] IRDA of India Registration No: 108 website: www.tataaig.comCIN: U85110MH2000PLC128425 UIN: TATHLIP18004V011819

Tata AIG General Insurance Company Limited5.Co-PaymentCo-payment means a cost sharing requirement under a healthinsurance policy that provides that the policyholder/insured willbear a specified percentage of the admissible claims amount. A copayment does not reduce the Sum Insured.6.7.Cumulative BonusCumulative Bonus means any increase or addition in the SumInsured granted by the insurer without an associated increase inpremium.Day Care CentreA day care centre means any institution established for daycare treatment of illness and/or injuries or a medical setupwith a hospital and which has been registered with the localauthorities, wherever applicable, and is under supervision of aregistered and qualified medical practitioner AND must complywith all minimum criterion as under –i.has qualified nursing staff under its employment;ii.has qualified medical practitioner/s in charge;iii.has fully equipped operation theatre of its own where surgicalprocedures are carried out;iv.maintains daily records of patients and will make theseaccessible to the insurance company’s authorized personnel.8.Day Care TreatmentDay care treatment means medical treatment, and/or surgicalprocedure which is:i.undertaken under General or Local Anesthesia in a hospital/day care centre in less than 24 hrs because of technologicaladvancement, andii.which would have otherwise required hospitalization of more than24 hours. Treatment normally taken on an out-patient basis is notincluded in the scope of this definition9.Dental TreatmentDental treatment means a treatment related to teeth orstructures supporting teeth including examinations, fillings(where appropriate), crowns, extractions and surgery.10.Domiciliary HospitalizationDomiciliary hospitalization means medical treatment for anillness/disease/injury which in the normal course would requirecare and treatment at a hospital but is actually taken whileconfined at home under any of the following circumstances:i.the condition of the patient is such that he/she is not in a conditionto be removed to a hospital, orii.the patient takes treatment at home on account of non-availabilityof room in a hospital.11.Grace PeriodGrace period means the specified period of time immediatelyii.has at least 10 in-patient beds in towns having a population of lessthan 10,00,000 and at least 15 in-patient beds in all other places;iii.has qualified medical practitioner(s) in charge round the clock;iv.has a fully equipped operation theatre of its own where surgicalprocedures are carried out;v.maintains daily records of patients and makes these accessibleto the insurance company’s authorized personnel;13.14.a.b.i.has qualified nursing staff under its employment round the clock;Acute conditionAcute condition is a disease, illness or injury that is likely to respondquickly to treatment which aims to return the person to his or herstate of health immediately before suffering the disease/ illness/injury which leads to full recoveryChronic conditionA chronic condition is defined as a disease, illness, or injury thathas one or more of the following characteristics:i. it needs ongoing or long-term monitoring throughconsultations, examinations, check- ups, and /or testsii. it needs ongoing or long-term control or relief of symptomsiii. it requires rehabilitation for the patient or for the patient tobe specially trained to cope with itiv. it continues indefinitelyv. it recurs or is likely to recur15.InjuryInjury means accidental physical bodily harm excluding illnessor disease solely and directly caused by external, violent, visibleand evident means which is verified and certified by a MedicalPractitioner.16.Inpatient CareInpatient care means treatment for which the insured personhas to stay in a hospital for more than 24 hours for a coveredevent.17.Medical AdviceMedical Advice means any consultation or advice from a MedicalPractitioner including the issuance of any prescription or followup prescription.18.Medical Expenses:Medical Expenses means those expenses that an InsuredPerson has necessarily and actually incurred for medicaltreatment on account of Illness or Accident on the advice of aMedical Practitioner, as long as these are no more than wouldhave been payable if the Insured Person had not been insuredand no more than other hospitals or doctors in the same localitywould have charged for the same medical treatment.HospitalA hospital means any institution established for in-patient careand day care treatment of illness and/or injuries and which hasbeen registered as a hospital with the local authorities underClinical Establishments (Registration and Regulation) Act 2010 orunder enactments specified under the Schedule of Section 56(1)and the said act Or complies with all minimum criteria as under:IllnessIllness means a sickness or a disease or pathological conditionleading to the impairment of normal physiological function andrequires medical treatment.following the premium due date during which a payment canbe made to renew or continue a policy in force without loss ofcontinuity benefits such as waiting periods and coverage of preexisting diseases. Coverage is not available for the period forwhich no premium is received.12.HospitalizationHospitalization means admission in a Hospital for a minimumperiod of 24 consecutive ‘In- patient Care’ hours except forspecified procedures/ treatments, where such admission couldbe for a period of less than 24 consecutive hours.19.Medical PractitionerMedical Practitioner means a person who holds a validregistration from the Medical Council of any State or MedicalCouncil of India or Council for Indian Medicine or for Homeopathyset up by the Government of India or a State Government and isthereby entitled to practice medicine within its jurisdiction; andis acting within its scope and jurisdiction of license.Regd Office: 15th Floor, Tower A, Peninsula Business Park, G. K. Marg, Lower Parel, Mumbai - 400 013 Toll Free No. (24x7): 1800 266 7780 Fax: 022 6693 8170 Email: [email protected] IRDA of India Registration No: 108 website: www.tataaig.comCIN: U85110MH2000PLC128425 UIN: TATHLIP18004V011819

Tata AIG General Insurance Company Limited20.Medically Necessary Treatmentspecific provider and consistent with the prevailing charges inthe geographical area for identical or similar services, taking intoaccount the nature of the illness/ injury involved.Medically necessary treatment means any treatment, tests,medication, or stay in hospital or part of a stay in hospital which:i.is required for the medical management of the illness or injurysuffered by the insured;ii.must not exceed the level of care necessary to provide safe,adequate and appropriate medical care in scope, duration, orintensity;iii.must have been prescribed by a medical practitioner;iv.must conform to the professional standards widely accepted ininternational medical practice or by the medical community in India.21.Network ProviderNetwork Provider means hospitals or health care providersenlisted by an insurer, TPA or jointly by an Insurer and TPA toprovide medical services to an insured by a cashless facility.22.OPD treatmentOPD treatment means the one in which the Insured visits aclinic / hospital or associated facility like a consultation roomfor diagnosis and treatment based on the advice of a MedicalPractitioner. The Insured is not admitted as a day care or inpatient.23.Pre-Existing DiseasePre-Existing Disease means any condition, ailment or injury orrelated condition(s) for which there were signs or symptoms,and / or were diagnosed, and / or for which medical advice /treatment was received within 48 months prior to the first policyissued by the insurer and renewed continuously thereafter.24.Pre-hospitalization Medical ExpensesPre-hospitalization Medical Expenses means medical expensesincurred during predefined number of days preceding thehospitalization of the Insured Person, provided that:i.Such Medical Expenses are incurred for the same condition forwhich the Insured Person’s Hospitalization was required, andii.The In-patient Hospitalization claim for such Hospitalization isadmissible by the Insurance Company.25.Post-hospitalization Medical ExpensesPost-hospitalization Medical Expenses means medical expensesincurred during predefined number of days immediately afterthe insured person is discharged from the hospital providedthat:i.Such Medical Expenses are for the same condition for which theinsured person’s hospitalization was required, andii.The inpatient hospitalization claim for such hospitalization isadmissible by the insurance company.26.Qualified NurseQualified nurse means a person who holds a valid registrationfrom the Nursing Council of India or the Nursing Council of anystate in India.28.30.Reasonable and Customary ChargesReasonable and Customary charges means the charges forservices or supplies, which are the standard charges for theRenewalRoom RentRoom Rent means the amount charged by a Hospital towards Roomand Boarding expenses and shall include the associated medicalexpenses.31.Shared AccommodationShared Accommodation means a hospital room with two or morepatient beds. This definition does not apply to ICU or ICCU.32.Surgery or Surgical ProcedureSurgery or Surgical Procedure means manual and / or operativeprocedure (s) required for treatment of an illness or injury,correction of deformities and defects, diagnosis and cure ofdiseases, relief from suffering and prolongation of life, performedin a hospital or day care centre by a medical practitioner.33.Unproven/Experimental treatmentUnproven/Experimental treatment means the treatmentincluding drug experimental therapy which is not based onestablished medical practice in India, is treatment experimentalor unproven.34.AgeMeans the completed age of the Insured Person on his / hermost recent birthday as per the English calendar, regardless ofthe actual time of birth.Section 3 – General ExclusionsWe will not make any payment for any claim in respect of anyInsured Person directly or indirectly for, caused by, arising fromor in any way attributable to any of the following unless expresslystated to the contrary in this Policy.1.Exclusions with waiting periodsi.We are not liable for any claim arising due to a condition for whichappearance of signs/symptoms, consultation, investigation,treatment or admission started within 30 days from policycommencement date except claims arising due to an accident.In case of renewals, this waiting period shall not be applicable tothe extent of sum insured under the previous policy in force. Ifany illness/procedure is specifically covered after a period of twoyears (under ii) the 30 day waiting period is superseded by thetwo year waiting period.ii.A waiting period of 24 months from the first policycommencement date will be applicable to the medical andsurgical treatment of illnesses, disease, or surgical proceduresmentioned below, unless necessitated due to cancer:PortabilityPortability means the right accorded to an individual healthinsurance policyholder (including family cover) to transfer thecredit gained by the insured for pre-existing conditions and timebound exclusions if the policyholder chooses to switch fromone insurer to another insurer or from one plan to anotherplan of the same insurer, provided the previous policy has beenmaintained without any break.27.29.Renewal means the terms on which the contract of insurancecan be renewed on mutual consent with a provision of graceperiod for treating the renewal continuous for the purpose ofgaining credit for pre-existing diseases, time-bound exclusionsand for all waiting periods.The following Illnesses/diseases would be covered after a waitingperiod of two years irrespective of the treatment undergone,medical or surgical:a. Tumors, Cysts, polyps including breast lumps (benign)b. Polycystic ovarian diseasec. Fibromyomad. Adenomyosise. Endometriosisf. Prolapsed UterusRegd Office: 15th Floor, Tower A, Peninsula Business Park, G. K. Marg, Lower Parel, Mumbai - 400 013 Toll Free No. (24x7): 1800 266 7780 Fax: 022 6693 8170 Email: [email protected] IRDA of India Registration No: 108 website: www.tataaig.comCIN: U85110MH2000PLC128425 UIN: TATHLIP18004V011819

Tata AIG General Insurance Company Limitedi.“AIDS” (Acquired Immune Deficiency Syndrome) and/or infectionwith HIV (Human immunodeficiency virus) including but notlimited to conditions related to or arising out of HIV/AIDS suchas ARC (AIDS related complex), Lymphomas in brain, Kaposi’ssarcoma, tuberculosis.ii.The abuse or the consequences of the abuse of intoxicantsor hallucinogenic substances such as intoxicating drugsand alco

per policy. The limit is the maximum per policy and more than one insured can utilize the amount. The benefit is payable after every two continuous claim free policy years with us. This benefit has a separate limit (over and above base sum insured) and do