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Baroda Uttar PradeshGramin Bank
HO/l 2/Refe rraU20l9 -20 I 2X Date: 10-05-2019
CIRCULAR TO ALLBRANCHES/REGIONAL OFFICES
Dear Sir,
Re: Groun Hosoital Cash Product from Tata AIG General Insurance Co. Ltd. for Rank'sCustomers
We are happy to inform that for the Bank's customers a new product from Tata AIG General
Insurance Co. Ltd. is being launched - Group Hospital Cash. This product can be availed only bythe customers of our bank provided they qualify the age criteria. The premium should be remittedthrough GENINS menu only.
This product is a family floater plan which covers upto 4 members of the family. The premium rates
and entry age arc mentioned as under:
Family plan for 4 members (Self,
spouse &, up to 2 dependentchildren)
Age (Years) Age (Years) Age (Years)
i 8-5s 56-65 >65 lRenewal)
Premium with GST (Rs.)(Age of the eldest member to be
considered)
2,625 4,725 5,670
Minimum entry age: 18 years for adults, 91days for dependent children.
Maximum entry age: 65 years for adults, 25 years for dependent children.
Customers above 65 years may renew the policy if taken before attarning age of 65 years.
The salient features and terms & conditions of the product are as under:
S.No. Covers/Features Details
Inpatient treatment hospital cash ofRs. 2000 per day for 30 days in apolicy year on hospitalization
No. of days would float amongst the familymembers (can be claimed multiple times amongthe family members for a total of maximum 30days in a policy year)
2Deductibles on Inpatient treatmenthospital cash
1 day per Hospitalisation (e.g. if hospitalizedfor 3
days then inpatient treatment hospital cash will be
siven only for 2 days i.e.2*2000: Rs. 4000)
aJ 30 days waiting period
Applicable for sickness only(Accidents covered from day 1)
4
Personal Accident(Accidental Death & PermanentTotal Disability)
Sum Insured of Rs. 5 Lakhs(Applicable to self only in case of floater)
5 Pre-existing diseasesCovered from day 7 after 30 days waiting period(i.e 31't day onwards since start of risk/policy)
6 Specified diseases waiting periodCovered from day 1 after 30 days waiting period(i.e 31't day onwards since start of risk/policy)
7
EMI protection(Applicable to self only in case offloater)
Hospitalisation for 10-15 days - 1 EMI upto Rs.
5000.Hospitalisation for more than 15 days - 1 moreEMI upto Rs. 5000.
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The detailed presentation from Tata AIG General Insurance Co. Ltd., claim form and list ofspecified diseases arc attached for your reference.
Yours faithfully,
(Jitendra Kumar)Generalffiaser
Encl: As above
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Tata AIGGroup Hospital Cash
Group Hospital Cash covers
Product USPs
• Accidental Death & PTD coverage for 5 Lacs
• EMI Payment in case of hospitalization
• Accidents covered from day 1
• Claims directly processed & settled by TataAIG Inhouse team
• Coverage for the entire family
• No pre-policy medical tests required
• Policy issuance at T+3
• Pre-existing diseases covered after 30 days
Product Features
• Inpatient benefit – after 24 hours of hospitalization
Base Cover
• Accidental Death (for Self)
•Permanent Total Disability (for self)
• 1 day deductible per hospitalisation
Waiting Period•Day 1 coverage in case of accident•30 days waiting period applicable for sickness • 31st day onwards coverage for PED & Disease specific
• EMI Protection Benefit
•Permanent Total Disability (for self)
Product Benefits
• Inpatient benefit of Rs. 2000 per day for 30 days
• Accidental Death & PTD coverage for 5 Lacs
EMI Protection Benefit• Hospitalization for 10 -15 days – 1 EMI upto Rs.5000• Hospitalization for >15 days – 1 more EMI upto Rs.5000
• Inpatient Hospital Cash Benefit :• Minimum 24hrs of continuous hospitalization• Rs. 2000 per day for 30 days in a policy year• 50% in case where 24hrs of hospitalization have been completed and on the dayof discharge, insured person is discharged before completion of 24hrs. Illustrationgiven below• Insured can claim multiple times in a policy year upto a maximum of 30 days i.e.
Illustration
• Insured can claim multiple times in a policy year upto a maximum of 30 days i.e.cumulative of all hospitalizations in a policy year
Date of admission
Time of admission
Date of Discharge
Time of Discharge
Benefit amount payable Rationale
1-Jan-19 10:00 AM 5-Jan-19 9:59 AM Rs.6,000Rs.2000 X
3=Rs.6,000
1-Jan-19 10:00 AM 3-Jan-19 11:00 AM Rs.3000
Rs. 2000 for 1 day; Rs.1000 even for additional 1 hour
1-Jan-19 10:00 AM 1-Jan-19 6:00 PM 0
As 24 hours hospitalization is not
completed
Eligibility
Customer Segments
Existing & New Customers of Bank
Minimum Entry age: 18 yearsMaximum Entry age: 65 yearsChildren: 91 days-25 years
AgeChildren: 91 days-25 years
1 yearTerm
No. of Days 30 days (no. of days would float amongst the family members)
Floater- Self/Spouse/Upto 2 dependent childrenPlan Type
1 day per hospitalisationDeductible
Rs. 2000 per day Benefit Sum
Insured
Claim Documentation
a. Claim formb. Claim documents required in case of:
Inpatient hospitalization benefit:i. Original Discharge summaryii. All medical reports, case histories, investigation reports, indoor case
papers/ treatment papers, if availablepapers/ treatment papers, if availableiii.Treating doctor’s certificate regarding missing information in case
histories e.g. Circumstance of injury and Alcohol or drug influence atthe time of accident, if applicable
iv.Copy of MLC (Medico legal case) records, if carried out and FIR (Firstinformation report) if registered, in case of claims arising out of anaccident and available with the claimant.
Claim Documentation
Accidental Death :i. Original \Attested copy of Death Certificateii. In the event of disappearance where death certificate is not
issued, we would require missing compliant report filed with thepolice authorities or police inquest/ investigation report.police authorities or police inquest/ investigation report.
iii.Copy of death summary, all previous medical records, ifhospitalised / treatment given.
iv.Legal heir/succession certificate , if requiredv. PM report (wherever applicable and conducted)
PTD:i. Certificate from Civil Surgeon or Medical Superintendent/Dean of
government hospital/medical board, confirming the Disabilitypercentage / period and prognosis
Claim Documentation
Hospital has to be a registered hospital or government hospital(including primary health centre)
Apart from above mentioned claims documents, we would requiredocuments as laid down by Regulation (as amended from time totime), currently mandatory NEFT (to enable direct credit of claimtime), currently mandatory NEFT (to enable direct credit of claimamount in bank account) and KYC (recent ID/Address proof andphotograph) requirements
Claim Servicing
Claims settlement would be directly done by TATA AIG inhouse claimsprocessing unit and on reimbursement basis
Hospital has to be a registered hospital or government hospital(including primary health centre)
Documents to be sent to: Documents to be sent to:Accident & Health Claims Department (Group Hospital Cash policy)Tata-AIG General Insurance Co. Ltd.A-501,5th Floor, Bldg No -4, Infinity Park,Dindoshi, Malad (E)Mumbai 400 097
Toll Free No.: 1800 266 7780/ For Senior Citizens: 1800 22 9966 Website : www.tataaig.com
Premium Details
Per Family Rates
18-55 56-65 >65 upto 4 members
Premium With GST (Rs.) 2,625 4,725 5,670
• Premium rates are for 1 year policy term• Age of the eldest member to be considered for premium computation e.g.
o Age of Self – 45 yearso Age of Spouse – 56 yearso Premium as per chart would be Rs.4725
Issuance Process
TATA AIG Business team will approach the customer (who has bank a/c in BUPGB) and explain the Product features
Customer
BUPGB branch manager will credit Tagic bank a/c through Tagic Menu only as per quotation and take debit mandate from Customer to debit his a/c.
Customer Agree
Customer will sign the enrollment form as per quotation shared by business team
Sales team will give acknowledgement copy to Customer and enter the Transaction ID on enrollment form /acknowledgement copy
Receipting at Tata AIG and Policy certificate will be issued post transaction ID verified by Banking ops from RPT file and bank statement shared by bank on daily basis however risk cover will start on and after fund received date.
Cancellation and Refund
• Cancellation & Refund request can be received from customer directly at TAGIC branches / customer service or at Partner branches.
• Partner can share the request to TATA AIG on [email protected]• TAT for cancellation and refund is 7 days from date of request with complete
details received at TATA AIG• All cancellation requests received, refund shall be processed as per product
T & C and third party guidelines.T & C and third party guidelines.• Refund shall be done in favor of insured back into the source account from
where the premium was received
• Customer ServiceIn the event of loss or for any service related queries customers should contact TATA AIG General Insurance through the below mentioned option:-
• Toll Free – 1800-266-7780• Tolled – 022-66939500• E-mail: [email protected]
Terms and conditions
1In addition to the conditions mentioned above, all the terms, conditions and
exclusions will be as per the Tata AIG Group Hospital Cash Policy Wording.
2
Quote is liable to change with change in information, specifically but not limited
to the given demography as per the aforesaid table. If the age demographic
distribution of the insurable population changes, the quote will have to be2
distribution of the insurable population changes, the quote will have to be
revised.
3In case of deletion of account holders, pro-rata refund to be done subject to nil
claims.
4Age of Primary insured/Adult insured person should be above 18 years. In case of
dependent children, entry age is from 91 days.
6 Claims would be serviced by directly by Tata AIG General Insurance Co. Ltd
Thank YouThank You
Specified Diseases & Treatment
The following Illnesses/diseases would be covered after a waiting period as specified in the
policy schedule/Certificate of Insurance irrespective of the treatment undergone, medical or
surgical:
a. Tumors, Cysts, polyps including breast lumps (benign)
b. Polycystic ovarian disease
c. Fibromyoma
d. Adenomyosis
e. Endometriosis
f. Prolapsed Uterus
g. Non-infective arthritis
h. Gout and Rheumatism
i. Osteoporosis
j. Ligament, Tendon or Meniscal tear (due to injury or otherwise)
k. Prolapsed Inter Vertebral Disc (due to injury or otherwise)
l. Cholelithiasis
m. Pancreatitis
n. Fissure/fistula in anus, haemorrhoids, pilonidal sinus
o. Ulcer & erosion of stomach & duodenum
p. Gastro Esophageal Reflux Disorder (GERD)
q. Liver Cirrhosis
r. Perineal Abscesses
s. Perianal / Anal Abscesses
t. Calculus diseases of Urogenital system Example: Kidney stone, Urinary bladder stone.
u. Benign Hyperplasia of prostate
v. Varicocele
w. Cataract
x. Retinal detachment
y. Glaucoma
z. Congenital Internal Diseases
The following treatments are covered after a waiting period as specified in the policy
schedule/Certificate of Insurance irrespective of the illness for which it is done:
a. Adenoidectomy
b. Mastoidectomy
c. Tonsillectomy
d. Tympanoplasty
e. Surgery for nasal septum deviation
f. Nasal concha resection
g. Surgery for Turbinate hypertrophy
h. Hysterectomy
i. Joint replacement surgeries Eg: Knee replacement, Hip replacement
j. Cholecystectomy
k. Hernioplasty or Herniorraphy
l. Surgery/procedure for Benign prostate enlargement
m. Surgery for Hydrocele/ Rectocele
n. Surgery of varicose veins and varicose ulcers
1 Group Hospital Cash – Claim Form Tata AIG General Insurance Company Limited
24x7 Toll Free - 1800 266 77 80 E-mail - [email protected] Website -www.tataaig.com
To be filled in by the insured
The issue of this Form is not to be taken in as admission of liability (To be filled in block letters)
a) Policy No.:
b) Sl. No. Certification No.:
d) Name: m
e) Address
a) Currently covered by any other Mediclaim/Health Insurance: Yes No
b) Date of commencement of first insurance without break:
c) If yes, Company Name
d) Have you been hospitalized in the last four years since inception of the contract? Yes No
Date: Diagnosis:
e) Previously covered by any other Mediclaim/Health Insurance Yes No
f) If yes, Company Name:
Name: m
Gender:
d) Date of Birth:
e) Relationship to Self Spouse Child Father
Primary Insured: Mother Other (Please Specify)
f) Occupation: Service Self Employed Homemaker Student
Retired Other (Please Specify)
g) Address
(if different from above)
a) Name of Hospital
where Admitted:
b) Room Category occupied: Day Care Single occupancy Twin sharing 3 or more beds per room
c) Hospitalizaton due to: Injury Illness Maternity
d) Date of injury/Date Disease first detected/Date of Delivery:
e) Date of Admission:
Group Hospital Cash Claim Form
DETAILS OF PRIMARY INSURED
DETAILS OF INSURANCE HISTORY
DETAILS OF INSURED PERSON HOSPITALIZED
DETAILS OF HOSPITALIZATION
M M
c) Company TPA ID No.:
Surn ame F irst nam e Mi ddle na e
City:
State:
Phone No.:
PIN:
Email ID:
D D M M Y Y Y Y
Policy No.:
Sum Insured (Rs.):
D D M M Y Y Y Y
Surn ame First nam e Mi ddle na e
Male Female c) Age: Years Y Y Months M M
D D M M Y Y Y Y
City:
State:
Phone No.:
PIN:
Email ID:
D D M M Y Y Y Y
f) Time: H H
D D M M Y Y Y Y
2 Group Hospital Cash – Claim Form Tata AIG General Insurance Company Limited
24x7 Toll Free - 1800 266 77 80 E-mail - [email protected] Website -www.tataaig.com
Date of Discharge: h) Time:
i) If Injury give cause: Self Inflicted Road Traffic Accident Substance Abuse/Alcohol Consumption
i) If Medico legal: Yes No ii) Reported to police: Yes No
iii) MLC Report & Police FIR attached: Yes No
j) System of Medicine:
Daily Hospital Cash Benefit claimed: ____________________
CLAIM DOCUMENTS SUBMITTED-CHECK LIST
Claim Form duly signed Copy of the claim intimation, if any
Hospital Main Bill Hospital Break-up Bill
ECG
Investigation Reports (Including CT/MRI/USG/HPE)
Doctors Prescription
Hospital Discharge Summary
Operation Theatre Notes
Doctor’s request for investigation
a) PAN:
c) Bank Name and Branch:
d) Cheque/DD Payable details:
I hereby declare that the information furnished in this Claim From is true & correct to the best of my knowledge and belief. If I have made any false or
untrue statement, suppression or concealment of any material fact with respect to questions asked in relation to this claim, my right to claim
reimbursement shall be forfeited. I also consent & authorize TPA/insurance company, to seek necessary medical information/documents from any
hospital/Medical Practitioner who has attended on the person against whom this claim is made. I hereby declare that I have included all the bills/
receipts for the purpose of this claim & that I will not be making any supplementary claim except the pre/post-hospitalization claim, if any.
Date:
Place: Signature of the Insured
DETAILS OF PRIMARY INSURED BANK ACCOUNT
DETAILS OF CLAIM
DECLARATION BY THE INSURED
H H M M D D M M Y Y Y Y
b) Account Number:
e) IFSC Code:
3 Group Hospital Cash – Claim Form Tata AIG General Insurance Company Limited
24x7 Toll Free - 1800 266 77 80 E-mail - [email protected] Website -www.tataaig.com
CHECK LIST OF ENCLOSURES FOR SUBMISSION OF CLAIM
Duly filled and signed Re-imbursement Form.
Original payment Receipt of the hospital bill.
CHECK LIST OF ENCLOSURES FOR SUBMISSION OF CLAIM
Note:
1. When original bills, receipts, prescriptions, reports and other documents are submitted to the other insurer or to the reimbursement provider, verified photocopies attested by such other organization/provider have to be submitted.
2. If original bills, receipts, prescriptions, reports and other documents are submitted to Us and Insured Person requires same for claiming from other organization/provider, then on request from the Insured Person We will provide attested copies of the bills and other documents submitted by the Insured Person.
In-patient Treatment /Day Care Procedures
Duly filled and signed Claim Form.
Photocopy of ID card / Photocopy of current year policy.
Original Detailed Discharge Summary with date of admission & discharge, clinical history, past history / procedure details/ Day care summary from the hospital.
Original consolidated hospital bill with break - up of each Item, duly signed by the insured.
Original payment Receipt of the hospital bill.
First Consultation letter and subsequent Prescriptions.
Original bills, original payment receipts and Reports for investigation.
Original medicine bills and receipts with corresponding Prescriptions.
Original invoice/Sticker of implants/bills for Implants (viz. Stent /PHS Mesh/ IOL etc.) with original payment receipts.
Road Traffic Accident
In addition to the In-patient Treatment documents:
Copy of the First Information Report from Police Department / Copy of the Medico-Legal Certificate. In Non Medico
legal cases
Treating Doctor's Certificate giving details of injuries (How, when and where injury sustained) In Accidental
Death cases
Copy of Post Mortem Report & Death Certificate ( If conducted)
For Death Cases
In addition to the In-patient Treatment documents:
Original Death Summary from the hospital.
Copy of the Death certificate from treating doctor or the hospital authority.
Copy of the Legal heir certificate, if the claim is for the death of the principle insured.
Pre and Post-hospitalisation expenses
Duly filled and signed Claim Form.
Photocopy of ID card / Photocopy of current year policy.
Original Medicine bills, original payment receipt with prescriptions.
Original Investigations bills, original payment receipt with prescriptions and report.
Original Consultation bills, original payment receipt with prescription.
Copy of the Discharge Summary of the main claim.
Organ Donation/Transplantation
In addition to the documents of general hospitalization
Organ Function test / blood test proving organ failure.
Treatment Certificate issued by the Transplant Surgeon of the hospital concerned.
Ambulance Benefit
Duly filled and signed Claim Form.
Photocopy of ID card / Photocopy of current year policy.
Original Bill with Original Payment Receipt.
Treating Doctor's consultation prescription indicating Emergency Hospitalization.
4 Group Hospital Cash – Claim Form Tata AIG General Insurance Company Limited
24x7 Toll Free - 1800 266 77 80 E-mail - [email protected] Website -www.tataaig.com
Customer Identification Procedure (as per KYC norms of IRDA)
Please submit the following documents in case of claim amount exceeds Rs. 100,000
Legal name and any other names used (Any one of the mentioned documents)
Proof of Residence (Any one of the mentioned documents)
Passport/ PAN Card/ Voter’s Identity Card/ Driving License/ Letter from a recognized public authority or public servant verifying the identity and residence of the customer
Telephone bill/ Bank account statement/ Letter from any recognized public authority/ Electricity bill/ Ration card