2. 2
HEALTH
INSURANCE
Base health insurance policy which covers
hospitalization expenses as per plan.
AGGREGATE
DEDUCTIBLE
All claims under the policy benefits shall be payable only if the
aggregate of covered medical expenses, in respect to
hospitalizations in a policy year is in excess of deductible
specified in policy schedule. In case of family floater policy, the
deductible shall be per policy per year and in case of individual
policy, the deductible shall be per insured person per year.
Group Medicare
360
Aggregate
Deductible
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How Aggregate Deductible plan works
Sum Insured Deductible Claim 1 Claim 2 Claim 3 Payable 1 Payable 2 Payable 3
15,00,000 3,00,000 1,00,000 50,000 2,00,000 - - 50,000
15,00,000 3,00,000 2,00,000 2,00,000 5,00,000 - 1,00,000 5,00,000
15,00,000 3,00,000 3,50,000 4,00,000 6,00,000 50,000 4,00,000 5,50,000
an 1 year deductible will be applicable on per policy year basis.
Aggregate of all admissible claims should cross deducible amount
Admissible claim amount will be calculated on basis of Group Medicare 360 terms and conditions
In case of floater policy, deductible amount floats over all insured members and at the time of claim, total of all claims
in the policy period will be considered for computation of claim amount payable under Group Medicare 360 .
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How Deductible works
4
All claims under the policy benefits shall be payable
only if the aggregate of covered medical expenses,
in respect to hospitalizations in a policy year is in
excess of deductible specified in policy schedule. In
case of family floater policy, the deductible shall be
per policy per year and in case of individual policy,
the deductible shall be per insured person per year.
E.g.: Mr. ABC has taken Group Medicare 360 with
deductible of Rs. 3 Lakhs. He meets with a medical
expense of Rs. 7 Lakhs.
Customer pays
Rs. 3 Lakhs deductible
Company pays the remaining
Rs. 4 Lakhs
1 2
3 4 5
HEALTH EXPENSES(INLAKHS)
6 7
Note: Admissible amount for all claims in a policy year should cross the deductible amount
HEALTH EXPENSES(IN LAKHS)
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TOP UP – GROUP MEDICARE
Sum Insured: ₹ 15 lacs / 20 lacs / 25 lacs
Aggregate Deductible : ₹ 3 lacs Deductible
Child Age : 91-25 Years
Adult Age : 19-60 Years
Self + Spouse +
up to 2dependent Children's
NTB OPPORTUNITY
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In-Patient Treatment
Covers expenses for hospitalization due to disease/illness/Injury during the policy
period that requires an Insured Person’s admission in a hospital as an inpatient.
Medical expenses directly related to the hospitalization would be payable. For e.g.:
› Room Rent, boarding expenses
› Nursing
› Intensive Care Unit charges
› Medical practitioner
› Anaesthesia, Blood, Oxygen
› Operation theatre charges
› Surgical appliances
› Medicines, drugs and
consumables
› Diagnostic procedures
› Cost of prosthetic
› Any other devices or equipment
implanted internally
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Pre-Hospitalization
expenses
Cover for expenses for Pre-
Hospitalization consultations,
investigations and medicines
incurred up to 60 days before
the date of admission to the
hospital.
Post-Hospitalization
expenses
Cover for expenses for Post-
Hospitalization consultations,
investigations and medicines
incurred up to 90 days after
discharge from the hospital.
Day Care
Procedures
Cover expenses for listed 541
Day Care Treatment due to
disease/illness/Injury during
the policy period taken at a
hospital or a Day Care Centre.
The list of such day care
procedures covered is
available on www.tataaig.com.
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Critical Illness
15 Listed Critical Illnesses covered.
Incase of CI related hospitalization, the base SUM INSURED doubles
No additional waiting period to avail this benefit apart from the standard
waiting period in the base product
This is an in-built feature in the plan with no additional premium
15 Named Critical Illnesses
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Organ
Donor
The Medical and surgical
expenses of the organ donor
for harvesting the organ where
an insured person is the
recipient.
Covers inpatient medical
expenses incurred for the
donor for harvesting the organ.
Ambulance
Cover
Cover for expenses incurred
on transportation of Insured
Person 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 Rs. 1000
per Hospitalization.
Family Transportation
Expenses incurred by any
immediate family member of the
insured on making travel
arrangements to meet the insured
person.
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Accidental Death Benefit
If primary member (Self) suffers an accident during the policy period and this is the sole and
direct cause of insured’s death within 365 days from the date of accident, then product pays a
fixed amount of 100% of the base Sum Insured.
This Sum Insured is over an above the base Sum Insured
This is an in-built feature in the plan with no additional premium
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Wellness Reservices
Will be shared once Tech is ready- also same has to be avail Tata AIG App). Also Same will be
available till offer is available and Same is applicable for renewal.
• Diagnostic Discounts:- 30%
• Medicine Delivery: 15% and home delivery
• Health Checkup :- 40% discount
• Teleconsultation general
• Teleconsultation Specialist
• Health Risk Assessment
• Complimentary annual health check up- 61 Test (As per define list) worth of Rs 1800.
(Has to be book via TAGIC app)
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Room Rent, ICU, Disease
wise sub-limit
› Single Private Room across Sum Insured
› No restriction on ICU admissions
› No disease wise sub limit
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Unique Selling Points
Inbuilt Accidental Death Benefit
Double SI indemnity cover in case of
hospitalization incurred due to listed CI.
Room Rent, ICU, Disease wise sub-limit
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Initial Waiting
Period
30 days will be applicable.
Pre-existing
Disease
24 months will be
applicable.
Specific Waiting
Period
24 months waiting period will be
applicable for illnesses/diseases
specified in the policy.
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Deductible Amount: 3Lac
Premium Table
(Annual) Per Person Rates (Rs.)(Exclusive of taxes)
Rs 15 lac/ 3 Lac Deductible
Age band 19-35 36-45 46-55 56-60
1A 1,349 1,893 3,195 4,793
2A 1,991 2,793 4,714 7,073
2A+2C 3,189 4,473 7,550 11,328
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Deductible Amount: 3Lac
Premium Table
(Annual) Per Person Rates (Rs.)(Exclusive of taxes)
Rs 20 lac/ 3 Lac Deductible
Age band 19-35 36-45 46-55 56-60
1A 1,720 2,412 4,072 6,109
2A 2,528 3,545 5,985 8,979
2A+2C 4,036 5,660 9,555 14,336
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Deductible Amount: 3Lac
Premium Table
(Annual) Per Person Rates (Rs.)(Exclusive of taxes)
Rs 25 lac/ 3 Lac Deductible
Age band 19-35 36-45 46-55 56-60
1A 2,091 2,932 4,950 7,426
2A 3,065 4,299 7,257 10,887
2A+2C 4,884 6,850 11,563 17,348
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Case Study1
Cashless
Service
Mr. Vishal Sinha, 38 years old, owned a grocery shop in Patna. His family included his wife
and two children. He earns around 50k per month. He has taken Term Insurance of 1
Crore to protect his family from any unseen circumstances. He leads a healthy life.
Mr. Sanjay opened a shop next to Mr. Vishal’s. One day, Mr. Sanjay met with a massive
accident on the way to his shop. He was rushed to JKL Hospital’s Emergency ward,
where the Medical team had to perform immediate Surgery. The hospital asked his family
to deposit `5 Lakhs immediately. Family members and friends of Mr. Sanjay arranged the
money by borrowing from lenders, post which the surgery was performed.
It took Mr. Sanjay almost 2 months to recover, making up to `23 Lakhs in Medical Bills.
This put Mr. Sanjay and family in a huge debt.
This scenario forced Mr. Vishal to think about Cashless Health Insurance with a high cover
for any
unforeseen situation.
Suggesta plan Mr. Vishalshouldopt to resolvehisconcern.
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Case Study 2
Insufficient
Cover
Mr. Mishra has taken a Health Insurance Policy of `5 Lakhs from Tata AIG
(Medicare). He now wants to increase the Sum Insured as he feels that the
cover is insufficient for his family, which includes his wife and 2 children. But
due to the recent market crisis he becomes hesitant in spending money.
Suggest a suitable plan to Mr. Mishra.
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