AROGYA SANJEEVANI INSURANCE POLICY TATA AIG GENERAL INSURANCE COMPANY LTD
This Policy is a contract of insurance issued by TATA AIG General Insurance Company Ltd (hereinaf ter called the ‘Company’) to the
proposer mentioned in the Schedule (hereinafter called the ‘Insured’) to cover the person(s)named in the Schedule (here inafter called the ‘Insured Persons’). The policy is based on the statements and declaration provided in the proposal
INSURANCE Operative Clause
If during the Policy Period one or more Insured Person(s) is required to be hospitalized for treatment of an Illness or Injury at a Hospital / Day Care Centre, following Medical Advice of a duly qualified Medical Practitioner, the Company shall indemnify Medically Necessary, expenses towards the Coverage mentioned in the Policy Schedule.Provided further that, any amount payable under the policy shall be subject to the terms of coverage (including any co-pay, sub limits), exclusions, conditions and definition contained herein.Maximum liability of the Company under all such Claims during each Policy Year shall be Sum Insured (Individual or Floater)opted and Cumulative Bonus (if any) specified in the Schedule
The terms defined below and at other junctures in the Policy have the meanings ascribed to them wherever they appear in this Policy and, where, the context so requires, references to the singular include references to the plural; references to the male includes the female and references to any statutory enactment includes subsequent changes to the same
INSURANCE Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.
INSURANCE Age means age of the Insured person on last birthday as on date
of commencement of the Policy.
INSURANCE Break in Policy means the period of gap that occurs at the end of the existing policy term, when the premium due for renewal on a given policy is not paid on or before the premium renewal date or within 30 days thereof
INSURANCE Cashless Facility means a facility extended by the insurer to the insured where the payments, of the costs of treatment undergone by the insured person in accordance with the Policy terms and conditions, are directly made to the network provider by the insurer to the extent pre-authorization is approved.
INSURANCE Co-payment means a cost sharing requirement under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible claims amount. A co-payment does not reduce the Sum Insured.
INSURANCE Dental Treatment means a treatment carried out by a dental practitioner including examinations, fillings (where appropriate), crowns, extractions and surgery.
INSURANCE ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses on a per day basis which shall include the expenses for ICU bed, general medical support services provided to any ICU patient including monitoring devices, critical care nursing and intensivist charges.
INSURANCE Medical Expenses means those expenses that an insured person has necessarily and actually incurred for medical treatment on account of illness or accident on the advice of a medical practitioner, as long as these are no more than would have been payable if the insured person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.
INSURANCE Policy year means a period of twelve months beginning from the date of commencement of the policy period and ending on the last day of such twelve-month period. For the purpose of subsequent years, policy year shall mean a period of twelve months commencing from the end of the previous policy year and lapsing on the last day of such twelve-month period, till the policy period, as mentioned in the schedule