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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



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:



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



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



Original Bill with Original Payment Receipt.

Treating Doctor's consultation prescription indicating Emergency Hospitalization.



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

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Documents

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