Group Medicare

Certificate of Insurance
New Business-0239862484-50001287-TRACKON-1-4094181
Intermediary Name : MUTHOOT FINCORP
Issuing Office : CORP OFFICE
Name of the Policy Holder (Master Policy) : MUTHOOT FINCORP LTD LIMITED
Intermediary Code : CA1017
Name of Insured Person : MR M REVANTH REDDY
Intermediary Contact No : 4712331560
Address : C/O M MADHU SUDANA REDDY, 304
3RD FLOOR, GENIUS SWARNA APARTMENTS, JAI
HIND GANDHI ROAD, CYBER HILLS COLONY, JAI
HIND ENCLAVE, MADHAPUR, BEHIND SEASONS Branch Code : 90900
SWIMMING POOL, MADHAPUR, MADHAPUR, K.V.
RANGAREDDY, TELANGANA, 500081 Business Type : New Business
HYDERABAD GSTIN No :
Master Policy No : 0239862484
Renewal No: 00
Endorsement No: 00
Certificate No : 50001287
Insured Person ID : 177804250002823
Place of Supply : TELANGANA
State Code : 36
Contact details of Insured Person :
• Phone/Mobile No.: 9398074360 • Email id :
Certificate Period : From 00:01 Hrs 10/04/2025 (Commencement date) To 23:59 Hrs 09/04/2026 (Expiry Date)
Date of First Policy inception with us : 10/04/2025
Type of Plan
Details : Individual
of Insured Persons Covered :

Existing
Relationshi
Name of the diseases Sum
p With Date Of Member Unique Pre-existing
Member Id Insured Age which are Insured
Insured Birth Since ID disease
Person permanently (Rs.)
Person
Excluded

0239862484/ 1778042
M REVANTH 05/04/200 10/04/20
17780425000 Self 20 5000282 100000
REDDY 5 25
2823/01 3

Nominee Details :
Nominee Name Relationship With Insured Person
MADUSUDHANA REDDY Father

Details of Cover :
Cover Details
In-Patient Treatment Which requires minimum 24 hours hospitalization upto Sum Insured, Rs.1,00,000
Pre/Post Hospitalization Expenses, 60/90 60 days pre hospitalisation and 90 days post hospitalisation, Rs.1,00,000
Medical Expenses for Day Care Procedures as per list of Tagic as may be amended from time
Day Care Procedures
to time, Upto 100% of In-Patient Treatment Sum Insured
Expenses for utilizing ambulance in case of an emergency up to Rs.2500/- per hospitalization.,
Ambulance Cover
Upto Rs. 2,500
Details of Additional Covers :
Cover Details Cover Details
1% of individual sum insured or Floater SI after every 2 claim free years only for self,
Health Check-up
Applicable for Self,1% of In-Patient Treatment Sum Insured and Within SI Limit
Hospital Daily Cash Allowance of INR 500 per day for completion of each continuous and
consecutive 24 hours of hospitalization during the policy period for maximum up to 15 days
Hospital Cash Benefit
with 1 day deductible within SI, Applicable for All Members, Per day amount Rs.500 Within SI
Limit,No. Of Day :15
Personal Accident Cover for Death/Permanent Total Disability shall be covered for a Capital
Accidental Death Sum Insured of Rs.200000 each for primary member in the Certificate of Insurance, Applicable
for Self,AD Sum Insured : Rs.200,000 Above SI Limit

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read policy wordings/salesbrochure carefully before
concluding a sale.
TATA AIG General Insurance Company Limited
Registered office : Peninsula Business Park, Tower A,15th Floor, G.K Marg,Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN :TATHLGP21248V022021
 Group Medicare
Certificate of Insurance
Details of Additional Covers :
Cover Details Cover Details
Co-Payment Applicable, Applicable for All Members,Co-pay for all claims of 10%
Limit on Room Rent No cap on Room Rent, Amount Mentioned/day Rs.
15% of the sum insured per child will be provided to the dependent children of insured member
Child Education Benefit (Up to 2 children only) on Death/Permanent disability due to accident, Applicable for Self,Up to
15% of Accidental Death Sum Insured
Funeral Benefit Covered up to INR 2500 under accidental death, Applicable for Self,Upto Rs.2,500
Expenses towards transportation of mortal remains in the event of death due to an accident up
Transportation of Mortal Remains to 3% of accidental death Sum Insured, Applicable for Self,3% of Accidental Death Sum
Insured
Permanent Total Disability/Personal Accident Cover for Death shall be covered for a Capital
Permanent Total Disability Sum Insured of Rs.200000 each for primary member in the Certificate of Insurance, Applicable
for Self, Permanent Total Disability SI : Rs.200,000
Details of Waiting Period :
Waiting Period Waiting Period Details Applicable To
30 days waiting period applicable for fresh
30 Days Waiting Period policy (not applicable in case of renewal) and Applicable for All Members
only in case of sickness related hospitalisation
24 months waiting period applicable for fresh
policy which will be reduced to 12 months at
Specified Disease Waiting Period Applicable for All Members
first renewal and waived off at second
renewal onwards
24 months waiting period applicable for fresh
policy which will be reduced to 12 months at
PED Waiting Period Applicable for All Members
first renewal and waived off at second
renewal onwards
Section 3 (General Exclusions – i, ii & iii) of the policy gets deleted and superseded by Section B12 – Waiting Period (B12.1, B12.2 & B12.3) of
Appendix II: Endorsements of this policy

Premium rates and/or scope of covers are subject to revision at the time of renewal under this policy
Important Exclusions
[Link] & Evaluation : (Code-Excl 04)
a) Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded
[Link]/ Weight Control : (Code-Excl 06)
Expenses related to the surgical treatment of obesity that does not fulfill all the below conditions:
1) Surgery to be conducted is upon the advice of the Doctor
2) The surgery/Procedure conducted should be supported by clinical protocols
3) The member has to be 18 years of age or older and
4) Body Mass Index (BMI);
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive methods of weight
loss:
I. Obesity-related cardiomyopathy
II. Coronary heart disease
III. Severe Sleep Apnea
IV. Uncontrolled Type2 Diabetes

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read policy wordings/salesbrochure carefully before
concluding a sale.
TATA AIG General Insurance Company Limited
Registered office : Peninsula Business Park, Tower A,15th Floor, G.K Marg,Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN :TATHLGP21248V022021
 Group Medicare
Certificate of Insurance
[Link] or plastic Surgery: (Code-Excl 08)
Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burns or
Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a
medical necessity, it must be certified by the attending Medical Practitioner.
[Link] and Infertility: (Code-Excl 17)
Expenses related to sterility and infertility. This includes:
[Link] type of contraception, sterilization
[Link] Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
[Link] Surrogacy
[Link] of sterilization
[Link] or Adventure Sports (Code Excl 09) : Expenses related to any treatment necessitated due to participation as a professional in
hazardous or adventure sports, including but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or
scuba diving, hand gliding, sky diving, deep-sea diving

[Link] of law (Code Excl10): Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to
commit a breach of law with criminal intent.
[Link] self-injury or attempted suicide while sane or insane.

[Link] of personal comfort and convenience like television (wherever specifically charged for), charges for access to telephone and telephone
calls, internet, foodstuffs (except patient’s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service,
guest service
[Link] or fitting of hearing aids, spectacles or contact lenses including optometric therapy unless explicitly stated and covered in the policy
[Link] treatment or part of a treatment that is not of a reasonable charge, not medically necessary; drugs or treatments which are not supported
by a prescription

Important Conditions.
1. Condition Precedent to Admission of Liability
The terms and conditions of the policy must be fulfilled by the Insured Person for the Company to make any payment for claim(s) arising under the
Policy.
2. Disclosure of Information
The policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of mis-representation, mis-description or non-
disclosure of any material fact by the Policyholder (Explanation: "Material facts" for the purpose of this policy shall mean all relevant information
sought by the company in the proposal form and other connected documents to enable it to take informed decision in the context of underwriting
the risk)

3. Fraud
If any claim made by the Insured Person, is in any respect fraudulent, or if any false statement, or declaration is made or used in support thereof,
or if any fraudulent means or devices are used by the Insured Person or anyone acting on his/her behalf to obtain any benefit under this policy, all
benefits under this policy and the premium paid shall be forfeited.

Any amount already paid against claims made under this Policy but which are found fraudulent later shall be repaid by all recipient (s)/
Policyholder(s), who has made that particular claim, who shall be jointly and severally liable for such repayment to the Insurer.

For the purpose of this clause, the expression "fraud" means any of the following acts committed by the insured person or by his agent or the
Hospital / Doctor, any other party acting on behalf of the Insured Person with intent to deceive the insurer or to induce the insurer to issue an
insurance policy:
a) the suggestion, as a fact of that which is not true and which the insured person does not believe to be true;
b) the active concealment of a fact by the insured person having knowledge or belief of the fact;
c) any other act fitted to deceive; and
d) any such act or omission as the law specially declares to be fraudulent
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of Fraud, if the insured person / beneficiary can prove
that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress the fact or that such mis-
statement of or suppression of material fact are within the knowledge of the insurer.

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read policy wordings/salesbrochure carefully before
concluding a sale.
TATA AIG General Insurance Company Limited
Registered office : Peninsula Business Park, Tower A,15th Floor, G.K Marg,Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN :TATHLGP21248V022021
 Group Medicare
Certificate of Insurance
4. Multiple Policies
i. In case of multiple policies taken by an insured person during a period from one or more insurers to indemnify treatment costs, the insured
person shall have the right to require a settlement of his/her claim in terms of any of his/her policies. In all such cases the insurer chosen by the
Insured Person shall be obliged to settle the claim as long as the claim is within the limits of and according to the terms of the chosen Policy.
ii. Insured person having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed under any other
policy / policies even if the sum insured is not exhausted. Then the Insurer shall independently settle the claim subject to the terms and conditions
of this Policy.
iii. If the amount to be claimed exceeds the sum insured under a single Policy, the Insured person shall have the right to choose insurer from
whom he/she wants to claim the balance amount and we will assist the insured person in facilitating the same.

5. Possibility of Revision of Terms of the Policy Including the Premium Rates

The Company , may revise or modify the terms of the Policy including the premium rates. The Insured Person shall be notified three months before
the changes are effected.

6. Migration
The insured person will have the option to migrate the policy to other health insurance products/plans offered by the company policy by applying
for migration of the policy atleast 30 days before the policy renewal date . If such person is presently covered and has been continuously
covered without any lapses under any health insurance product/plan offered by the company, the insured person will get the accrued continuity
benefits in waiting periods as per IRDAI guidelines on Migration.

For Detailed Guidelines on Migration, kindly refer Insurance Regulatory and Development Authority of India (Insurance Products) Regulations, 2024
F. No. IRDAI/Reg/8/202/2024 dated 20th March, 2024 and Master Circular on IRDAI (Insurance Products) Regulations 2024- Health Insurance Ref:
IRDAI/HLT/CIR/PRO/84/5/ 2024 dated 29th May 2024 and there subsequent amendments thereof. Withdrawal of Policy

7. Withdrawal of Policy
i. In the likelihood of this product being withdrawn in future, the Company will intimate the Insured Person about the same 90 days prior to expiry
of the Policy.
ii. Insured Person will have the option to migrate to similar health insurance product

Proportionate deductions are not applicable in respect of the hospitals which do not follow differential billing or for those expenses in respect of
which differential billing is not adopted based on the room category.

Claims Procedure Details :

Details of TPA/Claims Administrator:
For any claim related assistance, notification of claim and submission of claim related documents, insured person can contact:
Name of TPA : Tata AIG Health Claim
Website: [Link]
Email: healthclaimsupport@[Link]

Toll Free: 18002667780

1800229966 (For Senior Citizens)

Submit claim: TAGIC Health Claims,

TATA AIG General Insurance Company Limited
5th and 6th Floor, Imperial Towers, [Link] 7-1-6-617/A,
GHMC no - 615,616, Ameerpet, Hyderabad – 500016,
Telangana.

[Link] of Claim
Treatment, Consultation or Procedure: We or Our TPA* must be informed:

1 If any treatment for which a claim may be made and that At least 48 hours prior to the Insured Person’s admission.
treatment requires planned Hospitalisation:

2 If any treatment for which a claim may be made and that Within 24 hours of the Insured Person’s admission to Hospital.
treatment requires emergency Hospitalisation

Failure to furnish such intimation within the time required shall not invalidate nor reduce any claim if You can satisfy us that it was not reasonably
possible for You to give proof of such delay within such time. The Company may relax these timelines only in special circumstances and for the
reasons beyond the control of the insured.

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read policy wordings/salesbrochure carefully before
concluding a sale.
TATA AIG General Insurance Company Limited
Registered office : Peninsula Business Park, Tower A,15th Floor, G.K Marg,Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN :TATHLGP21248V022021
 Group Medicare
Certificate of Insurance
[Link] Service

Treatment, Consultation or Treatment, Consultation or Cashless Service is Available: We must be given notice that the
Procedure: Procedure Taken at: Insured Person wishes to take
advantage of the cashless
service accompanied by full
particulars:
If any planned treatment, Network Hospital We will provide cashless service At least 48 hours before the
consultation or procedure for by making payment to the extent planned treatment or
which a claim may be made: of Our liability directly to the Hospitalisation
Network Hospital.
If any treatment, consultation or Network Hospital We will provide cashless service Within 24 hours after the
procedure for which a claim may by making payment to the extent treatment or Hospitalisation
be made, requiring emergency of Our liability directly to the
hospitalisation Network Hospital.

3. Procedure for Cashless Service

[Link] Service is only available at Network Hospitals.
[Link] order to avail cashless treatment, the following procedure must be followed by You:
a. Prior to taking treatment and/or incurring Medical Expenses at a Network Hospital, You must call our designated TPA/Us and request pre-
authorization.
b. For any emergency Hospitalization, our designated TPA/We must be informed no later than 24 hours of the start of Your hospitalization/
treatment.
c. For any planned hospitalization, our designated TPA/We must be informed atleast 48 hours prior to the start of your
hospitalization/treatment.
d. Our designated TPA/We will check your coverage as per the eligibility and send an authorization letter to the provider. You have to provide
the ID card issued to You along with any other information or documentation that is requested by the TPA/Us to the Network Hospital.

[Link] case of deficiency in the documents sent to TPA/Us for cashless authorization or the ailment /treatment is not covered under the
policy,the same shall be communicated to the hospital/You by TPA/Us
f. We/TPA will respond within TAT as prescribed by the Regulator under the Master Circular on IRDAI (Insurance Products) Regulations 2024-
Health Insurance Ref: IRDAI/HLT/CIR/PRO/84/5/ 2024 and its subsequent amendments thereof
g. Rejection of cashless in no way indicates rejection of the claim. You are required to submit the claim along with required documents for us
to decide on the admissibility of the claim.
h. If the cashless is approved, the original bills and evidence of treatment in respect of the same shall be left with the Network Hospital.
Pre-authorization does not guarantee that all costs and expenses will be covered. We reserve the right to review each claim for Medical
Expenses and accordingly coverage will be determined according to the terms and conditions of this Policy.

4. Documents for claims :

Claim documentation will include but is not limited to the following :
i. Our claim form -duly completed and signed for on behalf of the Insured Person.
ii. Original Bills (pharmacy purchase bills, consultation bills, diagnostic bills) and any attachments thereto like receipts or prescriptions in
support of any amount claimed which will then become Our property.
iii. All medical reports, case histories, investigation reports, indoor case papers/ treatment papers (in reimbursement cases, if available),
. discharge summaries.
iv.A precise diagnosis of the treatment for which a claim is made.
v.A detailed list of the individual medical services and treatments provided and a unit price for each in case not available in the submitted
...hospital bill.
vi. All pre and post investigation, treatment and follow up (consultation) records pertaining to the present ailment for which claim is being
made, .. . if and where applicable.

Please refer Master policy wordings for details on supporting claims documents.

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read policy wordings/salesbrochure carefully before
concluding a sale.
TATA AIG General Insurance Company Limited
Registered office : Peninsula Business Park, Tower A,15th Floor, G.K Marg,Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN :TATHLGP21248V022021
 Group Medicare
Certificate of Insurance
Redressal of Grievance:
In case of any grievance the Insured Person may contact through
• Website: [Link]
• Call us 24X 7 toll free helpline 1800 266 7780 or 1800 22 9966 (Senior Citizen)
• Email us at customersupport@[Link]
• Write to us at: Tata AIG General Insurance Co. Ltd.7th and 8th Floor, Romell Tech Park, Cama Industrial Estate,
Western ExpressHighway, Goregaon(E), Mumbai, Maharashtra 400063
Visit the Servicing Branch mentioned in the policy document
lf lnsured person is not satisfied with the redressal of grievance through one of the above methods, Insured person may contact the grievance
officer at [Link]@[Link]. For updated details of grievance officer, kindly refer the link
([Link]
lf lnsured person is not satisfied with the redressal of grievance through above methods, the Insured Person may also approach the office of
lnsurance Ombudsman of the respective area/region for redressal of grievance as per lnsurance Ombudsman Rules 2017. Grievance may also
be lodged at IRDAI lntegrated Grievance Management System - [Link] [Link]/ and Bima Bharosa Portal - [Link]

Please visit our website or refer to Master Policy for INSURANCE OMBUDSMAN particulars.
Premium Details :
Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited.

Particulars Amount(Rs.)
Net Premium (Rs.) 2,367.00
IGST(18 %) 426.06
Total Gross Premium (Rs.) 2,793.00
Total Gross Premium (in words) Rupees Two Thousand Seven Hundred Ninety-Three And Paise Zero Only

GSTIN: 27AABCT3518Q1ZW-MAHARASHTRA , SAC CODE: 997133

Premium rates and/or scope of covers are subject to revision at the time of renewal under this policy

Stamp duty details :

This Certificate of Insurance shall at all times be read in conjunction with the master policy including terms and conditions of the master policy,
the sum insured under the master policy and the premium payable under the master policy.

80 D certificate of Income Tax Act, 1986

This is to certify that the MR M REVANTH REDDY has paid an amount of Rs 2,793.00 towards the premium for Group Medicare Product Certificate
No 0239862484 50001287 for the period From 10/04/2025 To 09/04/2026 and is eligible for a tax exemption under section 80 D of IT Act.

This certificate is subject to terms and conditions of the master policy. Please refer the master policy terms and conditions with the master policy
holder.

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read policy wordings/salesbrochure carefully before
concluding a sale.
TATA AIG General Insurance Company Limited
Registered office : Peninsula Business Park, Tower A,15th Floor, G.K Marg,Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN :TATHLGP21248V022021
 Group Medicare
Certificate of Insurance
For Policy wordings, please scan the below QR code :

For Tata AIG General Insurance Company Limited

Signature Not Verified

Digitally signed by: Shammi Kapoor
Date: 2025.04.10 [Link] +05:30
Location: Mumbai

Authorized Signatory
Policy Servicing Office:
TATA AIG General Insurance Company Limited
Registered Addres:- Peninsula Business Park, Tower A,15th Floor, Ganpatrao Kadam Marg,Lower Parel,MUMBAI,MAHARASHTRA,MUMBAI-400013

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read policy wordings/salesbrochure carefully before
concluding a sale.
TATA AIG General Insurance Company Limited
Registered office : Peninsula Business Park, Tower A,15th Floor, G.K Marg,Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN :TATHLGP21248V022021
 Group Medicare
Certificate of Insurance

Group Medicare

Member Id : 0239862484/177804250002823/01
Name : M REVANTH REDDY
Age : 20
Gender : MALE
Policy No : 0239862484 00 00
Valid from: : 10/04/2025
Valid till : 09/04/2026

TAGIC Health Claims,

TATA AIG General Insurance Company Limited
5th and 6th Floor, Imperial Towers, [Link] 7-1-6-617/A,GHMC no - 615,616,
Ameerpet, Hyderabad – 500016,Telangana, Toll Free : 18002667780

Insurance is the subject matter of the [Link] more details on risk factors, terms and conditions, please read salesbrochure carefully before concluding a sale.

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Fax : 022 6693 8170 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
 Group Medicare

ENROLMENT FORM FOR GROUP HEALTH POLICY

URN NO : URN No. AH/2018-19/HL-06

Partner Reference No. /

Name of the Group Administrator MUTHOOT FINCORP LTD 177804250002823
Application No

Customer ID / Account No 6203747968 Intermediary code CA1017

This is an application for Insurance & will form the basis of the policy certificate that We may issue. Every information, this application seeks is
important & mandatory. Please read all questions and answer them carefully. You must provide complete and correct information.
Incomplete/incorrect/partially correct information may lead to cancellation of proposal and policy certificate even if it is issued. We are under
no obligation to accept any proposal for insurance. If We accept a proposal for insurance, it shall be subject to the Policy terms and
conditions and We shall have no liability to make any payment under the Policy if proposal is not accepted by us or premium is not received by
Us in full and in time, or non-fulfillments of additional information requested by us, if any or if the proposal is under-process & claim arises in the
interim period before the decision on the proposal is given by us.
Commencement of risk cover under the policy is subject to receipt of premium by Tata AIG General Insurance Company Limited.
Please fill-up this form in CAPITAL LETTERS

Section I: Applicant Information

Name: First Name Middle Name Last Name

(Mr/Mrs/Ms)
MR M REVANTH REDDY

Date Of Birth: 05/04/2005 Gender: MALE Nationality: INDIAN RESIDENT

Mobile: 9398074360 Email ID:
Address for communication: C/O M MADHU SUDANA REDDY, 3043RD FLOOR, GENIUS SWARNA APARTMENTS, JAI HIND GANDHI
ROAD, CYBER HILLS COLONY, JAI HIND ENCLAVE, MADHAPUR, BEHIND SEASONS SWIMMING POOL, MADHAPUR, MADHAPUR, K.V.
RANGAREDDY, TELANGANA, 500081 Landmark: District: HYDERABAD , City: HYDERABAD , State: TELANGANA , Pin code: 500081
Unique id no. : PAN (incase of premium > Rs.50, 000) :

Group Medicare

Part A: Plan Details:

Sum Insured : 100,000
Deductible :
Tenure (in years) : 1 year
Plan Type : Individual

Part B: Proposed Insured Persons details:

NAME OF THE RELATIONSHIP WITH

[Link] Date of BIRTH GENDER OCCUPATION Adhar NO
INSURED PERSON APPLICANT

1 M REVANTH REDDY Self 05/04/2005 MALE

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
 Group Medicare

Part C: Medical & Lifestyle Information:

Note: This section is applicable for all the persons to be insured

• Please read, understand and confirm “Health Details” accurately and truthfully for each of the members to be insured , as this would be
the prime basis for issuance of your policy and subsequent claim admissibility if any.

• If, for any of the members proposed to be insured, the answer to any of the following questions/health statement is YES, then any such
member shall not be eligible to take this policy.
• Any mis-declaration or non-disclosure here will render coverage under the policy NULL & VOID ,ab initio.

Medical Information Yes/No

Have you or any of the persons proposed for insurance, ever suffered from or taken treatment, or No
hospitalized for or have been recommended to take investigations / medication / surgery or undergone a
surgery for any of the following medical condition?

l Cancer/Kidney failure/Stroke/Heart disease/Paralysis

l Any disease of major organs including but not limited to brain, heart, kidney, lungs, liver or any
neurological disorder
l Any joint disorder including restriction in movement or any form of arthritis

Are you or any of the persons proposed for insurance in good health? Yes

Are you or any of the persons proposed for insurance undergoing/awaiting any treatment for any No
illness?

Part D Premium Paid for product (including taxes):

Section V: Nominee Details

Nominee Name: MADUSUDHANA REDDY Relationship with the Applicant: Father

In the event of the death of the Applicant any payment due under the Policy shall become payable to the nominee in accordance with the
Policy terms and conditions. Nominee for any of the persons proposed to be insured shall be the Applicant. The nominee must be an
immediate relative of the Applicant. The nominee for all other Insured Persons proposed to be insured shall be the Applicant himself/herself.

Section VI: Declaration & Warranty On Behalf Of All Persons Proposed To Be Insured

I/ We hereby declare, on my behalf and on behalf of all persons proposed to be insured that the above statements, answers and/or
particulars given by me are true and complete in all respects to the best of my knowledge and that I/We am/ are authorized to propose on
behalf of these other persons.
I understand that the information provided by me will form the basis of insurance policy, is subject to the Board approved underwriting
policy of the Insurance company and that the policy will come into force only after full payment of the premium chargeable.
I/ We further declare that I/We will notify in writing any change occurring in the occupation or general health of the life to be insured/
proposer after the proposal has been submitted but before communication of the risk acceptance by the company.
I/We declare and consent to the company seeking medical information from any doctor or hospital who/which at anytime has attended on
the person to be insured/ proposer or from any past or present employer concerning anything which affects the physical or mental
health of the person to be insured/proposer and seeking information from any insurance company to whom an application for insurance
on the person to be insured/ proposer has been made for the purpose of underwriting the proposal and/or claim settlement.
I/We authorize the company to share information/data/details provided by me/us to any other person in connection with the proposal for
the sole purpose of underwriting, Policy servicing and/or claims servicing & settlement.
I understand that I will receive digital copy of my Policy and service-related communication. However, I would prefer to also receive the
physical copy of my Policy and service-related communication and I want these documents to be shared via postal mail to the address
as mentioned in this Proposal Form.
Signature of the Applicant: M REVANTH REDDY Date: 10/04/2025 Place: CORP OFFICE

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
 Group Medicare

The content of this form along with product benefits, terms/conditions and exclusions have been clearly explained to me. I/we have understood
these and confirm to abide by the policy terms & conditions.
Signature of the Applicant: M REVANTH REDDY
Name & Signature of agent/intermediary/Specified Person: MUTHOOT FINCORP LIMITED
Code: CA1017

Vernacular Declaration (Certification in case the applicant has signed in vernacular/thumb print)
The content of this form along with product benefits, terms/conditions and exclusions have been clearly explained by me in vernacular to the
applicant who has understood and confirmed the same.
Signature/Thumb impression of the Applicant:________________________________
Name & Signature of agent/intermediary/Specified Person: MUTHOOT FINCORP LIMITED

Prohibition of Rebates - Section 41 of the Insurance Act, 1938 as amended by Insurance Laws (Amendment) Act, 2015.
1. No person shall allow or offer toallow, either directly or indirectly, as an inducement to any person to takeout or renew or continue an
insurance in respect of any kind of risk relatingto lives or property in India, any rebate of the whole or part of the commissionpayable or
any rebate of the premium shown on the policy, nor shall any persontaking out or renewing or continuing a policy accept any rebate,
except suchrebate as may be allowed in accordance with the published prospectuses or tables of the insurer.
2.
No person shall allow or offer toallow, either directly or indirectly, as an inducement to any person to takeout or renew or continue an
insurance in respect of any kind of risk relatingto lives or property in India, any rebate of the whole or part of the commissionpayable or
any rebate of the premium shown on the policy, nor shall any persontaking out or renewing or continuing a policy accept any rebate,
except suchrebate as may be allowed in accordance with the published prospectuses or tables of the insurer.

Anti Money Laundering (AML) declarations

1. I/we hereby confirm that all premiums paid / payable in future will be from bonafide sources and not paid out of proceeds of crime and that
such premiums are not disproportionate to my/our income. I / we understand that the Company has the right to call for documents to establish
sources of funds and to cancel the insurance policy in case I / we are found guilty by any competent court of law under any of the statutes,
directly or indirectly governing the prevention of money laundering law in India.
I / we are not Politically Exposed Persons * nor are their close relatives / family members / associates . I / we shall keep the companyinformed if
we subsequently become a Politically Exposed Person / close relative / family member / associate of Politically Exposed Persons. “Politically
Exposed Persons” shall have the meaning assigned to it under Prevention of Money-Laundering (Maintenance of Records) Amendment Rules,
2023 as amended from time to time.

For office use only :

Employee ID :
Partner ID :

Insurance is the subject matter of the solicitation. For more details on risk factors, terms and conditions please read policy
document carefully before concluding a sale.

CUSTOMER ACKNOWLEDGEMENT

Application Number: 282025002285656 Date: 10/04/2025

Name of the Applicant: M REVANTH REDDY
We acknowledge with thanks the receipt of your application and amount by cash/cheque/Demand Draft/others of amount of Rs 2,793.00.
Neither the submission to us of this completed enrollment form for insurance nor any payment towards this application obliges us to agree to
issue a policy, which decision is and always shall be in our sole and absolute discretion. If we accept a proposal for insurance, it shall be
subject to the policy terms and conditions and we shall have no liability to make any payment if proposal is not accepted by us or premium is not
received by us in full and in time, or non-fulfillments of Pre-Policy Checkup (if applicable) and/or additional information requested by us. Failure to
deposit the entire premium or non-fulfillments of pre-policy check up (if applicable) or furnish additional information requested by us within 15
days from the date of proposal, we shall cancel your application and refund the premium paid without any interest subject to deduction of
pre-policy charges (if applicable & conducted). If we do not accept the proposal, we will inform you and refund any payment received from
you, towards this application, without interest within next 10 days.
We shall have no liability to make any payment under the Policy if proposal is under-process & claim arises in the interim period before the
decision on the proposal is given by us.

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
 Customer Information Sheet/Know Your Policy
Important details concerning your Policy are provided in this document. It is also advisable that you review your Policy
document.

Sr. No. Title Description Policy Clause No.

1. Name of the Insurance Policy Group MediCare

Policy Number 0239862484 / 50001287

2.

3. Type of Insurance Both Indemnity and Benefit

Product/Policy

4. Sum Insured (Basis) (Along Individual

with Amount)

Covers Cover Details

Which requires minimum 24 hours
In-Patient Treatment hospitalization upto Sum Insured,
Rs.1,00,000
Pre/Post Hospitalization 60 days pre hospitalisation and 90
Expenses, 60/90 days post hospitalisation, Rs.1,00,000
Medical Expenses for Day Care
Procedures as per list of Tagic as may
Day Care Procedures be amended from time to time, Upto
100% of In-Patient Treatment Sum
Insured
Expenses for utilizing ambulance in
Ambulance Cover case of an emergency up to Rs.2500/-
per hospitalization., Upto Rs. 2,500
Additional Cover Cover Details
1% of individual sum insured or Floater
SI after every 2 claim free years only
Health Check-up for self, Applicable for Self,1% of
In-Patient Treatment Sum Insured and
Within SI Limit
Hospital Daily Cash Allowance of INR
500 per day for completion of each
continuous and consecutive 24 hours
of hospitalization during the policy
Hospital Cash Benefit
period for maximum up to 15 days with
1 day deductible within SI, Applicable
for All Members, Per day amount
Rs.500 Within SI Limit,No. Of Day :15
Personal Accident Cover for
Death/Permanent Total Disability shall
be covered for a Capital Sum Insured
Accidental Death of Rs.200000 each for primary
member in the Certificate of Insurance,
Applicable for Self,AD Sum Insured :
Rs.200,000 Above SI Limit
Applicable, Applicable for All
Co-Payment
Members,Co-pay for all claims of 10%
No cap on Room Rent, Amount
Limit on Room Rent
Mentioned/day Rs.
Waiting Period
Waiting Period Applicable To
Details

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
 15% of the sum insured per child will
be provided to the dependent children
of insured member (Up to 2 children
Child Education Benefit only) on Death/Permanent disability
due to accident, Applicable for Self,Up
to 15% of Accidental Death Sum
Insured
Covered up to INR 2500 under
Funeral Benefit accidental death, Applicable for
Self,Upto Rs.2,500
Expenses towards transportation of
mortal remains in the event of death
due to an accident up to 3% of
Transportation of Mortal Remains
accidental death Sum Insured,
Applicable for Self,3% of Accidental
Death Sum Insured
Permanent Total Disability/Personal
Accident Cover for Death shall be
covered for a Capital Sum Insured of
Permanent Total Disability Rs.200000 each for primary member in
the Certificate of Insurance,
Applicable for Self, Permanent Total
Disability SI : Rs.200,000
30 days waiting period
applicable for fresh
30 Days Waiting policy (not applicable in Applicable for All
Period case of renewal) and Members
only in case of sickness
related hospitalisation
24 months waiting
period applicable for
fresh policy which will
Specified Disease be reduced to 12 Applicable for All
Waiting Period months at first renewal Members
and waived off at
second renewal
onwards
24 months waiting
period applicable for
fresh policy which will
be reduced to 12 Applicable for All
PED Waiting Period
months at first renewal Members
and waived off at
second renewal
onwards

5. Policy Coverage (What your The Customer Information Sheet should be read in conjunction with the Section 2:
Policy covers) Certificate of Insurance and Policy Wordings. Insurance Coverage will be Benefits
applicable only to the covers and up to the Sum Insured limits as
specifically mentioned in the Certificate of Insurance.

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
 In-Patient Treatment : We will cover for 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 provided:
i. Limit on Room Rent / Room Category:

We will, limit Room Rent up to the amount/percentage of Sum Insured

or room category as specified in the Policy Schedule/ Certificate of
Insurance.
ii. Associated Medical Expenses:

a. If the Insured Person is admitted in a room where the Room Rent

expenses incurred is higher than limit specified in the Policy
Schedule/ Certificate of Insurance, then the Insured Person shall
bear a rateable proportion of the t o t a l Associated Medical
Expenses (including surcharge or taxes thereon), except
pharmacy charges, diagnostic costs,costs of implants & medical
devices and consumables expenses, in the proportion of the
difference between the eligible Room Rent expenses to the Room
Rent expenses actually incurred. Proportionate Expenses is
applied in respect of the Hospital which follow differential billing
or for those expenses in respect of which differential billing is
adopted based on the Room Category.
b. If the Insured Person is admitted in a hospital room where the
room category opted is higher than the category specified in the
Policy Schedule/Certificate of Insurance, then the Insured Person
shall bear 10% of admissible claim amount In case of
unavailability of specified room category, the Insured Person is
eligible for next immediate available hospital room provided that
necessary documented proof for unavailability of such hospital
room is furnished to us.
iii. Limit on Treatment / Illness/ Surgery/ Medical Condition

We will cover the Medical Expenses incurred towards claim for a

specified treatment of an Illness/procedure upto the amount of Sub-
Limit applicable per claim during the Policy Year as specified in the
Policy Schedule/ Certificate of Insurance.

Day Care Procedures

We will cover expenses for listed 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
our website ([Link]). This benefit under the policy will be
limited to the amount specified in the Policy Schedule/ Certificate of
Insurance. Treatment normally taken on out-patient basis is not included in
the scope of this cover.

Ambulance Cover
We will cover for expenses incurred on transportation of Insured Person
in a registered ambulance 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 amount as specified on the policy
schedule/Certificate of Insurance. For this claim to be paid, the claim must
be admissible under section In-patient Treatment or Day Care Procedures
of this policy.

Inclusion of Health-Check up
We will pay the reasonable and customary Charges incurred, in respect of
health check up, during the Policy Year, up to the limit specified in the Policy
Schedule/ Certificate of Insurance.

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
 Inclusion of Hospital Cash Benefit
We will pay the Hospital Daily Cash Benefit as specified in the Policy
Schedule/ Certificate of Insurance for each continuous and completed 24
Hours of Hospitalisation during the Policy Year.

Accidental Death
If an Insured Person suffers an accident during the policy period and this is
the proximate cause of his death within 365 days from the date of accident
then We will pay to Insured person’s beneficiary or legal representative the
benefit Sum Insured specified in the Policy schedule/Certificate of
insurance.

Permanent Total Disability

We will pay the sum insured as specified in the policy schedule/Certificate
of Insurance if injury to you results in you suffering Permanent Total
Disability. The injury must occur within the policy period as mentioned in the
policy schedule/Certificate of insurance and the disability should continue
for 365 days from the date of accident which caused the injury.

Funeral Expenses
If we have accepted a claim under Accidental Death benefit, then we will
in addition pay fixed amount as specified in the policy schedule/Certificate
of insurance towards funeral expenses.

Deletion of Limit on Room Rent/ Room Category

Limit on Room Rent/ Room Category stands deleted

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
Sr. No. Title Description Policy Clause No.

6. Exclusions (What your Policy Standard Exclusions

doesn't cover) Section 3: Exclusions
Medical Exclusions
1. Investigation & Evaluation (Code - Excl 04).

a. Expenses related to any admission primarily for diagnostics and

evaluation purposes only are excluded.
b. All diagnostic costs that are not incidental or connected to the
present diagnosis and course of treatment are not covered.

2. Rest Cure, Rehabilitation and Respite Care: (Code - Excl 05) Costs
associated with any admission that are mainly connected to bed rest
enforcement rather than treatment. This also includes:

i. Custodial care, provided by skilled nurses, assistants, or

nonskilled individuals, for personal care needs such as
assistance with dressing, washing, and moving around,
whether at home or in a nursing home.

ii. Any services that give terminally ill patients access to physical,
social, emotional, and spiritual support.
3. Obesity / Weight Control: (Code - Excl 06)

Expenses related to the surgical treatment of obesity that does not

fulfill all the below conditions:
i. Surgery to be conducted is upon the advice of the doctor.

ii. The Surgery or Procedure conducted should be supported by

clinical protocols.
iii. The member has to be 18 years of age or older and

iv. Body Mass Index (BMI);

a. Greater than or equal to 40 or

b. Greater than or equal to 35 combined with any one of the

severe co-morbidities listed below after less intrusive
weight-loss treatments have failed:
I. Obesity - Related Cardiomyopathy.

II. Coronary heart disease.

III. Severe Sleep Apnea.

IV. Uncontrolled Type 2 Diabetes.

4. Change-of-Gender Treatments: (Code - Excl 07)

Expenses related to any treatment, including surgical management, to
change characteristics of the body to those of the opposite sex.

5. Cosmetic or Plastic Surgery: (Code - Excl 08)

Expenses for plastic surgery, cosmetic surgery, or any other
procedure to alter one's look, unless it is required for reconstruction
after an accident, burn(s), or cancer, or if it is a component of a
medically essential treatment intended to eliminate an immediate and
direct risk to the insured's health. The accompanying Medical
Practitioner must certify this in order for it to be accepted as a medical
necessity.
6. Treatment for alcoholism, drug or substance abuse or any addictive
condition and consequences thereof (Code - Excl 12).
7. Treatments received in heath hydros, nature cure clinics, spas or
similar establishments or private beds registered as a nursing home
attached to such establishments or where admission is arranged
wholly or partly for domestic reasons (Code - Excl 13).

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
Sr. No. Title Description Policy Clause No.

8. Dietary supplements and substances that can be purchased without

prescription including but not limited to vitamins, minerals and organic
substances unless prescribed by a Medical Practitioner as part of
hospitalisation claim or day care procedure (Code - Excl 14).
9. Refractive Error: (Code - Excl 15)
Treatment costs for correcting vision problems caused by refractive
errors less than 7.5 dioptres.
10. Unproven Treatments: (Code - Excl 16)
Costs associated with any experimental treatment, as well as any
associated services and materials. Unproven treatments are
treatments, procedures or supplies that lack significant medical
documentation to support their effectiveness.
11. Sterility and Infertility: (Code - Excl 17)
Expenses related to sterility and infertility. This includes:
i. Any type of contraception, sterilization.

ii. Assisted reproduction services including artificial insemination

and advanced reproductive technologies such as IVF, ZIFT,
GIFT, ICSI.
iii. Gestational Surrogacy.

iv. Reversal of Sterilization.

12. Maternity (Code - Excl 18):

i. Medical treatment expenses traceable to childbirth (including

complicated deliveries and caesarean sections incurred during
hospitalisation) except ectopic pregnancy;
ii. Claims for medical costs associated with a lawful medical
termination of pregnancy and miscarriage (except from
accidents) incurred within the Policy Period.
Non-Medical Exclusions
I. Hazardous or Adventure Sports (Code Excl09).

II. Breach of Law (Code Excl10).

III. Expenses incurred towards treatment in any hospital or by any

Medical Practitioner or any other provider specifically excluded
by the Insurer and disclosed in its website / notified to the
policyholders are not admissible.
Specific Exclusions
1. Exclusions with Waiting Periods.
i. Nine months maternity waiting period shall be waived off.

2. Medical Exclusions
i. Congenital External Diseases, defects or anomalies.

ii. Stem cell therapy however hematopoietic stem cells for bone
marrow transplant for haematological conditions will be covered
under Benefit B1 and B4 of this Policy.
iii. Growth hormone therapy.

iv. Sleep-Apnea.

v. Admission primarily for administration of Intra-articular or intra-

lesional injections or Intravenous immunoglobulin infusion or
supplementary medications like zolendronic acid.

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
Sr. No. Title Description Policy Clause No.

vi. Venereal disease , sexually transmitted disease or illness.

vii. All preventive care, vaccination including inoculation and

immunisations (Except in case of post- bite treatment and other
vaccines explicitly covered).
viii. Dental treatment or surgery of any kind unless as a result of
illness/accidental bodily Injury to natural teeth and also requiring
hospitalisation.
ix. Any non-allopathic treatment.

3. Non-Medical Exclusions
i. War or any act of war, invasion, act of foreign enemy, war like
operations (whether war be declared or not or caused during
service in the armed forces of any country), civil war, public
defence, rebellion, revolution, insurrection, military or usurped
acts, nuclear weapons/materials, chemical and biological
weapons, ionising radiation.
ii. Any Insured Person’s participation or involvement in naval,
military or air force operation.
iii. Intentional self-injury or attempted suicide while sane or insane.

iv. Items of personal comfort and convenience like television

(wherever specifically charged for), charges for access to
telephone and telephone calls, internet, foodstuffs (except
patient’s diet), cosmetics, hygiene articles, body care products
and bath additive, barber or beauty service, guest service.
v. Treatment rendered by a Medical Practitioner that is outside of
their discipline.
vi. Doctor’s fees charged by the medical practitioner sharing the
same residence as an Insured Person or who is an immediate
relative of an Insured Person’s family.
vii. Provision or fitting of hearing aids, spectacles or contact lenses
including optometric therapy unless explicitly stated and covered
in the policy.
viii. Any treatment and associated expenses for alopecia, baldness,
wigs, or toupees, medical supplies including elastic stockings,
diabetic test strips, and similar products.
ix. Any treatment or part of a treatment that is not of a reasonable
charge, not medically necessary; drugs or treatments which are
not supported by a prescription.
x. Crutches or any other external appliance and/or device used for
diagnosis or treatment (except when used intra-operatively and
explicitly stated and covered in the policy.
xi. Any claims made after the proposal or enrolment form date but
before the Policy or Certificate of Insurance is issued, where the
member's health status has changed and same is not notified to
us of the change.

7. Waiting Period Please refer to Point No. 4

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
Sr. No. Title Description Policy Clause No.

8. Financial Limits of Coverage Please refer to Point No. 4 Financial Limits as

Covered Under The
Policy
. Sub-limit (The Insurance
Company will not pay any
amount over this
predetermined limit)

. Co-payment (It is a
specified
amount/percentage of
the admissible claim
amount to be paid by
policyholder/insured)
. Deductible (It is a
specified amount):

- Up to which aninsurance
company will not pay any
claim, and

- Which will be deducted -

from total claim amount(If
claim amount is morethan
the specified amount)
Any other limit (As
applicable)

9. Claims/Claims Procedure This section explains about the procedures involved to file a valid claim by Section 5: Claim
the Insured member and processes related in managing the claim by TPA Procedure and Claims
or us. All the procedures and processes such as notification of claim, Payment
availing cashless service, supporting claim documents and related claim
terms of payment are explained in this section.

Notification of Claim

Treatment, Consultation or TATA AIG or Our TPA* Must

Procedure: be Informed:

1. If any treatment for which a claim At least 48 hours prior to the

may be made and that treatment Insured Person’s admission.
requires planned hospitalisation:

2. If any treatment for which a claim Within 24 hours of the

may be made and that treatment Insured Person’s admission
requires emergency to hospital.
hospitalisation / Home Care
Expenses wherever opted

*TPA as mentioned in the Policy Schedule.

Failure to furnish such intimation within the time required shall not
invalidate nor reduce any claim if you can satisfy us that it was not
reasonably possible for you to give proof of such delay within such time.
The company may relax these timelines only in special circumstances and
for the reasons beyond the control of the Insured.

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11
 Sr. No. Title Description Policy Clause No.

10. Grievances/Complaints Redressal of Grievance Section 4: General Terms

and Clauses
In case of any grievance the Insured Person may contact the company
through Website: [Link]
Email us at customersupport@[Link]
Courier: Customer Support,
TATA AIG General Insurance Company Limited, 7th and 8th Floor, Romell
Tech Park, Cama Industrial Estate, Western Express Highway, Goregaon
(E), Mumbai, Maharashtra 400063
Insured Person may also approach the Grievance cell at any of the
company’s branches with the details of Grievance.

Escalation Level 1:
If Insured Person is not satisfied with the Redressal of Grievance through
one of the above methods, Insured Person may contact the Grievance
Officer at manager customersupport@[Link]
For updated details of Grievance Officer, kindly refer the link -
[Link]
Escalation
- Level 2:
lf lnsured Person is not satisfied with the redressal of Grievance through
- above methods, the Insured Person may also approach the office of
lnsurance Ombudsman of the respective area/region for Redressal of
Grievance as per lnsurance Ombudsman Rules 2017.
Grievance may also be lodged at IRDAI Integrated Grievance Management
System - [Link]

1. Free Look Period

11. Things to Remember Section 4: General Terms
2. Cancellation and Clauses
3. Claim Settlement

12. Your Obligations In the event that the Policyholder misrepresents, misdescribes, or fails to
disclose any relevant fact, the policy will be void and all premiums paid
thereon will be forfeited to the company.

Declaration by the Policyholder:

I have read the above and confirm having noted the details.

Place: HYDERABAD

Date: 10/04/2025

(Signature of the Policyholder) MUTHOOT FINCORP LTD

The terms and conditions listed in the policy statement will take precedence in the event of a conflict.

Disclaimer: Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms & conditions, please refer sales brochure/policy
wordings on [Link] carefully, before concluding a sale. The trade logo displayed above belongs to TATA Sons Private Limited and AIG and is used by TATA
AIG General Insurance Company Limited under License.

TATA AIG General Insurance Company Limited

Registered office : Peninsula Business Park, Tower A, 15th Floor, G.K Marg, Lower Parel, Mumbai-400013
24*7 Toll free Number : 1800 266 7780 Email : customersupport@[Link] website : [Link]
IRDA of India Registration No : 108 CIN : U85110MH2000PLC128425 UIN : TATHLGP21248V022021
Page 11 of 11