TATA AIG Critical Illness health insurance Plan

Procedure for Reimbursement of medical expenses

• The TPA (Third Party Administrator) must be informed no later than 7 days of completion of such treatment, consultation or procedure using the Claim Intimation Form.
• Please send the duly signed claim form and all the information/documents mentioned therein to your designated TPA within 15 days of the occurrence of the Incident. Please refer to claim form for complete documentation.
• If there is any deficiency in the documents/information submitted by the insured, the TPA will send the deficiency letter within 7 days of receipt of the claim documents.
• On receipt of the complete set of claim documents, Tata AIG will send the payment for the admissible amount, along with a settlement statement within 30 days.
• The payment will be sent in the name of the proposer.

(Note: Payment will only be made for items covered under your policy and upto the limits therein.)

Procedure to avail cashless treatment

• For any emergency Hospitalisation, the designated TPA must be informed no later than 24 hours after hospitalization.
• For any planned hospitalization, kindly seek cashless authorization from the designated TPA atleast 48 hours prior to the hospitalization.
• TPA will check your coverage as per the eligibility and send an authorization letter to the provider. In case there is any deficiency in the documents sent, the same shall be communicated to the hospital within 6 hours of receipt of documents.
• Please pay the non-medical and expenses not covered to the hospital prior to the discharge.
• In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the provider within 6 hours.

(Note: n Insured person is entitled for cashless coverage only in our empanelled hospitals.)

Grievance redressal procedure

Tata AIG is committed to extend the best possible services to the insured. However, if you are not satisfied with our services and wish to lodge a complaint, please call our 24X7 Toll free number 1800266-7780 or 022-66939500 (toll number) or 1800 22 9966 (For Senior Citizens) or you may email to the customer service desk at customersupport@tataaig.com. After examining the issue and subsequent closure, Tata AIG will send our response within 10 days from the date of receipt of the complaint by them. In case the resolution is likely to take a longer time, we will inform you of the same through an interim reply.

In case you do not receive a resolution within 10 days or if the resolution still does not meet your expectations, you can write to manager.customersupport@tataaig.com . After analysing the matter internally and subsequent closure, we will send our response within a period of 8 days from the date of receipt at this email id.

In case you do not receive a resolution within 8 days or if the resolution still does not meet your expectations, you can write to Head - Customer Services at head.customerservices@tataaig.com . After examining the matter, we will send you our final response within 7 days from the date of receipt of your complaint on this email id.