Employees

Benefit Manual
FY 2025-2026
Group Mediclaim

01 02
Coverage Details Benefit Details

03 04
Enrolment Process Document Checklist

05 06
Hospitalization &
LKP and Contact Matrix
Claims
2
Employee
Benefits
GMC
Medical Benefit - Coverage Details

Policy Parameters

TATA AIG General Insurance Co Ltd

Insurer

TPA MD India Health Insurance TPA Pvt Ltd

Policy Number

Policy Start Date 01-04-2025

Policy End Date 31-03-2026

Coverage Type Family Floater

Self + Spouse + 3 Dependent Child + 2 Parents or Parents In-Law ( Cross Selection

Dependent Coverage Allowed ) with locking period of 2 years

INR 7,50,000 Per Family Per Year

IPD Sum Insured

INR 10,000 Per Family Per Year

OPD Sum Insured
 Medical Benefit- Dependent Coverage
Maximum no. of Members insured in a family
Employee Yes
Spouse Yes
Children Yes, 3 children up to the age of 25 years
Parents Yes (set of parent (Parent / In –Law) Cross selection is
allowed. Parents details once declared cannot be changed for
2 years until change in life continuity status (demise)
Cross selection of parents Yes
Siblings No
Others Not Covered
Mid Term enrollment of existing Dependents Not Allowed
Mid Term enrollment of New Joiners (New employees
Allowed (Within 30 days from DOJ
+their Dependents)
Mid term enrollment of new dependents (Spouse/Children) Allowed (Within 30 days from date of event)
Termination date End date of policy or last date in organization

• Comments:
• No age bar for differently abled child and Widowed daughter
• Special child is covered with no age limit until employment
• No change in the declaration in the middle of the policy for Live in Partner

Note : During the enrolment no documentation will be asked as proof of relationship, however valid documentation of the relationship may be
asked for at the time of claiming if required, though there will be no requirement for the dependents during declaration of the dependents.
Medical Benefit

Benefits / Extensions Coverage Benefits / Extensions Coverage

Standard Hospitalization Yes Dental Yes (OPD)

Pre-existing diseases Yes Pre-Post Hospitalization Exp. Yes

Waiver on 1st year exclusion Yes Baby cover day 1 Yes

Waiver on 1st 30 days exclusion Yes Ambulance Services Yes

Maternity benefits Yes Co pay on claims No

Pre & Post Natal Expenses Yes COVID Home Care Benefit Yes

Day Care Yes Disease Wise capping Yes

OPD Yes Ayush Yes

Domiciliary Yes Room Rent Yes

Vision Yes Organ Donor Charges Yes

Lasik Treatment Yes Terrorism cover Yes

Psychiatric Treatment Yes

 Extensions- Definitions
Benefits Definition

Any Pre-Existing
Benefits ailments such as diabetes, hypertension, etc. or related ailments for which care, treatment or
/ Extensions
Pre-existing diseases advice was recommended by or received from a Doctor or which was first manifested prior to the
commencement date of the Insured Person’s first Health Insurance policy with the Insurer
Any Illness diagnosed or diagnosable within 30 days of the effective date of the Policy Period if this is the first
First 30-day waiting Health Policy taken by the Policyholder with the Insurer. If the Policyholder renews the Health Policy with the
period Insurer and increases the Limit of Indemnity, then this exclusion shall apply in relation to the amount by which
the Limit of Indemnity has been increased

During the first year of the operation of the policy the expenses on treatment of diseases such as Cataract,
First Year Waiting Benign Prostatic Hypertrophy, Hysterectomy for Menorrhagia or Fibromyoma, Hernia, Hydrocele, Congenital
period Internal Diseases, Fistula in anus, Piles, Sinusitis and related disorders are not payable. If these diseases are pre-
existing at the time of proposal, they will not be covered even during subsequent period or renewal too

Expenses incurred in respect of newborn baby would be covered from day one subject to the insurers being
intimated about the birth of the child within 15 days of birth. If the baby has to be hospitalised for any illness ,
Baby Cover Day 1
disease or injury, e.g. If the baby has jaundice or some other medical problem, then the family floater limit
would apply. Normal baby expense at the time of birth is covered with the family floater SI.

During the Period of Insurance, for the amount incurred up to a maximum of INR.7500 for necessary
transportation of the Insured to the nearest Hospital, for treatment of an Illness or Bodily Injury which is
admissible and payable under the policy. In case of life-threatening emergency condition or Accident, subject to
Ambulance
certification by the Medical Practitioner of such life-threatening emergency hospitalisation directly to cardiac
Ambulance charges will be paid as per actual. Air Ambulance covered in case of life-threatening condition
within 250 km radius.

Day Care Procedure means the course of medical treatment, or a surgical procedure listed in the Schedule
Day Care which is undertaken under general or local anesthesia in a Hospital by a Doctor in not less than 2 hours and not
more than 24 hours.
 Additional- Coverage Extension
Benefits Terms
Internal & External Congenital Anomaly refers to a condition(s) which is present since birth, and which is abnormal with
Congenital Benefits / Extensions
reference to form, structure or position. Both Internal and external Congenital is covered.
Any Outpatient treatment that does not require hospitalization is covered up to the limit of INR 10,000 per
OPD family. This includes Dental / Vision / Diagnostic / Vaccination. Any expenses which are Cosmetic in nature
are not covered
Cost of Donor expenses will be covered with sub limit up to SI. Cost of organ excluded. Hospitalization and
Organ Donor screening expenses for both the patient and donor will be payable only once in policy period at the time of
hospitalization.

Chemotherapy Oral Chemotherapy drug and Adjuvant chemotherapy is also covered

Psychological Disorder Treatment of mental illness and neurodegenerative disorder is covered with family sub limit

Ayurveda, Yoga, Unani, Siddha, Homeopathy treatment covered up to full SI with reimbursement of
AYUSH
hospitalization bills if treatment taken in Government recognized / approved AYUSH hospitals

Bariatric Treatment Covered only for employees if BMI greater than 32 with co morbidity

Payable under the Policy if prescribed by the doctor & all the bills & payment proof from Physiotherapist are
Physiotherapy
provided.

Robotic/ Cyber Knife Covered up to full SI limit

HIV/AIDS Covered up to full SI limit

 Additional- Coverage Extension
Benefits Terms

Artificial limbs fitted following any surgical procedure Covered up to full SI limit

Genetic diseases or disorders Covered up to full SI limit

Age Related Macular Degeneration (ARMD) Covered up to full SI limit

Cochlear Implant Covered up to full SI limit

Keratoconus treatment Covered up to full SI limit

Biological / hormonal and adjuvant therapies Covered up to full SI limit

Immuno modulators Covered up to full SI limit

EECP-Enhanced External counter pulsation Covered up to full SI limit

Critical illness (Cancer etc.) Covered up to full SI limit

 Additional- Coverage Extension
Benefits Terms

Sleep apnea Covered up to full SI limit

Stem cell implantation/ surgery for bone marrow

Covered up to full SI limit
transplantation

Drug-eluting stents, Bio-Degradable Stents, all types of

Covered up to full SI limit
pacemakers, ICDs, foreign made implants

Comatose / Vegetative States Covered up to full SI limit

Renal Failure Covered up to full SI limit

Cholecystectomy Covered up to full SI limit

Outside Doctor/Surgeon/ Assistant Surgeon/Consultant

Covered up to full SI limit
visiting charges

Drug Therapy Covered up to full SI limit

Angiography Covered up to full SI limit

Covered for both eyes if refractory error is +/- 5 and above with no sub
Lasik
limit

Dental Covered under the OPD limit INR 10,000 per family per year.
 Additional- Coverage Extension
Disease Limit
Cataract Covered up to 10% of basic Sum Insured ( INR, 75,000) per eye
Total Knee/HIP replacement Knee and HIP replacement is capped at INR 200,000 per knee / hip
Hernia/Hydrocele Covered with sub limit of INR 100,000
Fess/Nasal Sinusitis Covered with sub limit of INR 75,000
Tonsil Surgery Covered with sub limit of INR 50,000
Appendicitis Covered with sub limit of INR 100,000
Hysterectomy Covered with sub limit of INR 125,000
Infertility Covered under Maternity C Sec Sub limit limit under IPD only

Fracture Covered up to INR 20,000 per claims under IPD limit even if taken on OPD basis

Gall Stone Removal Covered with sub limit of INR 75,000

Uterine Artery Embolization and HIFU Covered up to 20% of Sum Insured, max of INR 200,000
Balloon Sinusplasty Covered up to 50% of Sum Insured, max INR 350,000
Deep Brain stimulation Covered up to 70% of Sum Insured, max INR 525,000
Stereotactic radio surgeries Covered up to 50% of Sum Insured, max INR 350,000
Bronchial Thermoplasty Covered up to 30% of Sum Insured, max of INR 300,000
Vaporization of the prostrate Covered up to 30% of Sum Insured, max of INR 200,000
IONM Covered up to 15% of Sum Insured, max of INR 100,000
 Medical Benefit- Covered Expenses

Covers expenses related to:

Room and boarding -

Intensive Nursing
1% of SI for Normal Doctor's fees
Care Unit expenses
and no limit for ICU

Surgical fees, operating Drugs and Diagnostics including

theatre, anesthesia and Physical medicines pre-post (such as
oxygen and their therapy prescribed by laboratory, x-ray,etc)
administration the doctor
including pre-
post.

Dressing, ordinary
Costs of prosthetic devices if implanted Radiotherapy and
splints and plaster
during a surgical procedure chemotherapy
casts

• The expenses are payable provided they are incurred in India and within the policy period. Expenses will be reimbursed to LIST OF NON
the covered member depending on the SI limit available.
PAYABLE ITEMS
• Expenses on Hospitalization for minimum period of 24 hours are admissible.. However, this time limit will not apply for
specific treatments i.e., Dialysis, Chemotherapy, Radiotherapy, Cataract, Dental Surgery, Lithotripsy (kidney stone removal),
Tonsillectomy, D & C taken in the Hospital/Nursing home and the insured is discharged on the same day of the treatment will
be taken under Hospitalization Benefit. * (Refer Day Care List)
• A security deposit may be collected by the empaneled hospitals to cover the non admissible expenses.

Note : Valid documentation of the relationship may be asked for at the time of claiming, though there will be no requirement for the dependents during
declaration of the dependents.
Maternity Benefits
Maternity Benefit Details

Normal – Covered up to INR 75,000 within the Sum Insured

Benefit Amount
C- Section – Covered up to INR 1,00,000
Maximum of 3 children ( Extended up to 4th child in case of Twin at third
Expenses Covered
delivery
9 Months waiting period Not applicable
Covered within maternity limit
Pre-Post Natal Expenses Pre and post natal expenses are restricted to 9 month and 2 Months
respectively. ( means 60 days post childbirth)
Baby covered from day one within Sum Insured
(1) Incase of Specific illness of new born baby expenses towards the same
New-Born baby covered from Day 1 will be covered from normal sum insured
( 2) New born babies: are covered from the time of birth

• These benefits are admissible in case of hospitalization in India.

• Covers first 3 children only. Those who already have 3 or more living children will not be eligible for this
benefit.
• Expenses incurred in connection with voluntary medical termination of pregnancy during the first 12
weeks from the date of conception are not covered.
• In case of life-threatening situation during delivery for Mother or baby Family SI would be applicable

Note : During the enrolment no documentation will be asked as proof of relationship, however valid documentation of the relationship may be
asked for at the time of claiming if required.
Pre & Post Hospitalization Expenses

Pre-hospitalization Expenses

If the Insured member is diagnosed with an Illness which results in his / her Hospitalization
Definition and for which the Insurer accepts a claim, the Insurer will also reimburse the Insured
Member’s Pre-hospitalization Expenses for up to 30 days prior to his / her Hospitalization.

Covered Yes

Duration 30 Days

Post-hospitalization Expenses
If the Insurer accepts a claim under Hospitalization and immediately following the Insured
Member’s discharge, further medical treatment directly related to the same condition for
Definition
which the Insured Member was Hospitalized is required, the Insurer will reimburse the
Insured member’s Post-hospitalization Expenses for up to 60-day period.
Covered Yes

Duration 60 Days

Note : Valid documentation of the relationship may be asked for at the time of claiming though there will be no requirement for the dependents
during declaration of the dependents.
 COVID Home Care Treatment
Benefit Details Definition
Benefit Amount INR 15,000 per family
CovId 19 home care treatment expenses covered up to INR 15000 per family
Home Care Treatment means, treatment availed by the Insured Person at home for Covid-19 on
positive diagnosis of Covid-19 in a Government authorized diagnostic Centre, which in normal
course would require care and treatment at a hospital but is actually taken at home maximum
up to 14 days per incident provided that::-

Ø The Medical Practitioner advises the Insured Person to undergo treatment at home
Ø There is a continuous active line of treatment with monitoring of the health status by a
medical practitioner for each day through the duration of the home care treatment
Ø Daily monitoring chart including records of treatment administered, duly signed by the
treating doctor is maintained
Ø Insured shall be permitted to avail the services as prescribed by the Medical Practitioner.
Cashless facility shall be offered under home care expenses if the treatment is through a
Home Care Treatment network provider
Ø The Home Care treatment shall include the following, if prescribed by the treating Medical
Practitioner and is related to treatment of COVID:
i. Diagnostic tests undergone at home or at diagnostics center
ii. Medicines prescribed in writing
iii. Consultation charges of the medical practitioner
iv. Nursing charges related to medical staff
v. Medical procedures limited to parenteral administration of medicines
vi. Cost of Pulse Oximeter, Oxygen cylinder and Nebulizer (only rental cost)
 Voluntary Top Up insurance option

Annual Decide on top up insurance at the time of

Top Up Sum Annual Premium enrolment
Premium (Excl.
Insured (Incl. GST)
GST)
•Lock in period –2 years, upside in top up
INR 250,000
INR 5,580 INR 6,584
insurance possible but reduction or opting out
will not be possible.
INR 500,000
INR 7,278 INR 8,588 •Definition of parent/in-laws –once opted for
INR 750,000 the top up insurance, the parent definition
INR 9,704 INR 11,451
cannot be changed for 2 years, except in cases
INR 1,000,000 of demise.
INR 14,209 INR 16,767
INR 1,500,000 •Top Up limit will not be applicable to
INR 18,715 INR 22,084 a) Capped Ailment
INR 2,000,000
INR 24,953 INR 29,445 b) Maternity / Infertility
c) OPD / domiciliary
d) Room rent limit

• Top Up Options mirror the same benefits as provided in the base cover by Air India Limited
• Flexibility to chose any sum insured as desired, basis the above table
• Premium will be deducted from Salary in 6 EMIs
 Benefits of GMC Top Up

Hassle Free Additional Cover Benefits

No documentation required for Flexible Options – choose between 6 Higher coverage limit basis
Policy Issuance Top Up options requirement

No pre policy medical check-up Tax benefit under Sec 80D (as per IT
All covers as per base GMC Policy
required law under old tax regime)

Customized Product for AI

Waiting period waived Family Care at an affordable price
employees

Different plans available in the

market would range between INR
Heavily discounted top up Premium
Pricing Benefit 20000 – 1,00,000 for the Sum
for Flexible Sum insured options
insured amount ranging from INR 2
Lakhs-20 Lakhs

Through the same TPA – As the AI Better control on processes and less
Claims Handling
base policy delays

No age Limit for Parents Unlike Cost efficient top up premium for
Parents ( Age Limit )
individual retail plans family including parents
Enrolment
• Existing employees are covered under the policy from 1st Apr, 2025 . However, you must enroll your dependents within 30 days of start
date. If you fail to enroll, the next enrolment can be done only at next year.
• All New joiners must enroll their dependents within 30 days of joining the company.
• In case of change of status due to marriage or birth of child , enrolment must be done within 30 days of such event.

Sample Workflow

For addition of
The page will display employee
HR will send the TMIBASL will get dependents Employee
details. Employee has to update
Employee data to the data updated has to login with
his/her mobile number mandatorily
TMIBASL in LKP. credential shared in
before moving to next page
mail from LKP

Key in the details of the

Click on the disclaimers dependants you want to add
to complete the Select Top Up Add Dependent
and then click on the add
enrollment in the policy button. The added
dependant will be shown on
the web page

Send mail to HR
Error in data with details
E-card (ID) can be printed on card
downloaded through Employee
same employee login verifies details
– Tentatively after 45 on the ID card ID Card Ok Use card for
days of enrolment cashless
closure hospitalization
 Cashless process

• Cashless means the Administrator may authorize upon a Policyholder’s request for direct settlement of eligible
services and it is in accordance with charges agreed between a Network Hospital and the Administrator. In such
case the Administrator will directly settle all eligible amounts with the Network Hospital and the Insured Person
may not have to pay any deposits at the commencement of the treatment or bills after the end of treatment to the
extent as these services are covered under the Policy.

List of hospitals in the MD India network eligible for cashless process

Please visit the below given web link to check the updated list of [email protected]
Hospitals https://mdindiaonline.com/ProviderList.aspx
Emergency Hospitalization & Cashless Process
Step 1
Get Admitted

In cases of emergency, the

member should get admitted in
the nearest network hospital by
Member gets admitted in
showing their ID card along with
the hospital in case of
valid government ID
emergency by showing his
NO
ID Card along with valid Non cashless
government ID Pre-authorization Hospitalization
Step 2 given by the TPA Process
Pre-Authorization PROCESS
by hospital
Relatives of admitted member
should inform the TPA within 24
YES
Member/Hospital applies
hours about the hospitalization &
for pre-authorization to the
Seek pre-authorization. The
TPA within 24 hrs. of Member gets treated and
Approval letter would be directly
admission discharged after paying all
given to the hospital. In case of
denial member would be informed non-medical expenses like
directly by TPA refreshments, etc.

TPA verifies admissibility

Step 3 of the claim and issue
Treatment & Discharge approval/query/denial as
applicable Hospital sends complete
After your hospitalization has been set of claims documents for
approved, employee is not required processing to the TPA
to pay the hospitalization bill in case
of a network hospital apart from non-
medical items. The bill will be sent
directly to, and settled by TPA
Non-Cashless Claims Process

Admission procedure
• In case you choose a non-network hospital you will have to liaise directly with the hospital for admission.
• However, you are advised to follow the pre-authorization procedure to ensure eligibility for reimbursement of hospitalization expenses
from the insurer.

Discharge procedure
• In case of non network hospital, you will be required to clear the bills and hand over the claim to TPA Helpdesk for reimbursement from
the insurer. Please ensure that you collect all necessary documents such as – discharge summary, investigation reports etc. for
submitting your claim.

Submission of hospitalization claim

• You must submit the final claim with all relevant documents within 30 days from the date of discharge from the hospital.

Claims Process Claims Docs

Attach Document/PDF
Non-Cashless Claims Process

Insured admitted
Member intimates Claim registered Insured hands over
as per hospital
TMIBASL/TPA SPOC by TPA after relevant documents
norms. All A
before or as soon as receipt of claim to TPA within 30
payments made
hospitalization occurs intimation days of discharge
by member

Is document received • Insured will create

Is claim TPA performs medical within 30 days from the summary of
payable? scrutiny of the documents discharge Bills (2 copies)
and attach it with
the bills
• The envelope
NO NO should contain
clearly the
YES Claim Rejected Employee ID &
Employee e-mail

TPA checks document Is documentation

Claims Payment to be
sufficiency complete as
processing made vide transfer.
required

NO
Send mail about deficiency
and document requirement A
 OPD Claims – Reimbursement Process

• Employees can continue to avail OPD treatment with their preferred Network hospital/ diagnostic Centre or buy

medicines from a local pharmacy / medical shop and then Claims can be lodged with TPA for reimbursement.

• Employees need to fill in the claim form and along with original documents i.e. prescription/ Bills / reports, the same

need to be submitted to TPA Helpdesk at AI seven major location including HO.

• For Medicine bills prescription will be mandatory, validity of prescription will be 6 months.

• For long term treatments self-attested copies of prescription will be accepted

• All remaining documents i.e. Medicine bills, Payment receipts, diagnostic reports, prescription etc. will be required in

original.

• Employee can submit bills once in every quarter or as per treatment availed.

• OPD bills to be submitted within 3 months from date of treatment or INR 500 which ever is earlier.
 Claims Document List

Completed Claim form with Signature

Claims Form
Hospital bills in original (with bill no; signed and stamped by the
hospital) with all charges itemized and the original receipts

Discharge Report (original)

Attending doctors’ bills and receipts and certificate regarding Claim form
diagnosis (if separate from hospital bill) and check list

Original reports or attested copies of Bills and Receipts for

Medicines, Investigations along with Doctors prescription in Original
and Laboratory, Stickers in case of Implants E.g.: Lens (Cataract),
Stents (Heart Surgery) etc.

Follow-up advice or letter for line of treatment after discharge from

Address for sending claim documents
hospital, from Doctor.

Provide Break up details including Pharmacy items, Materials,

ATTN:
Investigations even though it is there in the main bill
Original Claim documents needs to be submitted to MDI
In case the hospital is not registered, please get a letter on the SPOC available at your Gurugram office
Hospital letterhead mentioning the number of beds and availability
of doctors and nurses round the clock. SPOC Name –Sneha Kamble
Address:MD India Health Insurance TPA Pvt. Ltd.
In non- network hospital, you may have to get the hospital and S. No. 46/1, E-space, A-2 Building, 3rd floor,
doctor’s registration number in Hospital letterhead and get the Pune Nagar Road, Vadgaonsheri,
same signed and stamped by the hospital, if required. Pune 411014.
For NEFT transfer for claim reimbursement . A signed copy of
cancelled chq with the claimants name mentioned on the chq *Please retain photocopies of all documents submitted
needs to be attached to the above form. Aadhaar card of patients
to be submitted.
 General Exclusions

• Injury or disease directly or indirectly caused by or arising from or attributable to War or War-like situations
• Vaccination/ Inoculation/ Circumcision other than medical grounds. Circumcision unless necessary for treatment of a
disease not excluded here under or as may be necessitated due to an accident, vaccination or inoculation or change of
life or cosmetic or aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an
accident or as a part of any illness.
• Congenital external diseases or defects/anomalies in case cosmetic in nature
• Hospitalization for convalescence, general debility, intentional self-injury, use of intoxicating drugs/ alcohol.
• Venereal diseases
• Injury or disease caused directly or indirectly by nuclear weapons
• Naturopathy
• Any non-medical expenses like registration fees, admission fees, charges for medical records, cafeteria charges,
telephone charges, Surcharge, cost of special diet etc.
• Cost of spectacles, contact lenses, hearing aids
• Any cosmetic or plastic surgery except for correction of injury
• Hospitalization for diagnostic tests only
• Vitamins and tonics unless used for treatment of injury or disease
• Voluntary termination of pregnancy during first 12 weeks (MTP)
 Deductions / Non-Payable Expenses
Administrative Expenses
Admission charges Registration charges Medico-legal charges Attendant stay charges
Relative stay charges Additional stay Gate pass/Attendant pass Conveyance charges
Booking charges Overhead charges Establishment charges Tax/Luxury charges
Surcharge/Service charges Incidental charges Waste disposal charges

Documentation Expenses
Documentation charges Discharge summary Medical records charges Birth certificate
Death Certificate Medical Certificate TPA charges

Consumables
cosmetic expenses Referral charges HIV charges Antiseptic/ disinfectant solutions
Soap & Powder (Talc) Preparation charges Oil & cream Outstation consultants /surgeons
Housekeeping charges Oxygen cylinder Donor organ charges Vaccination charges
RMO/duty doctor charges Sanitary pads/Diapers Mortuary/coffin charges Assistant charges for minor cases
ECG electrode charges Cassette/CD film charges Expenses towards sterilization Toiletries & stationeries

Services

Private nurse charges Food/beverages Water charges AC charges

Telephone charges Diet & Dietician TV / internet charges Stationary charges
Fax charges Electricity charges Newspaper / Magazine Lines / Laundry charges
 GMC Contact Details
Helpdesk Details
Employee Name Phone Number Location Days Email I.D Timings
Shashank /Rajesh 8530124929/ Delhi Mon to Friday
10:00 AM to 5:00
Pandey /Shashikant 8956726916/ Training [email protected]
Wed. PM
Behera 8530124930 Academy
Ms. Narayan 9545000178/ 10:00 AM to 5:00
Mumbai Mon to Friday [email protected]
Naik/Rakesh Pandey 8799952025 PM
10:00 AM to 5:00
Ms. Somen Debnath 9371820305 Kolkata Mon to Friday [email protected]
PM
8939255033/73 10:00 AM to 5:00
Mr. Arihant /Aboorvan Chennai Mon to Friday [email protected]
91059758 PM
10:00 AM to 5:00
Mr. Arun Kumar 8530126204 Hyderabad Mon to Friday [email protected]
PM
11:00 AM to 2:00
Mr. Yoganad 7391059565 Bangalore Mon, Tue, Thu [email protected]
PM
10:00 AM to 5:00
Hani P H 7709189791 Kochi Wed [email protected]
PM
Insurance Support Matrix
1st Level Contact 2nd Level Contact 3rd Level Contact
Toll Free 18002106869
For Cashless [email protected]
MD India TPA Delfi Anthony Francis Sneha Kamble Reempa Sarkar
Mobile-7249291781 Mobile-7709189959 Mobile- 7391059777
Email [email protected] Email I.D- Email I.D-
[email protected] [email protected]
Anil Kumar Julie Sinha Anuj Shrivastav
TMIBASL Email [email protected] Email I.D- [email protected] Email I.D-
[email protected]
Employee
Benefits
GPA
Group Personal Accident Policy

01 02
Benefit Details Enrollment in
the program

03 04
Claims Procedure Document Checklist

05
GPA Contact Details
GPA – Benefit Details
This insurance provides compensation/payment up to a financial limit as assigned by the company, to the insured
person or his legal personal representative, if the insured person suffers death or disablement due to an accident.
The cover is worldwide but payment of claim can only be made in India and in Indian Rupees.

Policy Parameter

Insurer Name The Oriental Insurance Co. Ltd

Policy Start Date 01-01-2025

Policy End Date 31-03-2026

3 times of CTC Min INR 15 Lac and Max INR 2 Cr (Pilots/Co-Pilots: Flat INR 2 Cr.)
Sum Insured

The sum insured considered is calculated basis CTC details for a specific
month and will be updated periodically as per arrangement with the insurer,
hence there can be deviation in settlement amount and CTC for the month in
which insurance is claimed
GPA – Benefit Details
Coverage Details

Accidental Death Yes (100% of Capital Sum Insured including Base+ Top Up)

Permanent Total Disability Yes (100% of Sum Insured considered will be Base+ Top Up))

Permanent Partial Disability Yes (As per chart )(Sum Insured considered will be Base+ Top Up))

Weekly compensation of 1.5% SA Subject to a maximum of INR 20,000 or 25% of the actual salary
Temporary Total Disability whichever is less subject to a limitation of a Maximum 100 weeks for Captain, Pilots & Cabin Crew.

Accidental Medical Expenses Covered up to 10% of Sum Insured or actual whichever is less

10% of Sum Insured or INR 100,000 whichever is lower for each child. Payable for 2 children in an
Child Education
event of an admissible accidental death claim (age below 23 years

INR 25000 or actual whichever is lower for Domestic travel & INR 50,000 or actual whichever is
Family Transportation Benefit
lower for International travel

Cremation Charges & Covered up to INR Covered INR 2,500 for each
Carriage of Dead Body

Covered up to 4% of Sum Insured or INR1,00,000 whichever is less

Repatriation of Remains

Geographical Limits Worldwide

Terrorism Covered
GPA – Benefit Details
Coverage Details

Animal / Insect / Snake

Covered
Bite
Covered under the policy except where insured/deceased is engaged in any criminal/Illegal activity
Murder
(copy of Final Policy investigation report to be provided )
Covered up to INR 50,000
In case of coma a lump sum amount of INR 50,000 will be paid if a person continues to be in coma for
Coma Benefit 30 days. And in case if the company declares that an employee is unable to join back the services
arising out of the same incidence due to certain PTD conditions then amount will be paid as per PTD
SI applicability. In such scenario INR 50,000 is payable over and above the PTD SI

Covered for 2nd and 3rd degree burns up to INR 50,000

An amount of INR 50,000 will be paid upfront at the time of incidence. And in case if the company
declares that an employee is unable to join back the services due to certain PTD conditions arising out
of the same incidence then amount will be paid as per below table, applicable on Sum Insured. In
such scenario INR 50,000 is payable over and above the PTD SI
Burns
2nd or 3rd degree burns on
At least 27% of body surface : 100% payment
At least 18% of body surface : 80% payment
At least 9% of body surface : 40% payment
At least 4.5% of body surface: 20% payment

(PTD- Permanent Total Disability)

Permanent and Visible Scarring of the face within 3 months of Accident is payable up to INR
1,00,000 if an Insured Person sustains Injury which has valid Claim under Accidental
Facial Scarring Benefit Dismemberment and Paralysis and/ or Permanent Total Disability and /or Permanent Partial
and Dental Disability and/ or Accidental Medical Expense which results in permanent and visible scarring of the
Reconstruction face and Dental reconstruction; recommended by Medical Practitioner if the treatment is taken
within three (3 ) months of Accident.
 GPA – Top Up
Coverage Details Top Up Sum Insured

Base SI is 15 lacs Top Up option of 5 / 10 / 15 lacs

Base SI is 3X CTC greater than 15 Lacs and less than 25 Lacs Top Up option of 10 / 15 / 25 lacs

Base SI is 3X CTC greater than 25 Lacs and less than 50 Lacs Top Up option of 15 / 25 / 50 lacs

Base SI is 3X CTC greater than 50 Lacs and less than 75 Lacs Top Up option of 25 / 50 / 75 lacs

Base SI is 3X CTC greater than 75 Lacs and less than 1 Crore Top Up option of 50 / 75 lacs and 1 crore

Base SI is 3X CTC greater than 1 crore and less than 1.50 Crore Top Up option of 75 lacs and 1 / 1.50 crore

Top Up option of 1 / 1.50 / 2 crore

Base SI is 3X CTC greater than 1.50 crore and less than 2 Crore

• Top Up Options for GPA will enhance the Sub limit of AD, PTD,PPD only, rest will be same benefits as provided in the base
cover by Air India
• The sum insured can be chosen as desired basis the above table.
• Premium will be deducted from Salary in 6 equal monthly installments
• CTC for non-flying staff and cabin crew will be as mentioned in employment contract/last performance appraisal letter
• Top Up once selected has lock-in period of 2 yrs.
 GPA – Details for PPD
Compensation Expressed as a
The Disablement
Percentage of Total Sum Insured
Permanent Total Disablement 100%

Permanent and incurable insanity 100%

Permanent Total Loss of two Limbs 100%

Permanent Total Loss of Sight in both eyes 100%

Permanent Total Loss of Sight of one eye and one Limb 100%

Permanent Total Loss of Speech 100%

Complete Removal of the lower jaw 100%

Permanent Total Loss of Mastication 100%

Permanent Total Loss of the central nervous system or he thorax and all abdominal organs resulting in the
complete inability to engage in any job and the inability to carry out Daily Activities essential to life without fulltime 100%
assistance

Permanent Total Loss of Hearing in both ears 75%

Permanent Total Loss of one Limb 50%

Permanent Total Loss of Sight of one eye 50%

Permanent Total Loss of Hearing in one ear 15%

Permanent Total Loss of the lens in one eye 25%

Permanent Total Loss of use of four fingers and thumb of either hand 40%

Parmer Total Loss of use of four fingers of either hand 20%

Permanent Total Loss of Use of one thumb of either hand

20%
a) Both joints 10% 10%
b) One joint

Permanent Total Loss of one finger of either hand:

5%
a) Three joints
3.5%
b) Two joints
2%
c) One joint
Enrolment
• Existing employees are covered under the policy from 01st Jan 2025.
• All New joiners must enroll within 30 days of joining the company/or as advised in enrolment mailer.

Sample Workflow

TMIBASL Team will get it For Top Up Employee

uploaded to LKP Portal & The page will display Enrollment Tab to
HR will send the Employee has to login with
mailer will be shared for view employee detail and move next to
data to the TMIBASL Team credential shared in mail
selection of Top Up as per select Top Up as per member grade
& mandatorily rest the
grade and designation
password

View you SI limit

Click on the disclaimers and Key in the details of the Top Up
Submit Tab to complete the you want to add and then click
enrollment in the policy on the add Top Up button.

Final acknowledgement
mailer will come confirming
the member participation

35
GPA – Claims Process

Claimant / Assignee notifies

HR within 24 hours , who in
turn would intimate TMIBASL
/ Insurer and submit required
claim documents within 30
days of the event

YES
On obtaining all relevant
NEFT will be done to
documents, Insurance
Is claim payable? Employee/Assignee as per company
Co. will begin processing
records within 45 working days from
the claims
date on which all queries of insurer
were addressed

NO

Claim Investigation and Insurer provides a valid

Review submission of all the reason for the rejection to
required documents HR/Claimant/ Assignee
 GPA – Claims Document Checklist

Death Claims Dismemberment / Disablement Claims Weekly Benefit Claims (TTD )

• Completed claim form • Completed claim form • Personal Accident Claim Form Duly
• Attending Doctor's report • Doctor's Report Completed With Signature And Stamp
• Death Certificate • Disability Certificate from the Doctor Of The Company And Medical Report to
• Post Mortem/ Coroner's report • Investigation/ Lab reports (x-ray etc.) Be Completed, Signed And Stamped By
• FIR ( First Information Report) • Original Admission/ discharge card, if The Attending Doctor With HSI
• Police Inquest report, wherever hospitalized. Registration Number.
• applicable • Police Inquest report, wherever applicable • Leave certificate on company’s letter
• Last 3 months salary slip • last 3 months salary slip head
• Salary/ wages certificate
• Final fitness certificate
• Medical papers, X’ray reports, X'ray
films, pathology reports, chemist bills
with prescriptions
Claim Form • Self attested driving license If insured
was driving and involved in Road
Accident
• Incident report
• Any other document pertaining to the
claim.
GPA Claim Form • Payslips for 6 months prior to the date
of accident till the date of resuming
duties
• Copy of AADHAR, PAN & Company
identity card

Note – The above list is indicative and further documents can be required on case-to-case basis.
 GPA – General Exclusions

• Service on duty with any armed force

• Insanity

• Venereal disease

• AIDS

• Influence of intoxicating drink or drugs

• Aviation other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft any
where in the world

• Nuclear radiation or nuclear weapons material

• Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war,
rebellion, revolution, insurrection, mutiny, military, or usurped power, seizure, capture, arrest,, restraint, detainment’s
of all kings, princes, and people of whatever nation, conditions and qualities so ever

• Childbirth, pregnancy or other physical causes peculiar to the female sex

• While committing any breach of law with criminal intent

Note : Above mentioned list is for reference purpose only, detailed terms are available in the policy copy and may vary on case-to-case basis.
Employee
Benefits
GTL
Group Term Life Policy

01 02
Benefit Details Enrollment Process

03 04
Claim Process Document Checklist

05
GTL Contact Details
 GTL – Benefit Details

Policy Parameters
Insurer Tata AIA life Insurance company Ltd

Policy Start Date 01-01-25

Policy End Date 31-03-26

Sum Insured 3 times of CTC with min SI of INR 15 lac and max at INR 2 Cr. (Pilots/Co Pilots:
Flat INR 2 Cr.)
The sum insured considered is calculated basis CTC details for a specific month
and will be updated periodically as per arrangement with the insurer, hence
there can be deviation in settlement amount and CTC for the month in which
insurance is claimed.

Coverage Death due to any reason

24*7 Worldwide Cover Covered

Employees can also opt for following:

1. Top up on GTL for self

2. Coverage of spouse under GTL
3. The Top Up benefit continues to the employees who opted last year. Details will be communicated shortly when top up window is enabled.
The top up and spouse coverage premium will be recovered from employees in 6 equal installments in the financial year.
GTL – Benefit Details

Policy Parameters

Hijacking & Kidnapping The amount payable to Claimant in case the Insured Member death is due to hijacking & kidnapping. The
amount specified in the Membership Register according to the terms and conditions of this Policy shall be
covered.

Drinking or Drug Abuse The amount payable to Claimant in case the Insured Member demise is due to drug or alcohol intoxication
according to the terms and conditions of this Policy.

Continuation of service above

The policy will extend the coverage to employees above retirement age in case of extension of service as per
retirement
company terms

Actively At Work
Waived Off

42
GTL–Enrolment

All existing employees are covered under the policy from 1st Jan 2025.
All New joiners must enroll within 30 days of joining the company/or as advised in enrolment mailer

Eligibility criteria:

➢ Having Attained 18 years of age and being under 65 years of age

➢ All regular full-time permanent & FTC employees based out of India or
deputed abroad
➢ Employees on probation, intended to become permanent employees upon
satisfactory completion of their probationary period and not employed on a
temporary basis .
GTL–Claims Process

Claimant / Assignee notifies

HR, who in turn would
intimate TMIBASL / Insurer
as soon as possible and
submit required claim
documents within 2 months
of the event

On obtaining all relevant YES

documents, Insurance
Co. will begin processing Payment is made in the favour of
Is claim payable?
the claims nominee through NEFT within 15
working days

NO

Claim Investigation and

Review within 10 working Insurer provides a valid
days of submission of all the reason for the rejection to
required documents and HR/Claimant/ Assignee
addressing queries
 GTL – Document Checklist

Document Checklist In case of Accident death

• First Information Report (FIR)

• Original copy of Completed Claimant Statement by the policyholder and • Police Inquest Report with final findings
designated beneficiary, with Policyholder’s Company stamp and authorized • Post Mortem Report (if carried out)
signature. (Please note that the signature of the beneficiary is also
required on the claim form) • English Translation of vernacular documents (if
applicable)
• Certificate from the airline that the deceased was
• Attested NEFT form (attested by the respective Bank) along with a copy of travelling as a passenger (in case of air accident)
the cancelled cheque (with the printed name of the policyholder/nominee)
OR a Bank passbook front page copy, to validate the account details & IFSC
Code of the payee.
Nominee
• Original/attested true copy of death certificate by Municipal Authority. GTL Claim Form declaration
Form
• Certification of date of birth of the insured member on a letterhead signed by
authorised signatory / Email from the ID of the Authorised signatory
Nominee
• Attested true copy of last two months salary slip /appointment letter Declartion form
/promotion letter /increment letter confirming Grade/designation/ CTC/
Basic monthly salary of the insured member. (This requirement may vary on
the basis of the Benefits mentioned in the signed quote)
NEFT Form
• Member Enrolment Form with name of the beneficiary mentioned.

• Attested true copy of relationship proof between designated beneficiary and

insured member.

Note – The above list is indicative and further documents can be required on case-to-case basis . Nominee will be verified by company as per company records
 GTL – Negative Country List

Afghanistan Sierrra Leone Equitorial Guinea Tajikistan

Democratic Republic Of The Congo (Zaire) Somalia Eritrea Togo

Guinea Venezuela - Others Ethiopia Monteserrat

Nepal (South Terrai Region, Birgank,
Guinea Bissau Yemen Gaza
Janakpura, Rangeli)
Ivory Coast Mali Guatemala Palestine
North Korea ( Democratic People's
Liberia Haiti Papua New Guinea
Republic Of Korea (Dprk)
Peru (Aychuco, Apurimac, Cusco, Junin &
Angola South Sudan Honduras Huancavelica Regions, Ene Apurimac River
Valley- Vrae)
Philippines
(Mindanao, Sulu Archipelago, Zamboanga
Indonesia (Aceh, Papua, Central Sulawesi
Burkina Faso Sudan Peninsula) (Occupations Other Than
Maluku, Border With East Timor)
Military, Security , Mineral Extraction &
Energy Sector)
Burundi Syria Israel - West Bank, Gaza, Jerusalem Republic Of Congo

Russia (Chechnya, Dagestan, Ingushetia,

Central African Republic Armenia- Nogorno Karabakh Kyrgyzstan Kabardino- Balkaria, Karachay- Cherkessia,
North Ossetia
Chad Azerbaijan (Others) Madagascar (Others) Rwanda
Iran Cameroon Morocco (Others) Uzbekistan

Iraq Chechyan Republic Mozambique (Nampula, Manica, Sofala) Western Sahara

Libya Dijibouti Myanmar (Burma)

Ecuador (Carchi, Sucumbios, Imbabura,
Pakistan Niue
Esmereldas

46
 Contact Details- GPA-GTL
For lodging a GPA, GTL, claim mail has to be sent to Air India SPOCs marking Anil from TMIBASL. All the claim
documents are in this manual, if you are not able the access the same, then refer Insurance Benefits section on
workplace (knowledge library HR Policies) or Success Factors

TMIBASL Contact Details

Name: Anil Kumar Name: Julie Sinha (for escalation only)
No : 8447325335 No : 9818183110
Email ID: [email protected] Email ID: [email protected]

HR Contact Detail Phone Number Region Email I.D

Ms. Priya Sharma 9319347921 HQ & North [email protected]

Mr. Anoop Nair 9952041788 Southern [email protected]

Mr. Anand Virkayade 9321064002 Western [email protected]

Ms. Bisnupada Das 9432216007 Eastern [email protected]

Ms. Deepa Roy 8589005047 Kochi [email protected]

ORIGINAL CLAIM DOCUMENTS TO BE SUBMITTED/COURIER AT BELOW ADDRESS

To
Name: Anil Kumar
Mobile :8447325335
Email: [email protected]
Tata Motors Insurance Broking and Advisory Services Limited
(Unit No- 3G 3rd Floor, M6 Plaza Uppal Tower Jasola District Centre, Jasola Vihar, New Delhi – 110025. India)
Employee
Benefits
Loss Of License (LOL)
Loss of License Policy

01 02
Benefit Details Enrollment Process

03 04
Claim Process Document Checklist

05
GTL Contact Details
LOL – Benefit Details

Policy Parameters

Insurer New India Assurance company Ltd

Policy Start Date 01-02-25

Policy End Date 31-03-26

Sum Insured • INR 3 Crore for Pilot

• INR 2 Crore for Co-Pilot
Coverage Pilots & Co Pilots (P1 & P2)

Waiting Period 60 Days

Air India - 80% of Base policy premium

Premium Contribution Employee - 20% of Base policy premium

(Actual amount will be highlighted in Life Ka Plan Portal)

Loss of License
To cover eligible pilots & Co-pilots against Temporary and/or Permanent Loss of
License held in connection with their occupation as Pilot due to accident and/or
Illness
LOL – Benefit Details
Policy Parameters
Sectio Waiting
Coverages Old Benefits New Benefits
n Period
2% of the max, Base + Top Up sum
Bodily injury or illness (except 2% of the Max SI or net take home,
insured (of each sum insured
classified illness*) resulting in whichever is lower per month up
A person) per month up to period of 60 days
insured person being temporarily to period of 12 consecutive months
12 consecutive months post
medically unfit post waiting period.
waiting period.
1.5% of the max, Base + Top Up 1.5% of the Max SI or net take
Classified illness resulting in person sum insured (of each sum insured home, whichever is lower per
B being temporarily medically unfit person) per month up to period of month up to period of 12 60 Days
12 consecutive months post consecutive months post waiting
waiting period. period.
Bodily injury or illness (except
classified illness) resulting in
100% of the max, Base + Top Up 100% of the max, Base + Top Up
insured person being rendered
C sum insured (of each sum insured sum insured (of each sum insured 60 Days
permanently medically unfit and
person) person).
unable to pursue any other vocation
as well
Bodily injury or illness (except
classified illness) resulting in
75% of the max, Base + Top Up 75% of the max, Base + Top Up
insured person being rendered
D sum insured (of each sum insured sum insured (of each sum insured 60 Days
permanently medically unfit but is
person) person).
able to pursue any other vocation
except operating an aircraft

Classified illness resulting in person 18% of the max, Base + Top Up 18% of the max, Base + Top Up
E being rendered permanently sum insured (of each sum insured sum insured (of each sum insured 60 Days
medically unfit person) person).

Note:*Classified Illness is defined as psychotic, psycho neurotic or mental ailment

51
 LOL– Top Up (PMU)
Coverage Details PMU Top Up Premium

Designation Top Up Sum Insured Premium Incl. GST

1,00,00,000 24,839

1,50,00,000 37,259

Pilots 2,00,00,000 49,678

2,50,00,000 62,098

3,00,00,000 74,517

1,00,00,000 24,839

Co-Pilots 1,50,00,000 37,259

2,00,00,000 49,678

Note:

• Above amounts are in INR and inclusive of all taxes.

• Premium will be calculated on pro-rata basis for new joiners and the amount will be deducted from their
salary in 12 equal monthly installments.
• Top up once selected has lock-in period of 2 Yrs
• Top-up once opted can not be enhanced during the mid year on account of promotion
Enrolment
• Existing cockpit crew are covered under the policy from 01st Feb 2025.
• All New joiners must enroll within 30 days of joining the company.
• The benefits of this policy are applicable to all the full-time Cockpit Crew (Pilots & Co Pilots) of Air India Ltd.
• This coverage is applicable from their date of joining or Policy start date whichever is later.

Workflow

TMIBASL Team will get it For Top Up Employee

uploaded to LKP Portal & The page will display Enrollment Tab to
HR will send the Employee has to login with
mailer will be shared for view employee detail and move next to
data to the Tata Team credential shared in mail
selection of Top Up as per select Top Up as per member grade
& mandatorily rest the
grade and designation
password

View you SI limit

Click on the disclaimers and Key in the details of the Top Up
Submit Tab to complete the you want to add and then click
enrollment in the policy on the add Top Up button.

Final acknowledgement
mailer will come confirming
the member participation

Note:
• The insured person shall not be under Nineteen or over 65 years of age at the commencement of this insurance
• Premium for Base Policy will be borne 80% by Air India and 20% by employee
• Member already TMU can not participate in Base & Top-up enrollment
• The member can only be added post attainment of fitness by DGCA with prorate premium for the balance period.
• Enhancement of the Sum Insured during the midterm due to a promotion will only be considered if no claims have
been reported during the relevant period only in Base policy.
53
Exclusion

No benefit is payable under this policy in the case of illness (whether a classified illness or not) or bodily injury or
death directly or indirectly resulting from:

1) War invasion, acts of foreign enemies, hostilities (whether war, be declared or not), civil war, rebellion,
revolution, insurrection, martial law, military or usurped power or attempts at usurpation of power.
2) Any hostile detonation of any weapon of war employing atomic or nuclear fission and/or fusion or other like
reaction or radioactive force or matter.
3) International act or international omission inducing self injury or suicide, or attempted suicide assault provoked
by the insured person dwelling or (except in bonafide self defense) fighting.
4) International exposure of the Insured person to exceptional danger (except in any attempt in bonafide self
defense) fighting.
5) Any criminal act of the Insured person for which Insured person shall have been liable to imprisonment.
6) Service on duty with any armed forces or in a war zone.
7) Injury/Illness/Death or sequels from venereal diseases.
8) Injury/death sustained directly or indirectly in a state of permanent or temporary insanity.
9) Loss of License due to stipulation from license issuing authority relating to the requirement of age for eligibility
to hold such a license of certificate.
10) Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC).
11) Any property damage or consequential loss.

Please note :

Any pilot/co-pilot who was declared TMU/PMU before inception of New Loss of License Insurance policy (i.e.,
before 1st Feb 25) will not be eligible for inclusion in this policy.

54
Claim Process

• Computation of Loss of License Insurance Amount (TMU)

For Loss of Income, the insurance company will take base policy into consideration for calculation of compensation
(@2% of SI or net take home whichever is lower) subject to TMU till he/she is declared fit to rejoin duty and is
reinstated at the end of 12 calendar months from the expiration of the said period of 60 (Sixty), Consecutive days
whichever shall first occur.

• Payment from Air India at the time of TMU

Pilots/Co-pilots will not be eligible for any payment from the organization (Total Fixed Pay, Flying or any other
allowances) during TMU period when pilot/co-pilot becomes eligible for TMU insurance. Any exceptional case
wherein pilot/co-pilot has been considered for ground duty/simulators, pilot/co-pilot will be paid as per office duty
allowance/simulator allowance upon approval from SVP Flight Operations Office and has to be communicated to
payroll by HRBP- Flight Operations

• If a Pilot/Co-pilot has any other policy will this affect the loss of income claim?
As confirmed by the Insurer, Insurer will not consider any other policy the pilot/co-pilot may have and the company
policy will pay whatever is the loss of allowances/income suffered by the pilot as per the above payout process.

• Computation of PMU insurance amount

Upon declaration of PMU, the compensation will be paid (Upto max sum insured) to pilot/co-pilot post prorated
deduction of compensation paid during TMU period

55
Loss of License – Claims Process

Note: All pilots/Co-Pilots have to follow TMU

Pilot/Co-Pilot to Notify Flight Ops Admin process set out in the company for claiming
(Ms. Rupali Rane), Base Company Doctor insurance amount. Failure to adhere to TMU A discharge voucher (with
and HRBP in the event they are declared guidelines (in subsequent slides) will lead to payment amount for insurance)
TMU within 48 hours., Further which Flight rejection of TMU claims will be provided by insurer every
ops team will intimate the same to month wherein base company
TMIBASL team within 48 working hours doctor has to confirm that pilot is
eligible for interim insurance
payment till a formal fitness
If claim certificate received from DGCA
payable (CA-35)
TMIBASL team will intimate insurer and ? Yes
register the claim within 3 working days
post intimation received Insurance Company will notify
TMIBASL and post confirmation
No
from base company doctor, the
payments will be released
Pilot/Co-Pilot to share all required Post completion of directly to the
documents to TMIBASL Team for loss of investigation, if insurer finds Insured account. (Subject to all
License claim post completion of 90 days discrepancies or incomplete the documents verified and
(60 days waiting period+30 days documents. Insurer to inform cleared by the Insurer) in 10
payable) within 10 working days the TMIBASL team and HR working days from date of
team within 7 working days. completion of investigation

Insurer to complete the Claim Note: LOL Claim Form

investigation and review of submission of For Loss of Income - Employee to submit the required
all the required documents within 28 documents by 5th of every month
working days post receipt of documents The Insurance benefit will stop the day Pilot is declared fit by
DGCA (CA-35).
If pilot becomes unfit in final medical assessment, insurance
period will continue and salary paid by the company will be
recovered
56
 TMU/PMU Process
Timelines /
Steps Responsibility
Actions
All TMU cases will be tracked by
following SPOCs in the organization for
company records:
Upon being declared as TMU, pilot to inform Pilot/Co-Pilot to
1. Flight OPS Admin SPOC
Notify Flight Ops Admin (Ms. Rupali Rane), Base Company
[email protected])
Doctor and HRBPs in the event they are declared TMU within Within 48 Hrs of
2. HRBP SPOC: Abhimanyu
48 hours. becoming TMU
Tomar ([email protected]
m)- North and western Region
E-mail of company doctors is in subsequent pages.
3. Kaustubha Sharma- Southern and
eastern region-
([email protected])

Leaves will be utilised, if leave balance exist for the first 60 1. Flight OPS Admin SPOC
days, (CL/SL/PL/EWB) on CAE Total Fixed Pay (including role- [email protected])
based allowances and guaranteed flying allowance) will be 2. HRBP SPOC: Abhimanyu
paid during this period. Tomar ([email protected]
No kind of flying or related allowances (sim. etc.) will be paid to m)- North and western Region
pilots in TMU scenario 3. Kaustubha Sharma- Southern and
Insurance benefit will start from 61st day (Payable at 2% sum eastern region-
insured or net take home whichever is lower, per month- Within 48 Hrs Of ([email protected])
Maximum for a period of 12 months), Roaster with name becoming TMU
mentioned to be downloaded by Pilot from CAE

The claim will be processed by insurer within 30-45 working

days post submission of all required documents and providing
necessary clarifications to the insurer. The document
submission and providing clarifications on queries is
responsibility of pilots
57
TMU/PMU Process

Steps Timelines / Actions Responsibility

Claim documents to be submitted to following Regional Insurance

For insurance claims; pilot has to share SPOCs:
claim documents with TMIBASL SPOC. 1. Vishal Verma- [email protected]
2. Julie Sinha- julie.sinha@tmibasl,com

Base Company doctor has to sign discharge voucher ensuring that

A discharge voucher (with payment pilot is unfit and eligible for TMU compensation.
amount for insurance) will be provided Discharge voucher is to be signed, stamped and shared within 3
by insurer wherein Air India Base working days by company doctor –
Doctor has to confirm that pilot is Whenever claim is being The following regional base doctors are authorised for signing on
eligible for insurance till a formal raised Discharge Voucher:
fitness certificate is received from
DGCA (CA-35) 1. Dr Arti Singh (DEL) [email protected]
2. Dr MR Lokhande (BOM)- [email protected]
3. Dr Thanzeer (BLR)- [email protected]
4. Dr.M Chandra Shekhar Reddy (HYD)-
[email protected]
5. Dr N P Jayakumar (MAA)- [email protected]
6. Dr Saswati Lall (KOL)- [email protected]

All Base Dr will track TMU pilots for reporting to them on time.
 TMU/PMU Process
Steps Timelines / Actions Responsibility

Base doctors should track whether pilots are

reporting at right time and inform company
doctor at HQ
(Dr. Shilpa [email protected])
Pilot is required to meet company doctor every 15 days or at a
As advised by company Dr. Shilpa should inform HRBP and insurance
frequency decided by company doctor after insurance benefit
doctor team (Vishal/Julie) if pilot is not reporting at
kicks in unless hospitalised.
time.
Insurance claims will be put on hold if pilots
do not report and are also not able to provide
proper reasoning for the same

Pilot to submit the medical documents to base company doctor

As advised by company
on recurrent frequency as advised by company doctor and keep
doctor
the company informed about his health Status.
1. Rupali Rane
([email protected]) will be Central
SPOC and coordinate with reginal SPOCs
2. Northen Region – Ankush Zatale -
[email protected]
3. Western Region - Ruplai Rane -
Pilot to inform Pilot admin team to obtain NOC for Special [email protected]
Post receiving fitness
Medicals after receiving fitness certificate from treating doctor / 4. Southern Region – A V Premnath -
certificate from treating
company doctor [email protected]
doctor
5. Eastern Region – Aseem Mondal -
[email protected]
NOC will be issued by the company doctor for
any kind assistance with applying for NOC on
the EGCA portal and for booking first available
slots and applying the same on Roster

59
TMU/PMU Process

Steps Timelines / Actions Responsibility

1. Flight OPS Admin SPOC

[email protected])
Pilot to submit form CA 35 to Ms. Rupali Rane once pilot clears
his medicals. Pilot to inform Rupali Rane (Flight Ops admin 2. HRBP SPOC: Abhimanyu
SPOC), HRBP, Company Doctor and Pilot Admin Team via Post clearing Medicals Tomar ([email protected]
email after receiving fitness certificate from DGCA. Within 48 Hrs of receiving m)- North and western Region
Fitness Certificate 3. Kaustubha Sharma- Southern and
The insurance benefit will stop on day pilot is declared fit by eastern region-
DGCA (CA-35) and can report back for flying duties.

Pilot to inform Ms. Rupali Rane, HRBP, Company Doctor Team

36 Hrs Of PMU declaration
via email in case a Pilot is declared PMU by DGCA.

Within 36 Hrs Of receiving

Pilot to submit PMU documents to Ms. Rupali Rane, HRBP,
the DGCA Medical
Company Doctor and Flight Ops admin
assessment
Pilot will be considered "Missing in Action" if Pilot or their next
of Kin are not reachable at a stretch of 3 Days in a row. This can 1. Base Company Doctor
attract Disciplinary Action. Its Pilot's responsibility to keep 2. Flight OPS Admin SPOC
company informed on his/her whereabouts all through his/her [email protected])
TMU period
3. HRBP SPOC: Abhimanyu
Note: Company Doctor to inform FlightOps admin and HRBP Tomar ([email protected]
incase of missing in action m)- North and western Region
4. Kaustubha Sharma- Southern and
eastern region-
([email protected]

60
Documents Checklist
Sr No Documents Required Responsibility
Insured person has to submit written notice in the event of disability or loss of license to the
1 FlightOps admin to confirm
company within stipulated time limit
2 Latest Fitness certificate before being declared TMU Employee to Provide
3 Certified copy of all documents in respect of medical treatment Employee to Provide

4 Original claim form & claim bill duly signed and stamped by AI Employee to Provide
For initial month of claim in one TMU period:
Self-attested pilot fixed salary pay slips from date of TMU declaration along with flying log-book
5 Employee to Provide
crew roster with name printed for said period and declaration/certifying document of TMU from
base company doctor
For Subsequent months in same TMU period : Self attested monthly pay slips along with flying
6 log-book crew roster for the month and declaration/certifying document of TMU from base Employee to Provide
company doctor
In case of TMU, if pilot is declared fit after necessary treatment then medical fitness certificate
7 Employee to Provide
from DGCA (CA35 and Final Medical assessment) to be submitted
Original Temporary medical unfit certificate(s) issued by DGCA before issue of Permanent medical
8 Employee to Provide
unfitness certificate
9 Original commercial pilots license, in case of PMU and certified copy for TMU Employee to Provide
In case of PMU; Self-attested copy of flying log-book/crew daily roster, from the date of initial
10 Employee to Provide
unfitness till date of declaration of PMU

Original permanent unfitness certificate issued by DGCA along with medical certificate from HR Team to share the NOC document with the
11 Employee. Employee to share the documents with
treating doctor regarding the capability of performing any other vocation
insurer
Certificate from employer on their letterhead stating that “the pilot has become permanent unfit
12 Employee to share the documents
for flying and has not appealed/will not be appealing against PMU unfitness DGCA Certificate
Confirmation whether the pilot is entitled to benefit under any other policy of
13 Employee to share the documents
insurance.

14 Copy of cancel cheque with name printed on it Employee to Provide

Please note that at the time of full and final settlement, all the documents mentioned above will be required in original form
(Hard copy) stamp by AI
Note: Validation & verification of the documents submitted for the claim should be verified by the employee only.
Original documents are mandatory for final settlement of the case from the date of TMU period.
All documents is required to be submitted in original for full and final settlement of the case.
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 Contact Details
For lodging a LOL claim mail has to be sent to Air India SPOCs (Ms Rupali Rane) marking Vishal Verma from TMIBASL. All the
claim documents are in this manual, if you are not able the access the same, then , please log into myAI and refer to the Policy
Section -> Insurance

TMIBASL Contact Details

Name: Vishal Verma Name: Julie Sinha (for escalation only)
No : 9549391261 No : 9818183110
Email ID: [email protected] Email ID: [email protected]

HR Contact Detail Phone Number Email I.D

Rupali Rane 9664111231 [email protected]

Niraj Anup Pardeshi 9004728305 [email protected]

Abhimanyu Tomar 9873694008 [email protected]

ORIGINAL CLAIM DOCUMENTS TO BE SUBMITTED/COURIER AT BELOW ADDRESS

To
Name: Vishal Verma
Mobile :9549391261
Email: [email protected]

Tata Motors Insurance Broking and Advisory Services Limited

(Unit No- 3G 3rd Floor, M6 Plaza Uppal Tower Jasola District Centre, Jasola Vihar, New Delhi – 110025. India)
Online Portal for Hospitalization policies

Link :- https://lifekaplan-eb.com/login

63
 Portal Features
LKP is an online tool that provides a one stop solution for all the hospitalization policy related needs

Policy Policy
Details Details

Enrollment Enrollment
Window

Flexi Flexi
Benefits Benefits

Claim
Employee Employer Claims
Status Dashboard Dashboard

Network
Hospitals Dashboard

Queries Health
E Card

Wellness Network
And Forms Hospitals
Disclaimer:

This manual is intended to be general summary of the benefits offered by your company & should be regarded as a guide only. While TMIBASL
shall make every reasonable effort to ensure the accuracy and validity of the information provided here in this document. TMIBASL accepts no
liability or responsibility for any errors or omissions in the content or for any loss or damages arising out of your reliance on information provided
here. If there is a conflict in interpretation or benefit applicability, then the terms & conditions of the policy will prevail.

Prepared by

Tata Motors Insurance Broking And Advisory Services Ltd

1st Floor, AfL House, Lok Bharti Complex
Marol Maroshi Road, Andheri East, Mumbai-400059
Tel: +91-2266207900
Fax: +91 22 29200135

Copyright © 2018. All rights reserved. No part of this publication may be reproduced, stored in the retrieval system, or be
transmitted in any form or by any means, electronic or mechanical, photocopying, recording or otherwise, without the prior written
permission of TMIBASL.