TNGDA - TN Doctors Mediclaim with Star Health & Allied Insurance Co. Ltd.

(for TNGDA members and all Doctors registered in Tamil Nadu Medical Council / Tamil Nadu Dental Council)
Eye OP No. 50, Govt. Rajaji Hospital, No. 1, Panagal Road, Madurai (TN) Pin 625020.
tngdamediclaim@gmail.com, Telegram & WhatsApp No. 75980 98909.

APPLICATION FOR ENROLMENT 2021 - 2022 Fresh / Renewal

I, Dr ________________________________________________ , TNMC / TNDC Regn. No. _________________ , hereby
submit my application for enrolment in the TN Doctors Mediclaim scheme, __________________________
month group, along with my family members as detailed below:
CATEGORY NAME SEX DOB AADHAAR ID NUMBER

Proposer (P/ P*)

Spouse (S)

Child (C1)

Child (C2)

Parent 1 (A1)

Parent 2 (A2)

The option P+S+C1+C2 only P+S+C1+C2+A1 only P+S+C1+C2+A1+A2 P*+S only

selected for Rs 15000 + GST @ 18% Rs 17500 + GST @ 18% Rs 20000 + GST @ 18% Rs 27000 + GST @ 18%
my family is Rs 17700/- per annum ¥
Rs 20650/- per annum ¥
Rs 23600/- per annum ¥
Rs 31860/- per annum¥

¥ An additional amount will be payable proportionate to availed claims amount during the previous year P* aged above 58 yrs, C aged up to 24 yrs only

I hereby nominate Shri/Smt. _________________________________ born on ______________ , who is related to me

as my ________________ is my nominee for the add on PA policy. My email id is _________________________-
_____________________________ and my mobile number is ___________________________ . I am residing at
______________________________________________________________________________________________________________________
_________________ . I have made online remittance on State Bank of India, Bank Collect for Rs ____________
bearing payment reference DU _______________________ . I hereby declare that I have understood the con-
ditions and benefits of this policy and also agree to abide by the rules and regulations of the TN Doc-
tors Mediclaim scheme. I hereby also accept the decision of the TN Doctors Mediclaim & the Star
Health and Allied Insurance Co. will be final with regard to settlement of claims.
Station : _____________
Date : _____________

Signature of Proposer:
Kindly make payment only on State Bank Collect using the link “https://bit.ly/tngdamediclaimpay”.
Kindly send the copy of the payment receipt, completed application form with copies of TNMC/TNDC registration certificate,
aadhaar for all members only by email to “drsmediclaimappl@gmail.com” 15 days before D.O.C to avail continuity in coverage.
After enrolment: Digital copies of COI, ID cards, etc will be sent to the email id provided above.
All future correspondence will be made only to the email id, mobile number and address provided above.
TNGDA - TN Doctors Mediclaim with Star Health & Allied Insurance Co. Ltd.
(for TNGDA members and all Doctors registered in Tamil Nadu Medical Council / Tamil Nadu Dental Council)
tngdamediclaim@gmail.com, WhatsApp No. 75980 98909.
TN Doctors Mediclaim - A Group Mediclaim Insurance; provides membership for TNGDA members, all doctors
registered in the Tamil Nadu Medical Council / Tamil Nadu Dental Council with their family members (including
parents/parent in laws), at a very low annual premium, renewable every year, with maximum benefits.
The salient features of this scheme from 2021-2022 are as provided below:
1. Sum assured is Rs. 5,00,000/- per family and is a floater model, which includes their family members up to
two children (only if age less than 24 yrs) and two of either parents/parent in law. For Senior Doctors
aged above 58 yrs, only spouse can be included.
2. Fixed premium irrespective of age of entry:
For 2 adults + up to 2 children (< 24 yrs) = Rs. 15000/- + Rs. 2700/- (GST)
For 2 adults + up to 2 children (< 24 yrs) + 1 Parent / Parent in law = Rs. 17500/- + Rs. 3150/- (GST)
For 2 adults + up to 2 children (< 24 yrs) + 2 Parents / Parent in laws = Rs. 20000/- + Rs. 3600/- (GST)
For Senior Doctors over 58 yrs & spouse = Rs. 27000/- + Rs. 4860/- (GST)
3. Every year renewal is provided with the same premium, in order to compensate the increase in the claims
ratio, an additional amount @ 6 - 10% of the claims availed during the last year is collected only from those
who have made claims.
4. A complementary Personal Accident Policy for Rs. 50,00,000/- worth Rs. 4,500/- for the is provided along
with this policy for Proposer only, till 70 years of age.
5. No premedical check-up for Proposer and all family members for enrolment in this policy.
6. This policy can be used settled claims over and above any existing Mediclaim policy including the Tamil
Nadu Government Health Insurance Scheme; provided an intimation is also given to Star Health and Allied
insurance Company at the time of admission and submitting settlement copy with the other company.
7. The premium paid is eligible for IT exemption under section 80D under the suitable option only.
8. Claims will be settled cashless if the person is hospitalized for more than 48 hrs in any of our network
hospitals, however in the case of Medical Emergencies & Accidents, treatment can also be taken in other
Hospitals and get reimbursed. In all cases immediate intimation shall be given to our Call Centre within 24
hours of hospitalization. Exclusion of certain procedures will be applicable as per the prevailing conditions
other than the 405 Day care procedures.
9. Room Rent Limits: Restricted to 1% of Sum Insured. If the insured occupies a room with a room rent more
than this, then all the other charges shall be limited to the charges applicable for the eligible room rent or
actual, whichever is lower.
10. Pre Hospitalization up to 30 Days and Post Hospitalization up to 60 Days with Emergency ambulance
charges up to a sum of Rs. 750/- per hospitalization and overall limit of Rs. 1,500/- per policy period is
permitted.
11. Sub-limits are applicable for the following procedures:
Maternity benefits, applicable only for the Employee or Dependent spouse, subject to a limit of Rs. 25,000/-
for normal / caesarean delivery applicable only after completion of first renewal.
For Cataract restricted to Rs. 25,000/- per eye and only one eye per person admissible in a policy period.
For Cardiovascular diseases including PTCA/CABG – Rs. 1.50 lakh.
For all Fractures up to Rs. 1.00 lakh.
For Joint replacement surgeries like THR/TKR up to Rs. 1.50 lakh.
For Cancer treatment up to Rs. 1.50 lakh.
For other major surgeries which should include surgeries for Prostate, Uterus, Genitourinary calculus and
Gall bladder calculus also up to Rs. 1.50 lakh.
Any claim is restricted to Rs. 3.00 lakh per admission, and overall claims for any individual is restricted to
5.00 Lakh in a year, even if they are listed in multiple policies.
12. Waiting period is applicable for fresh members for first year: Elective Cardiovascular procedures including
PTCA/CABG, Elective Joint replacement surgeries like THR/TKR, Treatment for Cancer by any mode, Organ
transplant procedures, Procedures for prostate, genitourinary calculus, Uterus, gall bladder calculus etc.
13. Co-pay will be admissible @10% for claims up to 1 lakh, 20% for claims up to 2 lakh and 30% for claims up
to 3 Lakh for all claims during cashless settlement itself/reimbursement.
14. The existing members in this group for last year will be treated as renewal this year, however the waiting
period will be applicable for family members if added newly. Addition or deletion of family members will
be done at the time of renewal only.
15. Any proposer or their family member if already enrolled in any other Doctors Mediclaim Group Insurance
with Star Health Insurance Company will be enrolled after approval from competent authority of this
scheme and also will be treated as fresh members only .
16. The application form can be downloaded using link: https://bit.ly/tngdamediclaimappl
for remittance of premium on State Bank Collect use link: https://bit.ly/tngdamediclaimpay
For enrolment / any clarifications contact:
Dr R. Ravichandraprabu - 9865910665 Dr G. Arul - 9500187889 Dr SV. Chandrakumar - 9487813199
to get the latest scheme details visit www.tngda.org