ROHINI Id.

Hospital Name:

Address

Hospital Discount (excluding below packages): __________% on open billing excluding MCI & Surgical Packages
Sl. No Room / Nursing / Monitors Amount Remarks
1 GENERAL WARD 1000
2 SEMI PRIVATE 1400 Room Rent Including Nursing and DMO Charges & Monitor
3 PRIVATE ROOM A/C 2200 Charges for ICU
4 ICCU, SICU, MICU, 3600
5 Consultant fee / visit (specialist) 400 Per Visit
6 Consultant fee / visit (Super specialist) 500 Per Visit
7 Ventilator charges per day 3400
8 Monitor Charges 500 Not Applicable for ICU
9 Pulse oxymeter charges 400
10 Syringe pump charges 300
11 Infusion pump charges 300
12 Nebuliser charges 100
13 ER - for first one hour 800
14 ER - for every additional one hour 500
15 Surfactant 1400
16 CPAP 1800
OT & OT Related Charges
17 C Arm Charges upto 5 minutes 1000
18 Microscope Charge 2000
19 Laproscope Charge 2500
Sl. No CARDIOLOGY & CVTS INCLUSION EXCLUSION G/W Semi Pvt (AC) PRIVATE ROOM (AC) Remarks
20 Angiography (includes cost of the dye) L1,L2,L3,L4 9700 10550 11450
21 Angioplasty L1,L3,L4 L2 54100 58750 62700

22 Angiography ( includes cost of the dye) with Angioplasty L1,L3,L4 57200 63900 67000
L2
23 CABG L1,L2,L3,L4 122300 128250 136850
24 Valve Replacement L1,L3,L4 L2 97450 106900 117250
25 Temporary Pacemaker Implantation L1,L3,L4 L2 12300 13300 15200
26 Permanent Pacemaker Implantation L1,L3,L4 L2 36100 38950 42800
27 DVR-Double Valve Replacement L1,L3,L4 L2 125750 138600 151450
28 EPS and RFA L1,L2,L3,L4 40250 44550 48850
Sl. No ENT INCLUSION EXCLUSION G/W Semi Pvt (AC) PRIVATE ROOM (AC) Remarks
29 Tonsillectomy L1, L2,L3, L4 14850 15850 16850
30 Adenotonsillectomy L1,L2, L3, L4 16850 18800 20800
31 Tympanoplasty/ Mastoidectomy L1, L2, L3, L4 22750 25750 28700
32 Mastoidectomy & Tympanoplasty L1, L2, L3, L4 32900 37600 41350
FESS WITH SEPTOPLASTY AND TURBINECTOMY OR
33 L1, L2, L3, L4 22750 25750 28700
POLYPECTOMY-UNILATERAL
FESS WITH SEPTOPLASTY AND TURBINECTOMY OR
34 L1, L2, L3, L4 30700 33650 37600
POLYPECTOMY-BILATERAL
35 Cortical Mastoidectomy With Myringoplasty L1, L2, L3, L4 30150 33900 37600
36 Peritonsilar Abscess Drainage(DAY CARE) L1, L2, L3, L4 11900 11900 13850
37 MYRINGOTOMY WITH GROMMET INSERTION L1, L2, L3, L4 12850 13850 15850
Sl. No GENERAL SURGERY INCLUSION EXCLUSION G/W Semi Pvt (AC) PRIVATE ROOM (AC) Remarks

38 Haemorrhoidectomy (STAPLER &TACKERS EXCLUDED) L1, L3, L4 L2 18500 20350 23100

Haemorrhoidectomy + Fissurectomy(STAPLER &
39 L1, L3, L4 L2 27700 31450 33200
TACKERS EXCLUDED)
40 Fissurectomy& Fissure Dilatation L1, L2, L3, L4 23100 25850 27700
41 High End Fistulectomy L1, L2, L3, L4 27700 31450 33200
42 Low End Fistulectomy L1, L2, L3, L4 23100 25850 27700
43 Appendectomy (Lap) L1, L2, L3, L4 26850 31450 34200
44 Appendectomy (OPEN) L1, L2, L3, L4 24950 26850 31450
45 Cholesystectomy (Lap) L1, L2, L3, L4 37950 42450 45300
46 Cholesystectomy (Open) L1, L2, L3, L4 33200 36100 37950
47 Excision of Pilonoidal Sinus WITH FLAP COVER L1, L2, L3, L4 29600 33200 35100

48 EXCISION OF PILONIDAL SINUS PRIMARY CLOSURE L1, L2, L3, L4 27700 31450 33200

49 Mastectomy (Simple) L1, L2, L3, L4 27700 31450 33200

50 Mastectomy (Radical) L1, L2, L3, L4 44350 49050 51700
51 Thyroidectomy (Total/Sub Total) L1, L2, L3, L4 33200 36100 37950
52 Inguinal Hernioplasty-Unilateral - Open L1,L3, L4 L2 27700 31450 33200
53 Inguinal Hernioplasty-Unilateral -Lap L1,L3, L4 L2 30600 34200 36100
54 Inguinal Hernioplasty-Bilateral - Open L1,L3, L4 L2 37950 42450 45300
55 Inguinal Hernioplasty-Bilateral - Lap L1,L3, L4 L2 43900 48300 50950
56 Umblical Hernioplasty - Open L1,L3, L4 L2 30600 34200 36100
57 Umblical Hernioplasty - Lap L1,L3, L4 L2 34200 37950 40700
58 Incisional Hernioplasty - Open L1,L3, L4 L2 36950 41600 43450
59 Incisional Hernioplasty - Lap L1,L3, L4 L2 40700 45300 49950
60 Circumcision(DAY CARE) L1, L2, L3, L4 9900 11000 12100
61 Perianal Abscess L1, L2, L3, L4 13850 15750 16600
62 Breast Lumpectomy L1, L2, L3, L4 18500 20350 23100
63 AV Fistula( DAY CARE) L1, L2, L3, L4 16600 16600 16600
64 Hydrocele L1, L2, L3, L4 18500 20350 23100
65 Right or left Hemi Coloctomy L1, L2, L3, L4 41600 46550 49050
 ROHINI Id.
Hospital Name:

66 Resection and Anastomosis of Small Intestine (Single) L1, L2, L3, L4 41600 46550 49050

67 Exploratory Laparotomy L1, L2, L3, L4 49950 55750 59050

68 ERCP – EPT/Stenting/Stone removal L1, L2, L3, L4 14750 16600 17600
Sl. No GYN / OBS INCLUSION EXCLUSION G/W Semi Pvt (AC) PRIVATE ROOM (AC) Remarks
69 Normal Delivery (With well baby care) L1, L2, L3, L4 24600 27300 30000
70 Instrumental Delivery (Including Well Baby Care) L1, L2, L3, L4 27300 30000 32800
71 LSCS (With Well Baby care) L1, L2, L3, L4 31200 33600 37000
72 LSCS for Twins(With Well Baby Care) L1, L2, L3, L4 34700 38200 41600
73 LAVH L1, L2, L3, L4 35900 39900 44900
74 TAH+BSO+ADHESIOLYSIS(OPEN OR LAP) L1, L2, L3, L4 39900 41900 43900
75 Ovarian Cystectomy L1, L2, L3, L4 27900 31900 35900
76 Dilatation & Curettage (D&C)( DAY CARE) L1, L2, L3, L4 11000 12000 13000
77 Vaginal Vault Prolapse Repair L1, L2, L3, L4 41900 46900 49900
78 Laproscopic Ovarian Drilling L1, L2, L3, L4 31900 35900 37900
Sl. No OPHTHALMOLOGY INCLUSION EXCLUSION G/W Semi Pvt (AC) PRIVATE ROOM (AC) Remarks
79 Cataract (Any Monofocal Lens Included) L1, L2, L3, L4 22000
Sl. No ORTHOPEDICS INCLUSION EXCLUSION G/W Semi Pvt (AC) PRIVATE ROOM (AC) Remarks
TOTAL KNEE REPLACEMENT-UNILATERAL(IMPLANT
80 L1, L3, L4 L2 55450 61400 76250
EXCLUDED)
TOTAL KNEE REPLACEMENT-BILATERAL(IMPLANT
81 L1, L3, L4 L2 114850 127700 135650
EXCLUDED)
HIP REPLACEMENT-UNILATERAL(IMPLANT
82 L1, L3, L4 L2 55450 61400 76250
EXCLUDED)
83 HIP REPLACEMENT-BILATERAL (IMPLANT EXTRA) L1, L3, L4 L2 114850 127700 135650

84 FRACTURE NECK FEMUR (IMPLANT EXCLUDED) L1, L3, L4 L2 39150 43650 48050
FEMUR SHAFT FRACTUERE - PROXIMAL / MIDDLE /
85 L1, L3, L4 L2 40150 44550 49950
DISTAL - (EXCLUDING IMPLANT)
TIBIA FRACTURE PROXIMAL / MIDDLE / DISTAL - ORIF
86 L1, L3, L4 L2 36500 40150 44550
/ CRIF WITH NAILING / LOCKI
ANKLE / TIBIA FRACTURE - ORIF / CRIF WITH SCREWS
87 L1, L3, L4 L2 31250 34750 38300
/ TBW - (EXCLUDING IMPLANT)
ARTHRODESIS - WRIST / ANKLE / SUBTALAR -
88 L1, L3, L4 L2 29350 33000 36500
(EXCLUDING IMPLANT)
89 FOOT FRACTURES - WITH WIRES L1, L2, L3, L4 17800 19600 22350
90 FOOT FRACTURES - WITH SCREWS L1, L2, L3, L4 19600 21350 24100
91 CALCANEAL FRACTURE : WITH PLATES L1, L3, L4 L2 24100 26750 30250
SHOLDER / HUMEROUS / ELBOW / BOTH BONES
92 L1, L3, L4 L2 29350 33000 36500
FOREAM FRACTURES - PLATES ANA
SINGLE FOREAM FRACTURE / WRIST FRACTURE -
93 L1, L3, L4 L2 22350 24950 27600
WITH PLATE (EXCLUDING IMPLANTS)
94 SCAPHOID FRACTURE FIXATION L1, L3, L4 L2 25850 28500 32100
95 HAND -'K' WIRES - SINGLE FRACTURE L1, L3, L4 L2 13850 14850 16850
96 HAND -'K' WIRES - MULTIPLE FRACTURE L1, L3, L4 L2 16950 18700 21350
97 MENISECTOMY L1, L3, L4 L2 29350 33000 36500
98 ARTHROSCOPIC SURGERY L1, L3, L4 L2 30250 33900 38300
99 SHOULDER - ARTHROSCOPY / OPEN - BANKART L1, L3, L4 L2 44550 49950 55200
SHOULDER - ARTHROSCOPY / OPEN - LATERJET / BONE
100 L1, L3, L4 L2 44550 49950 55200
BLOCK
101 SHOULDER - ARTHROSCOPY / OPEN - CUFF REPAIR L1, L3, L4 L2 40150 44550 49950
SHOULDER - ARTHROSCOPY / OPEN - CUFF REPAIR
102 L1, L3, L4 L2 40150 44550 49950
WITH ANCHORS
SHOULDER - ARTHROSCOPY / OPEN - SUB ACROMIAL
103 L1, L3, L4 L2 36500 40150 44550
DECOPRESSION
104 ACL Reconstruction/Repair L1, L3, L4 L2 33000 36500 41050
105 MCL Reconstriction/Repair L1, L3, L4 L2 33000 36500 41050
106 ACL & PCL Reconstruction and Repair L1, L3, L4 L2 41900 46300 51700
107 Laminectomy/Discectomy L1, L3, L4 L2 41900 46300 51700
108 Stabilization Of Spinal Column L1, L3, L4 L2 41900 46300 51700
THORACO / LUMBAR GLOBAL FIXATION+ / BONE
109 L1, L3, L4 L2 39150 43650 48050
GRAFT (EXCLUDING IMPLANTS)
THORACO / LUMBAR - ANTERIOR INTERBODY
110 FIXATION + /-BONE GRAFTING (EXCLUDING L1, L3, L4 L2 40150 44550 49950
IMPLANTS)
111 CARPEL TUNNEL RELEASE - UNILATERAL L1, L2, L3, L4 11550 12450 14300
112 CARPEL TUNNEL RELEASE - BILATERAL L1, L2, L3, L4 16950 18700 21350
113 Close Reduction of Fracture of Limbs and POP L1, L2, L3, L4 16050 17800 19600
114 Reduction of Compound Fractures L1, L2, L3, L4 14300 16050 17800
115 Close Reduction of Dislocations L1, L2, L3, L4 14300 16050 17800
116 IMPLANT REMOVAL FOR SMALL BONES L1, L2, L3, L4 14300 16050 17800
117 IMPLANT REMOVAL (FEMUR / TIBIA) L1, L2, L3, L4 19600 21350 24100
118 BONE GRAFTING FOR NON UNIONS - LOWER LIMB L1, L3, L4 L2 24100 26750 30250

119 BONE GRAFTING FOR NON UNIONS - UPPER LIMBS L1, L3, L4 L2 22350 24950 27600
ACETABULAR FRACTURE - POSTERIOR WALL /
120 L1, L3, L4 L2 40150 44550 49950
COLUMN ORIF (EXCLUDING IMPLANT)
ACETABULAR FRACTURE - ANTERIOR WALL /
121 L1, L3, L4 L2 41900 46300 51700
COLUMN ORIF (EXCLUDING IMPLANT)
PELVIS FRACTURE - EXTERNAL FIXATION (EXCLUDING
122 L1, L3, L4 L2 21350 24100 26750
IMPLANT)
123 Reduction of Dislocation in GA L1, L2, L3, L4 16050 17800 19600
Sl. No UROLOGY & NEPHROLOGY INCLUSION EXCLUSION G/W Semi Pvt (AC) PRIVATE ROOM (AC) Remarks
124 PCNL- Unilateral L1, L2, L3, L4 28750 32350 35900
125 PCNL- Bilateral L1, L2, L3, L4 41250 45800 50300
 ROHINI Id.
Hospital Name:
126 TURP L1, L2, L3, L4 30250 34000 37800
127 TURIS/PLASMA VAPOURIZATION L1, L2, L3, L4 31400 34950 38650
128 TURBT L1, L2, L3, L4 31400 34950 38650
129 HOLEP/GREEN LASER PROSTECTOMY L1, L2, L3, L4 34850 38350 42550
130 Urethral Meatotomy(day care) L1, L2, L3, L4 13250 14200 15100
131 Dialysis (ALL INCLUSIVE) L1, L2, L3, L4 1450 1450 1450
132 DJ Stent Removal L1, L2, L3, L4 7550 8500 9450
133 Cystoscopy(Therapeutic) L1, L2, L3, L4 9450 10400 11350
134 Cystoscopy ,URS With Dj Stenting (Unilateral) L1, L2, L3, L4 28350 31200 34000
135 Partial/Complete Nephrectomy L1, L2, L3, L4 41600 46300 51050
136 Orchidectomy-Unilateral L1, L2, L3, L4 18900 20800 22700
137 Orchidectomy-Bilateral L1, L2, L3, L4 22700 25500 28350
138 ESWL( DAY CARE) L1, L2, L3, L4 13250 14200 16050
139 URS(therapeutic) L1, L2, L3, L4 21750 24550 27400
140 RIRS L1, L2, L3, L4 38750 42550 47250
141 Nephrolithotomy/Pyelolithotomy L1, L2, L3, L4 38750 42550 47250

Terms and Conditions:

1. The packages will apply to all TATA AIG Cardholders.

2. The packages are inclusive of all expenses unless otherwise mentioned. Non-medical expenses such as telephone charges, admission charges, etc. do not fall within the purview of the
package tariff.
3. The packages will apply for routine cases only. In case of any cases with medical or surgical complications, the package tariff is eligible for enhancement provided the hospital submits a
detailed discharge summary describing the complications and treatment given.
4. If the Hospitalisation period exceeds the days mentioned in the package Hospital should provide proper justification for extended stay to charge for additional charges
without which claim will be settled for package rate.
5. The packages will apply to all categories of rooms as mentioned. For higher room than Private AC, the charges of Private AC Room will be applicable.
6. The package rates will be valid for minimum period of Two years or till the next revision.
7. Maximum Limit for Mesh is restrictedto Rs. 8000/-.
8. Whenever performed two surgeries in single sitting only 50% applicable for second / minor surgery.
9. When two procedures were done in a single Hospitalisation then Full package of major and 50% of the minor Surgery will be considered for settlement.
10. Hospital should provide single line package bill with all relevant investigation report and proper discharge summery and relevant documents in support of the diagnosis and treatment
of the package surgery.

Surgical Gradation
CHARGES FOR NON-PACKAGE SURGERIES
Semi Pvt PRIVATE
Sr.No. SURGERY GRADE Charge Category G/W
(AC) ROOM (AC)

1 Minor (Grade 1) Surgeon’s fees 2000 2500 3000

2 Intermediate (Grade 2-3) Surgeon’s fees 4500 5000 6000

3 Major (Grade 4-5) Surgeon’s fees 7200 9000 12600

4 Major Plus (Grade 6-7) Surgeon’s Fees 12600 15300 18000

5 Supra Major (Grade 8-9) Surgeon’s Fees 16200 18900 22500

6 Supra Major + (Grade 10 & above) Surgeon’s Fees 20400 23800 26350

Emergency, Complications & Other Enhancement in the charges will be processed maximum 10% extra after confirmation
from TAGIC Medical Team

Any OT Instrument & OT Gase charges are not paid seperately

OT: 25% of surgeon charges ; Anaesthetist: 20% of Surgeon Charges ; Assistant if appicable: 20% of Surgeon charges (One
Assistant applicable)

For Minor & Intermediate Category, Assistant Surgeon Charges will not be paid