Tata AIG MediCare Protect Health Insurance

Tata AIG provides a profound range of health insurance plans to help fulfil many insurance requirements. Tata AIG health insurance policies are divided into three types- Tata AIG MediCare, Tata AIG MediCare Protect, and Tata AIG Medicare Premier.

What is the Tata AIG MediCare Protect health insurance?

Tata AIG MediCare Protect health insurance is the most fundamental of the three plans. This plan covers basic pre- and post-hospitalisation expenses. The plan covers in-patient treatment expenses, organ donor expenses, consumable expenses, Ayush treatment cost, health checkup facilities, ambulance cover, and many other benefits.

Key Features of the Tata AIG MediCare Protect Health Insurance

The policy provides some alluring features that make it worth buying. These are:

• Automatically restores the insured sum up to 100% for the individual or family members.
• Covers expenses of consumables that are consumed during the period of hospitalisation directly related to the insured person's medical treatment or surgical treatment of illness or disease or injury.
• Covers expenses for 540+ Day Care treatment due to disease or illness or injury during the policy period taken at a hospital or a Day Care Center.
• Provides coverage for hospitalisation due to disease or illness or injury during the policy period for in-patient treatment.
• A 100% coverage of the sum is provided in case of the death of the insured person due to an accident.
• Provides cover for medical and surgical expenses for harvesting the organ in case of organ donation, where the insured person is the recipient.
• Coverage of up to Rs 20,000 is provided related to expenses for an economy class air ticket or railway ticket (first-class), to help a family member to be by the insured's side during his/her stay at the hospital.
• The plan provides coverage for pre-hospitalisation medical expenses incurred 30 days before admission.
• Post-hospitalisation expenses incurred 60 days after discharged from the hospital.
• Gives coverage for Domiciliary Hospitalization expenses in case the treatment exceeds 3 days. However, it is essential that the treatment is done for the management of an illness and not for enteral feedings or end of life care.
• The policy also includes ambulance cover for transporting the insured person to the hospital in case of an emergency with a coverage limit of Rs 5000.
• A special Ayush benefit for covering the expenses of in-patient treatment taken under Unani, Ayurveda, Homeopathy, or Siddha.
• Expenses incurred from a Preventive Health Checkup are covered by up to 1% of the sum insured subject to a maximum of Rs 10,000.
• The cumulative bonus benefit is also provided.
• Cashless hospitalisation for 3000+ hospitals.
• Lifelong renewal provided that all premiums are paid regularly.
• Sum insured enhancement.
• Zero sub-limits on expenses covering in-patient treatment, daycare expenses, domiciliary treatment, and organ donor expenses.
• Freelook period and a facility for cancelling the policy within a period of 15 days since receiving the policy documents.
• Income Tax benefit under Section 80D.

* Tax benefit is subject to changes in tax laws.

Benefits of Tata AIG MediCare Protect Health Insurance

The plan offers a variety of benefits to the insured person helping them secure and share some hefty medical expenses. The benefits provided by the plan include-

• In-patient Treatment

The policy covers the sum required for hospitalisation due to a disease or illness or injury during the policy period. It requires the admission of the insured in the hospital as an inpatient.

• Pre-hospitalisation Expenses

Provides coverage for Pre-hospitalization investigations, consultations, and drugs incurred for a period of 30 days before hospitalisation.

• Post-hospitalisation Expenses

Not only before being hospitalised but after the discharge of the insured person from the hospital, the policy helps cover expenses that are incurred for the next 60 days.

• Daycare Procedures

In this benefit, the policy gives cover for the listed Daycare Treatment expenses due to disease/illness/injury during the policy period. Treatment normally taken on an out-patient basis is not included in this cover.

• Organ Donor Benefits

This unique benefit helps cover the expenses for Medical and Surgical harvesting of the organ from the organ donor where an insured person is the recipient of an organ.

• Domiciliary Treatment Benefit

This benefit provides coverage for expenses related to the Domiciliary hospitalisation of the insured person in case the treatment exceeds 3 days. A certificate from the treating doctor is necessary to claim the benefit.

• Restore Benefits

The basic sum insured under the policy will be automatically restored upon the exhaustion of both the sum insured and the cumulative bonus during the policy period. This benefit can only be availed once in plan duration. The restored insured sum cannot be carried forward in case of a failure of utilisation.

• Ayush Benefit

This benefit is what makes Tata AIG health insurance unique in their policies. The benefit involves coverage for expenses of any in-patient treatment which is taken under Ayurveda, Unani, Siddha, and homoeopathy in government recognized centres.

• Ambulance Cover

A benefit common to all health insurance policies at Tata AIG is that they cover the expenses required for transportation of the insured person to the hospital for admission in case of emergencies or from one hospital to another to seek better medical care.

• Health Check-up

The plan also covers expenses incurred during a preventive health checkup up to 1% of the previous sum insured per policy. This is the maximum limit and can be utilised by more than one insured. The benefit has a separate limit and does not affect the cumulative bonus.

• Compassionate Travel

In certain medical situations, a person must be comforted by a close relative or a friend. This benefit comes to save the day by providing coverage for economy-class air ticket or railway ticket (first-class) to allow a family member to be at the insured's side during his stay at the hospital. This benefit also has a separate limit and does not influence the cumulative bonus.

• Consumables Benefit

This benefit enables the payment of all the expenses on the consumption of certain amenities during the period of hospitalisation, which is directly related to the insured person's surgical or medical treatment.

• Accidental Death Benefit (optional cover)

Under the circumstances that an insured person suffers an accident during the policy period, then the policy will pay a fixed amount of 100% of the sum insured.

• Cumulative Bonus

A cumulative bonus is generally a form of reward for the insured person for being fit and not filing a claim. The benefit of the bonus is granted in the year of renewal by making an increase in the amount of sum insured. Under this policy, about 10% Cumulative Bonus shall be applied to the sum insured for the next policy year following every claim-free policy year. The maximum cumulative bonus shall not exceed 100% of the sum insured in any year of the policy.

Exclusions under Tata AIG MediCare Protect Health Insurance

While opting for any insurance policy, it is important to acquire information about what the policy includes and what it excludes from the insurance cover. The exclusions of the MediCare Protect health insurance plan are categorised as Medical and Non-medical exclusions.

Medical Exclusions include the following:

• The hospitalisation for enteral feedings and other nutritional or electrolyte supplementation, unless it is certified by the medical practitioner attending the patient
• Infectious diseases such as AIDS and/or infection of HIV
• Any health conditions arising as a consequence of substance abuse or intoxicating agents like alcohol
• Idiopathic or alcoholic pancreatitis and its related disorders or any complications arising from it
• Treatment of obesity or any weight control programs
• Certain mental conditions such as psychiatric or mental disorders among other mental health conditions
• Certain experimental treatments like RFQMR - Rotational Field Quantum Magnetic Resonance, ECP - External Counter Pulsation, EECP - Enhanced External Counter Pulsation, Hyperbaric Oxygen Therapy, and Chelation therapy
• Dental surgery or treatment, unless there is any injury related to the accident
• Pregnancy or childbirth-related disorders except in case the miscarriage occurs due to accident or ectopic pregnancy (in-patient hospitalisation)

Non-medical exclusions include the following:

• In case the medical practitioner has the same residence as the patient or who is an immediate relative of the insured person’s family, the doctor’s fee will not be covered under the policy.
• Fitting of hearing aids, spectacles, or contact lenses, including optometric therapy.
• Expenses associated with conditions of alopecia, baldness, wigs, or toupees, and medical supplies like an elastic stocking, diabetic test strips, and similar products.
• Certain external appliances for diagnosis or treatment or crutches.
• Medical expenses caused by war, invasion, the act of foreign enemy, military or usurped acts, nuclear weapons, or radiations.

Eligibility to Buy the Tata AIG Medicare Protect Policy

To opt for Tata AIG Medicare Protect Plan, the applicants are required to be in the age group of 5 years onwards (with dependent children between ages 91 days and 5 years with their parents insured). The upper limit of entry age for TATA AIG MediCare plan is 65 years.

Waiting period- 48 months for pre-existing illness, 24 months for listed illnesses.

Grace Period- A Grace period of 30 days is allowed for renewing the policy.

Policy coverage type- The policy can be claimed for individuals or families. The policy coverage for the family is part of the family floater plans.

Premium payment- The premium is to be paid for the policy period before the policy commencement date, which is opted by the individual in the proposal form. One can either opt to pay the full premium upfront before the policy commencement date, or they can pay the premium on an annual or monthly basis. The premium chart is as follows-

*Premium mentioned is per person in INR (exclusive of GST) applicable for renewals only.

 Claim Process for the Tata AIG Medicare Protect Health Insurance

The policy is available online, and the claiming process will be administered by a specific third-party administrator duly licensed by IRDAI. Emergency hospitalisation requires to be intimated within the 24 hours, whereas for planned hospitalisation intimating 48 hours prior to admission is necessary.

For claiming the policy online:

Go to the Tata AIG insurance company website.

• Download the claim form of the particular policy and fill the form by providing the details.
• Submit the claim form and other documents required and proceed towards payment of the premium.
• A confirmation mail is received on the registered email id.
• The claim process can be a cashless claim or reimbursement claim.

Cashless Claim

• The claim process is initiated by filling the pre-authorisation form and submitting to the network hospital’s insurance/TPA desk.
• The claim request after undergoing processing will be approved, and the claim is then settled.
• In case of rejection of a claim, the proposer should opt for a reimbursement claim after discharge.

Reimbursement Claim

• Step-1 Verify the details.
• Step-2 Collect the documents (claim form, policy copy, medical certificate, pathological reports, hospital discharge card, original bills, investigation report, FIR/MLC copy, duty filled CKYC form).
• Step-3 Follow up for documents.
• Step-4 Submit the documents.
• Step-5 Wait for processing. The insurer will settle and reimburse the claimed amount through NEFT.
• Insurer may cancel the claim providing a valid reason or may ask for additional documents

How to Buy the Tata AIG Medicare Protect Health Insurance Policy?

To buy the policy, the individual is required to fill up the proposal form available online and provide all the required details correctly. One can also visit Paisawiki.com and complete the buying formalities by following a step-by-step process. Mode of payment can be via online mode. After choosing and calculating the premiums online, one can directly buy the policy at paisawiki.com in a few simple steps.

Documents Required for Buying Tata AIG Medicare Protect Health Insurance

The following documents are required for purchasing the policy:

• Age proof- documents - Birth Certificate, Passport, 10^thor 12^th class mark sheet, Voter ID, Pan Card, Aadhar card, Driver's license
• Proof of Residence- Documents accepted for proof include telephone bill, electricity bill, Driving license, Ration card, Voter ID, Aadhar card
• Passport size photographs

Renewal Process of the Tata AIG Medicare Protect Health Insurance

The policy can be renewed easily at paisawiki.com. Just follow the below steps:

• Visit the official website of Tata AIG insurance company
• Click on the 'renew' tab.
• Select ‘health’. Submit the policy number and registered phone number.
• Check and pay the premium amount.
• A confirmation mail is sent on completion of payment.
• The mode of payment available is via net banking or credit/debit card.

FAQs