Tata AIG MediPlus – Top-up Medical Health Insurance Plan
A top-up insurance plan supplements the insured person's current health insurance plan to shield him/her from additional expenses. It acts as a security umbrella that protects the insured from unforeseeable medical conditions. This plan enhances the sum insured under the basic health insurance policy of the policyholder.
What is Tata AIG MediPlus – Top-up Medical Health Insurance Plan?
As the name suggests, Tata AIG MediPlus – Top-up Medical Health Insurance Plan, is a top-up health insurance policy that intends to increase the insurance cover provided to a policyholder. This plan aims to cover the medical expenditure of the insured when the amount of such expenditure exceeds the threshold limit under the current health insurance plan of the insured.
Features of the Tata AIG MediPlus – Top-up Medical Health Insurance Plan
The policy comes with the following key features:
- Guaranteed Insurance Cover: This policy ascertains guaranteed insurance cover at the time of the renewal of the policy.
- Daycare Expenditure: The policy has enlisted 140 different daycare procedures for which, the claim is available to the insured. 24-hour hospitalization is not mandatory to claim such reimbursements.
- Dental Coverage: This policy covers the expenditure of dental treatment of the insured, but only if an accident or illness necessitates such treatment.
- 3000+ Hospitals Covered: This plan provides cashless settlement of claims at over 3000 hospitals all across India.
- Cover for a Maximum of 7 Dependent Family Members. Although the policy does not offer a family floater option, one can insure up to 7 dependent family members in the same policy but on an individual cover basis. This means one can insure himself/herself, his/her spouse, three children, and parents.
- Free Look Period: Tata AIG MediPlus Health Insurance Policy provides a free look period of 15days from the date of the receipt of the policy document. The insured can cancel the policy within the free look period in case of any objections with the terms and conditions of the policy. One can only cancel the policy if he/she has not made any claims under the policy. The aforesaid free look period is not applicable in case of renewal of the policies.
- Savings: One can save up to 10% of premium upon insuring two or more members in the policy. Another 7.5% of the premium can be saved by opting for a 2-year policy.
- Tax Benefits: One can take the benefit of tax deduction under section 80D of the Income Tax Act, 1961. The benefit is available to the extent of Rs25,000 in case of an individual, his/her spouse and children and Rs 30,000 in case of parents who are senior citizens.
*Tax benefit is subject to changes in tax laws.
Benefits of Tata AIG MediPlus – Top-up Medical Health Insurance Plan
The policy offers the following benefits:
- In-Patient Treatment: This plan covers the medical expenses incurred for the rent of the hospital room, boarding costs, costs of nursing, ICU (intensive care unit), medical practitioner(s), blood, oxygen, OT charges, anaesthesia, diagnostic procedures, surgical appliances, medicines, , the cost of prosthetics, and other equipment if such devices are implanted in the body of the insured during a surgical procedure.
- Pre-hospitalization Expenses: Tata AIG MediPlus – Top-up Medical Health Insurance Policy covers for the expenditure incurred in the 60 days, immediately preceding the hospitalization of the insured person. These expenses are covered under the policy if and only the insured was hospitalized for the same medical condition(s) he/she was undergoing treatment for, and the claim for such hospitalization expenses has been made by the insured.
- Post-hospitalization Expenses: This policy provides cover for the medical expenditure incurred in the 90 days, immediately succeeding the discharge of the insured from the hospital. These expenses are covered if and only the expenses related to the medical condition(s) he/she was hospitalized for, and the claim for such hospitalization expenses has been made.
- Day Care Procedure: Tata AIG MediPlus plan covers for the enlisted 140 daycare procedures, provided the insured has undergone such surgery or procedure as an inpatient in a hospital or a daycare centre. The claim for expenses will not be considered if the insured has undergone the aforesaid treatment in the outpatient department of a hospital or daycare centre.
- Organ Donor: If the organ of a donor is used for the insured, the expenses for the treatment of the organ donor regarding the harvesting of such organ is covered under the policy. The aforesaid organ should have been donated in compliance with the provisions of The Transplantation of the Human Organs Act, 1994. It should be noted that pre and post-donation medical expenses of the donor are not covered under this policy. The abovementioned claims are available only if the insurance provider has approved the claim of the insured for inpatient hospitalization expenses.
- Emergency Ambulance: The expenses undertaken for the ambulance with emergency facilities are reimbursable under this policy, provided the claim for in-patient hospitalisation expenses, or the insurance provider has approved in-patient daycare procedure expenses. The amount reimbursable under this health policy is the minimum of the definite expenses incurred or Rs 2000, per hospitalisation. The cost of transportation of the insured person from one hospital to the other is also covered under the TATA AIG MediPlus policy provided such transportation was medically necessary.
- Domiciliary Treatment: The medical expenses for the treatment taken at home, on the advice of the medical practitioner will be reimbursedonly if the insured person could not be transferred to the hospital or due to the unavailability of the beds in the hospital. For the above provisions, it is important that such treatment lasted for 3 or more days. It should be noted that if the insurance provider accepts the claim under domiciliary treatment, the provider is not liable to pay for the post-hospitalization expenses. However, pre-treatment expenses would be covered with respect to the provisions of the pre-hospitalization expenses.
The Tata AIG MediPlus – Top-up Medical Health Insurance Plan does not cover the expenses for the domiciliary treatment of Bronchitis, Asthma, Tonsillitis, Laryngitis & Pharyngitis, Cold and cough, Arthritis, Influenza, Gout, Chronic Nephritis, Rheumatism, Nephritic Syndrome, Diarrhoea and all type of Dysenteries including Diabetes Mellitus, Gastroenteritis, Insipidus, Hypertension, Epilepsy, Psychiatric or Psychosomatic Disorders of all kinds, Pyrexia of unknown origin.
Exclusions of Tata AIG MediPlus – Top-up Medical Health Insurance Plan
Despite its vast coverage for multiple medical conditions, the policy becomes null and void in case of a claim arising out of the following:
- Waiting Periods: Medical expenses undertaken by the insured during the waiting period are not covered under this policy. A 30-days waiting period from the effective date of the policy is applicable to all policy claims. However, this provision is not applicable in case the insured meets an accident during the waiting period.
- Pre-existing Conditions: Medical expenses for the treatment of pre-existing conditions of the insured shall not be considered valid for the claim, for a period of 4 years from the date of purchase of a retail health insurance policy from an Indian Non-life insurer, by the insured.
- Drug Abuse: Any disease caused by the consumption of intoxicating substances such as alcohol, drugs, nicotine, etc. is not covered under the Tata AIG MediPlus – Top-up Medical Health Insurance Policy. The treatment for substance addiction is also not covered.
- Psychiatric Disorders: Mental, psychiatric disorders, mental health treatments, Alzheimer’s disease, run-down condition, congenital diseases, defects and anomalies, genetic disorders, stem cell implantation, growth hormone therapy, and sleep-apnoea are not covered under the policy.
- Other Exclusions: Medical expenditure arising due to war, self-injury, involvement in naval, military or air force, participation in adventurous activities such as scuba diving, mountain climbing, rock climbing etc., weigh control treatments, plastic surgery, sexually transmitted diseases, non-allopathic treatment, dental treatment (excluding those necessitated by accident and those requiring hospitalization), pregnancy-related expenditure, fertility treatments, unproven treatments, etc. are not covered under this policy.
Eligibility for Tata AIG MediPlus – Top-up Medical Health Insurance Plan
Tata AIG MediPlus – Top-up Medical Health Insurance Option is a comprehensive plan because it covers everyone from the age of 91 days to 65 years. Any person who is above 18 years of age but below 65 years at the time of opting the policy, is eligible to buy this plan.
Claim Process of Tata AIG MediPlus – Top-up Medical Health Insurance Plan
To claim this Tata AIG health insurance policy, one must follow the certain steps:
- Eligibility for the Claim: An insured person or his/her nominee (in the event of the death of the insured) is eligible for the claim only if the full premium has been paid to the provider in time and the supporting documents of treatment are presented. It must be noted that the claim under this policy will be available only if the expenditure of the treatment exceeds the deductible. Such a claim is available to the extent of the sum insured.
- Notifying the Provider:It is important to notify the provider regarding the hospitalization of the insured for making claims.
- In case the hospitalization is planned, the provider must be informed at least 48 hours before the hospitalization.
- In case of emergency hospitalization, the provider must be informed within 24 hours from the admission of the insured in the hospital.
- In case of subsequent realization of the expenditure exceeding the deductible amount, the provider must be informed on the event of such realization.
- Cashless Settlement of the Claim: In case the insured wants to avail the facility of cashless claim settlement, the provider must be informed at least 48 hours before the planned hospitalization and within 24 hours from the emergency hospitalization.
Documents Required for the Claim Process
For making claims under this policy, the following documents are required:
Claim certificate, hospital discharge certificate, doctor’s report, bills with prescription and other reports are required for making claims. In the event of death, death certificate, post mortem report, copy of FIR, police inquest report(if applicable), are required.
How to buy Tata AIG MediPlus – Top-up Medical Health Insurance Plan?
One can buy Tata AIG MediPlus Policy through Paisawiki.com. It should be noted that to opt for Tata Top-Up, one should be insured under a basic health insurance policy. The steps for buying the policy from Paisawiki are:
- Go to the official website of Paisawiki.com.
- Navigate through the ‘health insurance’ option and go to the ‘get free quotes’.
- Provide necessary information and click on submit.
- A list of health insurance plans will appear. You can select your choice of the plan from the list and compare as well.
- Calculate the premiums. Once the policy is finalized, pay the premiums online through debit/credit card or net banking.
- On successful payment, the policy document will be sent to the registered email Id.
Documents Required to Buy the Tata AIG MediPlus – Top-up Medical Health Insurance Plan
For buying Tata AIG MediPlus – Top-up Medical Health Insurance Planone needs to furnish his/her correct details, including medical history, in the 'Application Form'. The medical examination may be required in some cases, depending on the sum insured.
Renewal of Tata AIG MediPlus – Top-up Medical Health Insurance Plan
Tata AIG MediPlus offers a lifelong renewal opportunity provided the request for renewal has been made to the provider before the end term of the policy.
A grace period of 30 days is offered to the insured to renew his/her policy. But, any disease contracted during the grace period will not be covered under the policy. It will be considered as a pre-existing condition post renewal of the policy.
The policy can be renewed through paisawiki by paying the premiums online. One can visit the website and go to the ‘renewal option on the homepage to renew the policy.
Ans: A deductible is an amount for which the insurance provider is not liable for. Under Tata MediPlus, the deductible amount is Rs 1,00,000 to Rs 5,00,000.
Ans: Yes, this top-up medical plan is a comprehensive plan it covers babies aged 91 days and above to adults who are less than 65 years of age at the time of opting the policy.
Ans: As the name suggests, a top-up plan is over and above the base health insurance plan. A top-up plan can help one cover the medical expenditure beyond the threshold of the base policy. So, it enhances the insurance cover provided to an individual.
Ans: The plan covers the expenditure incurred on dental treatment but only to the extent where such treatment is necessitated by an accident or such procedure requires the hospitalization of the insured. No other dental costs are covered.
Ans: This plan has enlisted 140 Daycare procedures that do not require hospitalization. So, one can claim for such day care treatments.
Other than that, treatment at home (known as the domiciliary treatment) is also claimable if the insured could not be transported to the hospital or in case of unavailability of hospital beds. Certain treatments taken at home are not eligible for a claim under this policy.
Written By: Paisawiki - Updated: 09 April 2021