TATA AIG MediCare Health Insurance
ATA AIG Medicare Health Insurance Plan is a comprehensive health plan that provides affordable financial cover for medical emergencies. Tata AIG General Insurance Company has carved its niche in the insurance market for the highest claims-paying potential.
The company has propagated this plan to provide extensive health care to a significant chunk of the country’s population. TATA AIG's plan offers global coverage along with a lifelong renewal and a strong network of more than 3,000 hospitals nationwide.
What is TATA AIG Medicare Health Insurance Plan?
This is a comprehensive health care policy by TATA AIG that provides a series of benefits to policyholders. With extensive coverage that includes most of the hospitalization expenses and diagnostic tests in India and abroad, the policy offers lifelong renewal. It also covers bariatric surgery, which is generally not covered by other contemporary health insurance policies by different insurance companies. The plan also comes along with attractive premiums on available covers and tenures.
Features and Benefits of the Tata AIG Medicare Health Insurance Plan
TATA AIG Health Insurance plan comes along with an array of exciting features and benefits that are discussed as follows.
Features of this plan are:
- This plan provides medical coverage for in-patient and daycare hospitalization of the insured inside and outside India.
- It also covers expenses incurred for medical or surgical treatment of illness/disease/injury.
- The policy covers expenses related to Bariatric Surgery for treatment of Obesity and weight control.
- Pre-hospitalization expenses up to 60 days and post-hospitalization expenses up to 90 days are covered.
- Provides feature to automatically restore your sum insured to 100% for you and your family.
- Emergency Air Ambulance expenses by airplane or helicopter are covered.
- More than 540 daycare procedures covered.
- Coverage for hospitalization medical expenses is extended.
- It provides coverage for high-end diagnostics listed in the policy document on OPD basis to a maximum of Rs 25,000 per policy year.
- This plan offers a 100% sum insured as an accidental death benefit in case of death of an insured person due to an accident.
- It provides a maternity cover up to a maximum of Rs 50,000/- per policy. This is applicable after 4 -year waiting period. There is no limit on the number of delivery events.
- Covers vaccination expenses up to Rs 10,000 for up to one year after childbirth.
- Organ donor expenses are covered when the insured person is the recipient.
- Vaccination Cover for HPV, Hepatitis B, Anti-rabies vaccine, and typhoid vaccination without any waiting period.
- Provides Rs 20,000 related to a round trip economy class air ticket/first-class railway ticket, for compassionate travel of an immediate family member to be with the hospitalized person .
- Daily cash for choosing shared accommodation for up to Rs 2000
- OPD Treatment subject to Rs 5000 per policy year annually provided the insured person has completed 2 years of continuous coverage.
- Domiciliary hospitalization for more than 3 days is covered.
- New Born Baby Cover is offered.
- Ambulance cover for a coverage limit of Rs 5000 is covered.
- Medical expenses incurred for in-patient treatment taken under AYUSH, Ayurveda, Unani, or Homeopathy etc. are covered.
- Preventive health check-ups to a maximum of Rs 10,000/- per policy are covered.
- Dental treatment expenses due to an accident, injury, or illness are covered.
- Covers costs for hearing aids every third year, the maximum payable is 50% of the actual cost of Rs 10,000/-
Benefits of this Tata AIG health insurance can be availed in a following manner:
- Lifelong Renewal:The company provides a lifelong renewal benefit for your policy if you have made the premium payments without any break.
- Free-look Period- This policy offers a free-look period of 15 days, in which you can return the policy if you are not satisfied with it.
- Second Medical Opinion:In case of a diagnosis of critical illness of the person insured as per the policy document, he /she can seek a second medical opinion from the medical practitioner during the policy period.
- Cumulative Bonus:The policyholder can get the advantage of 50% increase in cumulative bonus for every claim free year.
- Tax Benefit: The policy premiums qualify for deduction under section 80D of Income Tax (Amendment) Act, 1986.
- Quick Claim Settlement– TATA AIG provides a hassle-free and quick procedure for claim settlement so that you don’t need to run from pillar to post and can focus on the recovery.
- Vast Network of Hospitals:TATA AIG has a widespread network of hospitals across India. You can easily seek cashless hospitalization in any of the network hospitals by showing your original photo identity proof along with a cashless card.
Inclusion and Exclusions of the Tata AIG MediCare Health Insurance plan
Plan Inclusions are mentioned as below:
- Organ donor ‘s medical and surgical expenses related to harvesting the organ
- Daycare procedures due to a disease, illness, or injury during the policy period
- Up to 90 days post-hospitalization is covered after the insured person is discharged from the hospital
- Up to 60 days pre-hospitalization expenses covered immediately before the insured is hospitalized
- In-patient treatment
- OPD Dental Treatment subject to a maximum of Rs 10,000 per policy year annually
- Root Canal Treatment expenses covered for both single or multiple sittings
- Tooth extraction and tooth filling expenses covered
- Expenses related to obesity treatment or any weight control program
- General debility or exhaustion
- Any costs incurred for Psychiatric treatment or mental disorders
- Pre-existing conditions are covered after a waiting period of 36 months
The policy excludes the following from the list of coverage:
- Any medical expenses that are only for diagnostic and evaluation purposes
- Venereal disease/STDs/HIV/AIDS
- Sterility, Infertility treatment like surrogate or vicarious pregnancy; birth control, contraceptive supplies
- Lasik Laser treatment for eyesight correction
- Aesthetic or gender change treatments like sex transformation operations
- Plastic surgery or cosmetic surgery except in case of medically necessary treatment for skin or organ reconstruction due to accident, cancer, or burns. In such cases, it should be doctor’s certified
- Any type of sanatorium treatment
- Rehabilitation treatment or long-term nursing care
- Any diagnostic, X-ray, or laboratory examinations charges at the hospital not related to the specified injury or illness required at a Hospital
- Treatment rendered by a Medical Practitioner which is outside his discipline
- Doctor’s fees charged by the Medical Practitioner who is an immediate relative of an Insured Person's family
- Fitting of hearing aids, spectacles or contact lenses
Eligibility Criteria to apply for TATA AIG MediCare Health Insurance plan
The TATA AIG Medicare Health Insurance policy has simple eligibility criteria to apply for the plan. The policy covers persons in the following age group:
- The minimum age of entry is 5 years
- The maximum age of entry is 65 years
Dependent children between 91 days and 5 years can also be insured, provided both parents get insured under the plan.
Claim Process for the TATA AIG MediCare Health Insurance Plan
You can file a claim with TATA AIG for both cashless and reimbursement Claim settlement.
TATA AIG MediCare health Insurance plan offers a claims procedure under this policy administered by a TPA or a specified Third Party Administrator, licensed by IRDAI. The process for filing a claim is as follows:
Cashless Claims Procedure
If healthcare treatment is availed from a network hospital, then the insured can claim for a cashless settlement. The cashless claim steps are:
- Claim Intimation– The person insured needs to contact the designated TATA AIG TPA or the insurance team on time to inform about the hospitalization. This is at least 48 hours before for a planned hospitalization and within 24 hours in case of an emergency hospitalization, which might give rise to a claim.
- Claim Processing– The person insured can contact the Claims Assistance team for any claim related query or submit claim-related documents. You need to send a Pre-Authorization request mentioning the details of your hospitalization along with policy details.
- Claims Approval- Once your hospitalization request for a cashless claim gets approved, you can go ahead with the hospitalization and treatment procedures as prescribed by your doctor. TATA AIG health insurance will take care of your expenses as per your coverage amount.
Reimbursement Claims Procedure
In case of hospitalization in a non-network hospital that does not support a cashless claim facility, you need to inform the TATA AIG Health Insurance authorities. You can go ahead and take care of all expenses related to the treatment in the hospital.
- Keep a detailed record of all medical bills, prescriptions, investigation reports, and diagnostic tests, along with the final hospital discharge sheet.
- You would need to submit these documents within 30 days of being discharged from the hospital to the insurer’s Claims Management team.
- You can contact the TPA or submit by your own.
- Upon receiving and verification of the documents, the insurer will convey the decision and settle the claim accordingly. The admissible amount will be reimbursed through NEFT.
How to Buy the TATA AIG MediCare Health Insurance Plan?
You can easily buy the TATA AIG MediCare Health Insurance plan through paisawiki.com. All you need to do is to visit the Paisawiki’s website and follow the buying steps. Paisawiki provides a complete insurance package to compare online and assist you with the purchase, review, plan comparison, renewal, and claims assistance of all kinds of insurance policies.
You just need to provide your basic details like name, contact number, and email address before you are able to view free insurance quotes for various plan options by different insurance providers as per your feasibility. Once the plan is finalized, the premiums are to be paid online as well. Upon successful payment of the premiums, the policy document will be mailed to the registered email Id.
Documents Required to Buy the TATA AIG MediCare Health Insurance Plan
TATA AIG health insurance keeps its application process simple and easy to follow. You just need to keep a copy of the following documents handy in case you are planning to buy this policy.
- Age Proof- Voter Id/ PAN Card/AADHAAR/ Driving License/Passport/ Birth Certificate
- Identity Proof- Passport / PAN Card/ Voter Id/ Driving license
- Address Proof: Passport/AADHAAR Card/ Driving License/ ration card/Utility bills
- Medical reports, if required
- Passport size photographs of all members insured
- Duly filled and signed Proposal form
Renewal Process of TATA AIG MediCare Health Insurance Plan
The renewal of your TATA AIG health policy is necessary to enjoy the continued benefits of the plan. You can access paisawiki.com and choose 'Renew.' You can select your insurance product to continue with a quick online renewal of your policy.
You can also seek assistance from an agent offline for the Renewal process or directly visit a nearby branch of Tata AIG General Insurance Company to renew the policy.
Ans: Yes, TATA AIG Health Insurance allows the policyholder's change but only in case of renewal of the policy. If the policyholder is a minor, the policy can only be renewed by his natural guardians or any guardian appointed by the court.
Ans: Yes, you can terminate the health insurance policy if you do not wish to continue. You need to give written notice to the TATA AIG health insurance team, and the policy will be terminated the day that notice is received.
If no claim has been made under the policy, your premium amount will be refunded as per the short rate proportion.
Ans: TATA AIG provides the policyholder the facility to change the sum insured i.e., Enhance it, only at the time of renewal. This is subject to the underwriting guidelines provided by the insurer.
Ans: Yes, TATA AIG allows the policyholder to migrate to a similar health insurance policy with TATA AIG. The insured person was first insured with TATA AIG as a dependent, or when the insured person is about to complete the prescribed exit age.
If the policy has been continued without any break in the previous years, all credits and coverage features of the policy for the corresponding policyholder will be maintained during migration to a similar health insurance product.
Written By: Paisawiki - Updated: 22 October 2020