Tata AIG MediCare Premier Plan
Medical emergencies can strike anytime, anywhere. To protect people from such an emotionally and financially draining situation, various insurance companies have created health insurance plans. Such insurance policies provide financial coverage against hospitalisation due to various diseases. Thus the policyholder can pay attention to the patient's well-being without worrying about finances.
On this note, Tata AIG has launched the MediCare Premier Plan to cope up with the demanding situations. The plan is equipped with various offerings and benefits. It provides a sum insured ranging from Rs 5 lakh to Rs 50 lakh for policyholders to fulfil their health care expenses.
What is the Tata AIG MediCare Premier Plan?
The Tata AIG MediCare Premier Policy is created to provide coverage to a family from 91 days until 65 years. The plan has dual options for policyholders to choose from in the form of individual or family floater basis. The plan covers the cost of treatment and hospitalisation against various diseases and health conditions.
The person insured in a health insurance plan can cover for a maximum of up to 7 members. This indemnity based health policy provides a range of benefits without any sub-limit. Policyholders can avail cashless hospitalisation in a network of 4000+ hospitals in India.
Features and Benefits of Tata AIG MediCare Premier Policy
Let’s consider the multiple features and benefits of this TATA AIG health insurance plan, which make the plan worth buying. The features of the Tata AIG MediCare Premier Plan are:
- The plan covers the expenses incurred for hospitalisation due to any illness, disease, or injury if the patient requires to be admitted.
- The policy provides coverage against pre-hospitalisation expenses for up to 60 days before hospitalisation.
- It also covers medical expenses incurred post-hospitalisation for up to a maximum of 90 days.
- It provides coverage for daycare treatment due to diseases, injury, or illness at a daycare centre or hospital.
- The plan covers the cost of surgical and medical expenses of the organ donor for donating an organ to the insured person in the same hospital.
- Medical expenses due to availing medical treatment at the policyholder's home are also covered.
- In-patient dental treatment requiring hospitalisation in which anaesthesia expense is covered. But the dental treatment must be due to an accident or injury.
- AYUSH benefit is covered. The plan covers medical expenses incurred due to non-allopathic treatment taken as an in-patient.
- The plan provides an ambulance cover to the person insured per hospitalisation.
- The plan covers medical expenses for the newborn baby up to Rs 10,000.
The benefits of the Tata AIG MediCare Premier Plan are
- Lifelong Renewability - The plan offers a lifelong renewal option for the policyholder and his family if the premiums are paid without any gap.
- No Extra Charges - The renewal premium is based on the age of the policyholder, and there are no extra charges for individual claims made.
- Global Cover - The policy covers for various diseases diagnosed in India and treatment for those diseases done abroad. It also covers health-related travels.
- Bariatric Surgery Cover- It covers expenses for customary and reasonable expenditure for bariatric surgery if the person insured fulfils the terms of the policy.
- Sum Insured Restore Benefit - If the treatment equivalent to the sum insured and cumulative bonuses are utilised during a hospitalisation, the policy will restore all the sum insured amount in the policy which can again be used to treat a related illness after 45 days from which the claim was made.
- High-End Diagnostics - The policy will pay for the person insured's diagnostic tests listed in the policy on OPD basis, if required, up to a maximum of Rs 25,000 annually.
- Maternity Expenses - The plan covers maternity expenses for up to a maximum of Rs 50,000 for a boy and Rs 60,000 for a girl child per policy.
- Cumulative Bonus - There is an increase of 50% cumulative bonus for non-claim year. In a year if a claim is made, the cumulative bonus gets reduced by 50% in the next policy year.
- Tax Benefit - The premium paid in this plan qualifies for tax deductions under Section 80D of the Income Tax Act, 1961.
- Affordable Premium - The plan has quite affordable premiums in comparison to other health plans.
Inclusions of the Tata AIG MediCare Premier Plan
The list of inclusions of the Tata AIG MediCare Premier Policy covers the following:
- Accidental death benefit
- Daily cash for using a shared accommodation
- Daily cash for accompanying the insured child
- Emergency air ambulance cover
- First-year vaccinations of the newborn
- Hearing Aid
- Health Check-up
- High-end diagnostics
- OPD Treatment
- Prolonged hospitalisation benefit
- Second Opinion
- Vaccination cover
Waiting period of the policy
The policy has a waiting period of 24 months in which the policyholder has to wait for the said period before availing the treatment of pre-existing illness. There is a 2-years waiting period from the date of commencement of the policy for filing a claim.
Exclusions the Tata AIG MediCare Premier Plan
The expenses incurred for the following conditions are excluded under this policy:
- Breach of the law, i.e. due to drugs
- Cosmetic or plastic surgery
- Change of gender treatments
- Hazardous or adventure sports
- Investigation & evaluation of diseases
- Obesity or weight control-treated
- Rest cure, rehabilitation and respiratory care
- Refractive error treatment
- Sterility and infertility treatment
- Unproven treatments
*This list is only indicative and not exhaustive. For the complete list of inclusions and exclusions, one can refer to the policy document
Eligibility Criteria to Buy the Tata AIG MediCare Premier Policy
The eligibility of the Tata AIG MediCare Premier plan is as follows:
- Sum Insured options - 5 lakh, 10 lakh, 15 lakh, 20 lakh, 25 lakh, and 50 lakh
- Minimum entry age of the adult - 18 years
- Maximum entry age of the adult - 65 years
- Minimum entry age of the child - 91 days to 5 years
- Maximum entry age of the child - 21 years
The child can only be included if both parents are covered in the policy.
- Policy tenure - 1 year, 2 years or 3 years
- Covers individual or family.
- The policy can include 7 members of the family in which there are various options available. They are:
- Self, spouse, 2 parents, 2 parents in law, 1 child
- Self, spouse, 2 parents, 3 children
*The above information is subject to change as per the norms of the insurance provider.
Claim Process of the Tata AIG MediCare Premier Policy
Tata AIG Insurance Company ensures smooth and hassle-free claim settlement, where the policy can be claim for availing cashless or reimbursement facilities. The claim steps for both are explained below:
Cashless Claim: When healthcare treatment is taken from a network hospital, the insured can claim for cashless settlement. The steps are:
- For initiating a cashless claim process, go to the claim section. It is necessary to inform the policy provider company 7 days before undergoing any kind of hospitalisation for any type of surgery if preplanned. In case of hospitalisation due to an emergency, one must inform the insurance provider within 24 hours of hospitalisation.
- On admission to the network hospital, the person must provide all necessary documents at the helpdesk - policyholder's ID proof, health card provided by the insurance company, and policy document for cashless treatment.
- The person insured needs to fill up a claim form/pre-authorisation letter stating the reason for hospitalisation. After filling up the claim form and uploading/submitting all the documents, wait for the insurance provider to notify the person insured.
- Insurance companies usually notify the policyholder within 5-9 hours about claim approval or rejection, although the time taken varies from company to company.
- Once the person insured gets discharged from the hospital, they must leave all the original documents like receipts and bills at the hospital desk. One must make sure to pay the amount which is not covered by the insurance provider or co-payment if required.
Once all the above procedures are completed, the insurance provider will pay the outstanding bill.
Reimbursement Claim Process: If the treatment is not being done at any of the network hospitals, then the policyholder has to go for the reimbursement process.
- For this process, the policyholder can get admitted to the hospital of his/her choice and notify the insurer in advance. For accidental or emergency hospitalisation, intimate the insurer within 24 hours of hospitalisation.
- Once the surgery gets over and the person insured is discharged. Ensure to collect all the original medical bills, receipts, prescriptions discharge sheets and other medical bills and pay the sum due to hospitalisation and surgery undergone by the person insured.
- Inform the insurer about the claim initiation and fill the claim form. Ensure to include all the documents as requested by the insurance provider for the claim. The policyholder must submit prescriptions, original bills, medical receipts, and invoices for the claim process.
- After uploading all the documents, the policy provider will check and verify the documents received. After examination, it will reject or approve the claim. The insurer, if necessary, can ask the policy provider to submit more documents for acceptance of the claim.
- After a fixed time, the insurance provider will notify the person insured about approval through the registered email address and SMS.
On accepting the claim amount, the insurer will process the hospital bill and transfer bank account, which is done through NEFT.
Documents Required to Claim
The person insured must submit all essential documents for planned or emergency hospitalisation and claim for the hospital bills. The documents required to submit for the claim are:
- A medical report which notifies the person insured has no pre-existing disease
- A second copy of the first consultation letter prescription from the doctor and second opinion from the doctor
- For hospitalisation due to an accident, it is essential to submit an FIR copy of the accident
- Indoor case paper
- Signed up claim form
- Treatments bill
- Various medical certificates
- Extra documents as asked by the insurer
On submission of essential documents by the person insured, the insurer will inform about the claim approval.
How to Buy the Tata AIG MediCare Premier Policy?
The policyholder can buy AIG MediCare Premier Policy online as well as offline. Below is the process to purchase the plan.
- For buying the plan, visit the official website of Paisawiki.com to check all the plan details & buying it.
- Select the policy to buy it. Choose on the 'Buy Now' or go to the ‘Get Free Quote’ option
- Fill up the personal details asked on the secured. Select on the 'continue' option.
- After confirming the above details, the person insured can compare online with another health insurance plan or click on the 'continue' option.
- Enter all policy related details like name of the person to be insured, their age & medical details etc. Enter policy duration, the sum insured, etc. from the menu. For calculating premiums easily, the website has a premium calculator. On calculating the premium amount go to the next page to add riders.
- The person insured can add riders for greater coverage. Select the 'proceed' option.
- Add extra details and any other details.
- Upload the KYC documents asked by the policyholder.
- Agree to the terms & conditions of the plan.
- Enter all the necessary bank details for online transactions to pay for the premium amount.
- On payment of the required premiums, the policy document will be mailed.
To buy the policy offline, one can visit the branch office of TATA AIG Insurance Company and complete the formalities there.
Documents Required to Buy the Tata AIG MediCare Premier Plan
To buy the TATA AIG MediCare Premier Plan, the below documents are required:
- A coloured photograph of passport size.
- Age proof required for the policy: School or College Leaving Certificate, Birth Certificate, Voter Card, Permanent Account Number, i.e. PAN card, Driving License, Passport and Aadhar Card
- Address proof essential for the policy: Ration Card, Electricity Bill, Utility Bill, Bank A/C statement, Passport, Telephone Bill and Postpaid Bill
- Photo ID Proof: Voter ID, Driving License Aadhar Card, Passport or PAN card
Renewal Process of the Tata AIG MediCare Premier plan
The renewal process of the policy is as follows:
- Visit Paisawiki.com
- Select the policy renewal option. Enter the policy number & click to continue tab.
- Enter all the policy details like policy tenure, mobile number, email id, etc.
- Select the renew plan option.
- Add or remove family members, if want
- In case of an addition, one must mention the necessary details and upload documents if required.
- On adding riders or new members, one must calculate the new premium using the health premium calculator.
- Select the next option.
- The policyholder needs to agree to the new policy terms & conditions. Pay the renewal premium by adding bank details.
On payment of the renewal premium, the plan details will be mailed to the person insured.
Ans: Yes, the plan provides air ambulance cover for transportation.
Ans: Yes, this benefit is provided according to the Guidelines on Standardisation in Health Insurance, 2016.
Ans: The maximum limit of the air ambulance cover is up to a maximum of Rs 5 lakh.
Ans: The policy has a grace period of 30 days, during which all the premiums can be paid after the due date has passed.
Ans: Yes, the policy provides an accidental death benefit within 1 year from the accident.
Written By: Paisawiki - Updated: 21 October 2020