Tata AIG Wellsurance Executive Policy
Illness is unpredictable, and so is the cost of medical treatment. The sky-rising treatment costs are often unbearable and uncalled for one's pockets, yet one needs to pay for it when an emergency occurs. So, to answer the needs of the customer, there are various health insurance plans available. One such plan is the Tata AIG Wellsurance Executive Plan by the TATA AIG Insurance Company. This plan provides benefits like post-hospitalization, daily hospital cash, and in-patient hospitalization coverage.
What is the Tata AIG Wellsurance Executive Plan?
The Tata AIG Wellsurance Executive Plan is a health insurance policy that covers the costs of hospitalization against the premiums paid. The plan pays a lump sum amount at the time of need for hospitalization or critical illness detection. It allows one to get the best treatment possible without stressing about the affordability. It includes critical illness cover and hospital charges. The daily hospital cash benefit and other benefits provided makes it easier for the insured to deal with the uncertainties of life.
Key Features of the Tata AIG Wellsurance Executive Plan
The policy comes with the following features:
- Hospitalization Charges - The hospitalization charges incurred for the specified treatments of the policyholder's injury or illness are covered.
- Post-hospitalization Charges - The insured gets a lump sum amount for thecharges incurred in the post-hospitalization procedure, including:
- Post-operative physiotherapy charges, eligible for a minimum of 2 visits.
- Chemotherapy and/or radiation, payable only once in the lifetime of the policyholder and eligible for a minimum of 3 visits.
- Kidney dialysis is payable only once during the lifetime of the policyholder.
- In-patient Charges - Charges like room rent, OT rent, nursing charges, and other such expenses are also covered for the specified diseases.
- Daily Hospital Cash Benefit - Daily hospital cash facilities for ICU/ICCU admissions are distinctive features of the policy.
- Ambulance Charges - Ambulance charges incurred during hospitalization of the policyholder.
- Value-added services include facilities like free health care number, health portal, health query, savings on health premiums, wellness services, and e-newsletter subscriptions that will provide the insured with access to useful and valuable healthcare articles. It alsohelps in getting proper guidance for a maintained lifestyle in their stressful and hectic daily schedules.
Key Benefits of the Tata AIG Wellsurance Executive Plan
Some of the major benefits of this TATA AIG health insurance plan are:
- Major Surgeries - The Tata AIG Wellsurance Executive Plan pays a lump sum amount for the expenses incurred during major surgerieswhich are medically necessary but not caused by pre-existing diseases.
- Minor Surgeries - The Tata AIG Wellsurance Executive Plan pays a lump sum amount to cover the expenses incurred for specific minor surgeries that are medically necessary but not caused by pre-existing diseases.
- In-hospital Treatment Charges for Sickness/Illness - The Tata AIG Wellsurance Executive Plan pays a benefit to the insured for the daily expenses that are incurred during the treatment of any disease and/or sickness/illness and are subjected to a waiting period of 90 days. A physician must recommendthe policyholder.
- In-patient Hospital Treatment Charges for Accidents - The Tata AIG Wellness Executive Plan pays daily cash for in-patient hospitalization of the policyholder across India due to an injury or accident which is subjected to the deductibles in the policy schedule.
- Critical Illness - In case the insured is diagnosed with aparticular critical illness during the policy tenure, the person insured will receive a lumpsum payment from the insurer. The signs and symptoms indicating the critical illness need to appear 90 days after the policy commencement date. There is a survival period of 30 days from the date of diagnosis. After the survival period, the lump sum amount will be paid. This amount shall be provided only once during the policy period regardless of the number of critical illnesses or treatments suffered by the insured, and the benefits shall be terminated after the payment. After the renewal of the policy, the policyholder again becomes eligible for this benefit.
- Convalescence Benefits - In case the insured is hospitalized for five consecutive nights, the insurer pays a lump sum amount for the expenses incurred during the recovery period at home, which is paidimmediately after the person has been discharged from the hospital.
- Nursing Charges, Physician Charges, and Hospital Diagnostic Tests - The insured will be paid for all the expenses incurred in the cases mentioned above while admitted to the hospital, as specified in the policy schedule.
*The above information is subject to change as per the norms of insurance providers.
Inclusions of the Tata AIG Wellness Executive Plan
Here’s the list of diseases that fall under the critical illness and is covered by the policy.
- Severe Cancer
- Severe First Heart Attack
- Stroke with permanent symptoms
- Kidney Failure requiring dialysis (regular)
- Severe Coma
- Total Blindness (due to acute sickness/accident)
- Major Burns
- Multiple Sclerosis with symptoms (persisting)
- Permanent Paralysis of Limbs
The following is a list of the major surgeries that are covered by the policy:
- Brain surgery (Craniotomy, tumor removal)
- Post-traumatic surgery
- Bone marrow transplant
- Major organ transplant (excluding kidney transplant)
- Knee replacement
- Hip replacement
- Spinal surgeries
- Heart valve replacement
- Pacemaker implant
The following is a list of all the minor surgeries that are covered by the policy:
- Removal of Gall stones/kidney stones
- Hernia repair
- Removal of skin lesion
- Biopsy of growth
*For more details about the inclusions, it is preferable to refer to the policy wordings.
Exclusions of the Tata AIG Wellness Executive Plan
Although the plan covers a lot of treatments with extensive benefits, here is a list of the medical expenses that are excluded:
- All the pre-existing conditions and diseases will be covered after a waiting period of 4 consecutive policy years from the date of commencement of the policy provided that the policy is maintained without any break.
- Any critical symptoms/illness occurred within the waiting period of the initial 90 days shall not be covered.
- Any sexually transmitted diseases (HIV, AIDS), congenital anomalies and pregnancy or childbirth-related treatments are not covered.
- Weight control programs or ayurvedic, homeopath, or naturopath treatments are excluded.
- Any kind of intentional self-injury is not covered.
- Medical expenses caused by drug/alcohol abuse and/or overuse/misuse and addiction are excluded.
- Any medical expenses incurred during hostilities, war, civil war, nuclear weapon induced hospitalization, and invasion are excluded.
- Hazardous activities and adventureor professional sports are not in the list.
- Plastic, cosmetic, elective surgeries unless as a result of accidental injuries are not covered.
- Any medical expenses incurred in the treatment of nervous disorders, depression, anxiety, stress, mental disorders etc. are not covered.
- Any investigation, services, supplies or treatment not directly linked with the covered illness/disease/injury or not recommended by the hospital authority are not covered.
- Organ transplants that are considered experimental are excluded.
- Hospitalization outside of India is excluded.
Eligibility Criteria to Buy the Tata AIG Wellsurance Executive Plan
The age limit for Tata AIG Wellness Executive Plan ranges from 18 years to 65 years. The policyholder needs to be a citizen of India. The policy covers specific diseases as mentioned in the policy document.
Claim Process of the Tata AIG Wellsurance Executive Plan
Here’s the procedure required to claim the policy:
- If the insured person requires hospitalization for any illness, sickness, diseasethat is pre-planned, the policy provider company must be informed within 48 hours before admission to the hospital. In case of emergency hospitalization, then the insurer needs to be informed within 24 hours of admission to the hospital.
- After undergoing the necessarytreatment, the person insured needs to fill and submit the claim form, which can be acquired from the hospital's helpdesk. The person insured needs to submit the necessary documents.
- Afterreceiving the claim form, the insurer will verify the documents received, and they can ask for more documents, if unsatisfied.
- After the verification, the insurer will notify the policyholder about the claim's approval via the registered mobile number. They will processthe claim amount within 30 days of submitting the claim form. But if they require additional information & documents, it might take up to 6 months. The claim shall be settled following the IRDA guidelines set in 2002.
Documents Required for Claim
The following documents are the be produced in case of a claim:
- Duly signed claim form by someone held on behalf of the policyholder
- Photocopy of bills including pharmacy bills, consultation, and diagnosis bill, prescriptions, receipts in support of the treatment taken
- Hospital bills, receipts
- Medical receipts like case history, treatment papers, investigation reports, discharge summaries
- Precise diagnosis of the treatment for which the claim is processed.
- A detailed list of medical services and treatments undergoneby the individual and a unit price for each
- Prescriptions that name the insured person and holds the drugs prescribed with their price and a receipt of payment. The prescription needs to be submitted in correspondence of the doctor's invoice.
- Operation theatre bills
- Claim intimation proof
How to Buy the Tata AIG Wellsurance Executive Plan?
The steps of buying Tata AIG Wellsurance Executive Plan are:-
- Step 1: Visit the official website of Paisawiki.com.
- Step 2: Go to buy policy section. Step 3: Enter the name, address, email, mobile number, birth date, and other such details. Choose the proceed button.
- Step 4: Choose the sum insured, whether the policyholder is a smoker or not, gender, etc.
- Step 5: After filling all the KYC details, submit the medical details, if the policyholder is suffering from any major ailment.
- Choose the plan from the list suggested. One can also choose to add riders or compare the plan.
- Step 6: Enter bank details.
- Step 8: Pay the premium amount.
On successful payment, the policyholder will get the policy documents via email.
Documents Required for Buying the Tata AIG Wellsurance Executive Plan
The policy required the following documents:
- KYC details - For KYC, one needs to submit Aadhar Card, PAN Card, Voter ID.
- Address proof - Phone bill, electricity bill
- Income proof - Form 16, ITR
- Health Id Card received from the Government of India
- Medical tests
Steps for Policy Renewal
The policy is renewable, provided the premium is paid on the due date. Besides, a grace period of 30 days is provided in case of a delay. However, coverage shall not be provided during the period in which the premium has not been cleared. Post the grace period of thirty days; if the premium is not paid/cleared, the policy shall lapse, i.e., will be terminated. The policy can be renewed from Paisawiki.com very easily.
- Step 1: Visit the official website of Paisawiki for policy renewal.
- Step 2: Go to the renewal section. Enter the date of birth, policy number, and registered mobile number. Click on the proceed button.
- Step 3: The details will be generated. One can check the due date for the renewal of the policy. Click on renew policy option.
- Step 4: Enter the bank details to pay the premium.
- After the payment of the premium, the policy is renewed.
Ans: The expenses incurred each day during hospitalization or treatments fall under the daily benefits category.
Ans: No. Routine physical examinations fall under the exclusions and thus are not covered.
Ans: The period of confinement is the number of consecutive days the insured is hospitalized for.
Ans: The insurer covers the medical expenses that are not excluded in the policy schedule. This includes services and supplies that are necessary medically, services that are included in the policy schedule, and schedule of benefits.
Ans: Services and supplies prescribed by the hospital authorities that are essential for the treatment or diagnosis of any sickness or injury fall under the direct care and treatment of the sickness/injury, stand per the standards of good medical practices, not prescribed primarily for the policyholder's convenience, most appropriate and safe for the insured.
Ans: Here is a list of inclusions in the aforesaid category:
- MRI charges
- CT Scan or Doppler Study charges
- Lab Test and/or x-ray examination and/or ECG charges
- Physiotherapy charges
- Nursing Expenses
- Physician’s Visiting charges (Hospital Confined)
- Anesthetist's fees (for in-patient surgery)
Ans: No, any expense incurred during the treatment of reproductive organs or conditions like pregnancy, childbirth, miscarriage is not covered by the policy and is excluded in the policy schedule.
Ans: Valu-added services like gym, weight management centers, diagnostic centers, beauty parlors, and a list of offered tie-ups will be provided along with the center address and contact numbers available on the health portal and will be updated on regular intervals.
Ans: All the medical transportation expenses incurred while hospitalization (admission and discharge) shall be taken care of as per the policy schedule.
Ans: In case of loss of life due to any disease, illness/sickness or accidents included in the policy schedule, the benefit amount is payable as defined in the policy schedule, directly to the nominee declared by the policyholder. In the absence of the nominee, the amount will be paid to the policyholder's legal heir.
Ans: Yes, a survival period of 30 days is needed for the insured to proceed with the critical illness claims.
Ans: Yes, the plan allows free-look cancellations to the insured within 15 days after the issuance of the plan in case anyone changes their minds. In case the plan is canceled, the insured shall get the refund of the initial payment/premium, excluding certain charges.
Written By: Paisawiki - Updated: 22 October 2020