Tata AIG Medicare Premier
Overview
Tata AIG Medicare Premier is a comprehensive health insurance plan which covers all base benefits without any restrictions. Apart from hospitalisation expenses, the plan covers the cost of consumables, maternity expenses, OPD and dental treatments, high end diagnostic tests and global hospitalisation.
Tata AIG Medicare Premier is a slightly expensive health insurance plan. If you are looking for a feature-rich health insurance plan with no restrictions, this is a great choice.
Pros and Cons
- No room rent limit – Choose any room available in the hospital and you are fully covered.
- All daycare procedures covered – Covers surgeries and procedures requiring less than 24 hour hospitalisation.
- Consumables covered – Covers cost of consumables like syringes, gloves, oxygen masks etc. at no extra premium.
- Pre and Post hospitalisation expenses covered – Up to 60 and 90 days respectively
- Covers maternity expenses, OPD treatments and dental OPD treatments.
- Includes bariatric surgery for weight loss.
- Vaccination charges covered – Covers expenses related to Human Papilloma Virus (HPV) vaccine & Hepatitis B Vaccine, Anti-rabies vaccine & Typhoid vaccination
- Global planned hospitalisation covered – For illnesses diagnosed in India.
- Shorter waiting period of 24 months on PEDs.
- The plan is slightly expensive.
- No claim bonus reduces if you claim during a policy year.
- One-time restore benefit covers the same or related illness after a gap of 45 days.
Plan Benefits
Never spills the bill on you
Tata AIG Medicare Premier covers all inpatient hospitalisation expenses at actuals up to sum insured. The insurer also provides consumables coverage at actuals up to sum insured. The plan ensures you never pay any portion of hospitalisation expenses out-of-pocket.
No room restrictions
Tata AIG Medicare Premier covers all room categories. Choose to stay in any room available in the hospital.
All daycare procedures covered
In case you need to undergo a surgery or procedure that requires less than 24 hour hospitalisation, your plan covers these medical costs too.
Pre and Post-hospitalisation expenses covered
Covers treatment related medical expenses 60 days before and 90 days after hospitalisation up to sum insured. This includes consultation charges, diagnostics, medicines and other costs.
Alternative medicine covered
Want to take ayurvedic or homeopathic treatment for your illness? This plan covers the hospitalisation expenses fully up to sum insured.
Covers bariatric surgery for weight loss
If you undergo bariatric surgery for weight loss, the plan will cover the costs of surgery fully if BMI exceeds 40.
Restoration benefit available
If you claim fully or partially under the policy, the insurer restores an amount equal to your base sum insured. Restoration benefit is available only for the subsequent claims during the policy year. If you want unlimited restorations, you can buy an add-on.
Get Free Annual Health Checkup
Undergo preventive health checkup once every policy year to make sure you are hale and hearty, all at the cost of your insurer.
No claim bonus for not making a claim
Get rewarded from your insurer in the form of extra coverage at renewal, for a claim-free policy year. The insurer adds 50% of the base sum insured as no claim bonus for every claim-free year up to a maximum of 100%. However, in case you make a claim, the insurer reduces your no claim bonus by 50% of base sum insured.
Get coverage even if you are forced to be hospitalised at home
Get full coverage from your insurer even if you are forced to be hospitalised at home due to health conditions or hospitals running out of beds. In health insurance parlance, this is called domiciliary hospitalisation.
Covers ambulance charges
Need an ambulance in case of a medical emergency? Don’t worry. The plan covers road as well as air ambulance charges (up to specified limits) in case of an emergency.
Covers organ harvesting cost in case of an organ transplant
If you are an organ recipient, your insurer will cover the hospitalisation expenses of the organ donor for harvesting the donated organ.
Get global cover for planned hospitalisation
The plan covers the full cost of treatment up to sum insured if you take planned treatment anywhere in the world provided the first diagnosis happened in India.
OPD and Dental OPD benefits available
The plan also covers OPD and dental OPD costs up to a fixed limit after a waiting period of 2 years. You do not have to worry about OPD expenses anymore.
Covers maternity expenses
This plan also provides maternity coverage up to a fixed amount. Female insured lives can avail of this coverage after a waiting period of 4 years.
Vaccination coverage available
Get coverage for expenses related to Human Papilloma Virus (HPV) vaccine & Hepatitis B Vaccine after 2 years of continuous coverage and Anti-rabies vaccine & Typhoid vaccination without any waiting period. Claiming this benefit does not reduce your base cover.
Get daily cash benefit if you choose to stay in a shared accommodation
If you choose to stay in a shared accommodation during hospitalisation, your insurer rewards you with a fixed daily cash benefit. This has a separate limit over and above your base coverage.
Get daily cash if a child is hospitalised
If a child aged 12 or less is hospitalised, the insurer provides a fixed daily cash benefit to cover the expenses of an adult accompanying the child in the hospital. This also has a separate limit over and above the base cover.
Covers high end diagnostic on OPD basis
If you undergo some high end diagnostic tests (listed tests) on OPD basis, your insurer covers the cost of these tests.
Doctor teleconsultation and other wellness benefits are available
You can avail unlimited general or specialist telephonic consultations and other wellness services to stay healthy. Your insurer bears the cost.
Add-ons
Restore Infinity Plus
With this add-on, you get unlimited restorations of sum insured during a policy year upon full or partial exhaustion of the base cover. The restoration applies only to the subsequent claims (related or unrelated) in a policy year. This feature comes in handy in case of multiple hospitalisations during a policy year. This add-on is now mandatory for every new policy purchase.
Inflation Protect
Inflation protect add-on enhances your sum insured every year, protecting your coverage against inflation. The increase in the sum insured is in line with the CPI inflation rate.
Cumulative Bonus Shield
If you make a claim, your cumulative bonus under the policy is reduced by 50% of the sum insured. With this add-on, your cumulative bonus stays intact even if you claim up to Rs. 50,000/- in a policy year.
Advanced Cover
With this add-on, you can reduce the waiting period on 4 pre-existing illnesses from 2 years to a mere 30 days. The illnesses include diabetes, hypertension, hyperlipidemia and asthma.
Accident Suraksha
With this add-on, you get enhanced coverage against the risk of accidents. The insurer provides an additional sum insured for medical expenses incurred towards the inpatient treatment if you meet with an accident resulting in your hospitalisation. The insurer also pays 100% of the sum insured or Rs. 50 Lakh, whichever is lower, if the accident causes permanent total disability.
Mental Wellbeing
With this add-on, you get access to mental health screening once in a policy year at any of the emplanelled service providers. Your insurer also covers the cost of consultations/ therapy sessions with psychologists, dietitians and other healthcare professionals to maintain your mental wellbeing.
Cancer Benefit
This add-on provides coverage against the risk of cancer. The insurer pays a lump sum benefit if you are diagnosed with a cancer of specified severity. You can use this benefit amount for your treatment or to cover the potential loss of income due to this deadly illness.
Premium Savers
Aggregate Deductible
Opt for a deductible to get a discount on your premium. The aggregate deductible applies across all claims in a policy year. However, choose this option with caution as you need to pay the deductible amount upfront during a claim for the policy benefits to kick in.
Policy Conditions
| Sum Insured Range | Rs. 5 Lakh – Rs. 3 Crore |
| Entry Age | 91 Days – 24 Years for dependent children, 18 – 65 Years for adults. |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | Individual and Family Floater |
| Family Coverage | Up to 7 family members (Self, Spouse, 3 dependent children, Parents or Parents-in-law) |
| Premium Payment | Annual |
Exclusions
Waiting Periods
- Initial Waiting Period: 30 days (except accidents)
- Specific Illness Waiting Period: 24 months.
- Waiting Period on Pre-Existing Diseases: 24 months.
- Maternity Benefit Waiting Period: 48 months
- OPD Waiting Period: 24 months.
Medical Exclusions
- Congenital external defects or anomalies
- Alcoholic pancreatitis
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Unproven treatments
- Refractive error correction for less than 7.5 diopters
Non-Medical Exclusions
- Investigation and evaluation
- Self-injury or attempt to suicide
- Alcoholism, drug or substance abuse
- Treatment necessitated by committing breach of law with criminal intent
- Treatment taken by a medical practitioner outside his discipline
- War, terrorism, nuclear events
- Injuries from hazardous sports
About the Insurer
Tata AIG General Insurance is a joint venture between Tata Group and American International Group. The company was founded in 2001. It offers an extensive range of insurance policies including fire, marine, cargo, home, motor, health and travel insurance among other commercial and consumer lines of insurers policies.
Performance Highlights (FY24)
Turnover – Rs. 15,423 Crore
Claim Settlement Ratio – 96.67%
Incurred Claim Ratio – 71%
Volume of Claim Complaints – 12.11 / 10,000 claims
Network Hospitals – 12,000+
Get In Touch
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Frequently Asked Questions
What is the maximum entry age in the Tata AIG Medicare Premier plan?
Tata AIG Medicare Premier comes with a maximum entry age of 65 years for adults and 25 years for dependent children.
What sum insured options are available under Tata AIG Medicare Premier?
The plan offers sum insured options ranging from Rs. 5 Lakh to Rs. 3 Crore.
Is there a co-payment clause in Tata AIG Medicare Premier?
No, Tata AIG Medicare Premier does not apply a co-payment clause on any treatment.
Is there any room rent restriction in Tata AIG Medicare Premier?
No, the Tata AIG Medicare Premier does not impose any room rent restriction. You can choose any room available in the hospital.
Does Tata AIG Medicare Premier offer restoration benefits?
Yes, Tata AIG Medicare Premier offers one-time restoration benefit upon partial or full utilisation of sum insured. However, multiple restorations are available as an add-on.
Does Tata AIG Medicare Premier cover AYUSH treatment?
Yes, this plan covers hospitalisation expenses for AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) treatment up to sum insured.
Does Tata AIG Medicare Premier cover pre-existing diseases?
Yes, Tata AIG Medicare Premier covers pre-existing diseases after a waiting period of 2 years.
What is the waiting period on specific illnesses under Tata AIG Medicare Premier?
Tata AIG Medicare Premier comes with a 2 year waiting period for certain specified illnesses before claims can be made.
Does Tata AIG Medicare Premier cover daycare procedures?
Yes, Tata AIG Medicare Premier covers daycare procedures up to the sum insured.
Does Tata AIG Medicare Premier cover maternity and newborn expenses?
Yes, Tata AIG Medicare Premier covers maternity and newborn expenses after a waiting period of 4 years.
Does Tata AIG Medicare Premier provide global coverage?
Yes, it offers global coverage for planned hospitalisation, provided the first diagnosis of the medical condition happened in India.
Are health check-ups included in Tata AIG Medicare Premier policy benefits?
Yes, Tata AIG Medicare Premier provides free annual health check-ups up to 1% of the previous sum insured, subject to a specified limit. This benefit has a separate limit over and above the base sum insured.
