Tata AIG Medicare
Overview
Tata AIG Medicare is a comprehensive health insurance plan which covers all base benefits without any restrictions. There is no limit on room rent and ICU charges. Apart from hospitalisation and related expenses, the plan covers the cost of consumables, ambulance charges, vaccination charges and annual health check-ups.
Tata AIG Medicare is an expensive health insurance plan. If you are looking for a robust health insurance plan with no restrictions, this is a good 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
- Vaccination charges covered – Covers expenses related to Human Papilloma Virus (HPV) vaccine & Hepatitis B Vaccine, Anti-rabies vaccine & Typhoid vaccination
- Includes bariatric surgery for weight loss.
- The plan is expensive.
- No claim bonus reduces if you claim during a policy year.
- Longer waiting period of 36 months on PEDs.
- 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 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 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 minor 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 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 charge
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.
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.
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.
Policy Conditions
| Sum Insured Range | Rs. 3 Lakh – Rs. 20 Lakh |
| 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.
Medical Exclusions
- Congenital external defects or anomalies
- Alcoholic pancreatitis
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Maternity expenses
- Unproven treatments
- OPD expenses
- Dental 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 plan?
What sum insured options are available under Tata AIG Medicare
Is there a co-payment clause in Tata AIG Medicare ?
Is there any room rent restriction in Tata AIG Medicare ?
Does Tata AIG Medicare offer restoration benefits?
Does Tata AIG Medicare cover AYUSH treatment?
Does Tata AIG Medicare cover pre-existing diseases?
Yes, Tata AIG Medicare covers pre-existing diseases after a waiting period of 2 years.
What is the waiting period on specific illnesses under Tata AIG Medicare?
Tata AIG Medicare comes with a 2 year waiting period for certain specified illnesses before claims can be made.
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