TATA AIG Medicare

Let’s Understand The Product

The TATA AIG Medicare is a health insurance plan provided by Tata AIG General Insurance Company Limited. This plan is designed to give you customizable coverage options, aligning with your unique needs and financial preferences. You be rest assured knowing that you and your dear ones will be taken care of, without the stress of unforeseen financial burdens.
 

The Eligibility Guidelines of The TATA AIG Medicare Plan

• Minimum Age Of Entry: Dependent children can be covered from as young as 91 days, while adults are eligible from 18 years onwards.
• Maximum Age Of Entry: Adults can join the plan until they reach 65 years of age. For dependent children, the maximum entry age is 25 years.
   

The Specifics of The TATA AIG Medicare Plan’s Benefits And Limitations

The TATA AIG Medicare Plan goes beyond just covering your inpatient hospitalisation costs when you are in the hospital for more than 24 hours. This includes room and board expenses, nursing charges, the cost of prescribed medicines and drugs, medical practitioner fees, ICU charges, and other related expenses. Some of the critical aspects of the plan include –

• Pre & Post Hospitalisation Expenses
  If your doctor needs to run diagnostic tests before or after your hospital stay, this plan has got you covered. It takes care of these costs for a reasonable duration—up to 60 days before hospitalisation and 90 days after discharge. You should, however, keep in mind that the insurer covers these expenses only if they are related to the medical condition/disease for which you are hospitalised, and the claim must be approved as part of inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Surgeries or medical procedures that used to require a long hospital stay can now be completed in just 24 hours, due to the advancements in medical technology. The TATA AIG Medicare Plan covers 541 such daycare procedures without any limits. This means all the expenses for daycare treatments will be covered up to the sum insured, ensuring you have the support you need.
   
• Domiciliary Treatment Coverage
  When you are seriously ill or injured and cannot safely get to a hospital, or if there are no nearby hospital beds, domiciliary treatments bring medical care to your home. The TATA AIG Medicare Plan helps by covering the expenses for these home-based treatments up to the chosen coverage amount.
   
• Organ Donor Coverage
  The TATA AIG Medicare Plan does not just provide coverage for regular medical expenses but also extends support to cover organ donor costs where you are the recipient. This includes expenses related to harvesting organs for transplantation, all within the sum insured that you select for your policy.
   
• Modern Treatment Coverage
  Healthcare is evolving fast because of new technologies that bring us treatments that were once unthinkable. The TATA AIG Medicare Plan is tailor-made to keep up with these advancements, ensuring coverage for the expenses tied to these modern treatments, all covered up to the sum insured.
   
• Non-Medical Expenses
  This plan goes beyond just medical expenses; it extends to cover non-medical costs as well. These include essential consumables like gloves, nebulization kits, oxygen masks, etc., that are crucial for treatments. These small items can add up quickly and burn a hole in your pocket. With the TATA AIG Medicare Plan, you will be covered for these costs up to the sum insured. It is a financial safety net for those extra burdensome expenses when you need it most.
   
• Cumulative Bonus (No Claim Bonus)
  With the cumulative bonus feature, you will get an increase in your cover amount at the time of renewal, if you have stayed healthy and have not made any claims in the previous year. Under the Tata AIG Medicare Plan, you receive a 50% bonus on your coverage for each year that you don’t make a claim, up to a maximum of 100%. However, if you do make a claim during the policy period, the accumulated bonus reduces at the same rate it was earned.
   
• Restoration Benefit
  The Restoration Benefit is a feature that kicks in when your cover amount runs out during the policy year. It restores your sum insured once you have used up both the base sum insured and any cumulative bonus (if any). This benefit is there for subsequent claims, and you can use this benefit once every policy year for your entire life, as long as you keep renewing your policy. You can use this benefit immediately for unrelated illnesses. But, if it is a related illness, the restoration benefit kicks in only if you are admitted to the hospital for that illness at least 45 days after being discharged from your earlier hospitalization.
   
• Room Rent Limit
  The room rent limit is the maximum amount your insurance company covers for your hospital room. If your chosen room fits within this limit, you will not have to pay anything extra. But, if you go for a room with a higher rent than your coverage limit, you will be responsible for paying a share of the entire bill, not just the difference in room rent. However, with the TATA AIG Medicare Plan, you have the freedom to choose any room you want – whether it is a shared room, a single room, a private room, or any room available. You do not have to worry about room rent restrictions; the policy is designed to give you the flexibility to make the choice that is right for you.
   

Key Product Highlights

Some of the other key aspects of the TATA AIG Medicare Plan are –

• Global Coverage
  You can extend your health insurance coverage globally. If you are diagnosed with a medical condition in India that needs treatment abroad, the TATA AIG Medicare Plan has you covered up to the sum insured. It takes care of the medical expenses incurred during your international treatment, offering peace of mind when seeking healthcare beyond your home country. However, you should keep in mind there are specific terms and conditions related to this coverage.
   
• Optional Accidental Death Cover
  Think of this add-on as a financial safety net during difficult times. It adds an extra layer of protection for your loved ones. This feature comes into play if you have an unfortunate accident during the policy period, and this accident is the direct cause of your demise within a year. In such a situation, your family receives a fixed amount, equivalent to 100% of the sum insured. This lump-sum payment provides crucial financial support during a challenging and unexpected time.
   
• Bariatric Surgery
  Bariatric surgery, or weight loss surgery, includes various surgical procedures designed to assist people dealing with severe obesity in shedding excess weight. The TATA AIG Medicare Plan provides coverage for expenses related to bariatric surgeries and treatments. Specific details regarding coverage are outlined in the terms and conditions.
   

Waiting Period

When you get health insurance, there is a waiting period before coverage kicks in for certain illnesses or diseases. This is the time you need to wait before you can make a claim for these conditions. Here are the types of waiting periods –

• Initial Waiting Period: Except for accidents, all medical conditions have an initial 30-day waiting period. This means that you cannot claim for hospitalisation in the first 30 days, unless it is due to an accident.
   
• Pre-existing Diseases Waiting Period: A pre-existing disease is any condition you had in the 48 months before getting the health insurance plan. Under the Tata AIG Medicare Plan, there is a 36-month waiting period for pre-existing diseases. During this time, the policy will not provide coverage for any expenses related to your pre-existing conditions.
   
• Waiting Period For Specific Diseases: Insurance companies create a list of certain illnesses, separate from your pre-existing conditions, that will come with a waiting period. It does not matter if you had these diseases before or not; the waiting period is set by the insurer and does not depend on your current health. The Tata AIG Medicare Plan has a waiting period of 24 months for specific diseases.
   

Exclusions

Exclusions are those situations that are not covered in your health insurance and are of many types –

• Standard Permanent Exclusions: Standard permanent exclusions are those limitations set by IRDAI, which all insurance companies must follow. Some examples include –
  • Investigation And Evaluation: Hospital stays just for observation or monitoring.
  • Rest Cure, Rehabilitation, And Respite Care: Admission for bed rest without active treatment.
  • Obesity/Weight Control: Treatment or surgery for weight control.
  • Change Of Gender Treatment: Treatments meant to alter the body's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Procedures to modify body characteristics or appearance.
  • Profession In Hazardous Or Adventure Sports: Treatment expenses for professional participation in adventurous activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Breach Of Law: Expenses for treating someone who has committed or attempted a criminal act.
  • Excluded Providers: Treatment from medical practitioners or hospitals not covered by the insurance company.
  • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
  • Treatments In Establishments for Domestic Purposes: Expenses for treatment in health spas, nursing homes, or similar places arranged for domestic reasons.
  • Dietary Supplements, Unprescribed Substances: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Expenses for correcting refractive errors up to 7.5 diopters for better eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven to be effective.
  • Expenses Related to Birth Control, Sterility, Infertility: Contraception, sterilisation, artificial insemination, and advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  • Maternity Expenses: Costs related to pre/post-natal care, childbirth-related hospitalisation, etc.
     
• Additional Permanent Exclusions: Apart from the standard permanent exclusions mentioned earlier, insurance companies might add more exclusions for specific situations or medical conditions. If you have certain diseases or severe medical conditions that insurers find risky to cover, they might permanently exclude them from your policy. It is important to note that insurers can only apply permanent exclusions for illnesses specified by the Insurance Regulatory and Development Authority of India (IRDAI).
   
• Non-Standard Exclusions (Specific Exclusions): Specific exclusions in the Tata AIG Medicare Plan go beyond the standard permanent exclusions set by the IRDAI. These exclusions differ among insurance companies and depend on the policy's terms and conditions. Here are some notable specific exclusions that the Tata AIG Medicare Plan excludes from coverage –
  • Alcoholic pancreatitis.
  • Congenital external diseases, defects, or anomalies.
  • Stem cell therapy, except for hematopoietic stem cells used in bone marrow transplants for haematological conditions that are already covered under in-patient or daycare benefits.
  • Growth hormone therapy.
  • Sleep apnea.
  • Venereal diseases, sexually transmitted illnesses, or diseases.
  • All preventive care and vaccinations, including inoculations and immunizations, excluding explicitly covered post-bite treatment and other specified vaccines.
  • Dental treatment or surgery, unless specified under 'Inpatient Treatment – Dental.'
  • Any insured person's participation or involvement in naval, military, or air force operations.
  • Intentional self-injury or attempted suicide, whether sane or insane.
  • Provision or fitting of hearing aids, spectacles, or contact lenses, including optometric therapy, unless explicitly stated in the policy.
  • Treatment and associated expenses for alopecia, baldness, wigs, toupees, medical supplies like elastic stockings, diabetic test strips, and similar products.
  • Crutches or any external appliance or device used for diagnosis or treatment, except when used intra-operatively and explicitly covered in the policy.
     

Summary

Brochure and Policy Wording Links

• Brochure: https://www.tataaig.com/s3/TATA_Medicare_997f212ecb.pdf

• Policy Wording: https://www.tataaig.com/s3/Tata_AIG_Medi_Care_PW_b34c9c6817.pdf

FAQs

1. Is AYUSH treatment covered by Tata AIG Medicare?
   Yes, the Tata AIG Medicare Plan extends its coverage to include non-allopathic or AYUSH Treatments, including Ayurveda, Unani, Siddha, and Homoeopathy, up to the specified sum insured.
    
2. Does the Tata AIG Medicare Plan provide international coverage?
   Yes, the Tata AIG Medicare Plan ensures coverage for medical expenses accrued during treatments abroad, all within the limits of the sum insured. This coverage applies if the diagnosis originated in India, assuring global assistance for your healthcare security.
    
3. Does the Tata AIG Medicare Plan include maternity costs?
   No, the Tata AIG Medicare Plan does not cover maternity expenses.
    
4. Does the Tata AIG Medicare Policy cover consumables?
   Yes, all consumables, such as gloves, syringes, masks, cotton, etc., are covered by the Tata AIG Medicare Plan.
    
5. Are there room rent restrictions in the Tata AIG Medicare Plan?
   Fortunately, there are no restrictions on room rents when you are hospitalised. You have the freedom to choose any type of room for your hospital stay under the Tata AIG Medicare Plan.