Tata Aig Medicare Premier Plan: Cover Your OPD Expenses

What is Tata Aig Medicare Premier Plan?

The Tata Aig medicare premier plan provides financial protection and reduces all medical expenses. It saves you from all future financial losses arising due to disease & accident. It offers a lot of benefits with wide coverage. This plan provides coverage starting from 5Lakh to 3Crore sum insured. The medicare premier plan offers several benefits such as lifelong renewal, in-patient treatment, pre & post hospitalization, restore benefit, no claim bonus, domiciliary treatment, day care treatment, road ambulance, air ambulance, etc. rather than this it gives a lot of unique benefits such as global coverage for planned hospitalization, consumable benefit, normal OPD, dental OPD, maternity expense, vaccination, prolonged hospitalization, high & diagnostics, compassionate travel, hearing aid, accidental death benefit and many more. The medicare premier plan focuses on the requirement of customers & their families. Medicare premier plan provide more protection and security. Because of its features, no one can beat the plan of Tata Aig medicare premier plan. At present the company also covers COVID-19 after 15 days of policy purchase. You will get Tax benefit u/s 80D. There is a free look period of 15 days to go through your policy and change your decision for a better understanding, let's take a closer look at this plan.

Tata Aig Medicare Premier Plan Review

Network hospital – 8000+ network hospitals are covered under Tata Aig health insurance medicare premier plan.
Claim settlement ratio – Tata Aig health insurance has currently 96.43% claim settlement ratio.
Claim approval time – Tata Aig health insurance approves the claim within 30 minutes of claim intimation.
Claim type – In Tata Aig health insurance it settles the claim directly, there is no TPA [Third Party Administrator] between the company and the customer.

Eligibility Criteria of Tata Aig Medicare Premier Plan

There are some eligibility criteria for Tata aig medicare premier plan. Check the details as mentioned below:

Entry age	91 days to 65 years
Family size	Covered Up to 6 members
Plan type	Individual/Family floater
Tenure	1 Year, 2 Year, 3 Year
Cashless hospitalization	All over India
Base sum insured	5L, 10L, 15L, 20L, 25L, 50L, 75L 1Cr, 2Cr & 3Cr

Details of Tata Aig Medicare Premier Plan

Features	Medicare Premier Plan
In-patient treatment	Covered up to sum insured
Room rent	Actual
ICU charges	Actual
Pre-hospitalization	60 days
Post-hospitalization	Minimum 90 days to Maximum 200 days
Day care treatment	540+ day care treatment covered
Organ donor	Covered up to the sum insured
Domiciliary hospitalization	Covered up to the sum insured
Restoration benefit	Covered up to the sum insured
No claim bonus	50% of sum insured maximum up to 100%
Consumable benefit	Covered up to sum insured
Robotic surgery	Covered up to sum insured
Modern treatment	Covered up to sum insured
Home care treatment	For INR 5 lakh – Not applicable For above INR 5 lakh - covered upto sum insured
Road ambulance	Covered maximum INR 30000
Air ambulance	Covered Upto INR 5lakh
Health check-up	Covered maximum upto INR 25000
Daily cash for accompanying an insured child	0.25% of base sum insured maximum up to INR 2000/Day
Daily cash for choosing shared accommodation	0.25% of base sum insured maximum up to INR 2000/Day
Ayush treatment	Covered up to the sum insured
Bariatric surgery	Covered up to the sum insured
Second e-opinion	Once in a policy year
Global cover for planned hospitalization	Covered up to the sum insured
Compassionate travel	Covered maximum INR 50000
Vaccination cover	Covered up to the sum insured
Hearing aid	50% of actual expense maximum up to INR 10000/Policy
Maternity cover	Covered a maximum of upto INR 1.2 lakh
Delivery complications cover	Covered maximum INR 20000
First-year vaccination	up to INR 10000 for boy & up to INR 15000 for girl
Prolonged hospitalization	1% of sum insured
High and diagnostics	Covered maximum INR 50000
OPD treatment	Covered maximum INR 20000
OPD treatment - dental	Covered a maximum of INR 25000
Accidental death benefit	Covered a maximum of INR 50 lakh
In-patient treatment - dental	Covered up to the sum insured
Home physiotherapy	Covered
Wellness service	Covered
Wellness program	Covered
Tax benefit u/s 80D	up to INR 75000

Tata Aig Medicare Premier Plan Premium Calculation

The health insurance premium is an amount you need to pay to the insurer to keep your health insurance active. In return, the insurer is liable to pay for hospital bills and healthcare expenses which are incurred by you in case of a medical emergency. The health insurance premium depends on factors like age, location & family size. Let’s look at some examples of health insurance premiums as mentioned below:

Family Size	Sum Insured	Premium*
Individual	500000	8880/-
Self, spouse	500000	14207/-
Self, spouse & 1 child	500000	17400/-
Self, spouse & 2 child	500000	20790/-
Senior citizen	500000	24956/-

Unique Features of Tata Aig Medicare Premier Plan

Consumable benefit – All non-payable items are covered up to the sum insured.
Daily cash for accompanying an insured child – If a person is hospitalized in a shared room, the company will pay a fixed amount per day. 0.25% of the base sum insured maximum up to INR 2000/day.
Daily cash for choosing shared accommodation – If an insured child gets hospitalized whose age is 12 years or less, then the company will pay a fixed amount per day. 0.25% of the base sum insured maximum up to INR 2000/day.
Global cover for planned Hospitalization – The company will pay all the expenses of the insured person which is incurred outside India up to the sum insured. But the condition is the insured should be diagnosed in India. He can go abroad for treatment.
Compassionate Travel – If the person is hospitalized for more than five consecutive days in a place where no adult member of his family is present, the company will cover expenses related to a round trip economy class air ticket, or first-class railway ticket maximum of up to INR 50,000.
Vaccination cover – The company will cover the animal bite vaccine, typhoid vaccine from the same year & Hepatitis B & HPV vaccine after 2 years up to the sum insured.
Hearing Aid – The company will cover expenses for a hearing aid every third year. The maximum amount payable is 50% of the actual cost or INR 10,000/- per policy, whichever is lower.
Maternity Cover – The company will cover maternity expenses of INR 50000 for baby boy birth and INR 60000 for baby girl birth after 4 years of continuous policy.
Delivery complications cover – The company will cover delivery complications also.
First-year vaccination – The company will pay for the vaccination expense up to one year, after the birth of a baby.
Prolonged Hospitalization – The company will pay 1% of the sum insured to the customer if he is hospitalized for more than 10 continuous days.
High and Diagnostics – The company will cover expenses incurred for a diagnostics test only on an OPD basis maximum of up to INR 25000.
OPD treatment – The Company will cover normal OPD maximum up to INR 5000 after 2 years.
OPD treatment (Dental) – The company will cover dental OPD maximum of up to INR 10000 after 2 years.
Accidental Death benefit – If an Insured Person suffers an accident during the policy period and it cause the death of the insured within 365 days from the date of the accident, then the company will pay a fixed amount of 100% of the base Sum Insured.
In-patient treatment (Dental) – If a person gets hospitalized for more than 24 hours in case of a dental problem, then the company will pay for all expenses.
Home Physiotherapy – You can arrange 15 physiotherapy sessions at home with tata aig impaneled service providers within India.
Wellness Service – i. Unlimited tele-consultation general.
ii. Unlimited tele-consultation – specialist.
Iii. Health condition management.
a. Diet & weight management program.
b. Stress management program.
iv. Redeemable voucher/Discount on services.
v. Ambulance booking facility.
vi. Emergency help me feature.
vii. Wellness Program – Wellness program available.

Features of Tata Aig Medicare Premier Plan

Lifelong renewal - Renew your cover lifelong and stay covered forever.
No sub-limit on room rent - With this health plan you can get the room you like and the treatment you deserve without a hassle.
No geography-based sub-limits - No matter where you buy your policy you can get treated in any city or hospital you like in the country with no additional co-pays or sub-limits.
Hospitalization expenses - Cover medical expenses incurred at the time of hospitalization that include room rent, ICU expenses, nursing expenses, surgeon’s fees road ambulance charges and anesthesia fee, blood and oxygen, etc.
Pre-hospitalization - Medicare premier plan covers medical expenses for 60 days of pre-hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred before hospitalization.
Post-hospitalization - Medicare premier plan covers medical expenses for 90 days to 200 days post-hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred after discharge.
Day Care treatment - Daycare treatments are that surgery that takes hospitalization less than 24 hours like stones, cataracts, dialysis, chemotherapy, radiotherapy, etc.
Organ donor expenses - The company will indemnify the medical expenses incurred for a living organ donor’s treatment as an Inpatient for the harvesting of the organ donated.
Domiciliary hospitalization - Secure all medical expenses during domiciliary hospitalization.
Restore benefit - With the restore benefit of the medicare premier plan if any claim, partial or totally is made during the policy period then 100% of the sum insured will be restored automatically single time without any additional cost.
No claim bonus - If you are not taken any claim during the policy period then your sum insured will be increased by 50% of the sum insured every year maximum up to 100%.
Robotic surgery - All robotic surgeries such as cholecystectomy, gastric bypass, mediastinal tumor, atrial septal defect repair, coronary artery bypass, etc. are covered up to the sum insured.
Modern treatment - All modern treatments such as oral chemotherapy, stem cell therapy, bronchial thermoplasty, genetic diseases or disorders, deep brain stimulation, etc. are covered up to the sum insured.
Homecare treatment - Get treated at home.
Road Ambulance - Road ambulance covered up to INR 5000 to INR 30000/hospitalization
Air Ambulance - Air ambulances covered up to INR 5 lakh.
Health Check-up - Medicare premier plan provide health check-up from the same year onwards, 1% of the sum insured maximum up to INR 25000.
Ayush treatment – Medicare premier plan covers inpatient hospitalization expenses even for alternate treatments method—Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy.
Bariatric surgery - Bariatric surgery is covered up to the sum insured.
Second E-opinion - The company will provide you with a second opinion from a network provider or medical practitioner if an insured person is diagnosed with critical illnesses during the Policy Period.
Tax benefits - You can avail of tax benefits for the premium amount under section 80 D of the income tax act.
Free look period - Get a 15-day free look period to understand and change your decision.
Long-Term Discount - Pay for a 2 years policy term and get 5% discount and 10% discount on choosing 3 years policy term.

Waiting Period of TATA AIG Medicare Premier Plan

Cover from day 1 - Only accidental.
Cover after 30 days - Dengue, malaria, fever, jaundice, typhoid, etc.
Cover after 2 years - Stone, hernia, piles, ulcer, fistula, gallbladder, hip & joint replacement, tonsils, ENT surgery, Gyno surgery, etc.
Cover after 3 years – Pre-existing disease such as hypertension, thyroid, asthma, diabetes etc.

Exclusions of TATA AIG Medicare Premier Plan

Conflict & Disaster -Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war-like situations, or rebellion.
Breach of law – The company does not cover expenses for treatment directly arising from or consequent upon any insured person committing or attempting a breach of law with criminal intent.
Treatment for alcoholism & drug abuse – Treatment for alcoholism, drug or substance abuse or any addictive condition and consequence thereof remain uncovered.
Congenital external disease, defects, or anomalies – The company does not cover medical expenses incurred for congenital external disease defects or anomalies.
Investigation & Evaluation - Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
Unproven Treatments - Expenses related to any unproven treatment, services, and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures, or supplies that lack significant medical documentation to support their electiveness.
Unrecognized Physician or Hospital - Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Indian Medicine or by Central Council of Homeopathy.
Costs that are not Reasonable and customary and treatments that are not medically Necessary.

Renewal Process of Tata Aig Medicare Premier Plan

Life-long Renewal - Get a life-long renewal, regardless of your health status or previous claims made under your policy.
Sum Insured Enhancement - To protect yourself from rising medical expenses, you can enhance your sum insured or add more members of your family to your existing policy at the time of renewal.
Portability and Migration - You can port or migrate your policy at the time of renewal. Please reach out to us for any queries regarding migration and portability.

How to File a Claim

You can file a claim in TATA AIG Medicare Premier Plan in two ways as mentioned below:
1. Cashless Claim

Intimation – Fill up the pre-authorization form at the network hospital for cashless approval.
Approval/ rejection – once the hospital intimates the company, the company sends you the status update.
Hospitalization – hospitalization can be done on the basis of pre-authorization approval.
Claim settlement – At the time of Discharge Company will settle the claim directly with the hospital.

2. Reimbursement

Hospitalization – you need to pay the bills initially and preserve the original invoices.
Register your claim – Post-hospital discharge send to the company all your invoices and documents.
Verification – The company verifies your claim-related invoices and treatment documents.
Claim settlement – The company sends the approved amount to your bank account.

FAQ

Is there a waiting period for Medicare Premier?

Yes, of course. There are five types of waiting periods in Medicare Premier:

A 30-day waiting period applies to hospitalizations unless they are caused by an accident.
The waiting period for certain illnesses is two years, which is mandated before you can claim.
There is a 2-year waiting period for any pre-existing disease you may have when you buy the policy.
Waiting period for maternity and newborn claims: Pregnancies and births are subject to a four-year waiting period.
Waiting Period for OPD Treatments & OPD-Dental Treatments: The waiting period for OPD Treatments is two years.

Are there any restrictions on room rent in Medicare Premier?

Not at all. With Medicare Premier, you can stay in any room available in the hospital, including single private rooms, shared rooms, and deluxe rooms.

What is the restoration benefit offered by Medicare Premier?

There is a restoration benefit available through Medicare Premier. A policy year in which you are hospitalized multiple times will result in 100% of the cover being restored to you.

Is Medicare Premier covered for AYUSH treatments?

That's right. AYUSH treatments are covered by Medicare Premier.

Is there a bonus offered by Medicare Premier?

Yes, of course. No-claim bonuses are offered by Medicare Premier. Your sum insured grows by 50% every year if you don't make a claim, up to a maximum of 100%.

Is Medicare Premier a maternity plan?

It's true. If the child is a girl, TATA AIG's Medicare Premier plan offers maternity benefits up to Rs. 60,000.

Is Medicare Premier available internationally?

Yes, indeed. Medicare Premier from TATA AIG offers international coverage if you are diagnosed in India.

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