Tata Aig Criti Medicare Plan: Coverage Against Critical Illness

What is Tata Aig Criti Medicare Plan

It is a special health insurance policy offered by Tata AIG that provides a lump sum payment upon diagnosis of certain critical illnesses so that the policyholder can use the money for treatment. In addition to tax benefits under section 80D, the policy does not require a medical examination. You and your family must deal with the physical pain as well as the mental stress associated with being diagnosed with a critical illness. Moreover, critical illness treatments and procedures are known to have an adverse impact on your savings and financial resources. Making The Smart Decision To Put Your Health First Can Give You Peace Of Mind And Security. A lump sum payment will be made if the insured person survives for 30 days after being diagnosed with any of the covered critical illnesses. There are 11 chronic diseases covered by it. A panel of American doctors can provide a second opinion on an insured's illness. A preexisting illness or condition is not covered, however.

Benefits of Tata Aig Criti Medicare Plan

1)Illness that is critical - In the event that the insured person is diagnosed with Suffering from a Critical Illness During the Policy Period if you opted for the policy, The Sum Insured will then be paid as follows: A lump sum amount has been set aside for that Critical Project Provided illnesses in the policy schedule The fact is:
a. It is the first time a critical illness is diagnosed
b. A Critical Illness is diagnosed after 90 days from the first risk onset.
c. As specified in the policy schedule, the Insured Person survives the critical illness.
d. After a 48-month waiting period, pre-existing diseases and their related conditions will be covered. Those conditions must be disclosed to the insured at the time of application and not explicitly excluded Exclusion as a permanent policy.
e. We will pay for the second as well as third critical illness claims as listed in the Critical illness categories if more than one claim of critical illness is/are lodged during the lifetime of the policy under the multi-pay feature. However, we will not pay for more than one claim under one Critical illness category at the same time. For multiple claims under the Multi-Pay Feature, a waiting period of 60 days shall apply from the date of diagnosis of an earlier admissible Critical Illness Claim.
f. Upon payment of three claims under (The multi-Pay Feature), the Coverage under this section will cease to exist for that particular insured person during the policy's lifetime.

2)Premium Waiver (Applicable to Smart Century Premier Plan)- In the event the first Claim has been admitted by Us under Smart Century Premier Plan under Section A of this policy, we will waive 70% of the renewal premium payable to the Insured Person for the next 3 Policy Years. The Renewal Premium for that particular Insured Person will be waived in accordance with the terms and conditions of the expiring Policy.
3)Check-up on your health- Preventive Health Check-up expenses will be covered up to 1% of the previous policy year's Sum Insured, provided this coverage was in force in the previous policy year and no claims have been reported in the previous three consecutive Policy years. There is a maximum limit per insured person. Over and above the Sum Insured, this Benefit is payable. In the context of this benefit, a Preventive Health Checkup means medical tests performed for the purpose of assessing the health status and does not include diagnostic or investigative tests.
4)A second opinion from a medical professional - If an Insured Person is diagnosed with a covered Critical Illness during the Policy Period, we will arrange a second medical opinion upon their specific request from a Network Provider or Medical Practitioner. Under the following conditions, the expert opinion would be sent directly to the insured person.
a)The Insured Person can only use this Benefit once during the Policy Period.

b) will arrange a second medical opinion only based on the information and documentation you provide.

c)As part of this Benefit, the Insured Person is only entitled to request a Second Medical Opinion and it shall not be construed as a substitute for the Insured Person's visit or consultation with an independent medical practitioner.

d)In no event shall we be liable for any loss or damage caused by our opinions, advice, prescriptions, actual or alleged errors, omissions, or representations Of the Medical Practitioner.

e)In the event that a Second Medical Opinion is provided under this benefit, it cannot be used for any medico-legal purpose.

Inclusions of Tata Aig Criticare Plan

Inclusions of plan	Explanation
360 Degree Indemnity Coverage for Cancer	Treatment of Cancer (including in-situ cancer or precancerous lesions) is covered subject to applicable waiting periods and other policy terms and conditions.
Treatment in the hospital	During the policy period, we will cover Medical Expenses up to the Sum Insured specified in the Policy Schedule for Treatment of Cancer that requires hospitalization of the insured. In-Patient. A treating Medical Practitioner would prescribe reasonable and customary charges for medically necessary treatment directly related to the hospitalization.
Expenses associated with pre-hospitalization	The benefit applies if we have admitted a claim under In-Patient Treatment and we have paid the reasonable and customary pre-hospitalization medical expenses that are incurred up to 60 days before the date of admission to the hospital.
Expenses incurred after hospitalization	Upon discharge from the hospital, we will cover reasonable and customary post-hospitalization medical expenses up to the Sum Insured. As long as they have admitted a claim under the In-Patient Treatment, Day Care Treatment, or Home Care coverage of this policy, this benefit will be payable.
Treatment for daycare	A Person with Cancer (including in-situ cancer or precancerous lesions) will be covered for Reasonable and Customary Medical Expenses and Day Care Treatments up to the Sum Insured during the term of the policy.
Expenses associated with organ donation	When an insured person is a recipient, we will cover the Reasonable and Customary Medical and Surgical Expenses of the organ donor for harvesting the organ, provided that: i. Donors of organs are those who have made their organs available in accordance with the Transplantation of Human Organs (Amendment) Bill, 1994 and its amendments and who donate the organs for use by insured persons. ii. It has been medically recommended that the insured undergo a transplant as a result of An inpatient hospitalization claim has been accepted for the insured as part of cancer treatment Cancer patients undergoing treatment

Exclusions of Criti Medicare Plan

1. Treatments for change of gender - Treatment expenses, including surgical management, for any treatment Body characteristics of the opposite sex.

2. Surgery for cosmetic or plastic reasons - Expenses associated with cosmetic or plastic surgery Treatment is not necessary unless reconstruction is required As a result of an accident, burn(s), or cancer or as a part of the medically necessary treatment to eliminate a direct and immediate health risk for the insured. In order for this to happen A medical practitioner must certify it as a medical necessity.

3. Treatment for alcoholism, drug addiction, or both Abuse of substances or any addictive behavior The condition and its consequences.
4. Health-related treatments - Private beds registered as a nursing home attached to hydrotherapy clinics, nature cure clinics, spas, or similar establishments Domestic reasons are the primary reason for admission.
5. Substances and supplements used in the diet - Unless prescribed by a medical practitioner as part of a hospitalization claim or daycare procedure, items not requiring a prescription can be purchased without a prescription. This includes vitamins, minerals, and organic substances.
6. Treatment costs associated with refractive error Refractive errors less than 7.5 dioptres can be corrected with this procedure.
7. Treatments that have not been proven - Expenses incurred for or in connection with any unproven treatment, service, or supply. The term "unproven treatment" refers to a treatment, a procedure, or a supply without substantial medical documentation to support its effectiveness.
8. Pregnancy:

a. The cost of medical treatment associated with childbirth (including) A complex delivery process Expenses associated with cesarean sections Except during hospitalization A pregnancy that is ectopic.

b. Miscarriage expenses (unless it is an accident) Termination of medical treatment in accordance with law During the policy period, pregnancy occurred.

9. Sports that are hazardous or adventurous - As a professional, you may be required to pay for any treatment you require as a result of participating in hazardous or adventure sports, such as para jumping, rock climbing, mountaineering, rafting, motor racing, horse racing, or scuba diving, hand gliding, skydiving, and deep sea diving, among others.

FAQ

Under a critical illness plan, what is covered?

There are many critical-illness plans that cover diseases such as cancer, organ transplants, heart attacks, strokes, renal failure, and paralysis. Plan coverage does not apply if you're diagnosed with a disease, not on the list for your plan, and the list of covered illnesses varies from plan to plan.

How does Criticare benefit you?

A Star Criticare Plus Insurance Policy covers hospitalization expenses if the insured person is hospitalized for at least 24 hours due to illness or injury. The lump-sum payment will also be paid upon the diagnosis of a critical illness for the first time.

How much coverage does Criticare plus benefits provide?

There is a minimum sum insured of Rs. 2 lakhs and a maximum sum insured of Rs. 10 lakhs under this policy. Premium charges for this policy depend on the sum insured and the age of the policyholder.

After a claim is paid, will the policy continue?

A claim under the policy would terminate once it is paid. If the insured suffers from another covered illness or undergoes another covered surgery, no further claims would be provided.

Are there any provisions for renewal grace periods in the policy?

A grace period of 30 days is allowed for policyholders to renew their policies after their coverage expires. Coverage would continue without interruption if the policy is renewed within the grace period.

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