Eligibility Criteria of Tata Aig ElderCare Plan

This senior citizen health insurance plan is specially designed for individuals aged 61 years and above. Entry age, renewal terms, and coverage conditions are subject to policy guidelines and underwriting approval. Eligible applicants can continue the policy with lifetime renewability, ensuring long-term health protection in their later years:

Unique Features of Tata Aig ElderCare Plan

This senior citizen health insurance plan is designed to offer comprehensive medical coverage along with supportive care services tailored for elders. It combines hospitalization benefits, wellness support, and recovery assistance to ensure financial security and peace of mind during the golden years. Here are the key features of this plan:

a. Post-Operative Care – With this feature senior citizens can benefit from Home Nursing Services after a medically necessary surgery, where a qualified nurse is arranged at home within the city of residence in India for up to 7 days per policy year. In addition, the plan offers a Personalized Health Manager who provides telephonic assistance to help book medical appointments and coordinate with healthcare providers for services covered under the policy.
b. Home Physiotherapy – In it if the insured person is hospitalized for joint replacement surgery, stroke, or paralysis, the insurer will arrange up to 10 physiotherapy sessions at home within India, specifically in the city of residence. This benefit supports faster recovery and rehabilitation by providing professional physiotherapy care in the comfort of home after discharge.
c. Compassionate Care - A compassionate care can be arranged to support the insured person with Activities of Daily Living at home in India within the city of residence. This service is available during the post-hospitalization period for up to 14 days per insured person in a policy year.
d. Home Care Treatment Cover – This benefit covers reasonable medical expenses for treatment taken at home for specific illnesses or conditions mentioned in the policy. This domiciliary treatment benefit is available up to 10% of the chosen sum insured, excluding any accrued cumulative bonus.
e. Wellness Services - With this feature, insured members can access a range of wellness services aimed at maintaining and improving overall health and fitness. The plan offers up to 12 general tele-consultations per insured person each year, allowing easy access to medical advice from the comfort of home. In addition, policyholders can benefit from diet and nutrition consultations to support healthy lifestyle management. The plan also provides attractive discounts on diagnostic tests, medicines, medical devices, health supplements, and other healthcare-related services.
f. Home Assessment and Modification for Elderly Care/Disability - If the insured person is hospitalized for a medically necessary treatment and, after discharge, requires a wheelchair or other mobility support, the insurer arranges a professional home assessment to evaluate safety and recommend necessary modifications for elderly care or disability needs. If changes are advised by the assessor, the policy provides a fixed benefit of ₹5,000 to help with home alterations. This benefit is available when the request is made within six months of discharge and the hospitalization claim is admissible under the in-patient treatment cover, ensuring added support for safe and comfortable recovery at home.

Basic Features of Tata Aig ElderCare Plan

This senior citizen health insurance plan offers essential hospitalization coverage for illnesses and injuries, along with financial protection against rising medical costs. It also includes supportive benefits for recovery, preventive care, and structured cost-sharing terms to keep coverage transparent and manageable. These are the basic features of this plan designed to provide security and peace of mind in later years:

1. In patient treatment - This benefit covers medical expenses that arise due to hospitalization for any illness, injury, or disease during the policy period. If the insured person needs to be admitted to a hospital as an inpatient for medically necessary treatment, the plan takes care of the eligible hospitalization costs as per policy terms.
2. Annual Preventive Health Consultations – It offers one annual health consultation per policy year. This includes preventive dental check-ups, eye examinations, and orthopaedic consultations, helping insured members monitor their health and detect issues at an early stage.
3.  Consumable Benefit - The policy also covers the cost of specified medical consumables used during hospitalization, provided they are listed in the policy and directly related to the treatment of the insured person’s illness or injury.
4. High & End Diagnostics - Expenses for advanced diagnostic tests required on an OPD basis as part of treatment are covered up to ₹20,000 per policy year, over and above the base sum insured. This ensures access to modern and specialized diagnostic facilities without financial stress.
5. Cumulative Bonus – This plan offers a 10% cumulative bonus on the sum insured for every claim-free policy year, provided the policy is renewed without a break. The total accumulated bonus can go up to a maximum of 100% of the base sum insured.
6. Pre Hospitalisation Expenses – It covers the expenses occurred 30 days before hospitalization including doctor consultation, medicines etc.
7. Post Hospitalisation Expenses - It covers the expenses occurred 60 days after discharge including doctor consultation, medicines, doctor follow, test etc.
8. Day Care Procedures – All daycare treatments are covered up to the sum insured.
9. AYUSH Benefit – Ayurveda treatment like Unani, siddha, homeopathy all are covered up to the sum insured and to avail this benefit minimum 24 hours hospitalization is required.
10. Road Ambulance Cover – Road ambulance is covered up to Rs. 5000 per hospitalization.
11. Preventive Health Check-up - After every block of two continuous claim-free policy years, the insured person becomes eligible to avail specified medical tests on a cashless basis, as listed under the policy. This benefit encourages maintaining good health while rewarding policyholders for not making claims during that period.
12. Medical Second Opinion - This benefit can be availed once in every policy year for the specific medical conditions mentioned in the policy terms, ensuring coverage for defined health issues as per the plan guidelines.
13. Co Payment - Under This plan every admissible claim is subject to a mandatory 20% co-payment, which means the insured person pays 20% of the approved claim amount. However, this co-payment does not apply to Cataract Surgery and Joint Replacement Surgery, as these are covered under defined sub-limits.
For cataract (per eye) and joint replacement (per insured person), the coverage amount depends on the selected sum insured (₹5 lakh, ₹10 lakh, or ₹25 lakh) and the premium payment zone (Zone A, B, or C). The limits vary accordingly, ensuring structured coverage while clearly defining the maximum payable amount for these specific procedures under this senior citizen health insurance plan.
14. Waiver of co-payment – This feature is available as optional rider and if it is selected, the mandatory co-payment mentioned under the cost sharing section of the base policy will not apply. This means that for admissible claims under the base policy, the insured person will not be required to pay the usual co-payment amount.

Waiting Period of Tata Aig ElderCare Plan

Like most senior citizen health insurance plans, TATA AIG Elder Care comes with defined waiting periods. Coverage for any new illness begins after 30 days from the policy start date, except in case of accidental hospitalization, which is covered from day one.

Certain listed medical conditions, treatments, or surgeries mentioned in the policy are covered after a waiting period of 24 months. However, for specific procedures such as knee replacement or hip replacement, a longer waiting period of 48 months applies.

Pre-existing diseases that are disclosed at the time of policy purchase and accepted by the insurer will be covered after completing 24 months of continuous coverage. These waiting period terms help ensure structured and transparent coverage under this senior citizen health insurance plan.

Exclusions of Tata Aig ElderCare Plan

Like all health insurance policies, this senior citizen health insurance plan also has certain exclusions. Expenses related to non-medical treatments, cosmetic procedures, self-inflicted injuries, and conditions not covered under the policy terms are generally excluded. It is important to carefully review the policy wording to understand the complete list of exclusions and limitations.

1 . Drink and Drive 
2. Congenital External Diseases, defects or anomalies
3. Venereal disease, sexually transmitted disease or illness;
4. War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons.
5. Hazardous or Adventure Sports Expenses related to any treatment necessitated due
6. Any Insured Person’s participation or involvement in naval, military or air force operation,
7. Intentional self injury or attempt suicide while sane or insane.