Tata Aig Medicare Plan : A Plan With Inbuilt Consumable Benefit

Why Choose Tata Aig Medicare Plan

The TATA AIG Medicare 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 3Lakh to 20Lakh sum insured. The Medicare 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, Vaccination, Compassionate Travel, 8 Tele consultation(General physician), Emergency-24x7 Ambulance booking, Hearing Aid, Accidental Death Benefit and many more. The Medicare Plan focuses on the requirement of customers & their families. Medicare Plan provides more protection and security. Because of its features, no one can beat the plan of TATA AIG Medicare 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.

Network Hospital	8000+	Claim approval time	30 Min.
Claim settlement ratio	96.43%	Claim type	In house claim
Eligibility Criteria
Entry age		91 Days to 100 Years
Family size		Covered up to 8 members
Plan type		Individual/Family floater
Tenure		1 Year, 2 Year, 3Year
Cashless hospitalization		All over India
Base sum insured		3L, 4L, 5L, 7.5L, 10L, 15L, 20L

Features		Medicare Plan
Base Sum insured		5LAKH, 7.5LAKH, 10LAKH, 15LAKH, 20LAKH
In-Patient treatment		Covered up to sum insured
Room rent		Actual
ICU Charges		Actual
Pre-Hospitalization		60 Days
Post-Hospitalization		90 Days
Day Care treatment		540+ Day care treatment covered
Organ donor		Covered up to sum insured
Domiciliary Hospitalization		Covered up to sum insured
restoration benefit		Covered up to 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		Not available
Road Ambulance		Covered up to INR 3000/Hospitalization
Air Ambulance		Covered up to INR 2.5lakh
Health Check-up		1% of sum insured maximum up to INR 10000 after 2 continuous claim free years
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 sum insured
Bariatric surgery		Covered up to sum insured
Second E-opinion		Once in a policy year
Global cover for planned Hospitalization		Covered up to sum insured
Compassionate Travel		Covered up to INR 20000
Vaccination cover		Animal bite, Typhoid vaccination from day one & Hepatitis B & HPV after 2 year maximum up to INR 5000
Hearing Aid		50% of actual expense maximum up to INR 10000/Policy
Tele consultation-General Physician		8 Tele-consultation(General physician)/year
Emergency-24x7 Ambulance Booking		Available
Tax benefit u/s 80D		up to INR 75000
Waiting Period
From Day One		Only Accidental
After 30 Days		Dengue, Malaria, Fever, Jaundice, Typhoid etc.
After 2 Years		Stone, hernia, Piles, Ulcer, Fistula, Gallbladder, Hip & Joint replacement, Tonsils, ENT surgery, Gyno surgery, etc
After 3 Years		Pre Existing Disease Such As Hypertension, Thyroid, Asthma, Diabetes etc.
Optional Benefit		Accidental Death benefit

More Unique Features

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 20000.
Vaccination cover – The Company will cover Animal bite vaccine, Typhoid vaccine from the same year & Hepatitis B & HPV vaccine after 2 years up to INR 5000.
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.
Tele consultation-General Physician – You can avail of 8 tele consultations (general physician) every year
Emergency-24x7 Ambulance Booking – You can book your emergency Ambulance.

What is Covered Under TATA AIG Medicare 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, anesthesia fee, blood, oxygen, etc.
Pre-hospitalization - Medicare Plan covers medical expenses for 60 days pre-hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred before hospitalization.
Post hospitalization - Medicare Plan covers medical expenses for 90 days post hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred after discharge.
Day Care treatment - Daycare treatments are those surgery that take hospitalization less than 24 hours like Stone, Cataract, 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 Plan if any claim, partial or totally is made during the policy period then the 100% 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.
Road Ambulance - Road Ambulance covered up to INR 3000/hospitalization.
Air Ambulance - Air Ambulance covered up to INR 2.5 lakh.
Health Check-up - Medicare Plan provide health check-up after 2 claim-free years, 1% of the sum insured maximum up to INR 10000.
Ayush treatment – Medicare Plan covers In-patient hospitalizations 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 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 a 5% discount and a 10% discount on choosing 3 years policy term.

Add on covers

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.

Renewal Process

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 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.

Exclusions of TATA AIG Medicare 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.

FAQ

Do TATA AIG Medicare policyholders receive any discounts?

Yes, the plan offers a Family floater discount of 20% for two members, 28% for three members, and 32% for more than three members. Additionally, the policy offers a long-term discount of 5% on 2-year tenures and 10% on 3-year tenures.

How does the TATA AIG Medicare plan cover consumables?

Under 'Guidelines on Standardization in Health Insurance, 2016', items listed under 'Items for which insurers can offer optional coverage' will be covered by the plan.

Under the Tata Medicare Insurance Policy, is there a waiting period for vaccinations?

Rabies and typhoid vaccines do not have waiting periods. It takes 24 months to receive a Hepatitis B and HPV vaccine.

How many people can be covered under a Family Floater Policy?

Up to seven members of a family can be covered by a Family Floater Policy (the self, spouse, three dependent children (under 25 years old), and two dependent parents).

Does TATA AIG Medicare have a minimum age requirement?

A child under 91 days old is not eligible for coverage unless both parents are insured. Children under 5 are not eligible for coverage unless both parents are insured.

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