Tata Aig Medicare Plus Plan: Get Coverage Without Sub Limits

What is Tata Aig Medicare Plus Plan

This top-up policy from Tata AIG offers several features and benefits that are suitable for your needs at an affordable price. Medical expenses covered by the policy are reimbursed if they exceed the deductible. This policy can be proposed by anyone who is between 18 and 65 years of age and includes up to 7 family members including themselves, their spouses, up to three children, and up to two parents. Insured sums and deductibles range from Rs. 3 lakhs to Rs. 1 crore and Rs. 2 lakhs to Rs. 20 lakhs, respectively. Depending on your budget and requirements, you can purchase a policy for 1 year, 2 years, or 3 years. With Medicare Plus, the insured is covered for a wide range of medical expenses. An inpatient hospitalisation, a second opinion, a daycare procedure, a specific number of days' pre-hospitalisation and post-hospitalisation expenses, an AYUSH benefit, ambulance coverage, organ donation costs, domiciliary treatment costs, and global coverage (optional). Aside from coverage benefits, the policy offers other benefits such as tax deductions on premiums paid, lifetime renewals, and cumulative bonuses. Simply put, the policy protects you and your loved ones completely. Tata AIG Medicare Policy is an affordable and health insurance top-up policy that protects the health of you and your family. Besides providing comprehensive coverage, Medicare Plus also compensates the policyholder in case the sum insured is exhausted. A variety of coverage is provided by the policy, such as coverage for in-patient hospitalisation, second opinions, daycare procedures, pre- and post-hospitalization costs, AYUSH benefits, ambulance coverage, organ donation costs, global coverage, etc. Additionally, the policy offers tax deductions for premium payments, lifetime renewals, and cumulative bonuses, in addition to covering medical expenses over the deductible specified in the policy contract.

Benefits of The Medicare Plus Plan

Benefits of plan	Explanation
Treatment in the hospital	During the policy period, it will cover the costs associated with hospitalisation due to disease/illness/injury that requires an Insured Person to be admitted to a hospital as an inpatient. Hospitalization-related medical expenses would be reimbursable.
Expenses incurred after hospitalisation	Expenses incurred up to 90 days after discharge from the hospital, such as post-hospitalization consultations, investigations, and medications, will be covered by us.
Day care treatment	During the policy period, it will cover expenses for listed Day Care Treatment taken at a hospital or daycare centre due to a disease/illness/injury. Outpatient treatment is normally administered This cover does not cover the basis.
A donor of organs	In the event that an insured person is the recipient of an organ, it will cover all medical and surgical expenses of the organ donor for harvesting the organ, provided that: i. Donors are people whose organs have been made available in accordance with the Transplantation of Human Organs Act In accordance with the Organs (Amendment) Bill, 2011, the organ donated is for the use of the insured person. ii. Under the Inpatient Hospitalisation Treatment plan, I have accepted a claim for inpatient hospitalisation for the insured member.
Treatment at home	If the insured person's treatment exceeds three days, it will cover expenses related to domiciliary hospitalisation. Neither enteral feedings nor end-of-life care may be part of the treatment. In order to claim this benefit, one will need a doctor's certification.
Benefits of AYUSH	Ayush Hospital expenses incurred as an in-patient will be covered.
Coverage for ambulances	Upon request, it will cover expenses incurred for transporting the insured person in a registered ambulance to a hospital for admission in case of an emergency or from one hospital to another for better medical treatment and facilities, up to Rs. 3000 per hospitalisation.
Checkup for health	Preventive Health Check-up expenses will be covered up to 1% of the previous sum insured, subject to a maximum of Rs. 10,000/- per policy. More than one policy is allowed within the limit. The insured can use the amount. Benefits are paid once every two consecutive claim-free policy years with us. A separate limit applies to this benefit (over and above the base sum insured). It does not affect cumulative bonuses. This benefit is not deductible.

Inclusions of Medicare Plus Plan

1. Dental In-Patient Treatment - Dental treatment under anesthesia necessitated by an accident/injury/illness will be covered by us for medical expenses.

2. Getting a second opinion - If an Insured Person is diagnosed with any of the following illnesses during the Policy Period, you will receive a second opinion from a Network Provider or Medical Practitioner. A copy of the expert opinion would be sent directly to the insured.
i. Having cancer

ii. Failure of the kidneys

iii. Acute myocardial infarction

iv. Coronary artery disease

v. Bypass surgery for coronary artery disease

vi. Hemorrhage or stroke of the brain

vii. Failure of an organ requiring transplantation

viii. Replacement of the heart valve

ix. Tumors of the brain
3. Coverage worldwide - Medical expenses incurred outside India by the insured person, up to the sum insured, will be covered as long as the diagnosis was made in India and the insured travels abroad for treatment. Inpatient and daycare hospitalization expenses are only reimbursable on a reimbursement basis. On a case-by-case basis, cashless facilities can be arranged. In the event a claim is made under this benefit, it will be paid in Indian Rupees according to the exchange rate on the date of the claim Invoices published by the Reserve Bank of India (RBI) shall be used for converting foreign currency into Indian Rupees for claims payment. The next published exchange rate by RBI shall be used for conversion if these rates are not published on the date of invoice. In order to support the claim under this benefit, it will require the following additional documents from the insured person:

India's diagnosis proof
Passports and visas of insureds

4. Bonuses cumulative
i. A cumulative bonus of 50% will be applied - After every claim-free policy year, the Sum Insured will increase under the Policy for the next policy year, provided The Policy is renewed with Us without interruption. Any cumulative bonus shall not exceed 100% of the Sum Insured per Year.
ii. If a claim is made and a Cumulative Bonus has been applied, it will automatically reduce the Cumulative Bonus by 50% of the Sum Insured in the following Policy Year. Only the accrued Cumulative Bonus will be affected, not the Inpatient Sum Insured.
iii. For policies with a tenure of more than one year, the above guidelines of cumulative bonus will apply.
iv. In the case of a Family Floater, the Cumulative Bonus will be available only to those Insured Persons who were Insured Persons in the claim-free Policy Year and are continuing to be Insured Persons in the subsequent Policy Year.

Exclusions of Medicare Plus Plan

1. Evaluation and investigation
a. Any expenses incurred solely for diagnostic and evaluation purposes are excluded.
b. Expenses associated with diagnostic tests that are not related to the current diagnosis or that are not incidental. They are excluded from treatment.
2. Cure, rehabilitation, and rest Care during a respite
a. Administering medication primarily to enforce bed rest rather than to receive treatment. Additionally, this includes:
i. Home or nursing care for the elderly Assist with activities of daily living, such as bathing, dressing, and moving. A skilled nurse or assistant or a non-skilled assistant can help you around Personnel with skills.
ii. Providing terminally ill patients with any services they need Ensures physical, social, emotional, and spiritual well-being needs.
3. Controlling obesity and weight
Obesity surgical treatment costs that do not meet the following criteria:
a. Doctors recommend surgery based on their expertise
b. Clinical protocols should be accompanied by the study/procedure conducted
c. Members must be 18 years of age or older
d. A Body Mass Index (BMI) of 40 or greater combined with one or more of the following severe comorbidities failure of less invasive methods of weight loss;
i. Cardiomyopathy associated with obesity
ii. The coronary heart disease
iii. Sleep apnea of severe severity
iv. Diabetes type 2 uncontrolled
4. Treatments for change of gender - Costs associated with any treatment, including surgical management, are designed to change a person's characteristics into those of a person of the opposite gender.
5. Surgery for cosmetics or plastics - Unless it relates to reconstructing following an accident, burn(s), or another serious injury, cosmetic or plastic surgery expenses do not include Medically necessary treatment for cancer or to remove a direct and immediate health risk Those insured. There must be a medical practitioner's certification for this to be considered a medical necessity.
6. Behavioral treatment for addictions such as alcoholism, drug abuse, and substance abuse.
7. The treatments you receive in health hydro's, nature cure clinics, spas, or other similar establishments or in a private setting Nursing home attached to such establishments or in which admission is arranged wholly or partly for domestic purposes.
8. Supplements and substances used in the diet - Unless prescribed by a physician, vitamins, minerals, and organic substances can be purchased without a prescription. As part of a hospitalisation claim or daycare procedure, a medical practitioner.
9. Error of refractive index - The cost of treating refractive errors is less than 7.5 diopters in order to correct eyesight.

FAQ

What is the process for canceling this policy?

A refund is provided by the insurer if you cancel this policy within 15 days of the free look period. A portion of the premium will be deducted after 15 days.

Are there any discounts offered by TATA AIG Medicare to policyholders?

The plan offers a 32% discount if the policyholder opts for the family floater policy. Additionally, policyholders can take advantage of long-term discounts of 5% and 10% for 2-year and 3-year policies, respectively.

Can I renew my policy without a pre-medical checkup?

As long as you renew your health insurance every year on time, you are not required to undergo a pre-medical examination.

Tata AIG General Insurance Company offers Medicare Plus Policy. What are the eligibility requirements?

An adult can purchase a Medicare Plus Policy if he or she is 18 years old to 65 years old. You can also include dependent children under the policy if both parents are insured if they are between 91 days and 5 years old. You can also be covered as an individual if you are at least 5 years old.

Medicare Plus Policy waiting periods: what are they?

The following waiting periods apply to Medicare Plus policies:

There is an initial waiting period of 30 days calculated from the date of the policy's inception
Treatments or illnesses listed on this page require a waiting period of 24 months
Pre-existing conditions have a 36-month waiting period

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