Eligibility Criteria of Medicare Premier Plan

The Medicare Premier Plan is generally available to adults and dependent family members who meet the insurer’s standard age and underwriting requirements. Eligibility typically depends on factors like entry age, medical history, and policy tenure selection. Applicants must fulfil basic documentation and health disclosure norms as per the insurer’s guidelines to qualify for coverage:

Basic Feature of Tata AIG Medicare Premier Plan

Tata AIG General Insurance Medicare Premier is a comprehensive health insurance plan that offers wide hospitalization coverage, flexible sum insured options, and protection against rising medical costs. The plan includes in-patient treatment benefits, cashless facility at network hospitals, and financial security during medical emergencies. Designed for individuals and families, Tata AIG Medicare Premier combines essential health insurance features with reliable claim support to ensure complete medical protection:

a. In Patient Hospitalization - When you are admitted to a hospital for more than 24 hours Tata aig medicare premier covers all medical expenses 
b. Pre-Hospitalization – Medical expenses like tests, consultations, and medicines done before hospitalization are covered up to 60 Days in TATA AIG Medicare Premier.
c. Post-Hospitalization – Medical expenses like follow-up visits, tests, or medicines done after you get discharged are covered from 90 Days to maximum up to 200 Days depending on sum insured in TATA AIG Medicare Premier.
d. Room – In case of emergency you can go for any room in Medicare Premier Plan. 
e. ICU Charges – The plan pays for all ICU expenses if you need intensive care during hospitalization.
f. Organ Donor – Covers surgery and medical expenses for the organ donor if you undergo for an organ transplant.
g. Domiciliary Hospitalization – If you need treatment at home because hospital beds are not available or you cannot be moved, the plan covers home hospitalization.
h. Home Care Treatment – Above 50Lakh sum insured certain treatments such as a) Dialysis at home b) Chemotherapy at home c) Up to 25% of Sum Insured for Pandemic Care at home, max up to 15 day that can be safely done at home without hospitalization are covered as long as they are medically advised.
i. AYUSH Treatment – Treatment taken in Ayurveda, Yoga, Unani, Siddha, or Homeopathy is covered.
j. Preventive Health Check-Up – You get free health check-ups from same year onwards to monitor your health, even if you make claim under TATA AIG Medicare Premier Plan.
k. Road Ambulance – Covers ambulance charges from 5K to 30K depending on your sum insured when you need to be shifted to a hospital during an emergency.
l. Emergency Air Ambulance – Covers emergency air ambulance up to 5Lakh when immediate medical shifting is required.
m. Second Opinion – With TATA AIG MediCare Premier, you can get a second medical opinion from a trusted network provider or medical expert if you are diagnosed with the listed critical illnesses during the policy period. The expert opinion is directly sent to the insured person, helping you make informed decisions about your treatment.
n. Cumulative Bonus – TATA AIG MediCare Premier increases your sum insured by 50% of Sum Insured for every claim-free year (up to 100%). If a claim is made, the bonus reduces by 50% the next year.
o. Restore Benefit – If your base sum insured gets used up, the plan automatically restores it for future claims in the same year for a different as well as same illness.
p. Wellness Services – Tata AIG General Insurance MediCare Premier offers a range of wellness services designed to support your overall health and add extra convenience beyond standard hospitalization coverage. Policyholders can access unlimited tele-consultations with general physicians and specialists, along with structured health condition management programs such as diet and weight management or stress management support. The plan also provides redeemable vouchers or discounts on selected health services, an ambulance booking facility during emergencies, and a dedicated “Help Me” feature for quick assistance in urgent situations, enhancing the overall value of your health insurance coverage.
q. Wellness Program - Stay proactive about your health with the exclusive wellness program designed to promote preventive care and healthy living. The program includes a Health Risk Assessment to help you understand your current health status and identify potential risk factors early. You can also earn rewards by participating in healthy activities and wellness initiatives, and later redeem those rewards for OPD consultations, medical treatments, pharmacy expenses, health check-ups, and diagnostic services adding practical value to your overall health insurance benefits.

Unique Benefits TATA AIG Medicare Premier Plan

Tata AIG General Insurance Medicare Premier also comes with several advanced and value-added features that further strengthen your overall health insurance coverage. These modern benefits are designed to enhance your protection, helping you manage unexpected medical situations smoothly in the future. With Tata AIG Medicare Premier, you get a forward-looking health insurance plan that adapts to evolving healthcare needs:

1. Compassionate Travel (Per Policy Year) – If the insured person is hospitalized for more than 5 consecutive days and no immediate family member is present, the policy pays for a family member’s round-trip travel (economy air or first-class rail) to be with them. This benefit is covered up to ₹20,000 to ₹50,000 per policy year depending on your sum insured. 
2. Consumables Cover – The plan covers all specified hospital consumables such as PPE kits, gloves, masks, syringes, and other essential medical disposables used during treatment. These items are covered fully.
3. Global Cover for Planned Hospitalization – TATA AIG MediCare Premier provides international treatment coverage if the diagnosis is made in India and the insured travels abroad for planned medical care. Coverage includes in-patient and day care hospitalization up to the full Sum Insured on a reimbursement basis.
4. In-Patient Dental Treatment – TATA AIG MediCare Premier also covers dental procedures that require hospitalization under anaesthesia due to accident, illness, or injury.
5. Bariatric Surgery Cover – The policy covers medically necessary bariatric surgery, provided the defined eligibility criteria are satisfied. The insured individual must be 18 years or older, with a Body Mass Index (BMI) of 40 or above, or 35 and above along with serious co-morbidities such as sleep apnea, heart disease, or uncontrolled diabetes. Additionally, the procedure must be recommended by a qualified doctor and supported by proper medical justification to be considered for coverage.
6. Vaccination Cover – The plan provides coverage for essential vaccinations under specific categories. Certain vaccines, such as the anti-rabies vaccine and typhoid vaccine, are covered without any waiting period. Other vaccinations, including the HPV vaccine and Hepatitis B vaccine, become payable after completion of the specified waiting period, typically two years, as per policy terms.
7 . Hearing Aid Benefit – The policy pays for hearing aids every third year supporting those with hearing impairments, covering: 50% of actual cost or up to ₹10,000, whichever is lower.
8. Daily Cash for Choosing Shared Accommodation – If the insured person voluntarily opts for a shared accommodation during hospitalization, Tata AIG General Insurance provides a daily cash benefit as per the policy terms. The benefit is calculated at 0.25% of the base sum insured, subject to a maximum limit of ₹2,000 per day, helping reduce overall hospitalization expenses.
9. Daily Cash for Accompanying an Insured Child – If a child aged 12 years or below is hospitalized, the policy provides a daily cash benefit for one accompanying adult staying with the child. The benefit is calculated at 0.25% of the base sum insured, subject to a maximum limit of ₹2,000 per day, helping manage the additional expenses during the child’s hospitalization.
10. Maternity Cover – Maternity expenses are covered under the policy after completion of a 4-year waiting period, subject to specified limits based on the chosen sum insured. For policies with a sum insured of ₹50 lakh and below, coverage is available up to ₹50,000 for the birth of a boy child and ₹60,000 for the birth of a girl child. For higher sum insured options of ₹75 lakh and above, the coverage increases up to ₹1,00,000 for a boy child and ₹1,20,000 for a girl child, as per policy terms and conditions.
11. Delivery Complications Cover – Covers new born baby complications and medical treatment immediately after birth: Complications during delivery are covered up to ₹10,000 to ₹25,000 depending on your sum insured. Benefit applies only if the maternity claim is admissible.
12. First-Year Vaccinations for New-borns – Provides coverage for all required vaccinations during the baby’s first year: Up to ₹10,000 & Up to ₹15,000 for a girl child  (Triggered only if maternity claim is approved and baby is insured under the plan.)
13. Prolonged Hospitalization Benefit – If hospitalization exceeds 10 days continuously, the policy pays: 1% of Sum Insured as a lump-sum benefit.
14. High-End Diagnostics (Per Policy Year) – Covers advanced diagnostic tests on OPD basis such as PET CT, PET MRI, Liver Biopsy, CT-guided biopsy, DSA, Renogram, and more Up to: ₹25,000 (for 50lakh and below sum insured) ₹50,000 (for 75lakh and above sum insured)
15. OPD Treatment – After 2 years of continuous coverage, OPD expenses like doctor consultations and pharmacy bills are covered: ₹5,000 to ₹20,000, depending on the sum insured.
16. OPD Dental Treatment – After 2 years, OPD dental care such as root canal, fillings, and extractions is covered: ₹10,000 – ₹25,000, based on the sum insured.
17. Accidental Death Benefit - if the insured person dies within 365 days of an accident, the nominee receives 100% of the base sum insured with a maximum 50 lakh as a lump sum payout.

Add Ons of TATA AIG Medicare Premier Plan

Enhance your TATA AIG MediCare Premier Policy with powerful add-ons designed to increase coverage, reduce out-of-pocket expenses, and give you all-round protection:

1. Cancer Benefit Rider – Get a lump-sum payout if diagnosed with Cancer of Specified Severity. This benefit provides immediate financial support for treatment, recovery, and lifestyle needs.

2. Women Suraksha Rider – Specially designed to support women’s preventive care, hormonal health, and cancer protection.

 a) She Care+ –TATA AIG arranges specialized medical consultations for female insured members through empanelled service providers across India.
b) PCOD / PCOS Cover – Covers evaluation, diagnostic tests, and treatment for Polycystic Ovarian Disease/Syndrome, including menstrual irregularities.
c) Women+ Screening & Vaccination – Includes listed cancer screenings and Cervical Cancer vaccination for preventive care.

3. Accident Suraksha Rider – Added financial protection against accidental injuries and disability.

    a) Additional Sum Insured (Accidental Hospitalization) – Extra financial protection for hospitalization expenses arising solely due to an accident.
    b) Permanent Total Disability (PTD) Benefit – Get 100% of Sum Insured or maximum up to ₹50 lakh, if an accident causes Permanent Total Disability. This ensures strong financial support after a life-changing injury.

4. Advanced Cover Rider – Cuts down the waiting period for key lifestyle diseases to just 30 days for, Type 2 Diabetes, Hypertension, Hyperlipidemia, Asthma Ideal for customers seeking faster coverage for common chronic conditions.

5. Pocket Saver Rider – Get comprehensive OPD coverage, diagnostics, and medical supplies, ideal for day-to-day healthcare expenses.

    a) Out-patient Treatment – Covers in-person doctor consultations and diagnostic tests (non-preventive), as prescribed by a doctor.   
    b) OPD Treatment (Dental) – Includes dental consultations and specific dental procedures on an outpatient basis.
    c) OPD Vision Care – Covers eye specialist consultations and prescribed spectacle lenses (once every 2 policy years).
    d) OPD Pharmacy – Pays for prescribed medicines, drugs, and consumables.
    e) High-End Diagnostics – Covers advanced diagnostic tests (as listed) over and above the base sum insured.
    f) OPD Physiotherapy Benefit – Arranged through empanelled providers for physiotherapy sessions to treat injury, illness, or deformity.
    g) Medical Device Cover – that covers rental or purchase of medically prescribed medical devices.

6. Mental Wellbeing Rider – A holistic, modern rider for mental health support, therapy, rehabilitation, and lifestyle management.    
    a) Mental Health screening – Annual mental health screening through empanelled service providers.
    b) Psychological Therapy & Procedures – The policy also facilitates therapy sessions with registered psychiatrists or psychologists to support mental well-being. These sessions can be arranged for the management of mental disorders, behavioural disorders, and other psychiatric concerns, ensuring access to professional care as part of a comprehensive health insurance approach.
    c) Diet Consultation Rider – Provides consultations with dieticians/nutritionists to maintain healthy lifestyle and nutrition balance.
   d) Vocational Rehabilitation – Covers rehabilitation expenses when illness or injury affects mental health and impacts job performance.
   e) Stress Management Program – Arranges stress management sessions by healthcare professionals.
   f) Addiction Cessation Program – Provides structured programs to help insured individuals quit substance addiction.

Waiting Period in TATA AIG Medicare Premier Plan

Waiting periods are an important factor in any health insurance plan. They define the time you must wait before coverage becomes active for certain illnesses or conditions. Understanding these waiting periods helps you make the right choice when buying medical insurance in India:

1. Accidental Coverage – Day One Protection All accidental hospitalization cases are covered from day one of the policy. 
2. Initial Waiting Period – The initial waiting period is typically 30 days from the start of the policy. During this period, coverage for certain seasonal and uncertain illnesses becomes active. These conditions include, Dengue, Malaria, Fever, Heart Attack, Cancer
3. Specific Illness Waiting Period – 2 Years Some slow-growing or planned illnesses require a 2-year waiting period before coverage starts. These specific illnesses include, Cataract, Kidney Stones, Gall Stones, Piles, Hernia
4. Pre-Existing Disease (PED) Waiting Period – 2 Years A pre-existing disease (PED) is any medical condition you already have before buying a health insurance policy. Common pre-existing conditions include, Asthma, High Blood Pressure (Hypertension), Thyroid disorders, Cholesterol, Diabetes. These conditions are covered only after a 2-year waiting period, ensuring long-term financial protection for lifestyle-related or chronic illnesses. 
5. Maternity Waiting Period – 4-year waiting period is applicable for maternity related claim and coverage.

Discounts in TATA AIG Medicare Premier Plan

Getting the right health insurance plan not only provides coverage but also helps you save on premiums. Here’s a breakdown of all the discounts you can avail under TATA AIG Medicare Premier Plan:

A. Family Floater Discount – When you buy the policy as a family floater, you get special discounts based on how many family members are covered under the same policy.
2 Members - 20% Discount If you include 2 family members (for example: husband + wife), you get a 20% discount on the premium.
3 Members - 28% Discount If the policy covers 3 family members (for example: husband + wife + 1 child), you get a 28% discount.
More Than 3 Members - 32% Discount If your family floater includes 4 or more members (for example: husband + wife + 2 children or more), you get a 32% discount on the premium.
B. Long-Term Policy Discount - 5% discount if policy tenure is 2 years and 10% discount if policy tenure is 3 years or more.