Tata AIG Elder Care Plan

Tata AIG Elder Care Plan - Product Overview Of The Tata AIG Health Insurance For Senior Citizens

The Tata AIG Elder Care is a health insurance plan exclusively for seniors, brought to you by Tata AIG General Insurance Company Limited. Tailored to address the distinct health concerns of elderly individuals, this plan ensures they receive the necessary medical attention without financial strain. It offers a varied range of features and benefits, including discounts to make healthcare more affordable. With the Tata AIG Elder Care Plan, you can rest assured knowing that your older family members are covered for their healthcare needs.
 

Who Is Eligible To Benefit From The Policy?

The eligibility criteria under the Tata AIG health insurance for senior citizens are as follows –

• Minimum Age To Join: 65 years.
• Maximum Age To Join: 85 years.
   

Benefits And Limits That You Should Know About The Tata AIG Elder Care Plan

The Tata AIG Elder Care Plan covers inpatient hospitalisation expenses for hospital stays exceeding 24 hours, including room and board, nursing fees, doctor consultations, prescribed medications, ICU costs, and related expenses. Let's take a quick look at some of the other expenses covered by the Plan.

• Pre & Post-Hospitalisation Expenses
  The Tata AIG Elder Care Plan takes care of expenses both before and after your hospital stay. This includes the costs incurred for doctor visits, tests, medicines, etc. The plan covers costs up to the sum insured for a reasonable time, i.e., 30 days before hospital admission and 60 days after leaving the hospital. It is important to note that these expenses will only be covered if they are related to your hospitalisation, and if your claim is approved as part of your inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
• The Tata AIG health insurance for senior citizens covers daycare treatments, which are medical procedures or surgeries that used to need a long hospital stay but can now be done in just 24 hours because of better medical advancements that we have today. It covers daycare procedures up to the sum insured, so your expenses are covered up to the sum insured.
   
• Modern Treatment Coverage
  The field of healthcare is advancing every day because of new technology. This means that we now have treatments that were once thought impossible. With the Tata AIG Elder Care Plan, you are covered for these modern treatments, up to the cover amount, ensuring that you get the care you need without worrying about the cost.
   
• Consumables Benefit (Non-Medical Expenses)
  The Tata AIG Elder Care Plan does not just cover medical bills. It also takes care of other costs like cotton bandages, surgical tape, etc., that you might need during hospital stays. These items can be pricey and quickly add up. But with this plan, you are covered for these expenses up to your cover amount. Hence, you will not have to worry about the financial strain they could cause.
   
• Cumulative Bonus (No Claim Bonus)
  Cumulative Bonus (No Claim Bonus), is a reward you get from the insurance company when you do not make any claims throughout the policy duration. With the Tata AIG Elder Care Plan, you can earn a bonus of 10% of your base sum insured for each year without a claim, as long as you keep renewing your policy. However, if you do make a claim, the bonus you have earned will decrease by the same rate it was built up. Under this plan, you can accumulate a maximum bonus of 100% of your cover amount.
   
• Room Rent Limit
  Room Rent Limit refers to the highest amount covered by your insurance company for the hospital room you stay in. If you stick to a room within this limit, you will not have to pay extra. But if you go for a pricier room, you will have to cover a portion of the entire bill, not just the extra room cost. With Tata AIG Elder Care Plan, the room rent limit is up to a Single Private Room.
   

Other Highlights Of The Tata AIG Elder Care Plan

• Home Care Treatment Cover
  Home care treatment means getting treated for illnesses or conditions right in your own home instead of going to the hospital. It covers the costs of services that are incurred for listed medical conditions and its treatments like dialysis, chemotherapy, etc., up to 10% of the total cover amount. This coverage can be a big help for older people who find it hard to go to the hospital, as they can get the treatment they need while staying in their familiar surroundings. However, there are terms and conditions you need to follow to use this coverage.

• Post Operative Care
  Following your hospital stay, you might need extra care to help you recover and get better. This is where the post-operative care coverage under the Tata AIG health insurance for senior citizens comes in handy. It arranges for a qualified nurse to assist you at home for up to 7 days, sourced from nearby hospitals in the insurer’s network. And, if you cannot find a nurse nearby, the insurer will reimburse you up to Rs. 1,000 per day to cover the cost of assistance. Additionally, the plan also provides a personal health manager to help you access various services like home physiotherapy, nursing, compassionate care, etc. Just keep in mind, there are certain terms and conditions you will need to follow.
   
• Wellness Services
  The Tata AIG health insurance for senior citizens provides a variety of wellness services to help you stay healthy and fit. These services include –
• • Teleconsultations: Speak with qualified doctors through digital means for any health queries or preventive care. You can have up to 12 consultations each policy year.
  • Diet And Nutrition Consultation: Get advice on diet and nutrition through telecommunication and digital platforms.
  • Discounts From Network Providers: Enjoy discounts on diagnostic tests, medications, medical devices, health supplements, and other health services offered by our trusted providers.
     
• Home Assessment And Modification For Elderly Care/Disability
  The Tata AIG Elder Care Plan wants to make sure your home is comfortable and easy to navigate for elderly care or those with disabilities. This is why the insurer arranges for a home assessment to help identify any changes needed in your home to make it more accessible for the elderly. To help with these modifications, the plan offers a fixed reimbursement of Rs. 5000. This money can be used to cover the cost of changes suggested by the insurer's assessor. It is important to know this benefit is available once during your policy's lifetime and follows certain terms and conditions.
   

Understanding Waiting Periods Under The Tata AIG Health Insurance For Senior Citizens

When you buy a health insurance plan, there is a time frame before certain illnesses and diseases are covered. This is called the waiting period. After this time passes, you can start claiming for these conditions. Waiting periods come in different types, including –

• Initial Waiting Period
  When you first get your health insurance, there is a 30-day waiting period for all medical conditions, except accidents. This means you cannot claim for hospitalisation during this time, unless it is due to an accident.
   
• Waiting Period For Pre-existing Diseases
  Any health condition you have had in the 36 months before getting your health insurance is called a pre-existing disease. With the Tata AIG Elder Care Plan, there is a 24-month waiting period for pre-existing diseases. During this time, the policy will not cover expenses related to these conditions.
   
• Waiting Period For Specific Diseases
  Apart from your pre-existing conditions, insurers may have a list of certain medical conditions or illnesses that come with their own waiting period. This waiting period is set by the insurer and does not depend on your current health. With the Tata AIG health insurance for senior citizens, there is a 24-month waiting period for specific conditions or treatments. Additionally, there is also a 48-month waiting period for joint replacement surgeries like knee, hip replacements, etc.
   

What Are Excluded From Coverage?

Exclusions are situations where your health insurance plan will not provide coverage. They include –

• Standard Permanent Exclusions
  The IRDAI, which oversees insurance regulations, has set certain 'standard permanent exclusions'. These exclusions must be followed by all insurance companies. Here are some of them –
• • Observation And Monitoring Only: Hospital admissions solely for observation or monitoring purposes.
  • Bed Rest Facilities: Admissions to healthcare facilities for rest cure, rehabilitation, or respite care, where no active treatment is provided.
  • Weight Control And Obesity: Treatment or surgery for weight control or obesity.
  • Gender Alteration: Treatment aimed at altering the body's characteristics to those of the opposite sex.
  • Cosmetic Procedures: Any treatment or surgery intended to modify body characteristics or appearance.
  • Adventure Sports: Treatment expenses incurred while participating as a professional in adventure activities such as mountaineering, scuba diving, horse racing, river rafting, etc.
  • Criminal Intent: Costs related to a person's treatment who has attempted to commit or committed a breach of law with criminal intent.
  • Providers That Are Excluded: Treatment from a hospital or medical practitioner that is not approved by the insurer.
  • Addictive Conditions: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
  • Domestic Establishments: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
  • Non-Prescribed Supplements: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Errors: Expenses associated with correcting refractive errors for improved eyesight, of up to 7.5 diopters.
  • Unproven Treatments: Treatments, surgeries, medical procedures, etc., that are not proven to be effective.
  • Reproductive Technologies: Expenses related to birth control, sterility, and infertility treatments such as contraception, sterilisation, artificial insemination, ICSI, IVF, GIFT, ZIFT, gestational surrogacy, etc.
  • Maternity Expenses: Childbirth-related hospitalisation expenses, pre/post-natal costs, etc.
     
• Additional Permanent Exclusions
  Apart from the standard exclusions mentioned earlier, insurance companies might add more exclusions based on certain situations or medical conditions. If you have specific diseases or severe medical issues that insurers think are risky to cover, they may permanently exclude those conditions from your policy. However, it is important to note that insurers can only exclude illnesses listed by the IRDAI.
   
• Non-Standard Exclusions (Specific Exclusions)
  These are exclusions that are not part of the standard permanent exclusions set by the IRDAI. They can vary among insurance companies and depend on the terms and conditions of your policy. Below are some specific exclusions listed under the Tata AIG health insurance for senior citizens –
• • Alcoholic pancreatitis.
  • Congenital external diseases, defects, or anomalies.
  • Growth hormone therapy.
  • Sleep apnea.
  • Venereal sexually transmitted diseases or illnesses.
  • Dental treatment or surgery of any kind.
  • All preventive care, including vaccinations, except for post-bite treatment and explicitly covered vaccines.
  • Participation or involvement in naval, military, or air force operations by any insured person.
  • Attempted suicide or willful self-injury, whether sane or insane.
  • Provision or fitting of spectacles, hearing aids, or contact lenses, including optometric therapy, unless explicitly stated and covered in the policy.
     

Summary

Get To Know More With The Brochure And Policy Wording links

• Brochure: https://www.tataaig.com/s3/elder_care_brochure_8b110b6804.pdf
• Policy Wording: https://www.tataaig.com/s3/Elder_Care_Policy_Wordings_9d18315430.pdf

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