TATA AIG Medicare Premier Insurance Plan

Let’s Know The Plan Better!

TATA AIG Medicare Premier is a health insurance plan provided by Tata AIG General Insurance Company Limited. It is designed to offer you financial assistance during tough times, so you can concentrate on your recovery and well-being. It goes beyond basic hospitalisation coverage by providing a wide range of features and benefits, making it a comprehensive choice for both individuals and families.

Are You Eligible?

Minimum Entry Age

• Adults: 18 years
• Dependent Children: 91 days

Maximum Entry Age

• Adults: 65 years
• Dependent Children: 25 years
   

An Overview Of The Plan’s Benefits & Limits

TATA AIG Medicare Premier plan covers your inpatient hospitalisation expenses, which are the costs you incur when you are hospitalised for more than 24 hours, like room boarding and nursing charges, medical practitioner's fees, prescribed medicines and drugs, ICU charges, and related expenses.

• Pre & Post Hospitalisation Expenses
  You may need to undergo several tests before or after your admission to the hospital. Worry not! TATA AIG Medicare Premier has got your back. The expenses will be covered up to the sum insured for 60 days prior to hospitalisation and 90 days following discharge. It is of utmost importance to understand that the insurer will solely provide coverage for these expenses if they are directly related to the medical condition that resulted in your hospitalisation. Additionally, your claim for these costs must be approved as part of the inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Daycare treatments are medical treatments or procedures that used to necessitate lengthy hospital stays but can now be completed within 24 hours, thanks to advancements in healthcare technology. The TATA AIG Medicare Premier Plan provides comprehensive coverage for all daycare procedures up to the sum insured.
   
• Domiciliary Treatment Coverage
  Domiciliary Treatments are medical procedures for illnesses or injuries that require immediate attention in a hospital but are administered in the comfort of one's own home when the severity of a person's condition prevents them from being able to travel to a hospital or when there are no available beds in hospitals. The TATA AIG Medicare Premier Plan provides coverage for the expenses related to domiciliary treatments up to the sum insured.
   
• Organ Donor Coverage
  The TATA AIG Medicare Premier Plan also includes coverage for expenses related to organ donations up to the sum insured. This coverage takes care of the costs involved in harvesting the organ from the donor during organ transplantation, where you are the recipient.
   
• Modern Treatment Coverage
  The healthcare industry is currently experiencing a swift and remarkable transformation, thanks to technological advancements. As a result, modern treatments that were once unimaginable are now becoming a reality. The TATA AIG Medicare Premier Plan has been specifically crafted to keep pace with these advancements and offers coverage for these cutting-edge treatments up to the sum insured.

• Non-Medical Expenses
  The TATA AIG Medicare Premier Plan provides coverage for non-medical expenses, including gloves, gauze, bandages, nebulisation kits, oxygen masks, and other essential consumable items up to the sum insured - relieving you of additional burden.

• Room Rent Limit
  The room rent limit is the maximum amount that an insurance company will cover for the room chosen during a hospital stay. By selecting a room within this limit, you can avoid bearing any out-of-pocket expenses. However, if you choose a room beyond your eligibility, a proportionate deduction will be applied. In such cases, you will be responsible for paying a proportionate share of the total bill rather than just the difference in room rent. With the TATA AIG Medicare Premier Plan, you have complete freedom to select the room of your choice, whether it be a shared room, single room, suite, or any other available option - without any restrictions.

• Cumulative Bonus
  The TATA AIG Medicare Premier Plan offers you an opportunity to receive a bonus of 50% of the sum insured with the potential to increase up to a maximum of 100% of the sum insured if you don’t make any claims throughout the policy year. In the event of a claim being made, the accumulated bonus will be reduced by 50%. This benefit comes with certain terms and conditions.

• Restore Benefit
  The Restore Benefit is a valuable feature that automatically replenishes your sum insured if it is used up within a policy year. It comes into effect when you have fully utilised your base sum insured and any accumulated cumulative bonus under this plan. The Restore Benefit can be used for subsequent claims during the policy year. It's important to note that this benefit can be availed once in every policy year as long as you continue to renew your policy. The restored sum insured can be used for unrelated illnesses immediately and related illnesses after 45 days.
   

Noteworthy Features You Should Be Aware Of!

• Prolonged Hospitalisation Benefit
  The Tata AIG Medicare Premier Plan includes a notable benefit that provides financial assistance for extended hospital stays caused by a disease, illness, or injury. This benefit is activated when you are hospitalised for more than 10 consecutive days. If you or a family member covered by the plan requires an extended hospital stay due to a medical condition, the insurer will pay 1% of the sum insured. It is important to note that the benefit is subject to the terms and conditions outlined in the policy.

• Global Cover
  With the Global Cover, you can avail yourself of health insurance coverage beyond India. If you are diagnosed with a medical condition in India that necessitates treatment abroad, your policy will cover the medical expenses incurred during the international treatment, up to the sum insured. This benefit holds great significance in today's world, where travelling internationally for medical purposes is quite common. The policy also includes coverage for expenses associated with obtaining a visa for medical treatment abroad. To be eligible for coverage, the initial diagnosis needs to be done in India.

• OPD Treatment
  This benefit provides coverage for medical consultations with healthcare providers and the purchase of prescribed medications up to the specified limit in the policy. It ensures access to essential healthcare services and medications, even without hospitalisation. The coverage is subject to T&Cs specified in the policy.
   

Understanding Waiting Periods

Once you purchase a health insurance policy, you cannot claim for certain illnesses and diseases for a certain period of time. This timeframe is known as the waiting period. However, once this waiting period ends, you will be able to file claims for these conditions.

Here are some of the types of waiting periods -

• Initial Waiting Period
  Once you've bought your policy, there is a 30-day waiting period before you can make a claim for any medical condition, except for accidents. During this period, you will not be able to make a claim for any hospitalisation unless it is related to an accident.

• Waiting Period For Pre-Existing Diseases
  A pre-existing disease refers to any medical condition or illness that you have had within 48 months before buying a health insurance plan. It's important to note that the TATA AIG Medicare Premier Plan has a waiting period of 24 months for pre-existing conditions. During this time, the policy will not cover any expenses related to pre-existing conditions.

• Waiting Period For Specific Diseases
  Insurers have a list of certain medical conditions or illnesses for which they impose waiting periods regardless of whether you have experienced these in the past or not. This waiting period is decided by the insurer and is not affected by your current health status. Under the TATA AIG Medicare Premier Plan, there is a waiting period of 24 months for specific diseases.

What The Plan Does Not Cover?

Exclusions are situations or conditions that your health insurance policy does not cover. Let's take a look at some types of exclusions:

1. Standard Permanent Exclusions
   IRDAI has put forth a set of 'standard permanent exclusions' that all insurance companies must adhere to -

• Obesity/weight control: Treatments or surgeries for weight control or obesity.
• Profession in hazardous or adventure sports: Expenses from engaging in adventurous activities like mountaineering, surfing, paragliding, etc. as a professional.
• Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
• Investigation and evaluation:  Hospital admissions for observation or monitoring purposes.
• Rest cure, rehabilitation, and respite care: Admission to a bed rest facility without active treatment.
• Plastic/cosmetic surgery: Treatment or surgery that aims to alter your body characteristics or appearance.
• Narcotics: Treatments related to addictive conditions such as alcohol addiction, drug usage, etc.
• Breach of law: Expenses related to treating someone who has committed or attempted to commit a breach of law with criminal intent.
• Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
• Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that a medical practitioner hasn’t prescribed.
• Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
• Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
• Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, and more.
• Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
• Expenses related to birth control, sterility, and infertility: Treatments like contraception methods, sterilisation procedures, artificial insemination techniques, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.

2. Additional Permanent Exclusions
   In addition to the standard permanent exclusions mentioned earlier, insurance providers may also apply specific exclusions in your policy for certain circumstances or medical conditions. If you have certain diseases or severe medical conditions that are perceived as high-risk to cover, the insurance provider may choose to permanently exclude them from your policy. In India, insurers have the authority to impose permanent exclusions on a specific set of illnesses as determined by the Insurance Regulatory and Development Authority of India (IRDAI). They are not allowed to exclude any illnesses that are out of this list.
    
3. Non-Standard Exclusions (Specific Exclusions)
   The TATA AIG Medicare Premier Plan applies specific exclusions that extend beyond the standard permanent exclusions set by the IRDAI. It is crucial to note that these exclusions may vary among insurance companies and are based on the specific terms and conditions of the policy.
   Here are some specific exclusions listed under the TATA AIG Medicare Premier Plan:

• Alcoholic pancreatitis
• Congenital external diseases, defects, or anomalies
• Stem cell therapy (except for hematopoietic stem cells used for bone marrow transplant for haematological conditions, which may be covered under in-patient or daycare benefits of this policy)
• Growth hormone therapy
• Sleep apnoea
• Venereal diseases, sexually transmitted diseases or illnesses
• Preventive care, including vaccinations and immunisations (except for post-bite treatment and other explicitly covered vaccines).
• Dental treatment or surgery, unless specified under 'Inpatient Treatment - Dental'.
• Participation or involvement in naval, military, or air force operations.
• Intentional self-injury or attempted suicide, whether in a sound or unsound state of mind.
• Provision or fitting of hearing aids, spectacles, or contact lenses, including optometric therapy, unless explicitly stated and covered in the policy.
• Any treatment and associated expenses for alopecia, baldness, wigs, or toupees.
• Medical supplies, including elastic stockings, diabetic test strips, and similar products.
• External aids and devices, such as crutches or any other equipment used for diagnosis or treatment (excluding cases where they are used during surgery and specifically mentioned and covered in the policy).

A Quick Recap Of The Benefits & Limits

The OG Reading Material for Your Reference

• Brochure: https://www.tataaig.com/s3/TATA_Medicare_Premier_871b2dee42.pdf
   
• Policy Wording: https://www.tataaig.com/s3/Tata_AIG_Medi_Care_Premier_2f02f3813c.pdf

FAQs

1. Are AYUSH treatments covered under the Tata AIG Medicare Premier policy?
   Yes. Tata AIG Medicare Premier provides coverage for non-allopathic or AYUSH Treatments up to the sum insured.
    
2. What is the maximum coverage available under the Tata AIG Medicare Premier Plan?
   Tata AIG Medicare Premier provides you with health coverage of up to INR 3 Crores.
    
3. Are there any limitations on room rent with Tata AIG Medicare Premier?
   Under Tata AIG Medicare Premier, there are no restrictions on the room category when it comes to hospitalisation.
    
4. Is maternity coverage included in Tata AIG Medicare Premier?
   The Tata AIG Medicare Premier Plan provides coverage for maternity expenses as per the limits specified by the insurer.
    
5. Does the Tata AIG Medicare Premier plan provide coverage for consumables?
   The Tata AIG Medicare Premier Plan provides coverage for all consumables, such as gloves, syringes, masks, cotton, and more.