TATA AIG Mediclaim Insurance Faqs

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1.  Can we give wellsurance to NRIs? If yes then please let me know the conditions?
Yes we can give Wellsurance to NRI who are staying in India for more than 182 days post policy inception days. POI & Expats who are in long term work visa & employed under occupation class I & II can also be sourced. However the coverage is not valid outside India.

2.  There is very renowned hospital named XYZ which is not in the tie up list for wellsurance. Can I know whether that hospital can be put in the tie up list? All the high net worth customers would like to have this hospital in the tie up list. Kindly let me know whether we can include this hospital?
All Pan India level Hospital / Medical Care Service Provider Tie - ups for Cashless Facility is being done by our TPA - E.Meditek. However, we have forwarded your request to the TPA. If the same could be worked out between the Hospital Administration & our TPA then shall get it included and update

3.  For hospitalization will we get the money on actuals or the benefit that is mentioned, even if the actual amount is lesser than the benefit mentioned?
Wellsurance is a 100% Benefit plan with Dual Claims facility. It means the claims will be settled on 100% benefit basis and the amount would be as per the coverage level opted, irrespective of the actual cost incurred.

4.  In case if the SI is 3 lakhs. If the insured gets 2 critical illnesses in the same year say he gets cancer and takes 3 lacs and soon after 6 months gets a heart attack. In such a scenario will he again get the 3 lacs for heart attack in the same year?
Insured can claim for only one critical illness in one policy term (of 1 year). Further the critical illness for which the claims has been closed the current year will be deemed as pre-exiting condition and shall not be covered in subsequent years.?

5.  Please explain the cashless claim benefits. In case if insured goes for cashless and wants to also claim for his mediclaim in that case what would be the process for cashless. Since the insured needs to submit original papers for mediclaim how can he get the same is goes in for cash less for wellsurance.?
Shall share the process post discussion with TAGIC corporate claims team

6.  Can the insured claim for the medical tests like x-ray, lab tests without hospitalization?
For all hospitalization expense viz. Daily Hospital Cash, ICU, Physician, Nursing, Physiotherapist expenses, MRI, CT, X-Ray, & Other Diagnostic needs, the Person needs to be HOSPITALISED for filing claims.

7.  For family option we cover up to 2 children only. Incase if some one had 3 kids in that case what will be the scenario. Can the 3rd child be covered?
We do not have the provision for covering more than 2 children in one Policy of Wellsurance Family. However the customer may choose to have 2 separate policies where in the first policy covers Self + 2 Children & the second policy covers Spouse + 1 child or vice versa.

8.  Under pre-existing diseases if someone have a hole in heart? Will that be covered after the waiting period?
This is pre-ex and will not be covered even after the waiting period.

9.  Incase of a person undergoing Histectomy (uterus removal). In case if recommended by doctor to undergo an MRI every year. Will that person be paid for the same as it's recommended by doctor?
Will be considered as pre-ex and will not be covered.

10.  If someone have had cancer in past and is now cured completely and since last 4 years the person is in good health. After taking wellsurance if the cancer reoccurs will he be covered and paid all benefits.
No, It has to be the first instance of that critical illness.

11.  Biopsy of growth (DNC) if done in daycare where the person is not hospitalized for 24hrs. What benefits will he receive?
Day care is not covered.

12.  Cancer once paid in wellsurance plan and the patient gets cured completely. Will the plan pay any further money if the same form of cancer reoccurs subsequently after a few years?
One CI will be paid once in a lifetime of the insured.

13.  For the Executive plan is there any criterion that the women need to be working. Can we give the Executive and woman plan to women who are housewives?
There are no income criteria here for Wellsurance.

14.  Will a person be paid hospitalization benefits if admitted due to any other illness than critical illness? E.g. if a person has malaria or dengue and due to which he is recommended to get hospitalized. Will he be able to get hospital benefit and the related cost of MRI and other tests?
The insured will get SHC (post waiting period) for hospitalization other than CI / Covered surgeries for any hospitalization as recommended by a medical practitioner.

15.  If a person already had cancer and cured and if he gets heart attack as a side effect of radiation. Will he get benefits after the waiting period of 90 days?
This will be decided on a case to case basis.

16.  If a person has diabetes as per-ex. Will any related disease due to diabetes be covered after 4 yrs?
After 4 years of continuous renewal with us

17.  Wife wants to take the executive plan and files return. However due to shortage of funds in her account she is unable to give the cheque in her name and wants to give cheque which is in her husband's name. Is it allowed to do that?
The premium cheque can be issued by her husband.

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