TATA AIG MediCare Insurance, TATA AIG MediCare Insurance for best coverage

Key Features
Benefits
Waiting Period
Plan highlights
Exclusions

Health insurance policy that covers both Outpatient expenses & inpatient expenses
Option to choose premium to be paid and Sum Insured required
Premium options: Rs.15000/-; Rs.20,000/-; Rs.25,000/-; and Rs.30,000/-( applicable GST extra)
Sum Insured options(for inpatient hospitalization): Rs.1 lakh, Rs.2 lakhs, Rs.3 lakhs, Rs.4 lakhs and Rs.5 lakhs
Sum Insured Type option : Individual and Floater
Policy term: One year

Benefits of Medicare Plans ((All Amounts in ₹ INR)

Tata AIG Medicare Protect	Tata AIG Medicare	Tata AIG Medicare Premier
Maximum Sum Insured
200,000 / 300,000 / 400,000 / 500,000	3,00,000 / 4,00,000 / 5,00,000 / 7,50,000 / 10,00,000 / 15,00,000 / 20,00,000	5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000
Inpatient Treatment
Covered upto max SI	Covered upto max SI	Covered upto max SI
Room Rent Charges
Room Rent covered for Shared accomodation	Room Rent covered for Shared accomodation + Single Private Rooms	No restrictions
Ambulance Charges (per policy period)
upto ₹ 1,000 per hospitalisation	upto ₹ 3,000 per hospitalisation	upto ₹ 5,000 per hospitalisation
Air Ambulance (per policy period)
-	-	upto 5,00,000
Pre Hospitalisation Expenses incurred
upto 30 days	upto 60 days	upto 60 days
Post Hospitalisation Expenses incurred
upto 60 days	upto 90 days	upto 90 days
Delivery Charges (Normal)
-	-	50,000 (60,000 for a girl child)
Deliver Charges (Caesarean)
-	-	50,000 (60,000 for a girl child)
Waiting Period for Delivery
-	-	48 months
Coverage for New Born Child
-	-	10,000
First Year Vaccination Charges
-	-	10,000 (15,000 for a girl child)
Outpatient (OPD) Dental Cover
-	-	10,000 after completing two years of continous coverage
Daily Cash - per day limit for shared accomodation / accompanying and insured child
-	Upto 0.25% of Sum insured max ₹2,000 each	Upto 0.25% of Sum insured max ₹2,000each
Health Check Up
1% of Sum Insured subject to 3 claims free years upto ₹10,000	1% of Sum Insured subject to 3 claims free years upto ₹10,000	1% of Sum Insured every year upto ₹10,000
Restoration Benefit after exhaustation of Sum Insured (once during policy period)
upto Sum Insured	upto Sum Insured	upto Sum Insured
Bariatric Surgery(per policy period)
-	Covered	Covered
Accidental Death
-	-	Fixed amount of 100% SI
Day Care Procedures
541 listed procedures covered	541 listed procedures covered	541 listed procedures covered
Organ Donor
upto Sum Insured	upto Sum Insured	upto Sum Insured
Domiciliary Treatment
upto Sum Insured	upto Sum Insured	upto Sum Insured
E Opinion for Critical Illness
-	Included	Included
Ayush Benefit
Covered Upto Sum Insured	Covered Upto Sum Insured	Covered Upto Sum Insured
Global Coverage for Treatment
-	Covered upto max SI provided diagnosis was made in India	Covered upto max SI provided diagnosis was made in India
Second Opinion
-	Included	Included
Vaccination Charges (NIL waiting)
-	Covered for ₹ 5,000 for Anti Rabies and Typhoid	Covered for ₹ 5,000 for Anti Rabies and Typhoid
Vaccination Charges (after waiting period of 2 years)
-	Covered for ₹ 5,000 for HPV and Hepatitis B	Covered for ₹ 5,000 for HPV and Hepatitis B
Inpatient Dental Treatment
-	Included	Included
Hearing Aid
-	50% of Actual or 10,000 every third year	50% of Actual or 10,000 every third year
Prolonged Hospitalisation Benefit
-	-	1% of SI if continous hospitalisation is for more than 10 days
High End Diagnostics
-	-	Upto 25,000 per policy year
Outpatient Treatment
-	-	5000 once for every two years
Compassionate Visit (Travel)
Upto 20,000	Upto 20,000	Upto 20,000
Cumulative Bonus
10% of Sum Insured (for every claim free year) upto 100%	10% of Sum Insured (for every claim free year) upto 100%	10% of Sum Insured (for every claim free year) upto 100%
Consummables Benefit
Included as per IRDA 2016 guidelines	Included as per IRDA 2016 guidelines	Included as per IRDA 2016 guidelines
Accidental Death Benefit
-	-	100% of Sum Insured
Additional Covers
Accidental Death Benefit
Coverage upto 100% of Sum Insured only for Primary Insured	Coverage upto 100% of Sum Insured only for Primary Insured	NA

Hospitalization Cover : Room, Boarding, Nursing Expenses upto 1% of sum insured per day.
A proportionate deduction shall happen in hospitalization expenses if room rent limit is exceeded.
Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist Fees, Cost of Medicines and Drugs.
Ambulance charges up to Rs.750/- per hospitalization and Rs.1500/- per policy period.
Pre-Hospitalization expenses up to 30 days prior to admission in the hospital.
Post-hospitalization expenses up to 60 days from the date of discharge.
Expenses incurred for all day-care procedures.
Treatment for Cataract is subject to limits mentioned in the policy

Co - Payment :

Co-payment of 20% of each and every claim amount for fresh as well as renewal policies for insured persons whose age at the time of entry is above 60 years.

Waiting periods :

30 days (Not applicable for Accidents)
24 months for specified illness/ diseases.
48 months for treatment of Pre existing diseases

Out Patient Benefits :

Premium option and Sum Insured Option shall be deciding outpatient benefit level.
Medical expenses incurred in networked facility shall be reimbursed. There is no waiting period or co-pay applicable
Unutilized benefit in a policy year can be carried forward to immediately succeeding renewal year. No further carry over is permitted.

Tax Benefits :

Amount paid by any mode other than by cash for this insurance is eligible for relief under Section 80D of the Income Tax Act.

Free Look Period :

A free look period of 15 days from the date of receipt of the policy by the insured is available to the insured to review the terms and conditions of the policy. In case the insured is not satisfied with the terms and conditions, the insured may seek cancellation of the policy and in such an event the Company may allow refund of premium paid after adjusting the cost of pre-medical screening, stamp duty charges and proportionate risk premium for the period concerned provided no claim has been made until such cancellation.
Free look Period is not applicable at the time of renewal of the policy.

Renewal

Lifelong renewal.

Grace Period for renewal

30 days from date of expiry of policy.

No Third Party Administrator, direct in-house claim settlement.
Faster and hassle-free claim settlement.
Cashless hospitalisation.
Network of more than 8200+ hospitals across India.

TATA AIG MediCare Insurance

Eligibility

Benefits of Medicare Plans ((All Amounts in ₹ INR)

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