TATA AIG MediCare Plus Insurance

MediCare Plus is a top up health insurance plan to enhance your current health insurance with a higher total coverage at an affordable premium. It is the perfect health protection for you and your family which supplements your primary health insurance cover.

MediCare Plus plan eligibility

  • This is a top-up health insurance plan
  • Entry age is 18 years to 65 years for the proposer.
  • You can insure yourself, your spouse, upto 3 dependent children and your dependent parents. Child between 91 days to 5 years can be insured only when either parent is getting insured under this policy.
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TATA AIG Health Insurance Review

Sum Insured
3 lacs − 20 lacs options available
Tenure Options
1, 2 or 3 years options available
Claims Incurred Ratio *
78.00%
Claims Settlement Ratio **
80.61%
List of Network Hospitals
4,000+ hospitals
Number of Policies issued *
220,583
Number of Lives Covered *
2,248,000
Maximum Family Floater Coverage
Self, Spouse + 3 dependent children + 2 dependent parents
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

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TATA AIG MediCare Plus Insurance plan details

  • Benefits
  • Exclusions

Benefits of TATA AIG MediPlus insurance policy

  • In-patient Benefits – Covers expenses for hospitalization due to disease/illness/lnjury during the policy period that requires an Insured Person's admission in a hospital as an inpatient. Medical expenses directly related to the hospitalization would be payable.
  • Pre-Hospitalization – Medical Expenses incurred up to 60 days before the date of admission to the hospital.
  • Day-Care procedures – Covers expenses for 540+ Day Care Treatment due to disease/ illness/lnjury during the policy period taken at a hospital or a Day Care Centre.
  • Organ Donor – Covers Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the ecipient.
  • Post-Hospitalization – Medical Expenses incurred up to 90 days after the date of discharge from the hospital.
  • Domiciliary Treatment – Covers Medical Expenses incurred for availing medical treatment at home which would otherwise have required hospitalization. We will also cover pre and post hospitalization expenses in case of domiciliary hospitalization.
  • In-patient Dental Treatment – Covers expenses incurred towards hospitalization for dental treatment under anesthesia necessitated due to an accident/injury/illness.
  • AYUSH benefit – Covers Medical Expenses incurred for In-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy.
  • Ambulance cover – Covers expenses incurred on transportation of Insured Person in a registered ambulance to a hospital in case of an emergency or from one hospital to another, for better medical facilities & treatment, subject to 3000 per Hospitalization.
  • Second Opinion – Provides You a second opinion from Network Provider or Medical Practitioner, if an Insured Person is diagnosed with the mentioned Illnesses during the Policy Period.
  • Health Check-up – Expenses for a Preventive Health Check-up upto 1% of previous year policy sum insured subject to a maximum of 10,000/- per policy in the event of every two continuous claim free policy years with us.
  • Cumulative Bonus – 50% increase in cumulative bonus for every claim free year, upto a maximum of 100%. In the case a claim is made during the policy year, the cumulative bonus would reduce by 50% in the following year.
  • Consumables Benefit – Covers expenses incurred, for consumables, which are consumed during the period of hospitalization directly related to the insured person's medical or surgical treatment of illness/disease/injury.
  • Global Cover (Optional Cover) – Covers Medical Expenses related to Inpatient & Day Care Hospitalization of the Insured Person incurred outside India, provided that the diagnosis was made in India.

Exclusions of TATA AIG MediCare Plus plan

Medical Exclusions:
  • Alcoholic pancreatitis and its related disorders or complications arising out of it.
  • Admission primarily for diagnostic and evaluation purposes only.
  • Treatment of Obesity and any weight control program.
  • Congenital External Diseases, defects or anomalies.
  • Laser treatment for correction of eye due to refractive error.
Non-Medical Exclusions:
  • Treatment rendered by a Medical Practitioner which is outside his discipline.
  • Intentional self-injury or attempted suicide while sane or insane.
  • Any Insured Person attempting to commit a breach of law with criminal intent.

Tata AIG health insurance claims

Claim related information:

For any claim related query, intimation of claim and submission of claim related documents, you can contact Your TPA through:
  • Name of TPA : Family Health Plan Insurance TPA Ltd (FHPL)
  • Website : www.fhpl.net
  • Email
  • Toll Free
    • 1800-425-4033
    • 040- 23552899 (for Senior Citizens)
  • Fax : +91-40-23541400
  • Submit claim
    • Claims Department, Family Health Plan Insurance (TPA) Ltd, Srinilaya – Cyber Spazio Suite # 101,102,109 & 110, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, 500 034.

Procedure for Reimbursement of medical expenses

  • The TPA (Third Party Administrator) must be informed no later than 7 days of completion of such treatment, consultation or procedure using the Claim Intimation Form.
  • Please send the duly signed claim form and all the information/documents mentioned therein to your designated TPA within 15 days of the occurrence of the Incident. Please refer to claim form for complete documentation.
  • If there is any deficiency in the documents/information submitted by the insured, the TPA will send the deficiency letter within 7 days of receipt of the claim documents.
  • On receipt of the complete set of claim documents, Tata AIG will send the payment for the admissible amount, along with a settlement statement within 30 days.
  • The payment will be sent in the name of the proposer.
(Note: Payment will only be made for items covered under your policy and upto the limits therein.)

Procedure to avail cashless treatment

  • For any emergency Hospitalisation, the designated TPA must be informed no later than 24 hours after hospitalization.
  • For any planned hospitalization, kindly seek cashless authorization from the designated TPA atleast 48 hours prior to the hospitalization.
  • TPA will check your coverage as per the eligibility and send an authorization letter to the provider. In case there is any deficiency in the documents sent, the same shall be communicated to the hospital within 6 hours of receipt of documents.
  • Please pay the non-medical and expenses not covered to the hospital prior to the discharge.
  • In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the provider within 6 hours.
(Note: n Insured person is entitled for cashless coverage only in our empanelled hospitals.)

Grievance redressal procedure

Tata AIG is committed to extend the best possible services to the insured. However, if you are not satisfied with our services and wish to lodge a complaint, please call our 24X7 Toll free number 1800266-7780 or 022-66939500 (toll number) or 1800 22 9966 (For Senior Citizens) or you may email to the customer service desk at customersupport@tataaig.com.
After examining the issue and subsequent closure, Tata AIG will send our response within 10 days from the date of receipt of the complaint by them. In case the resolution is likely to take a longer time, we will inform you of the same through an interim reply.
Escalation level 1
In case you do not receive a resolution within 10 days or if the resolution still does not meet your expectations, you can write to manager.customersupport@tataaig.com . After analysing the matter internally and subsequent closure, we will send our response within a period of 8 days from the date of receipt at this email id.
Escalation level 2
In case you do not receive a resolution within 8 days or if the resolution still does not meet your expectations, you can write to Head - Customer Services at head.customerservices@tataaig.com . After examining the matter, we will send you our final response within 7 days from the date of receipt of your complaint on this email id.
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