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MediCare Premier Health Insurance

TATA AIG MediCare Premier Health Insurance

Coverage available is Rs. 5,00,000, Rs. 10,00,000, Rs. 15,00,000, Rs. 20,00,000, Rs. 25,00,000 and Rs. 50,00,000.
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Tata AIG MediCare Premier health insurance benefits

Key Features
Benefits
Waiting Period
Exclusions

Key features of TATA AIG MediCare Premier insurance

Global 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.
Bariatric Surgery: Covers expenses incurred for Bariatric Surgery for treatment of Obesity and weight control.
Emergency Air Ambulance: Covers expense for ambulance transportation by airplane or helicopter for emergency life threatening health conditions, which require immediate ambulance transportation to the hospital/medical centre.
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.
Restore Benefits: It automatically restores your sum insured to 100% for you and your family members.
Day Care Procedures: Covers expenses for 540+ Day Care Treatment due to disease/illness/injury during the policy period taken at a hospital or a day care center.
In Patient Treatment: Covers expenses for hospitalization due to disease/illness/Injury 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.
High End Diagnostics: Covers the insured person for the listed diagnostic tests on OPD basis if required as part of a treatment subject to Rs. 25,000 per policy year annually.
Accidental Death Benefit: Covers 100% of sum insured in the event of death of insured person due to accident. This benefit is not applicable for dependent children covered in the policy.
Maternity Cover: Covers maternity expenses – upto a maximum of Rs. 50,000/- (incase of birth of girl child cover would be for Rs. 60,000) per policy.No limit on number of delivery events.
First year Vaccinations: Covers vaccination expenses for up to one year after the birth of the child subject to a limit of Rs.10,000/- (in case of girl child cover would be for Rs. 15,000) provided the child is covered with us.
Organ Donor: Covers Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient.
Vaccination Cover: Covers expenses related to Human Papilloma Virus (HPV) vaccine & Hepatitis B Vaccine after 2 years of continuous coverage and Anti-rabies vaccine & Typhoid vaccination without any waiting period.
Compassionate Travel Vaccination Cover: Covers expenses upto Rs. 20,000 related to a round trip economy class air ticket, or first-class railway ticket, to allow the Immediate Family Member to be at insured person's bedside during his stay in the hospital.
OPD Dental Treatment: Covers expenses upto Rs. 10,000 related to root canal, filling, tooth extractions over and above sum insured. Does not impact cumulative bonus.
Other Features
- Pre-Hospitalization expenses
- Daily Cash for choosing shared accomodation
- Second Opinion
- OPD Treatment
- Ambulance Cover
- Health Checkup
- Hearing Aid
- Post-Hospitalization expenses
- Daily Cash for accompanying an insured child
- Domiciliary Treatment
- New Born Baby Cover
- Prolonged Hospitalization Benefit
- AYUSH Benefit
- In-patient Treatment-Dental
- Cumulative Bonus

Benefits of TATA AIG Medicare Premier (All Amounts in INR)

Benefits	Tata AIG Medicare Premier
Maximum Sum Insured	5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000
Inpatient Treatment	Covered upto max SI
Room Rent Charges	No restrictions
Ambulance Charges (per policy period)	upto ₹ 5,000 per hospitalisation
Air Ambulance (per policy period)	upto 5,00,000
Pre Hospitalisation Expenses incurred	upto 60 days
Post Hospitalisation Expenses incurred	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 ₹2,000each
Health Check Up	1% of Sum Insured every year upto ₹10,000
Restoration Benefit after exhaustation of Sum Insured (once during policy period)	upto Sum Insured
Bariatric Surgery(per policy period)	Covered
Accidental Death	Fixed amount of 100% SI
Day Care Procedures	541 listed procedures covered
Domiciliary Treatment	upto Sum Insured
E Opinion for Critical Illness	Included
Ayush Benefit	Covered Upto Sum Insured
Global Coverage for Treatment	Covered upto max SI provided diagnosis was made in India
Second Opinion	Included
Vaccination Charges (NIL waiting)	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
Inpatient Dental Treatment	Included
Hearing Aid	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
Cumulative Bonus	10% of Sum Insured (for every claim free year) upto 100%
Consummables Benefit	Included as per IRDA 2016 guidelines
Accidental Death Benefit	100% of Sum Insured
Additional Covers
Accidental Death Benefit	NA

Policy coverage starts 30 days from the first inception of the policy (except accident).
Any listed illnesses/treatments will be covered after a waiting period of 24 months.
Any pre-existing condition will be covered after a waiting period of 36 months

TATA AIG MediCare Premier insurance plan exclusions

Medical Exclusions

Conditions related to or arising out of HIV or AIDS
Abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol
Congenital External Diseases, defects or anomalies

Non-Medical Exclusions

War or any act of war, act of foreign enemy or war like operations
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
- info@fhpl.net
- seniorcitizensdesk@fhpl.net (for Senior Citizens)
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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