TATA AIG Medicare protect health insurance

Key policy features of Tata AIG medicare insurance

• Room Rent : Shared Accommodation(with 10% co-pay)/ Single Private A/c Room
• Co-pay : NIL co-pay for all treatment
• Restoration Benefit: NIL co-pay for all treatment

• Policy Type
  • Individual
  • Family Floater
    • Self
    • Spouse
    • 3 dependent children (upto the age of 25 years. Once the child completes 25 years, they can be covered as an Independent member without losing the continuity benefit)
    • 2 dependent parents
• Policy Tenure
  • 1 /2/3 years
• Lifetime Renewability

Eligibility of Tata AIG medicare insurance

• 5 years onwards
• Dependent children between 91 days to 5 years can be covered only if both parents are covered under the policy
• Maximum entry age is 65 years
• No maximum ceasing age

Description of key benefits under Tata AIG Medicare insurance

• Pre and Post Hospitalisation The Medical Expenses incurred upto 60 days immediately before the Insured Person is hospitalized and those expenses incurred upto 90 days immediately after dischargepost Hospitalisation is covered.
• In-patient Treatment The insurance company will cover 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.
• Bariatric Surgery Cover The policycovers reasonable and customary expenses for Bariatric surgery if the insured fulfils conditions as listed in the policy
• Sum Insured Restore Benefit If the Sum Insured including cumulative bonus is completely utilized during the policy period, an additional amount equivalent to the base Sum Insured will be restored once during the policy period and can also be used for admissions due to related illness/diseases after 45 days from the date of discharge of the earlier claim.This benefit cannot be carried forward to subsequent renewals.
• High End DiagnosticsThe policy will pay the insured for the listed diagnostic tests on OPD basis if required as part of a treatment subject to Rs. 25,000 per policy year annually.
• Emergency Air Ambulance Cover Coverage is available for ambulance transportation of the insured person in an airplane or helicopter subject to maximum of Rs. 500,000.
• Maternity Cover Tata AIG will cover Maternity Expenses upto a maximum of Rs. 50,000/- (in case of birth of girl child cover would be for Rs.60,000) per policy through Normal or Caesarean births.
• Consumables Benefit The policy pays for expenses incurred, for consumables which are listed in ‘Items for which optional cover may be offered by insurers’ under ‘Guidelines on Standardization in Health Insurance, 2016’, which are consumed during the period of hospitalization directly related to the insured’s medical or surgical treatment of illness/disease/injury.
• Cumulative bonus Upto50% increase in cumulative bonus for is available for every claim free year. In the case a claim is made during the policy year, the cumulative bonus would reduce by upto 50% in the following year.
• Day Care Procedures The policycovers expenses for listed 541 Day Care Treatments due to disease/illness/Injury during the policy period taken at a hospital or a Day Care Centre.
• Organ Donor The Medical and surgical Expenses of the organ donor for harvesting the organ where an insured person is the recipient is covered under the policy.
• Domiciliary Treatment The Medical Expenses incurred by an Insured Person for availing medical treatment at his home which would otherwise have required hospitalisation including pre and post expenses are covered.
• AYUSH benefit Medical Expenses incurred for In-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy are covered.
• Ambulance Cover For utilizing ambulance service for transporting insured person to hospital in case of an emergency is covered under the policy.
• New Born Baby Cover The policy covers medical expenses incurred for the medically necessary treatment of the new born baby upto Rs.10, 000 for complications related to delivery. This benefit will trigger only in case where thereis an admitted maternity claim.
• First year Vaccinations The policy will pay for vaccination expenses for up to one year after the birth of the child subject to a limit of ₹10,000/-(₹15,000/- limit in case of girl child) provided the child is covered with us. This benefit will trigger only in case where there is an admitted the maternity claim.
• Health Check Up Expenses for a Preventive Health Check-up upto 1% of policy sum insured subject to a maximum of Rs. 10,000/- per policy is offered under the plans.
• Second Opinion Tata AIG provides the insured with an option to seek a second opinion from Network Provider or Medical Practitioner, if an Insured Person is diagnosed with the mentioned Illnesses during the Policy Period.
• Vaccination Cover The policy covers expenses related to the cost of the following vaccines:
  • Without any waiting period - Anti-rabies vaccine following an animal bite / Typhoid vaccination
  • After 2 years of continuous coverage - Human Papilloma Virus (HPV) vaccine / Hepatitis B Vaccine
• Hearing Aid The policy offers coverage for reasonable charges for hearing aid every third year. The maximum payable is 50% of actual cost or Rs. 10,000/- per policy, whichever is lower.
• Daily Cash For Choosing Shared Accommodation The policy pays for a fixed amount per day as mentioned in the policy schedule if the Insured Person is Hospitalized in Shared Accommodation in a Network Hospital for each continuous and completed period of 24 hours. The benefit payable per day would be 0.25% of base sum insured and max. ₹2,000 per day.
• Daily Cash For Accompanying An Insured Child The policy also pay a fixed amount per day, as mentioned in the schedule, if the Insured Person Hospitalized is a child Aged 12 years or less, for one accompanying adult for each complete period of 24 hours. The benefit payable per day would be 0.25% of base sum insured and max ₹2,000 per day.
• Prolonged Hospitalization Benefit The insurer will pay a fixed amount of 1% of sum insured, in the event of insured hospitalized for a disease/illness/injury for a continuous period exceeding 10 days.
• High End Diagnostics Tata AIG will pay the insured for the following diagnostic tests on OPD basis if required as part of a treatment subject to Rs. 25,000 per policy year annually: a)Brain Perfusion imaging,b)CT guided Biopsy,c)CT Urography,d)Digital Subtraction Angiography (DSA), e)Liver Biopsy, f)Magnetic Resonance Cholangiography Scan, g) PET CT scans,h)PET MRI scans, i) Renogram
• OPD Treatment Once the insured has completed two years of continuous coverage with us, the policy covers expenses related to consultations and pharmacy subject to ₹5,000 per policy year annually subject to policy terms and conditions.
• OPD Treatment-Dental Once the insured has completed two years of continuous coverage with us, coverage is available for expenses related to the following dental treatments only subject to ₹10,000 per policy year annually for a)Root Canal Treatment (single or multiple sittings), b)Tooth extraction(s) and c)Filling
• Compassionate Travel In the event the Insured Person is Hospitalized for more than Five consecutive days in a place where no adult member of his immediate family is present, coverage is available for expenses related to a round trip economy class air ticket, or firstclass railway ticket, to allow the Immediate Family Member be at his/her bedside for the duration of his stay in the hospital. The expenses must be incurred within India and shall not exceed ₹20,000 during a policy year.
• Accidental Death Benefit If an Insured Person suffers an accident during the policy period and this is the sole and direct cause of his death within 365 days from the date of accident, then the policy pays a fixed amount of 100% of the base Sum Insured.