TATA AIG Elder Care

Tata AIG Elder Care is a health insurance policy offered by Tata AIG General Insurance Company Limited. This plan is specifically designed to cover the healthcare expenses of senior citizens, considering the particular health issues that accompany age. It provides a variety of benefits and features to provide assurance that you or any senior family members can receive the required medical attention, stress-free from financial burdens.

This policy is carefully designed for people between 65 to 85 years. Apart from hospitalisation and related expenses, it also covers a range of other requirements, including the cost of consumables, home physiotherapy, etc. Unlike most senior citizen policies, it comes with the liberty to waive off the compulsory copayment, and you are even allowed to enhance your sum insured depending on your claim record.

However, the plan has certain limitations. It does not cover domiciliary treatment or organ donor expenses. There are restrictions on room type, and zonal sub-limits apply to common treatments like cataracts, among others. The plan also does not provide a monthly premium payment option. Based on our research, the insurer has received fewer complaints related to claim settlement, but a higher number of complaints related to policy purchase.

Let’s now take a closer look at the features and benefits offered by the TATA AIG Elder Care Plan.

What are the benefits offered by the TATA AIG Elder Care Plan?

Here are the main features and benefits that make up the TATA AIG Elder Care Plan:

• Inpatient hospitalisation benefit: This cover insures the majority of costs when you are hospitalised for over 24 hours. It covers room rent, nursing services, medications that are prescribed by the doctor, consultation fees of the doctor, ICU charges, and other expenses when you get treated in the hospital. The policy safeguards you against the monetary burden of such costs.
• Pre-hospitalisation expenses coverage: Before you get hospitalised, you might have to get some medical checks done, blood tests, X-rays, CT scans, etc. These are referred to as pre-hospitalisation costs. In this policy, these costs are reimbursed for 30 days, up to the limit of the sum insured. But only if they are directly because of the disease that resulted in your hospitalisation, and the claim has been approved under inpatient care.
• Post-hospitalisation expenses coverage: Following discharge, there could still be follow-up visits to the doctor, medical investigations, or checks. These are known as post-hospitalisation costs. The policy pays for these for 60 days, up to the amount insured. Similar to pre-hospitalisation, they are paid only if they are related to the illness for which you have been admitted, and your inpatient claim is sanctioned.
• Daycare treatment coverage: Daycare treatments are medical procedures or surgeries that previously required long hospital stays but can now be completed in under 24 hours due to advancements in medical technology. The TATA AIG Elder Care plan covers all daycare treatments up to the sum insured, so you don’t have to worry about the cost involved.
• Domiciliary treatment coverage: Domiciliary treatment refers to receiving medical care at home for a serious illness or injury when hospitalisation is not possible. This could be due to the patient’s condition or the unavailability of hospital beds. The TATA AIG Elder Care plan does not offer domiciliary treatment coverage.
• Organ donor coverage: This policy does not provide organ donor coverage.
• Modern treatment coverage: Modern treatments include advanced and technologically complex medical procedures. Under this plan, such treatments are covered without any financial limit, as long as they are medically necessary and fall under the listed procedures.
• Non-medical expenses coverage: Non-medical expenses, without any financial cap, are also covered by the TATA AIG Elder Care policy up to the limit of the sum insured. These include the expenses of consumables expended in the treatment process, like nebulisation kits, gloves, oxygen masks, and similar medical inputs. Under the non-medical expenses cover, personal comfort items, toiletries, cosmetics, conveniences, and external medical devices (like BIPAP, CPAP, etc.) are excluded.
• No Claim Bonus: During the policy term, if you don't raise any claims, the insurer gives you a No Claim Bonus (NCB). If you make a claim during the policy period, the bonus you’ve built up will be reduced in the same proportion as it was earned. You receive a 10% bonus annually for each year you remain claim-free up to a maximum of 100% of the sum insured, so your coverage increases with time.
• Super No Claim Bonus: This is an advanced level of the standard NCB and operates under the same principles. Nevertheless, the TATA AIG Elder Care policy doesn't have a Super No Claim Bonus.
• Restoration benefit: The restoration benefit is meant to reinstate your sum insured after it has been exhausted during a policy year due to claims. However, the TATA AIG Elder Care plan does not offer this benefit.

Please note that the limitations and conditions mentioned above apply to a sum insured of Rs. 10 lakhs.

TATA AIG Elder Care: Financial Limits

• Room rent limit: The room rent limit is the maximum amount your insurance policy will pay for your hospital room charges. As long as you choose a room within this limit, you won’t have to pay anything extra. But if the room costs more than your eligible limit, a proportionate deduction will apply. Under the TATA AIG Elder Care plan, the room rent is limited to a single private room.
• ICU rent limit: The ICU rent limit refers to the maximum amount the insurer will cover for your stay in the Intensive Care Unit. With the TATA AIG Elder Care plan, there is no limit on ICU rent. ICU charges are covered in full, up to the total sum insured.
• Copayment: Copayment refers to paying a percentage of the claim amount yourself, and the rest is paid by the insurer. In the TATA AIG Elder Care plan, copayment is not required, but if the appropriate add-on is opted.
• Deductible: A deductible is the amount that you must pay upfront before the insurance plan begins paying for your medical expenses. The TATA AIG Elder Care plan has no deductible options available.
• Limits on surgeries/treatments: This refers to the maximum amount covered for certain medical procedures or treatments. Some health plans set limits here. Under the TATA AIG Elder Care plan:
  • Cataract treatment coverage:
    • Zone A: Up to Rs. 75,000
    • Zone B: Up to Rs. 70,000
    • Zone C: Up to Rs. 60,000
  • Joint replacement surgery coverage:
    • Zone A: Up to Rs. 3,00,000
    • Zone B: Up to Rs. 2,85,000
    • Zone C: Up to Rs. 2,50,000

Please note: The above financial limits apply to a 30-year-old individual with a sum insured of Rs. 10 lakhs.

TATA AIG Elder Care: Waiting Periods & Exclusions

👉 Waiting period

The waiting period is the duration after purchasing a health insurance policy during which certain illnesses or treatments are not covered. You can only raise claims for these conditions after the waiting period ends.

Here are the key types of waiting periods:

• Initial waiting period: For all illnesses except those caused by accidents, there is an initial waiting period of 30 days. During this time, you cannot raise a claim for hospitalisation unless it is due to an accident.
• Waiting period for pre-existing illnesses: Pre-existing illness means any sickness or disease you suffered in the 36 months preceding the purchase of the policy. Under the TATA AIG Elder Care plan, there is a waiting period of 24 months for pre-existing diseases. You will not be able to claim any costs arising out of these conditions during this period.
• Waiting period for specific diseases: Apart from pre-existing conditions, insurers also apply a waiting period for a list of specific illnesses, regardless of your medical history. Under the TATA AIG Elder Care plan, the waiting period is 24 months, and for joint replacement surgeries, it is 36 months.

👉 Exclusions

Exclusions refer to specific situations or conditions that are not covered under a health insurance policy. Below are some of the common exclusions:

• Standard Permanent Exclusions: As per the guidelines of the Insurance Regulatory and Development Authority of India (IRDAI), every health insurance provider must follow a defined list of standard permanent exclusions. Some of these include:
  • Investigation and evaluation: Hospital stays are done only for observation or monitoring.
  • Rest, rehabilitation, and respite care: Admission to a facility solely for rest or recovery, without active treatment.
  • Obesity/weight control: Surgeries, treatments, or procedures aimed at weight loss.
  • Gender reassignment: Medical interventions undergone in order to alter physical features in accordance with a different gender identity.
  • Plastic/Cosmetic surgery: Procedures or operations performed to modify or improve looks.
  • Adventure sports profession: Injuries sustained when engaged professionally in sporting activities like river rafting, mountaineering, scuba diving, etc.
  • Violation of law: Treatment for injuries sustained in attempting to commit an offense.
  • Excluded providers: Care received from hospitals or doctors not included in your policy.
  • Narcotics: Treatment or rehabilitation for dependency on alcohol, drugs, or allied substances.
  • Treatments in establishments arranged for domestic purposes: Treatment received in centres such as nursing homes, spas, or other home-based care arrangements not meant for medical treatment.
  • Dietary supplements bought over the counter: Vitamins, minerals, or other supplements that have not been prescribed by a registered medical practitioner.
  • Refractive error: Costs to treat refractive errors up to 7.5 diopters for vision correction.
  • Unproven treatments: Any medical intervention, surgery, or procedure that is not proven effective.
  • Sterilisation, conception, and infertility costs: Costs associated with sterilisation, contraceptives, artificial insemination, and high-tech fertility treatments such as IVF, GIFT, ZIFT, ICSI, and gestational surrogacy.
  • Maternity costs: Fees for maternity services, such as prenatal, postnatal, and delivery costs.
• Additional Permanent Exclusions: Apart from the standard exclusions, insurers can also apply additional permanent exclusions for certain diseases or conditions they consider too risky to insure. However, such exclusions must be from the approved list provided by IRDAI. Insurers are not allowed to permanently exclude any illness or condition that is not included on this list.
• Non-standard exclusions (Specific exclusions): Non-standard exclusions go beyond the standard permanent exclusions defined by the IRDAI. These exclusions are specific to each insurer and are based on the detailed terms and conditions outlined in the policy. Here are some of the specific exclusions under the TATA AIG Elder Care plan:
  • Treatment for alcoholic pancreatitis
  • Treatment related to external birth defects or anomalies
  • Expenses related to stem cell therapy (except for bone marrow transplant in haematological conditions)
  • Growth Hormone Therapy
  • Treatment for sleep apnoea
  • Venereal and sexually transmitted diseases
  • Preventive care, vaccination, inoculation, and immunisation costs (except post-bite treatment and other covered vaccines)
  • Any kind of surgery or dental treatment
  • Costs for hearing aids, spectacles, contact lenses, and optometric therapy
  • Expenses related to hair loss treatments or equipment, elastic stockings, and other similar medical supplies
  • Crutches or other external equipment used for diagnosis or treatment, except during surgery

What can you expect in terms of Claims Experience if you buy from Tata AIG General Insurance Company Limited?

• Speed of claims: Tata AIG General Insurance Company Limited has settled 84.12% of claims within 30 days, indicating a quick and hassle-free claims process for insured individuals
• Claim-related complaints: It was determined in the study that the percentage of complaints received by the insurer on overall claims is 0.12%, which is higher compared to other companies.
• Claims incurred ratio: Claims incurred ratio refers to the claims paid as compared to the premium received in a given fiscal year. Tata AIG General Insurance Company Limited’s ratio of 77.94% demonstrates how effectively the company is paying out claims from its overall income.
• Claim settlement ratio: The claim settlement ratio indicates the percentage of claims settled during a financial year out of the total claims received. Tata AIG General Insurance Company Limited has reported a claim settlement ratio of 94.51%.
• Network hospitals: Tata AIG General Insurance Company Limited offers access to a wide network of over 12,000 hospitals. This large network enables customers to avail of cashless treatment across different locations with ease.

How is the Customer Service of Tata AIG General Insurance Company Limited?

• Policy purchase complaints: Our research shows that Tata AIG General Insurance Company Limited has a complaint ratio of 0.01% for its after-sales service.
• Response on Toll-Free: Based on our research, the response time on toll-free for TATA AIG General Insurance Company Limited is average when compared with other companies.
• Twitter response time: According to our studies, Tata AIG General Insurance Company Limited’s Twitter response time is quick in comparison to other insurers.

About Tata AIG General Insurance Company Limited

Tata AIG General Insurance Company Limited is a joint venture between the Tata Group and American International Group. The company offers Home Insurance, Motor Insurance, Travel Insurance, Health Insurance, and Rural-Agriculture Insurance for individuals. For corporates, it offers Property & Business Interruption Insurance, Directors & Officers (D&O) Insurance, Professional and General Liability Insurance, along with others. It started operating in 2001 with its headquarters in Mumbai, India. Mr. Neelesh Garg is the firm’s CEO and Managing Director.