Tata AIG MediCare Premier

TATA AIG Medicare Premier is a health insurance policy offered by Tata AIG General Insurance Company Limited. 

The TATA AIG Medicare Premier Plan provides a range of features, benefits, and add-ons that address your and your family's medical needs. It ensures that you and your loved ones are protected during medical emergencies, easing any financial burden. However, it does not provide the monthly premium payment option. Additionally, according to our research, the insurer has received fewer claim settlement complaints but a higher number of policy purchase complaints.

What are the benefits offered by the TATA AIG Medicare Premier Plan?

• Inpatient hospitalization coverage: Like every other health insurance plan, the TATA AIG Medicare Premier Plan covers inpatient hospitalization expenses. These include expenses incurred when you are admitted to a hospital for more than 24 hours. Inpatient hospitalization expenses include room boarding and nursing charges, medical practitioner’s fees, cost of prescribed medicines and drugs, ICU charges, and other related expenses.
• Pre-hospitalization coverage: Pre-hospitalization charges refer to the medical expenses incurred before hospitalization, such as consultations, tests, checkups, and lab reports. These expenses will be covered by the insurer only if they are related to the medical condition for which you are later hospitalized, and your claim for them must be approved as part of inpatient hospitalization coverage. The TATA AIG Medicare Premier Plan covers pre-hospitalization expenses incurred up to 60 days before hospitalization.
• Post-hospitalization coverage: Post-hospitalization expenses refer to the medical costs that you may incur after being discharged from the hospital. These expenses may include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and more. To be eligible for coverage, the post-hospitalization expenses must be related to the condition you were hospitalized for and your claim must be approved under inpatient hospitalization. Under the TATA AIG Medicare Premier Plan, you are covered for post-hospitalization expenses incurred up to 90 days after hospitalization.
• Daycare treatment coverage: A daycare treatment is a medical procedure or surgery that traditionally required an extended hospital stay but can now be completed within 24 hours due to advancements in medical technology. All daycare procedures are covered by the TATA AIG Medicare Premier Plan. It imposes no limit on any daycare treatment, meaning the expenses will be covered up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments refer to medical treatments for illnesses or injuries that require immediate attention in a hospital but are administered at home because the patient is very ill or injured and cannot be transported safely to a hospital, or because there are no hospital beds available in the patient's immediate vicinity. The TATA AIG Medicare Premier Plan will cover domiciliary treatment costs up to the sum insured - subject to the treating doctor’s certification. And, the expenses will be payable only for treating an illness. 
• Organ donor coverage: The TATA AIG Medicare Premier Plan also provides coverage for organ donor expenses. It covers the costs associated with harvesting the organ, up to the sum insured you opt for under the policy.
• Modern treatment coverage: The field of healthcare is rapidly evolving with advancements in technology, leading to the development of modern treatments that were once considered impossible. These treatments, such as radio surgeries, stem cell therapy, etc. aim to cure ailments that were previously thought to be incurable. The TATA AIG Medicare Premier Plan is designed to keep pace with these advancements and covers the expenses associated with modern treatments, up to the sum insured.
• Non-medical expenses coverage: The TATA AIG Medicare Premier Plan not only covers medical expenses but also includes coverage for non-medical expenses. These non-medical expenses refer to the cost of consumables, such as gloves, nebulization kits, oxygen masks, and other items necessary for treatment. These consumables can often be expensive and can add up to a significant amount. The plan provides coverage for these expenses up to the sum insured, which can help alleviate the financial burden of such costs.
• No Claim Bonus: No-Claim Bonus is a reward given by the insurance company if no claim is made during the policy period. In the case of Tata AIG Medicare Premier Plan, if you do not make any claims during the previous policy year, you will be eligible for a bonus of 50% of the sum insured. However, if you make a claim during the policy period, the accumulated bonus amount will be reduced. The maximum bonus that can accumulate under this plan is 100% of the sum insured.
• Super No Claim Bonus: This is an accelerated version of the No Claim Bonus and works exactly like it. The TATA AIG Medicare Premier Plan doesn’t provide the Super No Claim Bonus feature. 
• Restoration Benefit: The Restoration Benefit is a feature where your sum insured is restored once it has been depleted within a policy year. Under the Tata AIG Medicare Premier Plan, the refill benefit is applicable for unrelated illnesses (for related illnesses, it is available after 45 days). It will activate only when the sum insured and No Claim Bonus are fully exhausted. And, the refill will apply once in a policy year and will be applicable for subsequent claims only.

Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured. 

TATA AIG Medicare Premier: Financial Limits

• Room rent limit: The maximum amount that your insurance company will cover for the room you are hospitalized in is known as the room rent limit. If you select a room that falls within your plan's room rent limit, you will not incur any out-of-pocket expenses. However, if you opt for a room with a higher rent than your eligibility, you will be subject to a proportionate deduction. This implies that you will be responsible for paying a proportionate share of the entire bill, rather than just the difference in the room rent. Under TATA AIG Medicare Premier Plan, you can choose any room type - there is no restriction. 
• ICU rent limit: This limit refers to the maximum amount that the health insurance policy will cover for the cost of a stay in the intensive care unit (ICU) of a hospital. It is worth noting that there is no ICU rent limit in the TATA AIG Medicare Premier Plan. This means that the plan covers the full cost of an ICU stay without any cap on the amount.
• Copayment: A copayment, or copay, is a portion of the approved claim amount that you are responsible for paying out of pocket. After you pay the copay, the insurance company will cover the remaining amount. There is no copayment limit in the TATA AIG Medicare Premier Plan. 
• Deductible: A deductible is the amount of money that you must pay out of your own pocket before your health insurance coverage kicks in to pay for medical expenses. The TATA AIG Medicare Premier Plan does not have any deductible limit.
• Limits on surgeries/treatments: This refers to the maximum amount that the health insurance policy will cover for specific medical procedures or treatments. Some policies may have specific limits on the amount that they will cover for certain procedures, while others may not have any such limits. Under the TATA AIG Medicare Premier Plan, there is no limit on important surgeries and treatments like cataract treatment or joint replacement surgery. Meaning, the policy covers the full cost of cataract treatment and joint replacement surgery without any cap on the amount.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs. 

TATA AIG Medicare Premier: Waiting Periods & Exclusions

👉Waiting period

After you purchase a health insurance policy, some illnesses and diseases may not be covered for a certain period of time, which is known as the waiting period. Once this period ends, you will be able to claim for these conditions. There are different types of waiting periods such as - 

• Initial waiting period: There is an initial waiting period of 30 days for all medical conditions except for accidents. Meaning, you will not be able to make a claim for any hospitalization for the initial 30 days, except in cases of accidents. 
• Waiting period for pre-existing diseases: A pre-existing disease is any medical condition or illness that you have had in the 48 months before applying for the health insurance policy. Under TATA AIG Medicare Premier Plan, there is a waiting period of 24 months applicable for pre-existing diseases. During this period, the policy will not cover any related expenses you undergo related to your pre-existing diseases. 
• Waiting period for specific diseases: Insurers will have a specified list of medical conditions or illnesses, other than your pre-existing conditions, which will have a waiting period regardless of whether you have had those diseases before or not. This waiting period is solely determined by the insurer and is not based on your current health status. TATA AIG Medicare Premier Plan has a waiting period of 24 months for specific diseases. 

👉Exclusions

Exclusions are situations that will not be covered under your health insurance policy. They include - 

• Standard permanent exclusions: The IRDAI has established a set of 'standard permanent exclusions', which are required to be enforced by all insurance companies. Some of these include - 

1.  Investigation and evaluation: Hospital admission solely for observation or monitoring purposes.
2. Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, where no active treatment is provided.
3. Obesity/weight control: Treatment or surgery for weight control or obesity.
4. Change of gender treatment: Treatment aimed at altering the body's characteristics to those of the opposite sex.
5. Plastic/cosmetic surgery: Treatment or surgery intended to modify body characteristics or appearance.
6. Profession in hazardous or adventure sports: Treatment expenses incurred while participating as a professional in adventure activities like river rafting, mountaineering, scuba diving, horse racing, etc.
7. Breach of law: Expenses related to the treatment of a person who has committed or attempted to commit a breach of law with criminal intent.
8. Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
9. Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged for domestic purposes: Expenses of treatment undergone in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances purchased without prescription: Vitamins, minerals, etc. not prescribed by a medical practitioner.
12. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility infertility: Contraception, sterilization, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalization expenses, etc.

• Additional permanent exclusions: In addition to the above standard permanent exclusions, insurance companies may impose additional exclusions for particular situations or medical conditions. If you have certain diseases or severe medical conditions that insurers consider risky to cover, they may permanently exclude them from your policy. However, it is crucial to understand that insurers are limited to a list of illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can apply a permanent exclusion. They cannot apply permanent exclusions to illnesses or diseases outside this list.
• Non-standard exclusions (Specific exclusions): These are specific exclusions that go beyond the standard permanent exclusions listed by the IRDAI. These exclusions may vary between insurance companies and may depend on the policy terms and conditions. Here is a list of some top specific exclusions under the TATA AIG Medicare Premier Plan - 

1. Treatment for alcoholic pancreatitis
2. Treatment related to external birth defects or anomalies
3. Stem cell therapy except for bone marrow transplant for hematological conditions
4. Growth hormone therapy
5. Treatment for sleep apnoea
6. Venereal and sexually transmitted diseases
7. Preventive care, vaccination, inoculation, and immunization costs (except post-animal bite treatment)
8. Dental treatment except for treatment required due to an accident
9. Injury or illness directly or indirectly due to terrorism, nuclear emissions, war, civil war
10. Injury or illness due to participation or involvement in naval, military, or air force operation
11. Treatment related to intentional self-inflicted injury or attempted suicide by any means
12. Provision or fitting of hearing aids, spectacles, contact lenses, and other similar products
13. Expenses related to hair loss treatments and products
14. Crutches or external equipment of any kind used for diagnosis or treatment, unless necessitated due to accident

What to expect in terms of claims experience if you buy from Tata AIG General Insurance Company Limited?

• Speed of claims: Tata AIG General Insurance Company has settled 69.59%of claims in less than 30 days. This indicates that you might have to wait a little longer to receive the claim amount.
• Claim-related complaints: According to our research, we found that Tata AIG General Insurance Company has received a very less number of complaints related to claims in comparison to other insurance companies. This suggests that their claims settlement process is smooth and that you are likely to have a hassle-free experience.
• Claims incurred ratio: The claims incurred ratio is a measure of an insurance company's financial performance. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected. The claims incurred ratio of TATA AIG General Insurance Company is 90.22%. 
• Claim settlement ratio: The claim settlement ratio refers to the percentage of claims that an insurer has settled by the insurer as compared to the total number of claims received by them in a financial year. TATA AIG General Insurance Company’s claim settlement ratio is 83.17%.
• Network hospitals: Tata AIG General Insurance Company has a vast network of hospitals, with over 7,200+ hospitals included in their network. The large number of network hospitals offered by Tata AIG General Insurance Company means that you have access to a wide range of healthcare providers in different locations - and you can avail of cashless treatment without worrying about the financial burden.

How is the customer service of Tata AIG General Insurance Company Limited?

• Policy purchase-related complaints: TATA AIF General Insurance Company has received 0.01% of complaints related to their after-sales service - as per our research.
• Response on Toll-Free: When it comes to customer service, our research found TATA AIG General Insurance Company’s response over the toll-free to be average compared to other insurance companies. 
• Response on Twitter: Our research suggests that Tata AIG General Insurance Company’s response rate over Twitter is quick.

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 insurance company offers a wide range of insurance products for individuals as well as corporates. It was established in 2001 and is based in Mumbai, Maharashtra. Mr. Neelesh Garg currently serves as the CEO and MD of the company.