Tata AIG Medicare is a health insurance policy offered by Tata AIG General Insurance Company Limited.
With distinctive features and benefits, it makes an excellent choice for those looking for a health insurance plan that meets their unique healthcare needs. Apart from hospitalisation expenses, it also covers dental treatment expenses and bariatric surgery (performed for weight loss) costs.
It is, however, not possible to pay the premiums on a monthly basis. We also found that the insurer received fewer complaints regarding claims settlement, but higher complaints related to policy purchases. This suggests that the insurer needs to focus on improving its policy purchase process in order to satisfy its customers.
What are the benefits offered by the Tata AIG Medicare Plan?
- Inpatient hospitalisation coverage: Expenses incurred when you are admitted to a hospital for more than 24 hours are called inpatient hospitalisation expenses. These include room boarding and nursing charges, medical practitioner’s fees, cost of prescribed medicines and drugs, ICU charges, and other related expenses. Tata AIG Medicare Plan covers these inpatient hospitalisation expenses.
- Pre-hospitalisation coverage: Expenses you incur before getting hospitalised are called pre-hospitalisation expenses. These include costs associated with consultations, tests, checkups, lab reports, etc. Your insurer will cover these expenses only if they are related to the medical condition for which you are later hospitalised and the claim is approved under inpatient hospitalisation coverage. Pre-hospitalisation expenses incurred up to 60 days before hospitalisation are covered by the Tata AIG Medicare Plan - up to the sum insured.
- Post-hospitalisation coverage: Expenses you incur after being discharged from the hospital are called post-hospitalisation expenses. These include follow-up consultations with your doctor, medical check-ups, rehabilitation sessions, physiotherapy, and more. In order to be eligible for coverage, your post-hospitalisation expenses must be related to the condition you were hospitalised for and your claim must be approved under inpatient hospitalisation. Tata AIG Medicare Plan covers post-hospitalisation expenses for up to 90 days after hospitalisation - up to the sum insured.
- Daycare treatment coverage: Previously, a daycare treatment required an extended hospital stay, but thanks to advancements in medical technology, it can now be completed within 24 hours. Tata AIG Medicare Plan covers 541 daycare procedures. It does not impose any limit on daycare expenses, so they will be covered up to the sum insured.
- Domiciliary treatment coverage: If you require medical attention but cannot be transported safely to a hospital because of the severity of illness or injury, or because there are no hospital beds available, these medical treatments can be administered at home. This falls within the ambit of domiciliary hospitalisation. Domiciliary treatments will be covered by the Tata AIG Medicare Plan up to the sum insured - if the treating doctor certifies it. Only expenses associated with treating an illness will be covered.
- Organ donor coverage: The Tata AIG Medicare Plan covers organ donor expenses, where you are the recipient. It covers the costs associated with harvesting the organ from the organ donor for organ transplantation up to the sum insured you choose at the time of purchasing the policy.
- Modern treatment coverage: Healthcare is undergoing a rapid transformation with advancements in technology, leading to the development of modern treatments that were once thought to be impossible. These treatments include radio surgeries, stem cell therapy, etc. that aim to cure ailments that were once regarded as incurable. Such treatments bring hope to many patients, offering them the opportunity to experience a new lease on life. The Tata AIG Medicare Plan keeps up with technological advances and covers modern treatments up to the sum insured.
- Non-medical expenses coverage: Consumables, such as gloves, nebulizer kits, oxygen masks, and other items necessary for treatment are considered non-medical expenses. Often, these consumables build up and become expensive, putting a financial strain on those who need to access medical care. Tata AIG Medicare Plan covers such expenses up to the sum insured - providing you with much-needed financial relief.
- No Claim Bonus: A No-Claim Bonus is a reward given by the insurance company if you don't make any claim during the policy period. Under the Tata AIG Medicare Plan, you will be entitled to receive a bonus of 50% of the sum insured if you do not make any claims during the previous policy year. A maximum bonus of 100% of the sum insured can be accumulated. The accumulated bonus amount will, however, be reduced if you make a claim during the policy period.
- Super No Claim Bonus: This is an enhanced version of the No Claim Bonus. The Tata AIG Medicare Plan does not offer a Super No Claim Bonus.
- Restoration Benefit: The Restoration Benefit restores your sum insured if it is depleted within the policy year. This allows you to continue to be protected against unforeseen medical expenses throughout the year, without the need to purchase additional coverage. The Tata AIG Medicare Plan offers refill benefits for unrelated illnesses immediately. For related illnesses, the restoration benefit will be available only if you're admitted to the hospital for that illness at least 45 days from the date of discharge of your earlier claim. The benefit activates once the sum insured and any No Claim Bonus are fully exhausted. Refills are applicable once per policy year and are available 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: Financial Limits
- Room rent limit: A room rent limit is an important factor to consider when choosing a health insurance plan. It is the maximum amount that the insurance company will cover for the room in which you are hospitalised. Choosing a room that is within the room rent limit of your plan will ensure that you do not incur any additional costs. There will, however, be a proportionate deduction if you choose a room with a higher rent than your eligibility. As a result, you will be required to pay a proportionate share of the total bill rather than just the difference in room rent. With the Tata AIG Medicare Plan, you are free to choose any type of room you want.
- ICU rent limit: It is the maximum amount that the health insurance policy will cover for a stay in the intensive care unit (ICU) of a hospital. There is no ICU rent limit in the Tata AIG Medicare Plan. So, the expenses associated with ICU stay are covered up to the sum insured.
- Copayment: The copayment, or copay, is the portion of the approved claim amount that you are responsible for paying from your end before the insurance company steps in to cover the remaining amount. Tata AIG Medicare Plan does not have a copayment limit.
- Deductible: A deductible is the amount you are required to pay before your health insurance coverage begins to pay for medical expenses. Tata AIG Medicare Plan has no deductible limit.
- Limits on surgeries/treatments: It is the maximum amount that a health insurance policy will pay for a particular medical procedure or treatment. Certain policies may have specific limits on the amount they will cover for certain procedures, while others may not. Tata AIG Medicare Plan places no limit on important surgeries and treatments like cataract treatment or joint replacement and provides coverage up to the sum insured.
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: Waiting Periods & Exclusions
Certain illnesses and diseases may not be covered for a certain period of time after you purchase health insurance. This is known as the waiting period. Once the waiting period has elapsed, you may submit claims for any medical expenses related to those conditions. Here are the different types of waiting periods -
- Initial waiting period: All medical conditions except for accidents have a 30-day waiting period. During the initial 30 days, you aren’t allowed to file a claim for any treatments, other than those related to 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. Pre-existing diseases are subject to a 36-month waiting period under the Tata AIG Medicare Plan. The policy will not cover any pre-existing disease-related expenses during this period.
- Waiting period for specific diseases: It is common for insurers to have a waiting period for certain illnesses and conditions, other than pre-existing conditions, regardless of whether you have had them in the past. This waiting period is not based on your current health status. It is solely determined by the insurer. There is a 24-month waiting period for specific diseases under the Tata AIG Medicare Plan.
Health insurance policies exclude certain situations from coverage. These are called exclusions.
- Standard permanent exclusions: All insurance companies are required to adhere to a set of 'standard permanent exclusions' defined by the IRDAI. They include -
- Investigation and evaluation: Admission to the hospital for observation or monitoring only.
- Rest cure, rehabilitation, and respite care: Admission to a bed rest facility with no active treatment.
- Obesity/weight control: Weight loss or obesity surgery.
- Change of gender treatment: Treatment intended to change the body's characteristics to those of the opposite sex.
- Plastic/cosmetic surgery: Modification of the body's appearance or characteristics through treatment or surgery.
- Profession in hazardous or adventure sports: The cost of medical treatment incurred for injuries sustained while participating in adventures like river rafting, mountaineering, scuba diving, horse racing, etc.
- Breach of law: Treatment costs associated with a person who attempts or commits a breach of law with criminal intent.
- Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurance company.
- Narcotics: Addiction treatments such as alcohol addiction, drug use, etc.
- Treatments in establishments arranged for domestic purposes: The cost of treatment received in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic use.
- Substances purchased without prescription: Dietary supplements, minerals, etc. not prescribed by a physician.
- Refractive error: Treatment for correcting refractive errors of up to 7.5 diopters for bettering the vision.
- Unproven treatments: Unproven surgical procedures, medical procedures, or treatments.
- Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
- Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
- Additional permanent exclusions: Insurance companies may also exclude coverage for specific illnesses or situations besides those listed above - depending on particular situations or medical conditions. Certain diseases or conditions that insurers deem risky to cover may be excluded from your policy as well. Insurers, however, can only apply a permanent exclusion to a set of illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI). A permanent exclusion cannot be applied to illnesses other than those listed.
- Non-standard exclusions (Specific exclusions): Exclusions that go beyond the standard permanent exclusions listed by the IRDAI are specific exclusions. Depending on the policy's terms and conditions, these exclusions may vary across insurers. Below are some of the top specific exclusions under the Tata AIG Medicare Plan -
- Treatment for alcohol-induced pancreatitis.
- Treatment associated with external birth defects or anomalies.
- Stem cell therapy for haematological conditions except for a bone marrow transplant.
- Growth hormone therapy.
- Treatment for sleep apnoea.
- Venereal and sexually transmitted diseases.
- Preventive care, vaccination, inoculation, and immunisation costs (except for the treatment of post-animal bite).
- Dental treatment or surgery of any kind except those covered under inpatient treatment benefit.
- Direct or indirect injury or illness caused by terrorism, nuclear emissions, war, or civil war.
- An injury or illness sustained while participating in a naval, military, or air force operation.
- Treatment related to self-inflicted injury or attempted suicide of any kind.
- Hearing aids, spectacles, contact lenses and other similar products.
- Treatments and products associated with hair loss.
- Any external equipment like crutches, etc. used for diagnosis or treatment, except in the case of an 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 means you will need to wait a bit longer to receive your claim payment.
- Claim-related complaints: Based on our research, Tata AIG General Insurance Company has received a low number of complaints related to claims at 0.10%. This is a testament to the company's commitment to providing a superior customer experience.
- Claims incurred ratio: This metric evaluates the financial performance of an insurance company. It represents the total amount of claims incurred by the insurer compared to the total amount of premiums they collected. TATA AIG General Insurance Company has a claims incurred ratio of 78.33%.
- Claim settlement ratio: The claim settlement ratio is the percentage of claims settled by an insurer compared to the total number of claims they received in a financial year. The claim settlement ratio of TATA AIG General Insurance Company is 81.95%.
- Network hospitals: Tata AIG General Insurance Company has an extensive hospital network with 8000+ hospitals. So, you can choose from a variety of healthcare providers and receive cashless treatment without worrying about finances.
How is the customer service of Tata AIG General Insurance Company Limited?
- Policy purchase-related complaints: According to our research, TATA AIG General Insurance Company has received 0.01% of complaints related to after-sales service.
- Response on Toll-Free: Compared to other insurance companies, TATA AIG General Insurance Company's response on their toll-free number was average.
- Response on Twitter: According to our research, Tata AIG General Insurance Company responds quickly to Twitter inquiries.
About Tata AIG General Insurance Company Limited
Tata AIG General Insurance Company Limited is a joint venture between the Tata Group and the American International Group. As part of its comprehensive insurance services, the company offers Home Insurance, Motor Insurance, Travel Insurance, Health Insurance, Rural Agriculture Insurance, etc. to individuals, as well as Property & Business Interruption, D & O, Professional, and General Liability Insurance for corporates. Founded in 2001, it is headquartered in Mumbai, Maharashtra. The CEO and MD of the company is Mr. Neelesh Garg.