Family Health Insurance

Family health insurance is medical insurance coverage that covers you and your family members under a single plan. The family members that get covered under this type of health insurance plan are the insured themselves, their spouse, children, parents and parents-in-law.

Since the coverage extends to multiple members under one policy, the sum insured is shared among all insured individuals. The family medical insurance plan covers various types of medical expenses such as hospitalisation expenses, health check-ups, Ayush benefits and much more.

Also Read: How Health Insurance works

Also Read: Individual Health Insurance

MediCare

TATA AIG offers a MediCare health insurance plan for families that offers comprehensive medical coverage. The minimum sum insured for this plan is ₹3 lakhs, and the highest sum insured can go up to ₹20 lakhs. Under this plan, the family can get a maximum discount of 32% for more than 3 members.

MediCare Premier

Families looking for enhanced coverage, such as high-end diagnostics, OPD treatment, and more, go with a TATA AIG MediCare Premier plan. The minimum sum insured under this plan is ₹5 lakhs, and it can go up to 3 crore.

Medicare Lite

For individuals and families looking for a cost-effective health insurance plan, we offer MediCare Lite, which offers comprehensive medical coverage in our empanelled network of “Valued Providers.”

Medicare Plus

With rising medical treatment costs, getting quality healthcare can be expensive. That is why we have a MediCare Plus health insurance plan for families. It is a type of health insurance plan that provides additional benefits and coverage over regular health insurance policies.

Criti Medicare

TATA AIG offers a Critic MediCare plan for families, which covers over 100+ critical illnesses. With this plan, if the insured or any of the family members mentioned in the policy document are diagnosed with a medical condition, they will receive a lump sum payout for treatment.

Also Read: Health Insurance for Parents

Restore Benefits

Medical emergencies and the hospitalisation costs that come with them can be expensive. This is why our MediCare plans come with an automatic restoration benefit. It enables the automatic refilling of your sum insured amount if you have exhausted your sum insured during a single policy year.

Wellness Programs and Services

At TATA AIG, we understand that nothing is more important than your health. Our wellness programs under our health insurance plans exemplify this and encourage you and your family to improve your health and fitness. We do this by offering redeemable vouchers for fitness services and discounts on pharmacy and diagnostics.

Guaranteed Cumulative Bonus

Under our MediCare plans, you can get a maximum cumulative bonus of up to 100% of your sum insured. This bonus is available on consecutive renewals with TATA AIG without a break. A 10% - 50%* (depending on the policy) cumulative bonus in health insurance will be applied to your sum insured for the next policy year after every claim-free policy year.

Compassionate Travel

A family health insurance plan offered by TATA AIG also includes compassionate travel. Suppose a policyholder is admitted to a hospital in India for five consecutive days in a place where no adult family member is present. In that case, we will cover travel expenses, which include round-trip economy-class air tickets or first-class railway tickets.

Global Cover

Another benefit of purchasing a TATA AIG family health insurance plan is global coverage for treatment outside India. If you are diagnosed with an illness in India and want to get treatment outside, the plan will cover the cost of the treatment.

Also Read: Benefits of Health Insurance

In-patient Treatment

One common inclusion under TATA AIG’s family health insurance plan is coverage for any disease, illness or injury that requires an insured person’s admission to the hospital. This covers all medical expenses that are directly related to hospitalisation.

Pre-Hospitalisation Expenses

The family health insurance plan also covers pre-hospitalisation expenses, which include consultations, medicines and investigations up to 60 days before hospital admission.

Post-Hospitalisation Expenses

The family health insurance offered by TATA AIG also covers post-hospitalisation expenses, including investigations, medicines, and consultations, up to the number of days specified in the policy after discharge from the hospital.

Organ Donor

The plan also covers the medical and surgical expenses for the person donating an organ to the insured person, provided the donation complies with the legal guidelines outlined in the Transplantation of Human Organs (Amendment) Bill, 2011.

AYUSH Benefit

TATA AIG’s family health insurance plan also covers medical expenses incurred for day care or inpatient treatment in AYUSH centres or hospitals. The benefits also cover pre and post-hospitalisation medical expenses, as mentioned in the policy.

Bariatric Surgery Cover

Family health insurance will also cover reasonable and necessary expenses for Bariatric Surgery if it is advised by a doctor.

However, the insured needs to be 18 years or older and have a BMI of 40 or more or a BMI of 35 or more, along with serious obesity-related health issues such as heart disease, severe sleep apnea, etc. after trying less invasive weight-loss methods.

Second Opinion

If an insured person is diagnosed with any of the following conditions during the policy period—cancer, kidney failure, heart attack, etc, the plan also offers a one-time second medical opinion from a network provider or qualified doctor.

High End Diagnostics

The plan will cover reasonable expenses for certain diagnostic tests done on an OPD basis, if required, as part of medically necessary treatment. The covered tests include Brain Perfusion Imaging, CT-guided Biopsy, CT Urography, DSA, Liver Biopsy, MR Cholangiography, PET CT, PET MRI, etc.

Accidental Death Benefit

If an insured person dies within 365 days of an accident that occurred during the policy period, and the accident is the only cause of death, we will pay 100% of the base sum insured, up to a maximum of ₹50 lakhs. This benefit does not apply to dependent children covered under the policy.

Emergency Air Ambulance

The family medical insurance plans also cover the cost of air ambulance transportation for the insured person in case of a life-threatening emergency that requires urgent transfer to a hospital for treatment. This is only covered if a doctor prescribes it and is medically necessary.

Note: These are some common benefits of the TATA AIG MediCare Premier policy. The inclusion may vary depending on the plan and sum insured.

• Medical expenses incurred for treatment of substance abuse, such as drugs, alcoholism, etc, are generally not covered under the plan.

• Medical expenses incurred due to self-injury or attempted suicide are not covered under the plan.

• Any illness or injury diagnosed or occurring after the proposal but before the policy start date, if not disclosed and accepted by the insurance provider, is not covered.

• Any injuries or illnesses caused by war, acts of war, invasion, civil war, rebellion, revolution, military action, etc., are not covered.

• Step 1: To buy family health insurance, visit the official TATA AIG website. Next, click on the “Personal” option and go to the “Health Insurance" section.

• Step 2: Choose the plan, and then select the insured family member such as self, spouse, parents, children, etc. After selecting the family member, click on the “Get Plan” option.

• Step 3: Enter the date of birth of family members and other details, and then click on the “See Plan” option. The different plans will appear, and compare health insurance premiums, coverage and sum insured.

• Step 4: Fill out the health insurance application form and upload all necessary documents. Once the document is submitted, pay the family health insurance premium.

• Step 5: Upon successful payment, the purchase policy will be sent instantly to your email address.

The procedure for filing a claim for family health insurance plans from TATA AIG involves two procedures which are:

• Cashless Claims
• Reimbursement Claims

TATA AIG Family Health Insurance Cashless Claim Process

• Step 1: To take cashless benefits, inform the TATA AIG’s representative within 24 hours of emergency hospitalisation and in case of planned hospitalisation, inform 48 hours prior to the admission.
• Step 2: Carry all the essential documents, such as policy documents, insurance cards and identity documents.
• Step 3: Visit the hospital TPA’s desk and fill out the pre-procedural forms. The TPA will raise the request for a cashless claim.
• Step 4: After reviewing the application, TATA AIG releases an authorisation letter that will be sent to hospitals directly.
• Step 5: Individuals and their family members can get medical treatment in the hospital. The bills will be settled directly by the TATA AIG and sent to the hospital.

TATA AIG Family Health Insurance Reimbursement Claim Process

• Step 1: To claim reimbursement, visit the TATA AIG’s website and fill out the claim form.
• Step 2: Submit all the documents, such as the claim form, discharge summary, prescription bills and more, to TATA AIG’s representative.
• Step 3: Upon receiving the documents, we will verify them and, based on that, either approve or reject the claim request.
• Step 4: If the family health insurance claim request has been approved, we will initiate the process of releasing the compensation amount.
• Step 5: Within a few days, you will receive the amount in your registered bank account.

• Original health insurance policy documents.
• All medical reports, case histories, investigation reports, treatment papers, etc.
• Documents to prove policyholder identity, such as Aadhar cards, passports, etc.
• Document to proof address such as ration card, etc.
• Any additional documents needed by the insurance company representatives.

Comprehensive Coverage & Benefits

One factor to consider while choosing family insurance is coverage and benefits. It is best to choose a plan that offers comprehensive coverage for insured family members, such as domiciliary treatment, day care procedures, maternity coverage and more.

Sum Insured Flexibility

Choose a family health insurance plan that allows the sum insured to be enhanced at the time of renewal. If at any time you want to expand your sum insured based on the family members and changing health needs, the plan should allow you to do so easily at renewal.

Easy Cashless Claim

When choosing affordable health insurance for families, it is best to look for a plan that offers a streamlined cashless claim process. Opt for insurance providers that are known for their quick claim approvals, minimal documentation, and efficient turnaround times

Waiting Period

The waiting period is another crucial thing to look for while buying the best medical insurance coverage for families. The waiting period is the time during which policyholders cannot access plan coverage. Once the waiting period is over, they can use the plan benefits. The waiting period for maternity cover in health insurance plans for families is 4 years, while for the pre-existing disease, it is 2 years.

Also Read: Waiting Period in Health Insurance

Policy Inclusions and Exclusions

Being aware of what the plan does and does not cover helps avoid surprises at the time of claim. Additionally, it is important to review key policy features such as portability options, renewal conditions, and provisions for mid-policy additions, especially if you plan to add new family members, like children, in the future.

Claim Settlement Ratio

While choosing a family health insurance plan, it is also crucial to check the claim settlement ratio. This helps decide how smooth the claim process is. The insurance provider with a high claim settlement ratio (over 90%) generally offers the best claim services.

A health insurance plan for a family not only provides coverage for all family members under one policy but also ensures that medical expenses are covered in case of illness, injury, or medical emergencies, offering financial security and peace of mind.

When it comes to the best medical coverage, TATA AIG offers the best family health insurance plan that can be customised based on your family’s healthcare needs. Secure your family with our health insurance plans today!

Sum Insured

This is the amount of money your insurer provides access to on policy purchase, which is used to cover your medical expenses.

Health Insurance Premium

A premium is a regular payment made to your insurer in exchange for the health insurance coverage they provide. The amount can vary depending on your policy type, your age and the sum insured.

Restoration Benefit

This is a feature included in our health insurance plan that recovers your full sum insured upon exhaustion during the policy term. For example, if you have a sum insured amount of ₹10 lakhs and it has been exhausted due to a medical emergency, then we will restore the amount up to the base sum insured (₹10 lakhs) upon exhaustion.

Cumulative Bonus

This is a benefit offered to policyholders on renewal if they have not filed any claims in the previous policy year. It increases your sum insured amount by a certain percentage without the need for an extra premium.

Critical Illness Insurance

This is a separate health insurance plan or add-on cover that provides coverage for critical illnesses like cancer. These plans have higher sum insured amounts and higher premiums.

Waiting Period

This is a time frame within which you can not claim coverage under your health insurance plan. The waiting period is only waived in case of accidents or emergencies. Most health insurance plans have an initial waiting period of 30 days from policy inception, after which you can claim medical coverage.

Network Hospital

This is a hospital that has a tie-up with the insurance provider to provide cashless claim facilities and lower fee rates to policyholders. Every health insurance provider has a list of network hospitals.