Health Insurance for Heart Patients

According to the Registrar General & Census Commissioner, India report, cardiovascular diseases account for 30% of deaths in India. With such a high prevalence, having health insurance for heart disease has become a necessity.

A medical insurance for heart patients is a medical coverage designed to address the medical conditions associated with the heart. These insurance policies for heart patients specifically cover expenses associated with hospitalisation, diagnosis, surgeries and more.

With the plan in place, patients with a cardiac history can receive timely and affordable medical care without financial strain.

Also Read: Congestive Heart Failure

With the prevailing number of heart-related ailments such as heart attack, stroke, etc, having heart insurance is a necessity. Here are some of the benefits of investing in the best health insurance for cardiac patients.

Lump Sum Payout

One of the benefits of having medical insurance for heart patients is the financial security it provides during medical crises.

The plan will provide a lump sum amount, as specified in the policy, to the policyholder in the event of a diagnosis with a critical illness, such as heart disease.

The amount will cover the high costs of surgeries, medications, and other expenses associated with treating heart conditions.

Access to Quality Care

With a heart patient heart insurance plan on your side, individuals do not have to worry about getting the specialised treatment in the best healthcare facilities. Typically, top-notch healthcare facilities are equipped with advanced equipment and staffed by experienced professionals.

Treatments at these facilities can be expensive, but with health insurance for heart patients, you will get timely and necessary medical attention in these facilities.

Pre-existing Conditions Coverage

The health insurance for heart patients also includes coverage for pre-existing diseases. It means that individuals suffering from existing heart conditions can also benefit from the policy.

However, to avail the benefit, policyholders need to fulfil the decided waiting period, which is mentioned in the policy.

Preventive Care & Early Detection

Many health insurance plans for individuals with heart conditions include annual preventive health check-ups and screenings.

This will help in diagnosing critical illnesses at an early stage and avoid serious complications. It also helps lower treatment costs and increases the chances of effective disease management and full recovery.

Anyone can purchase a health insurance plan that covers heart ailments. However, the following individuals should definitely consider investing in it.

• Individuals with a family history of heart diseases, such as heart attacks, strokes, etc.
• An individual who is already diagnosed with a heart condition requires ongoing treatment and management.
• People with sedentary lifestyles or high-pressure work who are more prone to heart diseases.

Also Read: Normal Heart rate for Men and Women

TATA AIG offers the Criti Medicare health insurance plan, which provides comprehensive protection against heart diseases. It pays lump-sum amounts on diagnosis of covered heart illnesses, with multi-pay options for multiple claims under different categories.

There are two main plans under this, namely the Smart Century Premier Plan and the Smart Half Century Plan. Each plan has three categories that cover various heart-related illnesses, including CABG, Pericardectomy, Angioplasty, and more. Let us take a look at the different categories.

How the Multi-pay Feature Helps?

TATA AIG health insurance plan for heart patients comes with a multi-pay feature. Under this, you can make multiple independent claims for different illnesses under separate categories. Let us understand the feature with an example.

Sumit has purchased the TATA AIG Smart Century Premier Plan with a sum insured of ₹10 lakhs on July 21, 2024, for a policy tenure of 1 year. Now with a multipay feature, Sumit has the flexibility to file claims under each category during policy tenure. Suppose Sumit files a claim for Myocardial Infarction, then he will get the sum insured of ₹10 lakhs.

However, once a claim is paid, he cannot make another category A claim during the policy lifetime. Later, if he developed another heart illness in Category B and C, such as Eisenmenger’s Syndrome, then he can file a claim for those illnesses separately.

Hospital Cash Benefit

The TATA AIG Criti Medicare plan includes a Hospital Cash Benefit, which pays a specified daily allowance ranging from ₹500 to ₹20,000 in the event of hospitalisation due to an illness during the policy tenure. It is especially beneficial for patients undergoing heart treatment, which often involves long hospital stays and post-surgery monitoring.

Wellsurance Benefit

It is an optional add-on to the Criti Medicare plan, focusing on post-operative recovery and long-term cardiac wellness. It is beneficial for patients who have undergone major heart procedures, such as CABG, valve replacement, or angioplasty. The add-on ensures continuous care beyond hospital discharge.

TATA AIG’s health insurance for heart patients is designed to cater to individuals across various age groups and family structures. Here are the eligibility details:

• Entry Age: Minimum age is 18 years, and the maximum age is 65 years.
• Coverage for Multiple Individuals: The policy extends to the policyholder, their spouse, dependent children, parents, parents-in-law, grandchildren, siblings, and extended family members, including nieces and nephews.
• Base Section Requirement: At least one base section (Critical Illness, Cancer 360 Degree - Indemnity, or Hospital Cash) must be selected.
• Risk Loading: Based on health status, risk loading may apply, capped at 157.5% for Critical Illness cover and 150% for other covers.
• Renewability: Policies are renewable for life, with a 30-day grace period for premium payment.

The working of mediclaim for heart patients is straightforward. Let us understand the plan's working by example. Mohit, 34 years old, buys a TATA AIG Criti Medicare plan for himself as his family has a history of heart conditions. The sum insured of the plan is ₹15 lakh.

After maintaining the policy for a few years, Mohit is diagnosed with a heart condition requiring bypass surgery. Since this falls under the list of covered critical illnesses and meets the waiting period requirement, he receives a lump sum payout of ₹15 lakh from Tata AIG.

This amount helps him cover surgery, post-treatment care, and recovery expenses without financial stress. The plan also ensures he can claim again in the future if diagnosed with another unrelated critical illness.

TATA AIG Criti Medicare offers coverage against various heart-related ailments. Some of them are listed below:

Open Heart Replacement

The plan covers the surgical replacement or repair of one or more heart valves, confirmed by a specialist and an echo.

Open Chest Coronary Artery Bypass Graft

The plan covers bypass surgeries done through the chest (sternotomy) or keyhole procedures. However, simple angioplasty or stent procedures are not included under this.

Myocardial Infarction

The plan offers coverage for the first major heart attack caused by reduced blood flow to a part of the heart, leading to damage to the heart muscle.

It should be confirmed through ECG, and severe symptoms like chest pain, etc. Under this, minor conditions like angina, mild coronary issues, or temporary enzyme changes are not covered.

Angioplasty

This procedure is used to open blocked or narrowed heart arteries by inflating a small balloon, with or without inserting a stent.

It is covered when at least a 50% blockage is found in one or more of the main coronary arteries, such as the left main, left anterior descending, circumflex, or right coronary artery. Simple diagnostic tests without actual angioplasty or stent placement are not covered.

Refractory Heart Failure

This is a severe form of heart failure where the heart is unable to pump blood effectively, even after at least six months of proper medical treatment.

A cardiologist diagnoses it based on symptoms such as extreme fatigue, breathlessness, chest pain during light activity, swelling in the legs or abdomen, fluid buildup, and others. Heart failure caused by autoimmune diseases, alcohol, or drug use is not covered.

Cardiomyopathy

This condition occurs when the heart muscle becomes stiff or weak, which makes it harder for the heart to pump blood. A cardiologist confirms this through tests such as an echocardiogram. The plan does not offer coverage for cardiomyopathy caused by alcohol or drug use.

Percutaneous Heart Valve Replacement

This refers to surgery done to repair or replace one or more damaged or diseased heart valves. The valve problem must be confirmed through an echocardiogram, and a specialist must verify the surgery.

Cardiac Rupture

This is a serious condition where the wall of the heart tears due to severe damage. It must be diagnosed by a specialist and confirmed through an echocardiogram or, in fatal cases, a post-mortem report.

Infective Endocarditis

It is an infection in the inner lining of the heart, usually caused by bacteria or other germs. The condition must be confirmed through a positive blood test that shows the presence of the infection, along with evidence of heart valve damage, such as leakage or narrowing.

The diagnosis and its severity must be supported by an echocardiogram and confirmed by a cardiologist.

Cardiac Pacemaker Insertion

This covers the surgical insertion of a permanent pacemaker or defibrillator to treat serious irregular heartbeats (arrhythmia) that other treatments can’t manage.

The procedure must be certified as medically necessary by a specialist, accompanied by medical proof.

Aorta Graft Surgery

This covers major surgery to repair or replace a damaged section of the aorta. It is done to treat conditions like aneurysm, blockage, or tearing of the aorta through open-chest or abdominal surgery. Minimally invasive or catheter-based procedures, such as angioplasty or keyhole surgeries, are not covered.

While TATA AIG heart health insurance provides extensive coverage, certain exclusions are in place to ensure fairness and clarity in claims.

Explicit Exclusion for Heart Patients

• Any type of angina pectoris and acute coronary syndromes are not covered under Myocardial Infarction.
• Heart failure due to autoimmune disorders are excluded.
• Under Open Chest Coronary Artery Bypass Graft surgery, angioplasty and any other intraarterial procedures are not covered.

Medical Exclusions

• Treatments related to alcoholism, drug or substance abuse.
• Procedures for obesity management or weight control.
• Costs associated with investigation and evaluation without a confirmed diagnosis.

Non-Medical Exclusions

• Claims against medical insurance for heart patients arising from any insured person attempting to breach the law with criminal intent.
• Intentional self-injury or suicide attempts, regardless of mental state.
• Treatments provided by a medical practitioner outside their area of expertise.

When purchasing health insurance plans for individuals with heart conditions, several key factors should be considered to make an informed decision.

Adequate Sum Insured

When purchasing a health insurance plan for critical conditions, such as heart disease, selecting an adequate sum insured is crucial. A sum insured is the amount you will receive when you are diagnosed with the condition.

TATA AIG critical illness plan for heart diseases comes with a sum insured option of ₹5 lakhs to ₹2 crores.

Waiting Period

While buying health insurance for heart patients, paying attention to the waiting period is also crucial. A waiting period is the timeframe during which policyholders cannot avail themselves of the plan benefit. TATA AIG health insurance plan comes with a waiting period of 60 days for multi-pay feature and 36 months for pre-existing disease.

Pre-existing Disease Coverage

While choosing the heart health insurance plan, also look for one to offer coverage for pre-existing diseases. TATA AIG heart health insurance comes with a waiting period of 36 months. When purchasing a plan, it is best to disclose any existing medical conditions to ensure you can enjoy the plan's benefits.

Also Read: Medical Insurance for Pre Existing Condition

Buying a health insurance plan for heart patients is simple with TATA AIG. Here is how you can buy health insurance plans.

• Go to the TATA AIG website and head to the “Personal” section, and go to the “Health Insurance" section.
• Choose the “TATA AIG Criti Medicare” plan and select the individuals you want to cover under the plan. Click on the “Get Price” option.
• Provide information such as date of birth, phone number, etc. Disclose any pre-existing diseases and then click the “See Plan” option.
• Review the plan carefully to ensure it aligns with your health needs.
• Once complete, proceed with the CKYC process and make a payment using a credit, debit, or QR code payment method.

After the payment is processed, the policy documents for the health insurance plan will be sent to the email address provided.

Renewing the health insurance policy for heart patients can be done in just a few steps with TATA AIG. Here is how you can renew the health insurance plan.

• Visit the TATA AIG website and click on the “Renewal” tab and choose the “Health” option.
• Provide the existing policy number and click on the “Renew” button.
• Thoroughly review the existing health insurance plan and make modifications as required.
• Once done, make a payment for a health insurance plan.

After the payment is made, renewed health insurance documents will be sent to the provided email address.

Filing a claim for health insurance for heart patients with TATA AIG is a straightforward process. Here is how you initiate the claim process.

Step 1: Notify TATA AIG Representative

Inform us about the diagnosis within 7 days of the incident occurrence, either by calling the helpline at 022-6489-8282 or through the self-service portal.

Step 2: Submit Claim form and Other Documents

You need to submit the claim form and provide other documents like a diagnosis report, a doctor’s letter, medical bills, etc.

Step 3: Reimbursement or Payout of the Money

After verifying the claim form and documents, we will either approve or reject the claim request. If it is approved, the decided amount will be sent to your bank account.

• A duly filled claim form.
• All relevant medical records, diagnosis and treatment history related to the patient’s heart condition.
• Copies of all hospital bills, receipts and any other medical-related expenses.
• A copy of the discharge summary from the hospital.
• Any prescriptions or medical certificates for heart patients related to the treatment from a cardiologist.

A dedicated health insurance for heart patients ensures that you get the best medical care without worrying about costs. From covering surgeries and hospital stays to offering preventive check-ups, the best health insurance for heart disease provides financial protection in times of crisis.

If you seek to buy a health insurance plan for heart disease, TATA AIG offers a customised and affordable plan. Our health insurance plan for heart patients covers major heart illnesses like cardiac rupture, repair of heart valves and more. Additionally, the plan includes hospital cash and wellness benefits. The plan can be issued as an individual or family floater plan.

We also offer senior citizen health insurance specifically designed for individuals aged 60 and above. This plan provides financial protection during medical emergencies and covers hospitalisation expenses, AYUSH treatments, daycare procedures, and more.

The plan ensures that senior citizens receive quality healthcare and the support they need without worrying about medical costs. Our medical insurance plan also offers benefits such as a cashless treatment facility, tax benefits, 24/7 customer support, and more. Secure your health with our customised health insurance plan now!