When thinking of health, DON'T Compromise!
Being the risk experts, we know there can be no compromise in the matters of health and making sure that starts with a robust insurance plan. Choosing the right mix of features and coverage levels is essential to get everything you would need in an ideal health insurance plan. Tata AIG Medicare is a simplified and comprehensive Health Insurance plan. The product is designed keeping in mind the important role that your health insurance plays considering the cost of medical emergencies. Tata AIG General Insurance has been accredited with iAAA rating by ICRA for highest claims paying ability. With a legacy built on trust, rest assured we will not compromise on your health and neither should you! Think Ahead.
UIN: TATHLIP18004V011819
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Features that make it the #RightInsurance
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Restore Benefits: It automatically restores your sum insured to 100% for you and your family members.
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Bariatric Surgery: Covers expenses incurred for Bariatric Surgery for treatment of Obesity and weight control.
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Global Cover: Covers Medical Expenses related to Inpatient & Day Care Hospitalization of the Insured Person incurred outside India, provided that the diagnosis was made in India.
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Cumulative bonus: 50% increase in cumulative bonus for every claim free year, upto a maximum of 100%. In the case a claim is made during the policy year, the cumulative bonus would reduce by 50% in the following year.
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In-Patient Treatment: Covers expenses for hospitalization due to disease/illness/Injury during the policy period that requires an Insured Person’s admission in a hospital as an inpatient. Medical expenses directly related to the hospitalization would be payable
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Day Care Procedures: Covers expenses for 540+ Day Care Treatment due to disease/illness/Injury during the policy period taken at a hospital or a Day Care Centre.
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Consumables Benefit: Covers expenses incurred, for consumables, which are consumed during the period of hospitalization directly related to the insured person’s medical or surgical treatment of illness/disease/injury.
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Vaccination Cover: Covers expenses related to Human Papilloma Virus (HPV) vaccine & Hepatitis B Vaccine after 2 years of continuous coverage and Antirabies vaccine & Typhoid vaccination without any waiting period.
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Compassionate Travel: Covers expenses upto Rs. 20,000 related to a round trip economy class air ticket, or first-class railway ticket, to allow the Immediate Family Member to be at insured person's bedside during his stay in the hospital.
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Accidental Death Benefits (optional cover): Covers 100% of sum insured in the event of death of insured person due to accident. This benefit is not applicable for dependent children covered in the policy.
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Pre-Hospitalization Medical Expenses: Medical Expenses incurred in 60 days before the date of admission to the hospital.
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Post-Hospitalization Medical Expenses: Medical Expenses incurred in 90 days after the date of discharge from the hospital.
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Domiciliary Treatment: Covers for expenses related to Domiciliary Hospitalization of the insured person if the treatment exceeds beyond three days. The treatment must be for management of an illness and not for enteral feedings or end of life care.
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Second Opinion: A second opinion from Network Provider or Medical Practitioner will be provided, if an Insured Person is diagnosed with the mentioned Illnesses during the Policy Period.
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Ambulance cover: For utilizing ambulance service for transporting insured person to hospital in case of an emergency, coverage limit Rs.3000.
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Hearing Aid: Covers reasonable charges for a hearing aid every third year. The maximum payable is 50% of actual cost or Rs. 10,000/- per policy, whichever is lower.
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Daily cash for accompanying an insured child: A fixed amount per day will be paid, as mentioned in the schedule, if the Insured Person Hospitalized is a child Aged 12 years or less, for one accompanying adult for each complete period of 24 hours. Coverage limit 0.25% of base sum insured and max. Rs. 2000 per day.
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In-patient Dental Treatment: Covers expenses incurred towards hospitalization for dental treatment under anesthesia necessitated due to an accident/injury/illness.
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Organ Donor: Covers Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient.
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AYUSH benefit: Medical Expenses incurred for In-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy.
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Health Checkup: Expenses for a Preventive Health Check-up up to 1% of policy sum insured subject to a maximum of Rs. 10,000/- per policy.
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Daily Cash for choosing Shared Accommodation: A fixed amount per day will be paid as mentioned in the policy schedule if the Insured Person is hospitalized in Shared Accommodation in a Network Hospital for each continuous and completed period of 24 hours. Coverage limit 0.25% of base sum insured and max. Rs. 2000 per day.
The above mentioned benefits are subject to terms and conditions apply.
For complete list of detailed benefits, please refer policy wordings
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Benefits to make the policy stronger
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Tax Benefit: The premium amount paid under this policy qualifies for deduction under 80D of Income Tax (Amendment) Act, 1986. This benefit is not applicable for premium amount paid towards accidental death benefit if opted and for premium paid in cash/ or by demand draft. Tax benefits are subject to changes in Income Tax Law.
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Settlement of your claims: We settle your claims hassle-free and quickly so that you can focus on quality and timely recovery rather than managing the funding of the treatment, subject to submission of all required documents.
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Network of hospitals: We are equipped to offer you quality health care in your city with our strong network of hospitals across India. Kindly carry original photo identity proof along with cashless card to avail cashless hospitalization in network hospitals.
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Lifelong Renewal: We offer you a lifelong renewal for your policy provided premium is paid without any break Your premiums will be basis the age and coverage. Your renewal premium will be basis your revised age band and there will be no extra loading's based on your individual claim.
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Situations where your policy won’t work
This policy will not apply if:
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Medical Exclusions:
- Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an Accident, Cancer or Burns.
- Rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care.
- All preventive care, vaccination including inoculation and immunisations (except in case of post- bite treatment and other vaccines explicitly covered);
- Hospitalization purely for enteral feedings (infusion formulae via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements, unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
- Experimental and Unproven treatments, Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Chelation therapy, Hyperbaric Oxygen Therapy.
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Non-Medical Exclusions:
- Charges incurred at a Hospital primarily for diagnostic, X-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness or Injury, for which confinement is required at a Hospital.
- Items of personal comfort and convenience like television (wherever specifically charged for), charges for access to telephone and telephone calls, internet, foodstuffs (except patient’s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service.
- Treatment rendered by a Medical Practitioner which is outside his discipline,
- Doctor’s fees charged by the Medical Practitioner sharing the same residence as an Insured Person or who is an immediate relative of an Insured Person’s family
Please refer to policy wordings for complete list of Benefits and Exclusions.
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Waiting Period:
- Policy coverage starts 30 days from the first inception of the policy (except accident).
- Any listed illnesses/treatments will be covered after a waiting period of 24 months.
- Any pre-existing condition will be covered after a waiting period of 36 months.
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Claim Procedure:
Claims under this policy will be administered by a specified Third Party Administrator (TPA) duly licensed by IRDAI.
Intimation & Assistance: Please contact our designated TPA/Us atleast 48 hours prior to an event which might give rise to a claim. For any emergency situations, kindly contact our TPA within 24 hours of the event.
Claim Related Information: For any claim related query, intimation of claim and submission of claim related documents,
You can contact TPA through:
Name of TPA: Family Health Plan Insurance TPA Ltd (FHPL)
Email: info@fhpl.net, seniorcitizensdesk@fhpl.net (for Senior Citizens)
Toll Free: 1800-425-4033, 040- 23552899 (for Senior Citizens)
Fax: +91 40 23541400
Website: www.fhpl.net
Submit claim: Claims Department, Family Health Plan Insurance (TPA) Ltd,
Srinilaya – Cyber Spazio, Suite # 101,102,109 & 110, Ground Floor,
Road No. 2, Banjara Hills, Hyderabad, 500 034
For list of network hospitals, please visit our/TPA website.
In case if the insured person opts for shared accommodation under the policy, but gets admitted in a room category higher than that, then 10% of admissible claim amount will be borne by the insured person.
For complete list of detailed benefits, please refer policy wordings
Please refer to policy wordings for complete list of Benefits and Exclusions
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MediCare Proposal Form - Medical Terminologies
Chest Pain/Heart Disease:
- Most common cause is blockages in the blood vessels leading to your heart
- It is caused by medical conditions affecting any of the organs located in the chest or upper abdomen, including the heart, blood vessels, lungs, airways, muscles, bones, esophagus, or stomach
- Most common examples of diseases falling under this category :
- Heart attack
- Bypass surgery
- Angina
- Problems related to Heart Valves
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Arthritis
- It means pain, swelling and stiffness in a joint or joints
- It is an inflammation of the joints
- It can affect one joint or multiple joints
COPD
- A group of lung diseases that block airflow and make it difficult to breathe
- Chronic obstructive pulmonary disease is a chronic inflammatory lung disease that causes obstructed airflow from the lungs
Kidney Failure/Dialysis
- most common causes of kidney failure are diabetes and high blood pressure
- When kidneys fail, it means they have stopped working well enough to survive without dialysis or a kidney transplant
- dialysis is a treatment that removes wastes and extra fluid from your blood
Liver Cirrhosis/Hepatitis B or C
- Hepatitis B is an infection of liver. It can cause scarring of the organ, liver failure, and cancer
- Hepatitis and chronic alcohol abuse are frequent causes
- Liver cirrhosis is a late stage of scarring (fibrosis of liver)
Cancer
- A disease in which abnormal cells grow uncontrollably and destroy body tissue
HIV/AIDs
- HIV is a virus that damages the immune system. The immune system helps the body fight off infections.
- AIDS is a disease that can develop in people with HIV. It’s the most advanced stage of HIV
Stroke, Epilepsy, Paralysis
- Stroke is damage to the brain from interruption of its blood supply
- Epilepsy (convulsion) is a disorder in which nerve cell activity in the brain is disturbed, causing seizures. Most commonly known as fits in non medical terms
- Paralysis is the loss of the ability to move some or all of the body. A condition involving a loss of muscle function in the body that may be accompanied by sensory loss, also referred to as loss of feeling
Psychiatric, Mental Illness or disorder
- It is a mental illness that greatly disturbs thinking, moods, and/or behavior and seriously increases risk of disability, pain, death, or loss of freedom
- Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities.
- It is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines.
- Most common examples are depression, schizophrenia, bipolar disorder
Ulcerative Colitis/Crohn’s disease
- A chronic, inflammatory bowel disease that causes inflammation in the digestive tract
- Ulcerative colitis (UC) is a disease that affects large intestine, or colon. It causes irritation and swelling called inflammation. Eventually that leads to sores called ulcers in the lining there.
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Autoimmune Diseases
- A disease in which the body's immune system attacks healthy cells.
- Immune system disorders cause abnormally low activity or over activity of the immune system. In cases of immune system over activity, the body attacks and damages its own tissues (autoimmune diseases). Immune deficiency diseases decrease the body's ability to fight invaders, causing vulnerability to infections
- Most common examples are rheumatic heart disease, rheumatoid arthritis, Systemic lupus erythematosus (SLE)
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