Tata AIG MediCare | Premier | Protect

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 immunizations (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.

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 the policy document for a complete list of benefits and exclusions.

Medical exclusions:

• 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.
• Dental treatment or surgery of any kind unless as a result of Accidental Bodily Injury to natural teeth and also requiring hospitalization
• Pregnancy, voluntary termination of pregnancy, maternity or birth (including caesarean section) except in the case of ectopic pregnancy in relation to - Inpatient Hospitalization only and miscarriage due to accident

Non-Medical Exclusions:

• 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.
• Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy,
• Any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.
• Any treatment or part of a treatment that is not of a reasonable charge, not medically necessary; drugs or treatments which are not supported by a prescription.
• Crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively and explicitly stated and covered in the policy).

Please refer to the policy document for a complete list of benefits and exclusions.

Medical exclusions:

• Admission primarily for diagnostic and evaluation purposes only
• Venereal disease, sexually transmitted disease or illness.
• Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services.
• Laser treatment for correction of eye due to refractive error
• Aesthetic or change-of-life treatments of any description such as sex transformation operations, treatments to do or undo changes in appearance or carried out in childhood or at any other times driven by cultural habits, fashion or the like or any procedures which improve physical appearance.
• 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.

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.

• Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy unless explicitly stated and covered in the policy

• Please refer to the policy document for a complete list of benefits and exclusions.

Yes, cashless settlement under this policy is available if the hospital you choose falls under Tata AIG network. If we are not connected with the hospital, the expenses will be reimbursed later upon submission of needed documents.

Global coverage of medical expenses will be provided if the illness is detected in India and the insured travels abroad for treatment.

The premium payable on renewal shall be paid to Us on or before the policy period end date and in any event before the expiry of Grace period. A Grace Period of 30 days for renewing the Policy is provided under this Policy. If the renewal premium has been received by Us as mentioned above, We will ordinarily offer renewal terms for life unless

We believe that You or any Insured Person or anyone acting on Your behalf or on behalf of an Insured Person has acted in a fraudulent manner or any misrepresentation under or in relation to this Policy or the renewal of the Policy poses a moral hazard.

We, at TATA AIG, give you the luxury of a cashless facility. In case of hospitalisation, the insured person does not need to pay anything for the covered expenses. TATA AIG would handle all the payments. However, this facility is only available in hospitals under our network. There are different procedures to claim the insurance for planned and emergency hospitalisation, depending on the situation.

1. Planned hospitalisation When the date for a surgery or any treatment is decided beforehand, it is called planned hospitalisation. In such cases, you would need to submit the cashless claim form to a TATA AIG branch by email or letter at least 48 hours before the treatment. After we have received your cashless claim form, the hospital will be notified, and you will be provided with a confirmation letter. The health card, along with the confirmation letter needs to be submitted by you on the day of your admission to the hospital. After that, you can sit back and relax as we make the payments.

2. Emergency hospitalisation Emergency hospitalisation includes sudden and unexpected medical emergencies like an accident. To claim medical insurance in such a situation, you would have to generate a Claim Intimation or Reference Number. You should inform our allied hospital or us within 24 hours of the emergency hospitalisation. Keep your policy number handy. For a complete list of important documents, please refer to your policy.

When cashless claim facility is not available, or the hospital is not affiliated with us, you will have to cover the medical expenses at the time of hospitalisation, which we will reimburse later. Verification is a very important step in this claim process. You must verify the details before signing on the bill. Any discrepancy could affect the claim process to a great extent - even rejection. You would need your policy paper and insurance card, along with all important medical documents.

Please note that you can also make an insurance claim online or by contacting our toll-free helpline at 1800 266 7780. However, before you make a claim, please check if it falls under the list of inclusions.

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

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.

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)