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 Premier 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 that we will not compromise on your health insurance and neither should you! Think Ahead.
ADVT: TAGIC/WebApp/TGMCPRE/Nov 18/8 Ver 1 / All 1290
Features that make it the #RightInsurance
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.
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.
Bariatric Surgery: Covers expenses incurred for Bariatric Surgery for treatment of Obesity and weight control.
Restore Benefits: It automatically restores your sum insured to 100% for you and your family members.
Emergency Air Ambulance: Covers expense for ambulance transportation by airplane or helicopter for emergency life threatening health conditions, which require immediate ambulance transportation to the hospital/medical centre for upto Rs. 5 lacs. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
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.
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.
High End Diagnostics: Covers the insured person for the listed diagnostic tests on OPD basis if required as part of a treatment subject to Rs. 25,000 per policy year.
Accidental Death Benefit: 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.
Maternity Cover: Covers maternity expenses – up to a maximum of Rs. 50,000/- per policy subject to a waiting period of 4 years of continuous coverage under this policy subject to IRDAI portability guidelines. (in case of birth of girl child cover would be for Rs. 60,000) per policy. No limit on number of delivery events.
First year Vaccinations: Covers vaccination expenses for up to one year after the birth of the child subject to a limit of Rs.10,000/- (in case of girl child cover would be for Rs. 15,000) provided the child is covered with us.
Organ Donor: Covers Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient.
Vaccination Cover: Covers expenses related to Human Papilloma Virus (HPV) vaccine & Hepatitis B Vaccine after 2 years of continuous coverage and Anti-rabies vaccine & Typhoid vaccination without any waiting period. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
Compassionate Travel: Covers expenses up to 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. In the event the Insured Person is Hospitalized for more than Five consecutive days in a place where no adult member of his immediate family is present. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
OPD Dental Treatment: Once the Insured has completed two years of continuous coverage with Us, we will pay for expenses related to the following dental treatments only subject to a maximum of Rs.10,000 per policy year annually:
- Root Canal Treatment (single or multiple sittings)
- Tooth extraction(s)
This benefit has a separate limit (over and above base sum insured) and does not affect Cumulative Bonus
Pre-Hospitalization Medical Expenses: Medical Expenses incurred in 60 days before the date of admission to the hospital.
Post-Hospitalization Medical Expenses: Medical Expenses incurred in 90 days after the date of discharge from the hospital.
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. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
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. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
OPD Treatment: Once the insured has completed two years of continuous coverage with us, we will pay for expenses related to consultations and pharmacy subject to Rs. 5000 per policy year annually subject to policy terms and conditions. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
Second Opinion: A second opinion from Network Provider or Medical Practitioner will be provided, if an Insured Person is diagnosed with illnesses mentioned in policy wordings during the policy period.
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.
New Born Baby Cover: Covers medical expenses incurred for the medically necessary treatment of the new born baby up to Rs.10, 000 for complications related to delivery. This benefit will trigger only in case where we have admitted the maternity claim.
Ambulance cover: For utilizing ambulance service for transporting insured person to hospital in case of an emergency, coverage limit Rs.5000.
Prolonged hospitalization Benefit: Pays a fixed amount of 1% of sum insured, in the event of insured hospitalized for a disease/illness/injury for a continuous period exceeding 10 days. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
AYUSH benefit: Medical Expenses incurred for In-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy.
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. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
In-patient Dental Treatment: Covers expenses incurred towards hospitalization for dental treatment under anesthesia necessitated due to an accident/injury/illness.
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. This benefit has a separate limit (over and above base sum insured) and does not affect cumulative bonus.
Cumulative bonus: 50% increase in cumulative bonus for every claim free year. In the case a claim is made during the policy year, the cumulative bonus would reduce by 50% in the following year.
For complete list of detailed benefits, please refer policy wordings.
Benefits to make the policy stronger
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 and for premium paid in cash/ or by demand draft. Tax benefits are subject to changes in Income Tax Law.
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.
Network of hospitals: We are equipped to offer you health care in your city with our network of hospitals across India. Kindly carry original photo identity proof along with cashless card to avail cashless hospitalization in network hospitals.
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.
For complete list of detailed benefits, please refer policy wordings.
Situations where your policy won’t work
This policy will not apply if:
- 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.
- 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 policy wordings for complete list of Benefits and Exclusions
- 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 24 months.
- 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: firstname.lastname@example.org, email@example.com (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
Please refer to policy wordings for complete list of Benefits and Exclusions.
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
- Problems related to Heart Valves
- 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
- 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
- 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)
- A disease in which abnormal cells grow uncontrollably and destroy body tissue
- 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.
- 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)