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    Tata AIG MediCare Protect Health Insurance

    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 Protect 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!

     

    UIN: TATHLIP18007V011819

     

    ADVT: TAGIC/WebApp/TGMCPRO/Nov 18/7                Ver 1 / All 1289

     

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    Or You Can Contact Us on Our Toll Free No: 1800 266 1363

    • Features that make it the #RightInsurance

      • 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.

      • Restore Benefit: It automatically restores your sum insured to 100% for you and your family members.

      • Cumulative Bonus: 10% increase in cumulative bonus for every claim free year, upto a maximum of 100% provided policy is renewed with us without a break. In the case a claim is made during the policy year, the cumulative bonus would reduce by 10% in the following year

      • 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.

      • 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.

      • Organ Donor: Covers Medical and surgical Expenses of the organ donor  for harvesting the organ where an Insured Person is the recipient.

      • Ambulance Cover: Covers expenses, upto Rs 1,000 per hospitalization, on transportation of Insured Person in an ambulance to a Hospital for admission in case of an Emergency or from one hospital to another for better treatment

      • 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.

      • 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.

      • 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.

      • Pre-Hospitalization Medical Expenses: Medical Expenses incurred in 30 days before the date of admission to the hospital.

      • Post-Hospitalization Medical Expenses: Medical Expenses incurred in 60 days after the date of discharge from the hospital.

      • 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.

         

        The above mentioned benefits are subject to terms and conditions apply.

        Room Category available under this policy is Shared Accommodation. In the event insured person gets admitted in a room category higher than shared accommodation, then 10% of admissible claim amount will be borne by the insured person.

         

        For complete list of detailed benefits, please refer policy wordings.

    • 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.

      • 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 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.

      • 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.

      • Disclaimer: Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms & conditions, please refer sales brochure/policy wordings carefully, before concluding a sale.

         

    • Situations where your policy won’t work

      This policy will not apply if:

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      • General 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 policy wordings for complete list of Benefits and Exclusions.

         

        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 48 months.

         

      • 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.

         

        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
          •   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)




    Information & Disclaimers