Understanding the Aggregate Deductible Benefit in Your MediCare Select Health Plan

The aggregate deductible in health insurance is an amount that the insured must pay before they can get the claim amount from the insurer. It is a cumulative amount calculated over the policy’s tenure and is a crucial part of top-up plans. An aggregate deduction may also be a part of family insurance plans. In the case of family insurance, the aggregate deductible of all the members must be paid, even if one member makes the claim.

It is an out-of-pocket expense for the insured, after which the insurance coverage kicks in. An aggregate deduction option in health insurance applies to the total claims made in a year as opposed to a per-claim deductible, which applies to one claim at a time.

Some insurance providers offer an aggregate deductible as a percentage of the sum insured. In contrast, others offer it as a lump sum amount. For example, some insurance plans offer 5% of the sum insured, while others may offer 25k aggregate deductible. TATA AIG’s MediCare Select plan offers you an aggregate deductible option of ₹10,000, ₹25,000, ₹50,000 or ₹1,00,000, giving you the freedom to choose an amount that is best suitable for you.

Understanding the concept and the benefits of the aggregate deductible discount is crucial while purchasing a health insurance policy. Let us consider an example for better understanding.

Suppose you have opted for an aggregate deductible of ₹50,000. Your hospital expenses during the year are ₹25,000, ₹35,000 and ₹70,000. In this case, you must only have to pay the medical expenses up to ₹50,000 to exhaust the aggregate deductible discount.

After you have paid ₹50,000, the insurer will pay the rest of the claim amounts that arise during the policy year. So, you must pay ₹50,000, i.e. ₹25,000 (claim 1), ₹25,000(claim 2). The insurer will pay the remaining ₹80,000(₹10,000 from claim 2 and 70,000 from claim 3) as part of the insurance. This, the larger chunk of your role medical expenses, is borne by the insurer saving you from financial stress.

Besides, all the consecutive claims made after the deductible payment will be covered under your insurance as long as the policy is valid.

Here is a tabular representation of the aggregate deductible medical insurance example.

It is essential to mention that any claim that you make before paying the aggregate deductible amount will be rejected, as the insurer is not eligible to pay for them.

Under the MediCare Select plan, an aggregate deductible is not compulsory. Rather, it is offered under the optional coverage of the plan, allowing you to decide whether to include it in your health policy or not.

This flexibility allows you to determine whether you have the financial stability to cover the aggregate deductible amount or if you prefer regular coverage. You also have various aggregate deductible options available to choose from, based on your financial capacity. You can opt for an aggregate deductible amount of ₹10,000, ₹25,000, ₹50,000 or ₹1,00,000.

TATA AIG's MediCare Select insurance plan is a highly customisable solution that allows you to build your insurance cover according to your needs. From individuals to families, working professionals and senior citizens, it serves everyone.

Here is an example to understand how the aggregate deductible option in health insurance works. Suppose you have purchased the TATA AIG MediCare Select plan and chosen a deductible amount of ₹25,000. During the year, you made 2 claims, ₹15,000 and ₹25,000.

In this case, you must pay a total of ₹25,000 towards the claim (₹15,000 for the first claim and ₹10,000 for the second claim). The remaining amount from the second claim, i.e. ₹15,000 (25,000-10000), will be paid from the insurance coverage.

TATA AIG MediCare Select plan is, in itself, a highly beneficial insurance plan, as it can be tailored for different individuals. By opting for the aggregate deduction discount, you can reap the following additional benefits.

Low Premium Payment

An aggregate deductible is an out-of-pocket expense for the insured, which reduces the insurance company’s claim liability. Since the insurer pays lower claim amounts, it charges lower premiums, which benefits the insured, helping to save on premiums.

Works as a Backup Coverage

The aggregate deduction option in health insurance acts as a backup cover, saving you from large medical bills as all the expenses incurred after the deductible limit is paid by the insurer.

Support for Costly Medical Bills

Choosing the aggregate deductible health insurance gives you the opportunity to pay the smaller hospital bills and use the insurance cover to take care of the larger amounts. Thus, you can manage your finances efficiently in the long run.

Financially Stable Individuals

The aggregate deductible discount offered under the TATA AIG MediCare Select plan may be a suitable option for individuals who have stable finances and are capable of bearing the initial cost up to the deductible amount.

Young and Healthy Individuals

Individuals under 40 years of age who are healthy and have no major health issues can also choose the aggregate deductible option, as they may not need to make huge claims. Thus, they can bear the small medical expenses initially, while keeping the premium low. Later, the insurance cover can take care of the larger medical bills in case of emergencies.

Those Who Want to Save Premiums

Individuals, young and elderly, who want to save on insurance premiums can also benefit from the deductible option under TATA AG MediCare Select insurance. As you select the aggregate deductible optional cover, you pay the initial claim amount and save on the premiums.

People Who Expect High Medical Bills

People undergoing treatments for chronic illnesses or who have advanced surgeries planned may incur high medical costs, which exceed the aggregate deductible. In such cases, the optional deductible coverage benefits them by paying a higher portion of the expenses.

Before you choose the aggregate deductible for your MediCare Select plan, here are a few factors to consider to make the right decision.

Financial Capability

When considering the aggregate deductible health insurance option with your MediCare Select plan, it is crucial to assess your financial stability. If you have a fixed source of income and sufficient savings to pool in the deductible amount in case of medical emergencies, then the deductible option is the right choice.

Medical Condition

Next, you must assess your medical conditions to determine if the aggregate deductible option is suitable for you or not. If you do not have any chronic conditions and lead a healthy lifestyle, you are less likely to face hospitalisation. In such a case, you can opt for the aggregate deductible and save on premiums.

Age

Your age influences the decision regarding the aggregate deductible discount. If you are a young working individual, aggregate deductibles can work in your favour as your claims may be low and you have a steady income to pay the deductibles. On the contrary, elderly individuals may experience greater health issues, leading to higher claim amounts. In this case, it may not be beneficial for them to choose the deductible option.

Family Medical History

Look back at your family medical history to see if any of your family members suffered from chronic illnesses or critical health conditions. In such a case, it may be beneficial to avoid choosing the aggregate deductible option, as it can lead to significant out-of-pocket expenses for you if any serious health issue was to arise.

Type of Plan

The type of plan that you choose also affects your decision regarding the aggregate deductible option. Under family insurance plans, the aggregate deductible must be paid in full before making a claim for any insured family member. For example, if you choose the deductible of ₹1,00,000 under the MediCare Select plan, you must pay the full amount before the insurance starts covering your claims.

TATA AIG MediCare Select plan gives you the freedom to customise your plan as you want. Under this health insurance policy, the aggregate deductible is given as an optional cover to suit your requirements.

To further enhance your freedom, you have various options to choose from, including deductible amounts ranging from ₹10,000 to ₹1,00,000. This freedom ensures that you can select an amount that suits your budget while lowering your insurance premium.

Besides, you also have the option to choose many other optional covers, such as consumable benefits, maternity care, women-specific add-ons and much more. All these features ensure that you have access to the best health insurance policy from TATA AIG- With You Like Family, With You Always!