Health Insurance 343 views December 27, 2021

TATA Medicare Plan protects you and your loved ones against medical expenses that may happen in due course of your health insurance policy term. The following are the key features of this TATA AIG Health Insurance Plan –

  • Restore Benefits
  • Bariatric Surgery
  • Global Cover
  • Cumulative Bonus

Let’s know more about the benefits of the TATA Medicare Plan on this page below.

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TATA Medicare Plan Benefits

The following benefits are payable under the TATA Medicare Plan.

In-Patient Treatment – If you’re hospitalized due to disease, illness or injury during the policy period, the insurer will pay the expenses for the same.

Pre-Hospitalization Expenses – The insurer will cover any expenses incurred before hospitalization, such as consultations, investigations and medicines. This is available up to 60 days before the date of admission to the hospital.

Post-Hospitalization Expenses – The insurer will cover expenses for post-hospitalization consultations, investigations and medicines up to 90 days from the date of your discharge.

Day Care Procedures – The listed daycare treatment shall be covered during the policy period if the same is taken at a Hospital or a Day Care Centre. Outpatient treatment is not included in the scope of this cover.

Organ Donor – Your donor will get coverage for medical and surgical expenses for harvesting the organ.

Domiciliary Treatment – If you take treatment at home and that exceeds three days, the insurer will cover the expenses resulting from the same. For this, the insurer requires certification from the treating doctor fulfilling the conditions as mentioned in your policy.

Restore Benefit – Your Basic Sum Insured shall automatically be restored to 100% upon exhaustion of the Sum Insured and Cumulative Bonus. This is available to you only once during the policy period.

AYUSH Benefit – If you receive in-patient treatment under Ayurveda, Unani, Sidha, and Homeopathy at a government hospital or in any institute recognized by the government or accredited by The Quality Council of India or National Accreditation Board for Hospitals and Healthcare Providers.

Ambulance Cover – The insurance company will cover any expenses incurred on transportation to the hospital, in case of an emergency or from one hospital to another, up to INR 3,000 per hospitalization.

Health Checkup – You can get health check-up cover, subject to 1% or INR 10,000 (whichever is less) per policy year. The benefit is available to you after every two continuous claim-free years.

Compassionate Travel – When the hospitalization is for more than five consecutive days, the company will cover the cost of an immediate family member visiting you at the hospital. This will include a round trip economy class air ticket or first-class railway ticket, subject to INR 20,000 in a policy year.

Consumables Benefit – Any expenses incurred for consumables and are listed in ‘Items for which optional cover may be offered by insurers under ‘Guidelines on Standardization in Health Insurance, 2016’.

Global Cover – Medical expenses incurred outside India are covered up to the sum insured, provided the diagnosis was made in India. You can only get in-patient and daycare hospitalization on a reimbursement basis. The cashless facility is arranged on a case-to-case basis.

Bariatric Surgery Cover – The insurer shall cover any reasonable and customary expenses for Bariatric Surgery upon meeting the following conditions:

i. Proceeded upon the advice of the Doctor
ii. Your age is 18 years and above
iii. Body Mass Index (BMI) >= 40
iv. BMI >= 35 in conjunction with any of the following severe comorbidities following –

  • Obesity-related cardiomyopathy
  • Coronary heart disease
  • Severe sleep apnea
  • Uncontrolled Type2 Diabetes

In-Patient Treatment – Dental – Cost towards hospitalization for dental treatment under anesthesia if necessitated due to an accident, injury or illness.

Vaccination Cover – Expenses related to the vaccines for –

  • Anti-rabies vaccine following an animal bite
  • Typhoid vaccination
  • Human Papillomavirus (HPV) vaccine (after 2 years of waiting period)
  • Hepatitis B Vaccine (after 2 years of waiting period)

Note – Expenses related to the doctor, nurse or any incidental expenses are not payable. This benefit is subject to actual expenses or INR 5,000 per policy, whichever is lower.

Hearing Aid – For a hearing aid every third year, the insurer will pay 50% of the actual cost or INR 10,000, whichever is lower.

Daily Cash for Shared Accommodation – A fixed amount is paid per day if you’re hospitalized in shared accommodation in a network hospital for each continuous and completed period of 24 hours. The benefit is subject to a minimum of 0.25% of the base sum insured and a maximum of INR 2,000 per day.

Daily Cash for Accompanying an Insured Child – You will get a fixed amount daily if your child aged 12 years or less undergoes hospitalization. This is payable to the accompanying adult for each complete period of 24 hours. The benefit is a minimum of 0.25% of the base sum insured and a maximum of INR 2,000 per day.

Second Opinion – You can get a second opinion from the network provider or medical practitioner if you’re diagnosed with any of the following.

i. Cancer
ii. Kidney Failure
iii. Myocardial Infarction
iv. Angina
v. Coronary bypass surgery
vi. Stroke/Cerebral hemorrhage
vii. Organ failure requiring transplant
viii. Heart Valve replacement
xi. Brain tumors

You can use this benefit only once during a policy year.

Accidental Death Benefit (Optional Cover) – If you choose this cover and suffer from an accident during the policy period which results in your death within 365 days from the date of the accident, your nominee will get a fixed amount of 100% of the base sum insured.

Cumulative Bonus – Every claim-free year, 50% of the cumulative bonus will apply to the sum insured, provided that the policy is renewed without a break. The maximum bonus is 100% of the sum insured.

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