Medicare: Tata AIG's Value for Money Flagship. Does it tick all boxes?

Medicare's Coverages - A Glance At The Benefits.

Jul 28, 2021

We have compiled for you Brief Notes on Tata AIG’s Flagship Health Insurance Plan: Medicare. Please refer to the Policy Wordings attached herewith for in-depth knowledge of the plan.

Room Rent: No Capping.

There is no ceiling on room rent.
If you choose a shared room, not a private room, at any of the Network Hospitals, the Insurance Company will pay you 0.25% of the Total Sum Insured (SI) per day (a maximum of 2000 per day).

No Claim Bonus (NCB): 50%

A No Claim Bonus of 50% every year up to 100%.
The SI increases by 50% if you go a year without filing a claim.
The SI decreases by 50% if you file a claim.

It does not go below your basic sum insured, nor does it increase more than 100%.
The insurer will not increase the amount insured beyond 20 lakhs, nor will we reduce it below 10 lakhs, if the Basic SI is 10 lakhs.

Restore Benefit: 100%

A 100 per cent restoration of SI after SI and the cumulative bonus is exhausted.
A claimant who has previously filed a claim for a related illness/disease must wait 45 days to file another claim.
Restoration Benefits do not apply to treatment outside of India.

Consumables: Covered.

The policy covers medical consumables.
This ensures that patients' out-of-pocket expenses are negligible.

Global Coverage:

After a patient is diagnosed in India, treatment can be taken outside the country.
The treatments are not limited to only critical illnesses.
Restore benefit will not be eligible for the treatments taken abroad.
Global cover Includes ONLY inpatient treatment and daycare procedures.

Day Care Procedures: 541+

There are 541+ procedures that don't require 24 Hrs hospitalization.

Bariatric Surgery: Covered (with conditions*)

Minimum age of 18 is required.
A BMI of 40 or Greater.
A BMI greater than or equal to 35 as well as having Cardiomyopathy (related to obesity)/ Coronary Heart Disease/ Severe Sleep Apnea/ Type II Diabetes not under control.

Organ Donor:

In the event that you receive an organ (legally, of course) then the Insurance Company will cover the medical & surgical expenses related to harvesting an organ.

Second Opinion:

The Insurance Company will provide a second opinion once during your policy year, if you are diagnosed with:-

Cancer.
Kidney failure.
Coronary bypass surgery.
Brain tumour.
Myocardial infraction.
Angina
stroke/ cerebral haemorrhage.
Organ failure requiring a transplant.
Heart valve replacement.

Ayush Treatments:

These include AYURVEDA, UNANI, SIDHA, and HOMEOPATHY. (Excludes spa treatments).
Only Inpatient Hospitalisation is covered.

Covered at:-

Government Hospital.
Hospitals approved by QCI/ NABH/ CCIM/ CCH.
Ayush Hospital with 15 Beds, 5 Doctors, 24 Hrs Paramedical Staff, Maintaining proper records.

Domiciliary Treatment:

It’s basically, treatment taken at home, if:-

The patient is not in a condition to be taken to the hospital.
There are no available rooms at hospitals.
A treatment that lasts longer than three days.

External Feeding & end-of-life care aren't covered.

Vaccination for Adults:

Without Waiting Period:

Anti Rabies (Dog Bite)
Typhoid

After 2 years:

Hepatitis B.
HPV.

HEARING AID:

The sum of 50% of the actual cost or 10,000 rupees. Every third year.

Dental Treatments: :)

In-patient Treatments (requiring 24 hours of hospitalization) and taken under anaesthesia are covered.

Compassionate Travel:

The company will pay Round-Trip (MAX: Rs. 20,000) (Economy Airfare or First Class Train Fare), if:-

Hospitalization exceeds five days &
There is no adult member of the immediate family present.

Other Benefits:

If your child is hospitalized and is under 12 years of age, 0.25% of the SI (up to a maximum of Rs. 2,000 a day).

Pre-hospitalization period: 60 days.
Post-hospitalization period: 90 days.
Health Checkup: Free Health Checkup After every 2 claim-free years. (1% of SI, Max. 10,0000 per year) .

Modern Treatments (Covered from Oct 2020)

Oral chemotherapy (given in OPD)
Stem cell therapy
Deep Brain stimulation
Uterine Artery Embolization & HIFU
Immunotherapy- Monoclonal Antibody to be given as an injection
Stereotactic radio surgeries
Robotic surgeries
Intra vitreal injections
Bronchial Thermoplasty
The vaporisation of the prostate (Green laser treatment or holmium laser treatment)
IONM - (Intra Operative Monitoring) Neuro
Balloon Sinuplasty

Other Conditions & Treatments (Covered from Oct 2020)

Treatment for correction of eyesight due to refractive error beyond +/- 7.5 dioptres
Genetic diseases or disorders
Any mental illness, stress or psychological disorders
Peritoneal dialysis (as a part of pre & post hospitalisation)
Expenses related to any admission primarily for enteral feedings
Obesity/Weight control treatment (if specified conditions are met)
Post Hospitalization expenses for Domiciliary treatment
Age-Related Macular Degeneration (ARMD)
Expenses on Artificial life maintenance (including life support machine use) up to the vegetative state, irrespective of whether such treatment results in recovery of restoration of the previous state of health or not.