Tata Medicare

What we love?
Provides Global Cover upto Sum Insured

Cover amount: ₹5 Lakh

Cashless hospitals: 288

Premium:₹662/month (₹7934 paid annually)

Claim Settlement Ratio: 97%

97% Claim Settlement Ratio
This is explained as (Number of Claims Settled / Number of Claims) by the Insurance Company.
Source: Public Disclosures (NL25 for 2018-19).
Claim Settlement ratio for Covid-19 is 89.19% as per Insurer.
Total Covid claims paid – ₹303 Cr., Total number of Covid claims – 27,388 (approved + paid), Total number of cashless Covid claims – 32,000 (approved + paid).

Bonus on No Claim
50% increase in cumulative bonus for every claim free year, upto a maximum of 100%. In the case a claim is made during the policy year, the cumulative bonus would reduce by 50% in the following year

Worldwide Emergency
Covers Medical Expenses related to inpatient & Day Care Hospitalization of the Insured Person incurred outside India, provided that the diagnosis was made in India.

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( Day 1 cover ).

Consumables cover
Covers expenses incurred, for specified consumables, which are consumed during the period of hospitalization directly related to the insured person’s medical or surgical treatment of illness /disease/injury.

What’s covered

Covid-19 Coverage

Hospitalization due to omicron and all other variants of covid-19 are covered

Why is it Important

Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention

ProTip: Protect yourself and others from infection by staying at least 1 metre apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently

Room rent limit

Any room category

Why is it Important

A lower cap is better as room rent eats into the claim amount which should be spent on treatment cost.

ProTip: Always opt for rooms within your rent eligibility, In case you opt for a room above this cap, you will have to bear the additional expenses

Restoration of cover

Automatically restore the Basic Sum Insured upon exhaustion of the Sum Insured and accrued Cumulative Bonus, during the policy period.

Why is it Important

It helps at the time of second hospitalization in the same year

ProTip: The restoration amount varies, please check the plan T&C for when restoration is allowed.

No claim bonus

50% increase in Sum Insured (max 100% and 50% decrease in case of claim)

Why is it Important

Since the medical expenses are rising every year, this benefit ensures you have sufficient funds for any medical emergency.

Free health checkup

Expenses for a Preventive Health Check-up upto 1% of previous year policy sum insured subject to a maximum of Rs. 10,000/- per policy in the event of every two continuous claim free policy years with us.

Why is it Important

Health checks ensure you are treated before your medical condition gets serious.

ProTip: Look for the type, cost and number of tests your insurer allows.

Co-pay

Full claim paid by Insurer

Existing Illness cover

There is a waiting period of 3 years for coverage on conditions declared and existing at the time of first purchase

Why is it Important

The shorter waiting period, the better as the cost of your current illness can be expensive

Covid-19 Patient Eligibility

After 1 month of covid negative report date

Why is it Important

Most people infected with the virus will experience mild to moderate respiratory illness and recover without requiring special treatment. However, some will become seriously ill and require medical attention

ProTip: Protect yourself and others from infection by staying at least 1 metre apart from others, wearing a properly fitted mask, and washing your hands or using an alcohol-based rub frequently

Cashless hospitals

7500+ Network hospitals

Why is it Important

The higher the number of network hospitals the better as you can avail cashless treatment at more places.

ProTip: Check if the hospital of your choice or those near you are part of the network.

Pre-hospitalization coverage

Medical expenses that are incurred in 60 days before hospitalisation are covered

Why is it Important

Typically there is a period of OPD and diagnostics before one is discharged. Longer the Pre-Hospitalisation cover period, better it is

ProTip: Make sure you claim the medical expenses for the same illness for which you got admitted later on.

Post-hospitalization coverage

Medical expenses that are incurred in 90 days post hospitalisation are covered

Why is it Important

There are usually expenses on medicines and treatments even after hospitalization. This benefit helps to cover the same.

ProTip: More the number of days covered, the better it is

Day care treatment

541 listed Day care treatments that take less than 24 hours of hospitalization due to technological advancement but otherwise would have needed a day are covered

Why is it Important

The number of day care treatments are increasing every day and it is important that your insurance covers the same.

ProTip: Look for plans which cover maximum Day Care procedures

Hospitalization at home

Treatments done at home due to patient condition or unavailability of hospital bed are covered upto Sum Insured

Why is it Important

The higher the cover amount, the better as sometimes — especially during seasonal outbreaks like dengue — hospitals may not have accomodation.

ProTip: Look out for the cover amount and the number of days at home treatment is covered.

Alternate medicine (AYUSH)

Upto SI for utilizing ayurveda, unani or other alternate medicine methods

Why is it Important

This benefit covers you for alternative treatment options which are becoming more and more popular.

ProTip: Don’t forget to check if your insurance plan covers AYUSH treatment

Ambulance charges

Road Ambulance charges are Rs.3000 per hospitalization

ProTip: Check if your insurance plan covers the Ambulance cost and how much

Worldwide coverage

Medical Expenses of the insured Person incurred outside India, upto the sum insured provided that the diagnosis was made in India and the insured travels abroad for treatment

ProTip: The higher the coverage the better as medical treatments abroad are expensive.

Cover for organ donor

Medical expenses on harvesting the organ from the donor for organ transplantation are covered upto SI

Why is it Important

It ensures that expenses of the donor are covered, and the insured gets the organ that is required in time

ProTip: Make sure the cover amount is high as the organ transplant is expensive.

Daily cash allowance

Fixed amount payable as per policy schedule

Why is it Important

The money can be used for meeting additional expenses that are not covered by health insurance

ProTip: The higher the daily cash allowance the better as these additional costs do add up during hospitalization.

Daily cash allowance

Fixed amount payable as per policy schedule

Why is it Important

The money can be used for meeting additional expenses that are not covered by health insurance

ProTip: The higher the daily cash allowance the better as these additional costs do add up during hospitalization.

Animal bite vaccination

Upto Rs 5000 in case of animal bite

Why is it Important

This add-on is beneficial as stray animals are everywhere and you can’t predict when one might bite you.

What’s not covered

Maternity cover

This plan doesn’t provide coverage for maternity & related claims

Why is it Important

Higher the maternity cover and a shorter waiting period is better. This allows you to avail the best hospitals and doctors for your new born.

ProTip: Check the waiting period after which you can claim for maternity.

Domestic evacuation

No cover for emergency evacuation services

E-consultation

No complimentary access to doctors in company network through a call

Why is it Important

It is a value-added service and you get a convenient second opinion.

Discount on Renewal

No wellness factors are included

Out patient consultation benefits

No coverage for treatments not requiring hospitalization, such as consultations

Why is it Important

The higher the coverage the better as most treatments do not require hospitalization.

ProTip: If you stand to lose your NCB, it is advisable not to claim OPD expenses.

About Tata AIG

Tata AIG General Insurance commenced its operations in India in early 2001 and is a joint venture between Tata Group and American International Group (AIG) which is a leading international insurance organization with operations in more than 130 countries and jurisdictions. AIG companies serve commercial, institutional, and individual customers through one of the most extensive worldwide property-casualty networks of any insurer. In addition, AIG companies are leading providers of life insurance and retirement services around the world. Tata AIG offers a range of general insurance covers for businesses and individuals and has a comprehensive range of general insurance products for Liability, Marine Cargo, Personal Accident, Travel, Rural-Agriculture Insurance, Extended Warranty etc. The company has an asset base of approximate 0.6 billion USD, a workforce of 2523 employees and 9446 agents and is present in 98 locations across India.

Most Asked Question For Your Profile

Are PPE kits and other consumable items covered in Health Insurance policies?
Mostly policies don’t cover it by default, however you can buy some very low cost riders and get consumables like PPE kits covered. These include riders such as Care Shield with Care Health Products, or Safeguard with Max Bupa products.

 

Is HomeCare treatment covered in my Health Insurance policy?
Many Comprehensive health plans provide Home Care treatment where Hospitalisation was required, but patients couldn’t be hospitalised because beds weren’t available. This will include the cost of treatment, diagnosis, medication, oxygen, etc. Check with your advisor for options where HomeCare for Covid-19 is also covered

 

Will my Health policies cover Black Fungus or any other complications of Covid-19?
Absolutely, Health Insurance covers Covid-19 and all its related complications such as Black Fungus.

Cashless Process

In cashless process the hospital expenses are settled directly between the insurance company and the network hospital. No cash has to be paid by the insurance policy holder.

    • Step 1: Find network hospital

      Click here to view the list of Cashless Hospitals

    • Step 2: Inform the insurer

      There can be 2 types of hospitalisation.

      • Planned Hospitalization – Kindly intimate insurer 48 hours prior to your admission by calling on 1800-425-4033 / 04023555353 (Ext No. – 762) or writing at [email protected]
      • Emergency Hospitalization – In case of an emergency hospitalization, call and inform at 1800-425-4033 / 04023555353 (Ext No. – 762) within 24 hours of your admission.
  • Step 3: Preauthorization

      • Approach Hospital’s Insurance / TPA desk for Pre-Authorization Emergency Hospitalization.
      • Show your insurance policy and provide valid photo id proof.
      • Hospital will send the cashless request to insurer and coordinate for authorization.
  • Step 4: Discharge

    Hospital will share all the necessary documents with insurer / TPA for approval.

  • Step 5: Claim settlement

    Insurer will scrutinize the shared documents and give the authorization on the final bill amount in case of approved transactions.Any inadmissible expenses,copayments,deductions will have to be paid by you.

Pro Tip – Once your cashless claim is approved, you can also reimburse your pre and post hospitalization expenses through the reimbursement process.

Re-imbursement Process

In case of hospitalization in non calshless network hospital you can still take an advantage of your health insurance policy by making a Reimbursement claim where you can pay the medical bills directly to the hospital and then gets expenses reimbursed from the insurance company.

  • Step 1: Inform the insurer (Claim Intimation)

    There can be 2 types of hospitalisation.

    • Planned Hospitalization – Kindly intimate insurer 48 hours prior to your admission by calling on 1800-425-4033 / 04023555353 (Ext No. – 762) or writing at [email protected]
    • Emergency Hospitalization – In case of an emergency hospitalization, call and inform at 1800-425-4033 / 04023555353 (Ext No. – 762) within 24 hours of your admission.

    The insurer needs to provide complete details including hospital name, diagnostic and treatment details, date of admission, etc.

    The insurer will provide a reference ID for all future communication pertaining to the claim request.

  • Step 2: Claim registration

    The completed and duly filled claim form has to be sent along with the document checklist.
  • Step 3: Claim settlement

    Insurer will scrutinize the shared documents and give the authorization on the final bill amount in case of approved transactions.Any inadmissible expenses,copayments,deductions will have to be paid by you.