TATA AIG MediPrime Health Policy

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Introduction/Overview

Tata AIG MediPrime Plan is a comprehensive health insurance policy which will reimburse the cost of medical treatment done by a person for any injury, illness or accident. This policy aims to provide financial assistance to the insured in the event of a health emergency.

It covers hospitalization costs and expenses incurred to undergo day-care treatments which do not require the person to be admitted in the hospital. This plan can be renewed for life and it has no sub limits. It provides for accidental dental treatment and non-allopathic, in-patient treatments like Ayurvedic, Unani or Homeopathy.

It can be bought as individual or family floater cover. Under the family cover, the sum insured can be utilized by any of the insured members in case of need.

Key Features

  • No use of third party administrators (TPA) to process claims. The company has a direct claim service team
  • Cashless hospitalization at 5000+ hospitals
  • Lifelong renewal provided premium is paid without any break.
  • The longer term option of two years
  • Wide range of No medical check-up up to 45 years and up to Sum Insured of Rs 5 lacs.
  • Coverage amount ranging from Rs.2 lacs to Rs.10 lacs
  • Income tax benefit on the premium paid as per Section 80D of the Income Tax Act
  • Family Floater Option is allowed under this plan. 10% Family discount in Individual plan if 3 or more family members are covered
  • Free Look Period of 15 days from the date of receipt of the Policy document to review the terms and conditions of this Policy

 

Benefits

MediPrime Benefits

Sum Insured (in lacs)

Sum Insured (in lacs)

(per Policy Year)

Rs. 2.00, Rs 3.00, Rs 4.00

Rs. 5.00, Rs 7.50, Rs 10.00

a)In-patient Treatment 

Covered without Sub-limits 

Covered without Sub-limits

b)Pre-hospitalization

Covered without Sub-limits 

Covered without Sub-limits

c) Post-hospitalization

Covered without Sub-limits 

Covered without Sub-limits

d) Day Care Procedures

Covered without Sub-limits 

Covered without Sub-limits

e) Domiciliary Treatment

Covered without Sub-limits 

Covered without Sub-limits

f) Organ Donor Expenses

Covered without Sub-limits 

Covered without Sub-limits

g) Emergency Ambulance

 Up to Rs. 2,500 per hospitalization

 Up to Rs. 2,500 per hospitalization

h) Dental Treatment (In case of Accident)

In-patient treatment - Up to 100% of Sum Insured and Outpatient Dental treatment - Up to Rs 5,000.

In-patient treatment - Up to 100% of Sum Insured and Outpatient Dental treatment - Up to Rs 7,500.

I) Ayush Benefit

Inpatient Ayurveda, Unani, Sidha or Homeopathy treatment maximum up to Rs 20,000

Inpatient Ayurveda, Unani, Sidha or Homeopathy treatment maximum up to Rs 25,000

j) Daily Cash for Accompanying an Insured Child

Rs 300 per day, maximum up to Rs 9,000 per hospitalisation

Rs 500 per day, maximum up to Rs 15,000 per hospitalisation

k) Vaccination (In case of post-bite treatment)

In-patient treatment - Up to 100% of Sum Insured and Outpatient Vaccination - Up to Rs 5,000

In-patient treatment - Up to 100% of Sum Insured and Outpatient Vaccination - Up to Rs 5,000

l) Health Check-up

Up to 1% of the Sum Insured per Policy subject to a maximum of Rs 5,000 per Insured Person only once at the end of a block of every continuous four claim free years.

Up to 1% of the Sum Insured per Policy subject to a maximum of Rs 5,000 per Insured Person only once at the end of a block of every continuous four claim free years.

 

Details about Premium

Annual premium in Rupees

 

Policy Details

Minimum sum assured – 2 lakhs

Maximum sum assured – 10 lakhs

Coverage type: Individual/ family floater

No claim bonus: 10% increase in annual inpatient sum insured for every claim free year subject to a maximum of 50%. If a claim is made, the cumulative bonus would reduce by 20% in the following year

Grace period: 30 days for renewing the Policy. However, coverage would not be available for the period for which no premium has been received.

Policy termination: 3 months prior to the expiry of the policy

 

Additional Features or Riders

  • Sum Assured can be enhanced at the time of  renewal
  • Cumulative Bonus of 10% increase of the annual Sum Assured for every claim free year
  • Health check-up expenses on every 4 years of continuous renewal
  • Provides cash benefit for accompanying an insured child at the time of hospitalization
  • Covers maximum 5 family members (upto a maximum of 2 adults and 3 children under a single MediPrime family floater policy)

Exclusions

  • Pre existing diseases will not be covered for the first 4 policy years given there has been continuous renewal from the policy start date
  • Treatment done in the first 30 days from the commencement of the policy, unless the treatment is done as a result of accident or emergency. This is referred to as a waiting period.
  • Any illness or disease contracted due to intake of alcohol/drugs or other addictive substances will not be covered.
  • The waiting period for specific conditions will be 24 months Any pre-existing condition will be covered after a waiting period of 48 months
  • Any treatment which begins during waiting periods
  • Accidents related to war / Intentional self injury or attempted suicide / Abuse of drugs and alcohol and nicotine addiction / Treatment of Obesity / Sleep Apnoea / Maternity / Psychiatric or mental disorders / congenital diseases / Conditions related to or arising out of HIV/AIDS / etc.

Documents Required

Policyholder has to fill up an ‘Application form/ proposal form’ with accurate medical history along with the address proof. Medical examination may be required in some cases, based on the sum insured and the age of the person.

Eligibility

Entry age for the policyholder, spouse and parents is 18 years to 65 years with lifetime renewal option.