TATA AIG MediSenior Health Plan

Introduction/Overview

The TATA AIG MediSenior plan is a comprehensive plan that is made especially for the retired senior citizens of our family. It takes care of the medical expenses incurred after the retirement of the senior citizens so that they live a stress free life thereafter without thinking much about the expenses.

The plan provides comprehensive coverage against in-patient hospitalization, pre-hospitalization and post-hospitalization, daycare procedures, domiciliary and organ donor expenses, emergency ambulance.

Key Features

• Lifelong renewal provided premium is paid without any break.
• Coverage amount ranging from Rs.2 lacs to Rs.5 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. 5% Family discount in Individual plan
  if  2 family members are covered.
  Choice of paying the premium for 1 year or 2 years

Benefits

In-patient hospitalization that includes ICU, room rent, nursing, medicines, drugs etc are covered by the policy.	The Pre hospitalization expenses of 30 days and post hospitalization expenses of 60 days are taken care of by the policy.
140 different day care procedures that do not require 24 hours of hospitalization are covered.	Domiciliary treatment when the benefactor could not be transferred to the hospital is covered.
The organ donor and his or her expenses incurred are covered by the policy.	There is a system of portability by the company where any benefactor can apply 45 days before the premium renewal date of the existing policy.
One benefit of the policy says that the settlement of the claims is made hassle free by the company.	There is a network of 3000+ hospitals across India.

 

Co-payment for Accommodation Type

Shared Accommodation or any lower accommodation type: Insured has to pay 15% of the admissible claim amount

Single Occupancy or any higher accommodation type: Insured has to pay 30% of the admissible claim amount

 

Co-payment for Day Care Procedures

Insured has to pay 15% of the admissible claim amount for expenses incurred from day care procedures

Co-payment for Specific illness/surgeries

 

For expenses incurred from treatment of the following illnesses and Surgeries, the insured has to pay 30% of the admissible claim amount.

• Cataract(each eye)
• Hysterectomy
• Cholecystectomy
• Transurethral resection of the prostate (TURP) / Benign prostate surgery
• Surgery of Hernia
• Angiography (CT Angiogram excluded)
• Arthroscopy
• PID - Discectomy
• Mastectomy
• Joint replacement
• PTCA (Angioplasty)
• Hydrocele
• Major organ Transplant
• Coronary Artery Bypass Graft (CABG)
  

 

Details About Premium

Annual premium in Rupees

 

 

*The above rates may vary. Please check the policy wordings for more details.

 

Policy Details

Minimum sum assured – 2 lakhs

Maximum sum assured – 5 lakhs

Coverage type: Individual/ family floater

No claim bonus 5% non cumulative discount will be offered on the premium payable at each renewal after every claim free policy year provided the policy is renewed with the company without any break .

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

• Additional 7.5% discount by paying premium of 2 years in advance
• Minimum entry age under this policy is 61 years
• Sum Assured can be enhanced at the time of  renewal
• Pre policy check is mandatory and must be done in a diagnostic center in the network
  

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 except Accident related / 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.

Eligibility

Entry age for the policyholder, spouse is 61 years with lifetime renewal option.