TATA AIG MediRaksha Insurance

Key policy features of Tata AIG MediRaksha insurance

• Room Rent: Restricted to 1% of Sum Insured
• Co-pay : Co-pay of 15% for all treatments
• Restoration Benefit : NIL Restoration Benefit
• Ease of Timely Claims Settlement.
• Cashless facility across a strong and wide network of hospitals across India.
• No medicals on enrollment – Upto 55 years.
• No loading on renewal premium in case of a claim.
• Get a family discount of 10%, if 2 or more members of a family are covered under the same policy on Individual sum insured basis.
• Get an additional 7.5% discount in premium by paying premium of 2 years in advance as single premium.
• Renewal incentive like free health check up.
• Tax Benefits-Get tax benefits for premium paid on policies as per section 80D of the Income Tax Act.Tax benefits are subject to changes in tax laws.

Unique selling proposition of Tata AIG MediRaksha health insurance

• Entry age is 18 years to 65 years for the proposer.
• you can insure yourself, your spouse, upto 3 dependent children and your dependent parents. Child between 91 days to 5 years can be insured only when either parent is getting insured under this policy.

Benefits of Tata AIG MediRaksha Insurance

• In – patient hospitalization – including room rent ,ICU, nursing, medicines drugs & consumables covered.
• Pre and Post Hospitalization medical expenses - Expenses incurred upto 30 days immediately before hospitalization and upto 60 days immediately after discharge are covered.
• Day Care Procedures –Covers 144 day care treatments.
• Organ Donor - The policy covers inpatient medical expenses incurred on the insured (i.e recipient) and the organ donor for harvesting.
• Health Checkup - 1% of the Sum Insured in the fourth year Policy subject to a maximum of Rs. 1,000 per Insured Person only once at the end of a block of every continuous four claim free years during which You have been insured with Us.
• Settlement of your claims - We settle your claims hassle free and quickly
• Network of Hospitals - network of 3000+ hospitals across India
• Lifelong Renewal - We offer you a lifelong renewal for your policy
• Portability - A policy holder desirous of porting (shifting) his policy to us shall apply at least 45 days before the premium renewal date of his existing policy.
• Tax savings - If one purchases a health insurance policy for self /spouse/children, he/she can claim a tax deduction of upto Rs. 25000. When one purchases a health insurance policy for parents (a senior citizen), he/she is eligible for an additional tax deduction benefit upto Rs. 30,000. These benefits are covered under section 80D of Income Tax Act 1961. Tax benefits are subject to changes in tax laws.
• Copayment of 15% on each and every claim under this policy: Co-Payment means a cost-sharing requirement applicable under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible amount. A Co-Payment does not reduce the Sum Insured.

Exclusions under the MediRaksha Health product

• Intentionally self-inflicted Injury or illness;
• Conditions related to or arising out of HIV;
• AIDS; War; Congenital anomalies;
• Pregnancy and all related conditions; Abuse of drugs and alcohol and addiction or overdose etc.

Note: Please refer to policy wordings for the list of exclusions.

Tata AIG health insurance claims

Claim Related Information:

For any claim related query, intimation of claim and submission of claim related documents, you can contact Your TPA through:

• Name of TPA : Family Health Plan Insurance TPA Ltd (FHPL)
• Website : www.fhpl.net
• Email
  • info@fhpl.net
  • seniorcitizensdesk@fhpl.net (for Senior Citizens)
• Toll Free
  • 1800-425-4033
  • 040- 23552899 (for Senior Citizens)
• Fax : +91-40-23541400
• Submit claim
  • Claims Department, Family Health Plan Insurance (TPA) Ltd, Srinilaya – Cyber Spazio Suite # 101,102,109 & 110, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, 500 034.

Procedure for Reimbursement of Medical Expenses

• The TPA (Third Party Administrator) must be informed no later than 7 days of completion of such treatment, consultation or procedure using the Claim Intimation Form.
• Please send the duly signed claim form and all the information/documents mentioned therein to your designated TPA within 15 days of the occurrence of the Incident. Please refer to claim form for complete documentation.
• If there is any deficiency in the documents/information submitted by the insured, the TPA will send the deficiency letter within 7 days of receipt of the claim documents.
• On receipt of the complete set of claim documents, Tata AIG will send the payment for the admissible amount, along with a settlement statement within 30 days.
• The payment will be sent in the name of the proposer.

(Note: Payment will only be made for items covered under your policy and upto the limits therein.)

Procedure to avail Cashless Treatment

• For any emergency Hospitalisation, the designated TPA must be informed no later than 24 hours after hospitalization.
• For any planned hospitalization, kindly seek cashless authorization from the designated TPA atleast 48 hours prior to the hospitalization.
• TPA will check your coverage as per the eligibility and send an authorization letter to the provider. In case there is any deficiency in the documents sent, the same shall be communicated to the hospital within 6 hours of receipt of documents.
• Please pay the non-medical and expenses not covered to the hospital prior to the discharge.
• In case the ailment /treatment is not covered under the policy a rejection letter would be sent to the provider within 6 hours.

(Note: n Insured person is entitled for cashless coverage only in our empanelled hospitals.)

Grievance Redressal Procedure

Tata AIG is committed to extend the best possible services to the insured. However, if you are not satisfied with our services and wish to lodge a complaint, please call our 24X7 Toll free number 1800266-7780 or 022-66939500 (toll number) or 1800 22 9966 (For Senior Citizens) or you may email to the customer service desk at customersupport@tataaig.com.

After examining the issue and subsequent closure, Tata AIG will send our response within 10 days from the date of receipt of the complaint by them. In case the resolution is likely to take a longer time, we will inform you of the same through an interim reply.

Escalation Level 1
In case you do not receive a resolution within 10 days or if the resolution still does not meet your expectations, you can write to manager.customersupport@tataaig.com . After analysing the matter internally and subsequent closure, we will send our response within a period of 8 days from the date of receipt at this email id.

Escalation Level 2
In case you do not receive a resolution within 8 days or if the resolution still does not meet your expectations, you can write to Head - Customer Services at head.customerservices@tataaig.com . After examining the matter, we will send you our final response within 7 days from the date of receipt of your complaint on this email id.