TATA AIG health insurance

Tata AIG health insurance benefits

• Key Features of Tata AIG Health Plans

  • Room Rent : No Room Rent Restrictions
  • Co-pay : NIL co-pay for all treatment
  • Restoration : Upto 100% of Base SI per year for unrelated illnesses

  Some of the key features under the Tata AIG health insurance plans include :

  • Higher sum insured options in MediCare (upto ₹20 Lacs) and MediCare Premier (upto ₹50 Lacs)
  • No room rent restrictions in MediCare Premier / MediCare
  • In case of MediCare, two variants for accommodation cover – Single Private room/ Shared
  • Restore Benefit (for related as well as unrelated illnesses)
  • Longer tenure upto 3 years
  • Consumables Benefit available
  • Higher Cumulative Bonus than most plans in the India market
  • Optional PA cover for MediCare Protect and MediCare
  • Tata AIG is equipped to offer quality health care with our strong network of 4000+ hospitals across India.
  • Lifelong renewal: Lifelong renewal for your policy provided premium is paid without any break. Premiums will be basis the age, sum insured and plan with no extra loading
  • Global Cover: Insured can be covered for Medical Expenses incurred outside India, upto the sum insured provided that the diagnosis was made in India and the insured travels abroad for treatment.
  • Process
    • Uniform PPC grids
    • Simpler & Reduced medical questions in Proposal Form
    • Tele Underwriting – Medical Examination Report over the telephone
  • Claims
    • Plan for in house servicing of claims

• Why should one insure themselves through Tata AIG health insurance?

  Some of the key reasons to trust Tata AIG with your Health Insurance policy are as follows:

  • One of the leading brands in India across all products including Health Insurance – know for transparency and integrity
  • Cashless claims facility at over 4,000+ hospitals across the country
  • State of the art 24*7 call centre for assistance and claims settlement across all product lines
  • Catering to needs as per a developing Indian Health market in terms of Benefits / Sum Insured Options
  • Maximum coverage at affordable premium rates backed up from superior claims and customer support.

• 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
    • [email protected]
    • [email protected] (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 [email protected].
  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 [email protected] . 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 [email protected] . 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.

• Exclusions under the Tata AIG’s health products

  The following are the key Medical and Non Medical Exclusions under Tata AIG’s Medicare Plans. Please go through the Terms and Conditions of the policy for the complete list of the exclusions:

  Medical Exclusions

  • “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human immunodeficiency virus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS related complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.
  • The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.
  • Treatment of Obesity and any weight control program subject to cover under benefit bariatric surgery.
  • Psychiatric, mental disorders (including mental health treatments); Parkinsons and Alzheimer’s disease;
  • Congenital external diseases, defects or anomalies;
  • Stem cell implantation or surgery; or growth hormone therapy;
  • Sleep-apnea
  • Charges related to peritoneal dialysis (CAPD), including supplies
  • Admission primarily for diagnostic and evaluation purposes only.
  • Venereal disease, sexually transmitted disease or illness;
  • Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services.
  • Laser treatment for correction of eye due to refractive error;
  • Aesthetic or change-of-life treatments of any description such as sex transformation operations, treatments to do or undo changes in appearance or carried out in childhood or at any other times driven by cultural habits, fashion or the like or any procedures which improve physical appearance.
  • Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an Accident, Cancer or Burns.
  • All preventive care, vaccination including inoculation and immunisations (except in case of post- bite treatment and other vaccines explicitly covered);

  Non-Medical Exclusions

  • War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, ionising radiation.
  • Any Insured Person’s participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
  • Intentional self-injury or attempted suicide while sane or insane.
  • Charges incurred at a Hospital primarily for diagnostic, X-ray or laboratory examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness or Injury, for which confinement is required at a Hospital.
  • Items of personal comfort and convenience like television (wherever specifically charged for), charges for access to telephone and telephone calls, internet, foodstuffs (except patient’s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service as well as similar incidental services and supplies.
  • Doctor’s fees charged by the Medical Practitioner sharing the same residence as an Insured Person or who is an immediate relative of an Insured Person's family.
  • Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy unless explicitly stated and covered in the policy.
  • Any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.
  • Crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively and explicitly stated and covered in the policy)
  • Any claim incurred after date of proposal and before issuance of policy where there is change in health status of the member and the same is not communicated to us.
  • All expenses incurred by the Policyholder/ Insured Person at the Hospital or any institution about which the Company has expressly notified that the Claim incurred at such Hospital/institution shall not be payable (except reimbursement claims related to accidents and life threatening conditions). The updated list of such Hospitals can be obtained through the Company's website or Call Center.