TATA AIG MediSenior Insurance

Unique selling proposition of Tata AIG MediSenior health insurance

• Room Rent: Copay of 15%-Shared Accommodation/30% -Single Accommodation
• Co-pay : 15% for Daycare Procedures / 30% for Specified Illnesses
• Restoration Benefit : NIL Restoration Benefit

• Plan life
  • Renewal available throughout ones life
    
    
• Policy options
  • Individual
  • 5% discount if two family members (self and spouse) are covered under this policy.
  • Premium payment options for 1 or 2 years available.
  • Get 7.5% discount for buying a 2 year policy.
    
    
• Sum Insured options
  • Covers up to 1 lakhs, 3 lakhs and 5lakhs
    
    
• Pre-policy check
  • Pre policy medical tests are mandatory and it is done at network diagnostic centres.
  • if the proposal is accepted then 50% of incurred expense is reimbursed.
  • The validity of the medical test reports is 90 days from date of medical test.
    
    
• Claims Free Discount
  • 5% non-cumulative discount will be offered on the renewal premium if there are no claims in the previous year.
    
    
• Waiting period
  • Coverage starts 30 days after the 1st inception of the policy except for medical expenses arising out of accidents.
  • Policy covers specific illness and treatment only after 24 months
  • re-existing diseases are covered only after 48 months
    
    
• Portability
  • Current policy holders who want to move to a different policy, can do within 45 days before the renewal date of the existing policy.
  • Portability will ensure that these accrued benefits are transferred and time bound exclusions are also transferred.

Tata AIG MediSenior Insurance coverage details

• In-patient Treatment: Covers medical expenses for room rent, ICU, nursing, medicines drugs and consumables.
• Pre Hospitalization: 30 days pre hospitalization incurred expenses
• Post Hospitalization: Medical expenses incurred up to maximum of 60 days immediately upon discharge from hospital
• Domiciliary Treatment: The medical expenses incurred by a person for treatment taken at his home on the advice of the attending medical practitioner which could not be transferred to a hospital or a hospital bed was unavailable for his use.
• Emergency Ambulance: Rs.2000/- maximum for transportation of the insured person by private ambulance services to the nearest hospital offering necessary services.
• Day Care Procedures: 140 day care procedures are covered under this health insurance policy which require hospitalization for less than 24 hours.
• Organ Donor: Pays for medical expenses for an organ donor’s treatment during an organ transplant surgery.
• Tax Benefit: Avail tax benefits on the premiums paid towards your health insurance under Section 80D of the Income Tax Act.

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

1. Cataract(each eye)
2. Hysterectomy
3. Cholecystectomy
4. Transurethral resection of the prostate (TURP) / Benign prostate surgery
5. Surgery of Hernia
6. Angiography (CT Angiogram excluded)
7. Arthroscopy
8. PID - Discectomy
9. Mastectomy
10. Joint replacement
11. PTCA (Angioplasty)
12. Hydrocele
13. Major organ Transplant
14. Coronary Artery Bypass Graft (CABG)

Note: If a claim is accepted for any of the above mentioned surgery then no additional co-payment will be applicable on the accommodation for the same claim. No 2 different co-payment will be applicable for a single claim.

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.