TATA AIG Medi Prime is a health insurance plan which provides a host of coverage benefits and also boasts of settling cashless claims within 4 hours of being intimated. There is no co-payment clause in the policy and so the policyholder is saved from paying anything from his pockets.
Step 1 – the policyholder chooses the Sum Assured, the policy term and the members covered.
Step 2- If the covered member (s) face any medical contingency and the related expenses are covered by the plan the expenses incurred are paid by the plan.
Step 4 – if the plan matures and no medical contingencies occur, no benefit is paid. The Sum Insured is, however, increased by 10% each successive year when a claim is not paid.
Karan, a non-smoking male aged 35 years, buys a family floater plan covering himself, spouse and two children. He chooses a Sum Insured of Rs.10 lakhs.
Option 1 – Karan’s kid has a fracture and is hospitalized. The hospital bills come to Rs.1.25 lakhs which are paid by the plan.
Option 2 – if the plan matures and Karan doesn’t suffer any medical emergency, no benefit is paid. The Sum Insured attracts a No Claim Bonus of 10% and increases to Rs.11 lakhs while the premiums remain the same.
Coverage features | Sum Insured Rs.2,3,4 lakhs | Sum Insured Rs.5,7.5, 10 lakhs |
Hospitalization | Covered | Covered |
Day care treatments | 140 procedures covered up to the Sum Insured | 140 procedures covered up to the Sum Insured |
Pre-hospitalization | 30/60 days | 30/60 days |
Post hospitalization | 60/90 days | 60/90 days |
Domiciliary hospitalization | Covered up to the Sum Insured | Covered up to the Sum Insured |
Organ donor expenses | Covered up to the Sum Insured | Covered up to the Sum Insured |
Ambulance cover | Up to Rs.2500 per hospitalization | Up to Rs.2500 per hospitalization |
Inpatient dental treatments | Covered up to Sum Insured | Covered up to Sum Insured |
Outpatient dental treatments | Up to Rs.5000 | Up to Rs.7500 |
AYUSH treatments | Up to Rs.20,000 | Up to Rs.25,000 |
Post bite vaccination | Inpatient treatment – up to Sum Insured Outpatient treatment – up to Rs.5000 |
Inpatient treatment – up to Sum Insured Outpatient treatment – up to Rs.5000 |
Daily cash for accompanying minor child | Rs.300/day to a maximum of Rs.9000 | Rs.500/day to a maximum of Rs.15,000 |
Health check-ups | Covered once every 4 years up to 1% of Sum Insured. Maximum limit – Rs.5000 | Covered once every 4 years up to 1% of Sum Insured. Maximum limit – Rs.5000 |
Minimum | Maximum | |
Age at entry (in completed years) | Policyholder and adults - 18 years Dependent children – 91 days to 5 years |
65 years |
Term of the plan | 1 year | 2 years |
Premium paying options | Single pay | |
Sum Assured | Rs.2 lakhs | Rs.10 lakhs |
Illnesses suffered during the first 30 days of the plan commencement are not covered.
Pre-existing illnesses or conditions are not covered by the plan in the first 4 years of the policy
Specific illnesses are not covered in the first two years of the plan.
Illnesses or accidents caused due to genetic disorder or stem cell surgery, substance abuse, participation in adventure sports or hazardous activities, criminal acts, attempted suicide, war and hazardous substances, etc. are not covered.
Treatments like dental treatments, cosmetic treatments, maternity related expenses, artificial life support, weight loss treatments, non-allopathic treatments or due to HIV/AIDS, etc. are not covered.
Below are the sample rates of premium (inclusive of service tax and educational cess) payable by a non-smoking male for different combinations of age and members covered. The policy is taken for 1 year and the Sum Insured is Rs.5 lakhs.