TATA AIG Medi Prime Plan

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.

Key features of the plan

• No pre-entrance medical check-ups are required till 45 years of age if the Sum Insured selected is up to Rs.5 lakhs.
• There are no sub-limits on room rent, ICU charges and other hospitalization expenses.
• No claim based loading is applicable on renewal premiums
• Cashless claim facility is available across more than 3000 hospitals in India.
• Accidental dental treatments are also covered under the plan
• Both individual and family floater plan can be taken

How does the plan work?

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.

Example

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.

Plan benefits

• Medical benefits – the list of medical expenses covered by the plan and their extent is as follows:

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

• No Claim Bonus – if the policyholder does not make a claim in any policy year he earns a cumulative bonus of 10% increase in the Sun Insured subject to a maximum of 50%.
• Premium discounts – premium discounts are allowed for buying a policy of 2 years. The rate of discount is 5%. If 3 or more people are covered under the plan, another 10% discount is given.

Eligibility Criteria

What is not covered by the plan?

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.

Premium Illustration

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.