Overview
The TATA AIG Medicare Plus Super Top-up is a health insurance policy designed to supplement existing health coverage. It offers sum insured options up to ₹1 crore and features a global cover option (optional benefit) for daycare and in-patient treatments provided that the diagnosis was made in India. The plan also includes benefits like domiciliary treatment, AYUSH treatment, and ambulance cover (in case of an emergency, subject to Rs. 3000 per Hospitalization). In addition, it provides a cumulative bonus of maximum up to 100% of Base SI for claim-free years and offers lifelong renewability. The plan also comes with premium discounts for longer policy terms and family coverage.
Experts Review
Written by Nikhil Nair
Senior Writer
The TATA AIG Medicare Plus Super Top-up plan is a comprehensive health insurance solution that effectively supplements existing coverage. Its key advantage is the ability to increase the sum insured limit at affordable premiums, making it ideal for individuals seeking enhanced financial protection against high medical bills.
The plan offers a cumulative bonus, lifelong renewability, and cashless claims at over 11,000 hospitals, ensuring seamless healthcare access. Additionally, it provides optional global cover options and covers daycare procedures, AYUSH treatments, and ambulance expenses, enhancing its utility for diverse healthcare needs.
However, while the plan is generally comprehensive, it may not be the most affordable option compared to other super top-up plans available in the market. Despite this, its lack of co-payment, room rent restrictions and disease wise sub limits make it a valuable addition to any health insurance portfolio.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No Restoration Benefit, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature.
TATA AIG
Key Insights
Founded
2001
TATA AIG was established 24 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
89% claims settled in 30 Days
TATA AIG settles 89% of all claims it receives. This is reasonable performance, though there is room for improvement compared to top insurers.
Network Hospitals
11,000+
TATA AIG maintains a moderate network of 11,000 hospitals, offering reasonable coverage across key locations.
Complaints
11 complaints per 10,000 claims registered
TATA AIG experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 90 days after discharge. This includes the cost of medication by the way.
Add-ons
Global Cover
Get coverage for planned treatments abroad upto 100% of sum insured if the diagnosis is made in India for that illness.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Stem cell therapy; however hematopoietic stem cells for bone marrow transplant for haematological conditions will be covered under benefit B1 or B4 of this policy.
Growth hormone therapy.
Admission primarily for administration of Intra-articular or intra-lesional injections or Intravenous immunoglobulin infusion or supplementary medications like Zolendronic Acid.
Venereal disease, sexually transmitted disease or illness.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Tumors, Cysts, polyps including benign breast lumps
Polycystic ovarian disease
Fibromyoma
Adenomyosis
Endometriosis
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
Maternity benefits not offered.
Doctor consultations are not covered.
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Frequently Asked Questions
Does Medicare Plus Super Top-up have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Medicare Plus Super Top-up have room rent restrictions?
Does Medicare Plus Super Top-up offer a restoration benefit?
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