Overview
The TATA AIG Medicare Premier plan is a comprehensive health insurance policy offering sum insured options from ₹5 lakhs to ₹3 crores. Key features include 100% automatic restoration of the base sum insured, coverage for daycare procedures (up to SI), and global cover for planned hospitalizations (up to SI). It also provides benefits like bariatric surgery (up to SI), high-end diagnostics cover (up to ₹25,000/year for SI up to ₹50L; up to ₹50,000/year for SI from ₹75L to ₹3 Cr), and OPD cover (up to 20K for OPD & up to 25K for OPD Dental treatments depending on SI opted for), and emergency air ambulance services (up to ₹5L for SI up to ₹50L; for SI above ₹50L, up to ₹5L outside network and full SI within network). Additional coverages include vaccination cover (up to SI), hearing aid expenses (50% of actuals; maximum 10,000 per policy ), and daily cash for shared accommodations (0.25% of base Sum Insured; maximum 2,000 per day).
Experts Review
Written by Nikhil Nair
Senior Writer
The TATA AIG Medicare Premier plan stands out from the base Medicare plan with its enhanced features like global cover for planned hospitalizations and high-end diagnostics on an OPD basis. The inclusion of bariatric surgery and emergency air ambulance services adds significant value for individuals requiring specialized care. The plan also offers wellness services such as teleconsultations and health condition management, which promote proactive health management.
That said, the plan has several drawbacks. The underwriting process is strict, with an age entry cap of 65 years, which may exclude individuals with major health issues or pre-existing conditions. The plan is expensive compared to standalone health insurance companies, which could deter budget-conscious buyers.
Additionally, the restoration benefit is limited to once per policy year, and there is no option to reduce the waiting period for pre-existing conditions. The four-year waiting period for maternity benefits might also be a drawback for young families planning parenthood.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No significant drawbacks found.
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
Maternity
STANDOUT
The insurer will also cover expenses related to maternity— Think hospitalization expenses incurred while giving birth. But they’ll only pay upto ₹50,000 and make you wait 3 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
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 just 2 years. It’s probably the best deal you can get to be honest.
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
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
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Frequently Asked Questions
Does Medicare Premier 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 2-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 3-year waiting period before you can make claims related to pregnancy and childbirth.
- OPD Treatment & OPD-Dental Treatment Waiting Period: There’s a 2-year waiting period before you can claim benefits for OPD Treatments.
Does Medicare Premier have room rent restrictions?
Does Medicare Premier offer a restoration benefit?
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