With several health insurance plans available in the market, at times, it becomes difficult to choose the right one. While there are certain standard features across the plans, there could be certain differentiating features too. Therefore, one needs to carefully look at them before taking the buying decision.
Here, we look at Tata AIG MediCare Health Insurance plan to see what all is included and excluded in it. The plan has at least three differentiating features – Global coverage, restore benefit cover and coverage for Bariatric Surgery.
Global cover
In case of medical expenses incurred outside India, the coverage upto the full sum insured (including cumulative bonus) will be available. However, the condition is that the diagnosis was made in India and the insured travels abroad for treatment. The medical expenses payable will be limited to inpatient and daycare hospitalisation only on reimbursement basis, while the cashless facility may be arranged on case to case basis.
Restore Benefit Cover
The plan comes with the restore benefit cover which automatically restores the basic sum insured upon exhaustion of the sum insured and accrued cumulative bonus, during the policy period. However, remember that the benefit for related illness or diseases would be available, for admissions after 45 days from the date of discharge of the earlier claim.
Bariatric Surgery
Bariatric Surgery is primarily for the treatment of obesity and weight control. The MediCare plan covers it subject to the following conditions:
i. Surgery to be conducted is upon the advice of the doctor
ii. Insured has to be 18 years of age or older and
iii. Body Mass Index (BMI) greater than or equal to 40
Accidental cover
If the insured person suffers an accident during the policy period and this is the sole and direct cause of the death within 365 days from the date of accident, then the plan pays an amount equal to the base sum insured.
Cumulative Bonus
For every claim free year, the plan provides a cumulative bonus of 50 percent of the sum insured accumulating up to a maximum of 100 percent of sum insured. However, if a claim is made, then in the subsequent policy year, the cumulative bonus in reduced by 50 percent of the sum insured. Importantly, there will be no impact on the sum insured, only the accrued cumulative bonus will be decreased
Health Check-up
Most plans come with the feature of Preventive Health Check-up. MediCare covers expenses for a Preventive Health Check-up upto 1 percent of previous sum insured subject to a maximum of Rs. 10,000 per policy. The limit is the maximum per policy and more than one insured can utilise the amount. The benefit is payable after every two continuous claim free policy years.
Dental treatment and vaccination
The plan provides cover for medical expenses incurred towards hospitalisation for dental treatment under anesthesia necessitated due to an accident, injury or illness. Further, the plan will cover expense incurred towards Human Papilloma Virus (HPV) vaccine and Hepatitis B Vaccine, provided the policy has 2 years of continuous coverage. The first year vaccination expense of the new born up to a limit of Rs. 10,000 is also covered.
Basic features
Apart from pre and post-hospitalisation expenses for illness, accident, surgeries, dental treatment and hearing aid charges, ‘MediCare’ also offers compassionate travel benefit for an insured’s immediate kin up to a limit of Rs. 20,000.
‘MediCare’ offers a sum insured option of up to Rs. 20 lakh coverage. Most importantly, the plan does not have any sub-limit for any diseases, no co-pays and no room rent capping. The policy covers 540+ day-care surgeries including organ donation, maternity cover with no limit on deliveries.
What to do
The plan has three variants – ‘MediCare Protect’, ‘MediCare’ and ‘MediCare Premier’. Check the features that suit you and then decide as no two plans are strictly comparable. In addition to the pre-existing disease which gets covered after 48 months of the policy, there could be waiting period for certain ailments and situations for 30 days or 24 months. Remember, to read the permanent exclusion list before you buy any health insurance plan including this one.
