Tata AIG ElderCare Plan
Tata AIG ElderCare insurance is a health insurance policy introduced by Tata AIG General Insurance Company to take care of the health of senior citizens. The policy has come up with coverage for daycare procedures, cover for hospitalisation expenses, home nursing services, and many more. Keeping in mind the needs of the elderly, this policy also offers wellness features, and different equipment for the elderly such as wheelchairs, walkers, etc which usually the general health insurance policies do not cover.
The policy is designed to cater to the needs of the senior people. One of the unique features of this policy is that it provides preventive health care benefits for some specialities. One can avail of these annual consultations at free cost irrespective of the claims that they make. If any insured person needs care at home, this policy will also cover home care expenses. Every person has different needs health-wise. Therefore, this policy has kept a provision for a health manager who will look after the needs of the insured. Therefore, Tata AIG ElderCare is a comprehensive all-in-one policy for people who are 61 years and above.
|Age at entry
|61 years and above
|Pre and Post-Hospitalisation Cover
|Available up to the sum insured
|Road ambulance cover
|Up to a maximum of Rs. 2,000 per hospitalisation for registered ambulances.
|Preventive health check-ups
Up to 1% of the previous sum insured
Maximum:f Rs. 10,000 in ElderCare policies
|Long-term policy benefit
5% discount on premium for a 2-year tenure.
10% discount on premium for a 3-year tenure.
|Lifelong on timely premium payments
|Sum Insured on specific surgical procedure
|ElderCare: Rs. 5 Lacs/Rs. 10 Lacs/Rs. 25 Lacs respectively.
|Mandatory co-payment of 20%
What Are The Features and Benefits of ElderCare Offered By Tata AIG?
Here are the important mentions.
- This policy offers comprehensive health coverage. The minimum sum assured is Rs. 2 lakhs and the maximum is Rs. 20 lakhs. Within this range, the policy offers a wide range of benefits including daycare procedures, in-patient hospitalisation, pre and post-hospitalisation, etc.
- One can avail of the benefit of preventive health check-up. This benefit can be used by multiple individuals insured under this policy. This will not affect the number of claims made by the insured person.
- Apart from the allopathic treatment, people often opt for AYUSH treatments. This policy also covers the expenses incurred due to this type of treatment.
- If your sum insured gets exhausted during the policy period of an active policy, then the company will offer the restore benefit where you will get up to the basic sum insured along with the applicable bonus. Only once in the entire policy period, you can get this benefit.
- If any insured person needs an organ transplant being the donor, then the policy will reimburse the expenses incurred for this organ transplant procedure.
- Daycare procedures that require hospitalisation of less than 24 hours will be covered by this policy.
- Sometimes, for senior citizens, it becomes impossible to visit the hospital to receive the treatment. In that case, home treatment expenses will be covered under the benefit of domiciliary hospitalisation.
- For the emergency transportation of the patient from one hospital to another, the provision of a road ambulance is there. The limit is Rs. 3000 per hospitalisation.
- If an insured person is diagnosed in India and for better treatment he/she needs to travel abroad, then this policy covers the expenses of that too. Restore sum insured cannot be used for this benefit. Only the basic sum insured and the applicable bonus can be used.
- This policy also offers an optional benefit that is accidental death benefit. If the insured person dies due to an accident within the policy period of an active policy, then the company will reimburse the 100% basic sum insured to the beneficiary of the policy.
Exclusions of Tata AIG ElderCare
Although this policy offers a sack full of benefits and advantages, there are certain exclusions as well for which this plan will not offer any benefits. The important mentions are as follows.
- Any pre-existing disease that is not declared at the inception of the policy.
- Any claim that does not follow the terms and conditions of the policy as well as the company.
- Any claim or health issue arising out of taking intoxication substances.
- Expenses related to the treatment of obesity and infertility will not be covered under this policy.
- Any breach of contract will be acceptable.
- Any procedure or treatment related to sex change, or plastic surgery will be covered by the policy.
- If treatments and procedures received are not valid or recognised, then the company will not be liable to pay.
- The treating medical practitioner has to be recognised by the concerned authority and he/she should have having proper licence.
- Health hazards incurred due to radiation, ionising will not be covered.
- Any health risks incurred due to war, war-like situations, protests, riots, public unrest, etc will be covered.
- Items that are needed for personal comfort and convenience and not medically needed will not be covered as well.
- Medical equipment like fitting of hearing aids, spectacles, etc will not be covered until and unless it is mentioned in the policy schedule.
- Admissions related to enforced bed rest will not be compensated.
Claim procedure of Tata AIG ElderCare
This policy offers both cashless and reimbursement claim procedures. Here are the detailed steps of both.
Cashless Claim Process:
- To avail of this benefit, one has to get admitted to one of the network hospitals of the company.
- For planned hospitalisation, the insurer has to be intimated within 48 hours of the hospitalisation, and for emergency hospitalisation, within 24 hours the company has to be informed.
- For Global Cover, this cashless facility will be available only for in-patient hospitalisation and daycare procedures.
- Once the company is intimated, the insured will check your eligibility and will do a background check. After that, it will send an authorization letter to the hospital directly.
- The insured person has to submit related documents such as the health ID card issued by the insurer, and valid ID proof to the TPA or the insurance provider.
- After the submission of all the required documents, the company will settle the claim amount directly with the hospital.
- If the cashless claim is not approved, you always have a provision to apply for a reimbursement claim.
Reimbursement Claim Procedure:
- For this type of claim procedure, you can choose the hospital of your choice.
- Go to the official website of Tata AIG General Insurance.
- On the top, there will be the claim tab. Click on that.
- Click on the initiate claim option. Here it will be the health option.
- Now you must log in to your online customer portal using your registered details.
- Fill in the blanks, and upload the documents that are required.
- After the intimation of the claim, the company will verify all details.
- If no discrepancy is found, the claim amount will be sent to your bank account.
- Original hospital bills along with other receipts such as pharmacy bills, treating doctor’s reports, etc.
- Duly signed and filled out claim form.
- Health ID issued by the insurer.
- KYC details
- NEFT details of the registered bank
- All medical reports, case history, medical practitioner’s reports, etc.
- Discharge certificate of the hospital
- Valid ID proof.
- Address proof.
- Copy of the settlement letter of the insurer or TPA
- Receipts of the implants or stickers of the same in case of implant surgery
- FIR or report of the concerned authority in case of an accident.
- Any other document as requested by the insurer.
Premium calculation of ElderCare Policy
To have a better understanding of the plan, here is an example.
Suppose, Mr. Bose, a 63-year-old retired person wants to buy a Tata AIG ElderCare policy. Let us find out how much premium amount he has to pay to buy this policy for the following credentials.
For your better understanding here is an example.
Mr. Sinha, a 63-year-old retired government employee bought this Tata AIG ElderCare Insurance Policy. Let us find out how much premium he has to pay for different sum insured options along with the following credentials.
|Rs. 10 lakhs
|Rs. 25,820 including 18% GST
|Rs. 15 lakhs
|Rs. 28,956 including 18% GST
|Rs. 20 lakhs
|Rs. 30,351 including 18% GST
Frequently Asked Questions
For this policy, the waiting period is 30 days. However, day 1 cover is available only in case of accidents.
Many factors can influence the premium amount that one has to pay for this policy. The important mentions are as follows.
- Age of the insured person
- Medical history
- Family background (If they have any history of chronic disease)
- Sum insured amount
- Policy period
- Pre-existing diseases
If you want to renew your existing policy, follow the step-by-step guide.
- Go to the official website of Tata AIG.
- Click on the All Products tab and select the Tata AIG ElderCare option.
- Click on the renew existing policy option
- Enter the policy number and provide other information as required.
- Check all the details carefully, and pay the renewal amount online.
Yes, Tata AIG has this provision of transferring the policy. For this, you have to apply before 45 days of the renewal date of the existing policy and apply for the transfer. The same has to be intimated to Tata AIG as well. After a thorough background check, you can get the approval to transfer your senior citizen plan to Tata AIG. any accrued bonus and exclusions will remain unaffected.
As per the guidelines of the IRDAI, if the policy-seeker accepts the risk then the insurance company has to reimburse 50% of the cost of the pre-policy medical screening. In other cases, the entire amount has to be borne by the policy-seeker himself/herself.