Cashless Mediclaim Policy

MediPrime – Cashless Health Insurance
 

Does your health insurance offer you cashless claim in 4 hours** & help you save on tax too? We do. Tata AIG MediPrime is a transparent health insurance policy without any sub-limits on health expenses, so both you and your savings remain healthy.

 
Calculate Health Insurance premium online for MediPrime   Buy MediPrime health insurance policy online   Renew MediPrime health insurance policy online
 
Key Features
 
  • No medicals on enrollment – Upto 50 years and/or for sum assured below Rs 5 lacs
  • Comprehensive hospitalization coverage withoutany sub-limits
    • On inpatient treatment expenses
    • On day care procedures expenses
    • On domiciliary treatment
    • On organ donor expenses
  • Tax Benefits-Get tax benefits for premium paid on policies as per section 80D of the Income Tax Act.Tax benefits are subject to changes in tax laws.
  • No co-pay is applicable
  • Cashless hospitalization at 3000+ hospitals     Click here to view the list of network hospitals
  • No loading on renewal premium in case of a claim
  • We offer lifelong renewal provided premium is paid without any break.
  • 15 days Free Look period (For the new business only)
  • 30 days Grace Period (For renewals only).
  • Sum Insured Enhancement – Sum Insured can be enhanced only at the time of renewal. However the quantum of increase shall be as per underwriting guidelines of the company.
  • Changes will be notified to the policyholders 3 months in advance in case of revision /modification in approved product.
  • Option to migrate to similar Indemnity health insurance policy
  • Likelihood of withdrawal of the product will be notified to the policy holders 3 months prior to the expiry of the policy and option would be given to migrate to similar Health Insurance policy
 
What are the benefits offered by Tata AIG MediPrime?
 
What does Tata AIG's MediPrime cover?
 

    Coverage without any sub-limits on health expenses

  • Room & ICU charges.
  • Day Care Procedures - Medical expenses for 140 different Day Care procedures which do not require 24 hours hospitalization due to technological advancement.
  • Domiciliary Treatment - Medical Expenses incurred by an Insured Person for availing medical treatment at his home which would otherwise have required hospitalization.
  • Organ Donor - In-patient medical expenses incurred on the insured (i.e. recipient) and the organ donor for harvesting (i.e. surgery & storage of organ) for organ transplantation.
What is not covered under Tata AIG MediPrime cover?
 

Following is a partial list of the policy exclusions. Please refer to the policy wording Section 3 major exclusions for the complete list of exclusions.

  1. War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind.
  2. Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self injury or attempted suicide while sane or insane.
  3. Any Insured Person’s participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
  4. The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies.
  5. Treatment of Obesity and any weight control program.
  6. Psychiatric, mental disorders (including mental health treatments); Parkinson and Alzheimer’s disease; general debility or exhaustion (“run-down condition”); congenital internal or external diseases, defects or anomalies; genetic disorders; stem cell implantation or surgery; or growth hormone therapy; sleep-apnoea.
  7. Venereal disease, sexually transmitted disease or illness; “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human immunodeficiency virus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS related complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.
  8. Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth (including caesarean section) except in the case of ectopic pregnancy in relation to 1)a) only.
  9. Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services.
  10. Save as and to the extent provided for under 1)h), Dental treatment and surgery of any kind, unless requiring Hospitalisation
  11. Expenses for donor screening, or, save as and to the extent provided for in 1)f), the treatment of the donor (including surgery to remove organs from a donor in the case of transplant surgery).
  12. Treatment and supplies for analysis and adjustments of spinal subluxation; diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except for treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
  13. Treatment of nasal concha resection; circumcisions (unless necessitated by illness or injury and forming part of treatment); laser treatment for correction of eye due to refractive error; aesthetic or change-of-life treatments of any description such as sex transformation operations, treatments to do or undo changes in appearance or carried out in childhood or at any other times driven by cultural habits, fashion or the like or any procedures which improve physical appearance.
  14. Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an Accident, Cancer or Burns.
  15. Experimental, investigational or unproven treatment, devices and pharmacological regimens; measures primarily for diagnostic, X-ray or laboratory examinations or other diagnostic studies which are not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any Illness for which confinement is required at a Hospital.
  16. Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care.
  17. Save as and to the extent provided for under 1)i), Any non allopathic treatment.
  18. All preventive care, vaccination including inoculation and immunisations (except in case of post- bite treatment); any physical, psychiatric or psychological examinations or testing; enteral feedings (infusion formulae via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements, unless certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
  19. Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to charges for admission, discharge, administration, registration, documentation and filing.
  20. Items of personal comfort and convenience including but not limited to television (wherever specifically charged for), charges for access to telephone and telephone calls, internet, foodstuffs (except patient’s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service as well as similar incidental services and supplies, and vitamins and tonics unless vitamins and tonics are certified to be required by the attending Medical Practitioner as a direct consequence of an otherwise covered claim.
  21. Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed; treatments rendered by a Medical Practitioner who shares the same residence as an Insured Person or who is a member of an Insured Person's family, however proven material costs are eligible for reimbursement in accordance with the applicable cover.
  22. Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.
  23. Any treatment or part of a treatment that is not of a reasonable charge, not medically necessary; drugs or treatments which are not supported by a prescription.
  24. Artificial limbs, crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively).
  25. Any exclusion mentioned in the Schedule or the breach of any specific condition mentioned in the Schedule and accepted by the insured, as per Our underwriting guidelines.
  26. Any non medical expenses (list enclosed)
Track your Claims
 
How can I Claim?
 
  • Take advantage of cashless hospitalization facility across the +3000 strong network of hospitals. In case you have availed of treatment at hospitals not listed on the network, you can settle the bills at the hospital and then submit your original claim documents with required medical records to the TPA for reimbursement.
  • For any emergency Hospitalization, please carry your cashless card and identity proof. The TPA must be informed within 24 hours after hospitalization. For planned hospitalization, kindly seek cashless authorization from TPA at least 48 hours prior to the hospitalization. For any claim related query &/or assistance, contact our Third Party Administrator (TPA) Family Health Plan (TPA) Limited as per details given below.
  • Claims Department, Family Health Plan (TPA) Ltd, Ground Floor, Srinilaya - Cyber Spazio, Road No: 2, Banjara Hills, Hyderabad 500034. Website: www.fhpl.net ,
    Email: info@fhpl.net ,
    Toll Free: 1800-425-4033, Fax: +91-40-23541400 / 1800 22 9966 (Only for Senior Citizens)
  • Please contact our designated TPA atleast 7 days prior to an event which might give rise to a claim. For any emergency situations, kindly contact Our TPA within 24 hours of the event.

Download Claim Form

View & Download : Policy Wordings, Customer Information Sheet & Premium Table
 
Frequently Asked Questions
 

Q1. What is the Entry Age applicable for MediPrime?

Entry age for Enrollment in MediPrime for an Adult is 18 to 65 years and for a Child is 91 days to 21 years. Policy is however renewable for life upon payment of premium provided the cover is maintained with us without a break unless cancelled due to fraud or misrepresentation.

Q2. What are the Policy Term Options available in MediPrime?

It offers the option of 1 Year & 2 Years Term. For 2 year term plan, 5% discount on the Premium is available.

Q3. What are the In-Patient (Hospitalization) Related Benefits offered in MediPrime?

MediPrime offers 10 different categories of Hospitalization & In-Patient treatment related Coverages

  • Pre Hospitalization cover of upto 30 days from the date of Hospitalization
  • In-Patient or Hospitalization Benefits
  • Post Hospitalization cover for upto 60 days from the date of discharge
  • Accidental Dental Treatment & Hospitalization
  • Post Bite Vaccination treatment & hospitalization
  • Organ Donar expenses for organ harvesting
  • Domiciliary expenses for treatments taken at home
  • Ayush Benefit for In-Patient treatment through Alternate Medicines such as Ayurveda, Homeopathic, Unani & Siddha.
  • Daily Cash for accompanying an insured child during hospitalization.
  • Emergency Ambulance for Hospitalization.

Q4. What are the OPD benefits offered in MediPrime?

There are 2 specific OPD Benefits in MediPrime.

  • Accident related Dental Treatment & Hospitalization.
  • Post Bite Vaccination Treatment & Hospitalization.

Q5. List the Coverages included in the In-Patient / Hospitalization Benefits.

This includes the expenses incurred for the following in the event of hospitalization.

  • Room rent, boarding expenses & ICU.
  • Nursing & Medical Practitioners.
  • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances.
  • Medicines, drugs and consumables.
  • Diagnostic procedures.
  • The Cost of prosthetic & other devices implanted internally during surgery.

Q6. What is the waiting period applicable for various benefits in MediPrime?

  • 30 days for all illnesses (except accident) in the first year and is not applicable in Section 3 b) subsequent renewals.
  • 24 months for specific illness and treatments in the first two years and is not applicable in subsequent renewals Section 3 c)
  • Pre-existing Diseases will be covered after a waiting period 48 months and it Section 3 d) will get reduced by 1 year on every continuous renewal of your policy Payout

Q7. What are the timelines for Notification of Claims to Tata AIG or our Claims TPA?

  1. Cashless Hospitalization needs to be Intimated to FHPL (TPA)
    • Emergency Hospitalization-Immediate and or within 24 hours of the Insured Person’s admission to Hospital.
    • Planned Hospitalization- Immediate information and or atleast 48 hours prior to the Insured Person’s admission.
  2. Reimbursement Hospitalization needs to be intimated to FHPL (TPA)-
    • Emergency Hospitalization-Immediate and or within 24 hours of the Insured Person’s admission to Hospital.
    • Planned Hospitalization- Immediate information and or atleast 48 hours prior to the Insured Person’s admission.
  3. Claim submission in case of Reimbursement to FHPL (TPA)
    • Within 7 days from the date of discharge of the Insured Person’s admission to Hospital.

Q8 . What are the List of Documents for Claims Filing?

  • Our claim form, duly completed and signed for on behalf of the Insured Person.
  • Original Bills (including but not limited to pharmacy purchase bill, consultation bill, and diagnostic bill) and any attachments thereto like receipts or prescriptions in support of any amount claimed which will then become our property.
  • All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries.
  • A precise diagnosis of the treatment for which a claim is made.
  • A detailed list of the individual medical services and treatments provided and a unit price for each.
  • Prescriptions that name the Insured Person and in the case of drugs: the drugs prescribed, their price and a receipt for payment. Prescriptions must be submitted with the corresponding Doctor’s invoice.

**After submitting all requisite documents in time and within network hospitals

Disclaimer: * Tax benefits are subject to changes in tax laws. This benefit is U/S 80D. If one purchases a health insurance policy for self / spouse / children, he/she can claim a tax deduction of upto Rs. 15,000. When one purchases a health insurance policy for parents (a senior citizen), he/she is eligible for an additional tax deduction benefit upto Rs. 20,000

 

 
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