Affordable Health Insurance Plan

MediRaksha – Affordable Health Insurance Plan


MediRaksha is an affordable health insurance policy that will help you and your family in taking care of a medical emergency and the rising medical costs you may have not predicted so far. It is a basic medical insurance plan, covering emergencies and illnesses, hospitalization and surgical treatments.


MediRaksha Key Features:

  1. Ease of Timely Claims Settlement.
  2. Cashless facility across a strong and wide network of hospitals across India.
  3. No medicals on enrollment – Upto 55 years.
  4. No loading on renewal premium in case of a claim.
  5. Get a family discount of 10%, if 2 or more members of a family are covered under the same policy on Individual sum insured basis.
  6. Get an additional 7.5% discount in premium by paying premium of 2 years in advance as single premium.
  7. Renewal incentive like free health check up.
  8. 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.
Salient Features of MediRaksha
  • In-patient Treatment:Covers hospitalization expenses due to an illness or accident. We will pay for the medical expenses for Room rent , boarding expenses, ICU, nursing, medicines drugs & consumables. Sub limits are applicable as 1% of sum insured on per day room rent and 2% of sum insured on per day ICU room rent.
  • Pre and Post Hospitalization: Upto 1% of admissible claim amount or actual expenses whichever is less per hospitalization towards medical expenses incurred in 30 days before hospitalization and 60 days immediately after discharge post hospitalization.
  • Day Care Procedures: The Medical expenses for 144 Day care procedures which do not require 24 hours hospitalization due to technological advancement.
  • Organ Donor:The Medical Expenses for an organ donor’s treatment for the harvesting of the organ donated.
  • Health Checkup:1% of the Sum Insured in the fourth year Policy subject to a maximum of Rs. 1,000 per Insured Person only once at the end of a block of every continuous four claim free years during which You have been insured with Us.This must be claimed by insured person within 12 months post expiry of the fourth year policy.
  • Settlement of your claims: We settle your claims hassle free and quickly so that you can focus on quality and timely recovery rather than managing the funding of the treatment ,subject to submission of all required documents .
  • Network of Hospitals: We are equipped to offer you quality health care in your city with our strong network of 3000+ hospitals across India. Kindly carry original photo identity proof along with cashless card to avail cashless hospitalization in network hospitals.
    Click here to view the list of network
  • Lifelong Renewal: We offer you a lifelong renewal for your policy provided premium is paid prior to policy expiry or within grace period. Your premiums will be basis the age and coverage .Your renewal premium will be basis your revised age band /sum insured/ term and there will no extra loadings based on your individual claim..
  • Portability:A policy holder desirous of porting (shifting) his policy to us shall apply at least 45 days before the premium renewal date of his existing policy. The accrued benefits and time bound exclusions will also be transferred without any interruption. Portability will be provided in accordance to IRDA guidelines issued from time to time.
  • Tax savings: If one purchases a health insurance policy for self /spouse/children, he/she can claim a tax deduction of upto Rs. 25000. When one purchases a health insurance policy for parents (a senior citizen), he/she is eligible for an additional tax deduction benefit upto Rs. 30,000. These benefits are covered under section 80D of Income Tax Act 1961. Tax benefits are subject to changes in tax laws.
  • Copayment of 15%,on each and every claim under this policy: Co-Payment means a cost-sharing requirement applicable under a health insurance policy that provides that the policyholder/insured will bear a specified percentage of the admissible amount. A Co-Payment does not reduce the Sum Insured.
What is not covered in Tata AIG General Insurance Company Limited MediRaksha?

We will not make any payment for any claim in respect of any Insured Person directly or indirectly for, caused by, arising from or in any way attributable to any of the following unless expressly stated to the contrary in this Policy:

  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 (known /unknown), defects or anomalies; genetic disorders; stem cell therapy 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) Inpatient Treatment 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. Dental treatment and surgery of any kind, other than accident and requiring Hospitalisation
  11. Expenses for donor screening, or, save as and to the extent provided for in 1)e) Organ Donor, 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. 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.
  16. 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.
  17. Convalescence, cure, rest cure, sanatorium treatment, rehabilitation measures, private duty nursing, respite care, long-term nursing care or custodial care.
  18. Any non allopathic treatment./li>
  19. 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.
  20. 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.
  21. Items of personal comfort and convenience including but not limited to television (wherever specifically charged for), charges for access to telephone and telephone calls (wherever specifically charged for), 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.
  22. 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.
  23. 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.
  24. 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.
  25. Artificial limbs, crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively).
  26. Any specific time bound or lifetime exclusion(s) applied by Us and specified in the Schedule and accepted by the insured as per our underwriting guidelines.
  27. Any non medical expenses as listed in Annexure III of the policy document.
Frequently Asked Questions

Q1. What is the Entry Age applicable for MediRaksha?

Entry age for Enrollment in MediRaksha for an Adult is 18 to 65 years and for a Child is 91 days to 21 years.If the application for renewal and the renewal premium has been received by Us before the expiry of the Policy Period We will ordinarily offer renewal terms for life unless We believe that You or any Insured Person or anyone acting on Your behalf or on behalf of an Insured Person has acted in an improper, dishonest or fraudulent manner or any misrepresentation or non cooperation under or in relation to this Policy or the renewal of the Policy poses a moral hazard.

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

Policy is available for 1 year and 2 years. Get an additional 7.5% discount in premium by paying premium of 2 years in advance as single premium.

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

In-patient Treatment – covers hospitalization expenses due to an illness or accident. We will pay for the medical expenses for Room rent (as per the sub-limits), boarding expenses, Nursing, Intensive care unit (as per the sub-limits), Medical Practitioner(s), Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, Medicines, drugs and consumables, Diagnostic procedures, Cost of prosthetic & other devices or equipments if implanted internally during a Surgical Procedure.

Q4. What is the waiting period applicable for various benefits in MediRaksha?

  • 30 days for all illnesses (except accident) in the first year and is not applicable in Section 3 C 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 c)
  • Pre-existing Diseases will be covered after a waiting period 48 months and it will get reduced by 1 year on every continuous renewal of your policy Payout. Please refer Section 3 C d) for detailed information.

Q5. What are the timelines for Notification of Claims to Tata AIG General Insurance Company Limited 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 15 days from the date of discharge of the Insured Person’s admission to Hospital.

Q6. 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.

Q7. What are the timeliness for claim settlement ?

  • We shall make the payment of claim that has been admitted as payable by Us under the Policy terms and conditions within 30 days of submission of all necessary documents / information and any other additional information required for the settlement of the claim All claims will be settled in accordance with the applicable regulatory guidelines, including IRDA (Protection of Policyholders Interest Regulation), 2002. In case of any delay in payment as stated herein, We will pay you interest at the prevalent bank rate plus 2 % at the beginning of the financial year in which claim is settled. For the purpose of this clause, ‘bank rate’ shall mean the existing bank rate as notified by Reserve Bank of India, unless the extent regulation requires payment based on some other prescribed interest rate

Q8. What are the renewal conditions applicable in the policy ?

  • 30 days Grace Period (For renewals only).
  • In the likelihood of this policy being withdrawn in future, we will intimate you about the same 3 months prior to expiry of the policy. You will have the option to migrate to similar health insurance policy available with us at the time of renewal with all the accrued continuity benefits such as waiver of waiting period etc. provided the policy has been maintained without a break as per portability guidelines issued by IRDA.
  • Option to Migrate

    We will offer the Insured Person an option to migrate to similar health insurance Policy with Us provided that

    i) Insured Person has been insured with Us for first time under this Policy as a dependant.
    ii) This option for migration to similar Indemnity health insurance policy shall be exercised by the Insured Person only when he/she is at the end of specified exit age, and certainly at the time of renewal only.
    iii) Insured Person will be offered continuity of coverage & suitable credits, if any , for all the previous policy years, provided the policy has been maintained without a break.

  • The renewal premium for this policy will not change unless We have revised the premium and obtained due approval from IRDA Premium at renewal will also change if you move into a higher age group, opt for change of deductible or, change the term
  • We offer life long renewal subject to application for renewal and the renewal premium in full has been received by the due dates and realisation of premium, unless the insured person or any one acting on behalf of an insured person has acted in an improper, dishonest or fraudulent manner or any misrepresentation or non cooperation under or in relation to this policy or the policy poses a moral hazard.
Track your Claims
How can I Claim?
  • Intimation & Assistance – Please contact our designated TPA atleast 48 hours 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.
  • Contact details for claims - Family Health Plan (TPA) Ltd. Claims Department, Tata AIG General Insurance Company Limited , Ground Floor, Srinilaya – Cyber Spazio, Road No: 2, Banjara Hills, Hyderabad Pin : 500 034.
  • FHPL Toll Free Number: 1800 425 4090 Toll Free: 1800-425-4033,
    Fax: +91-40-23541400 / 1800 22 9966 (Only for Senior Citizens)
  • NOTE - Specified Third Party Administrator (TPA) licensed by IRDA will process all claims under this policy on behalf of Tata-AIG General Company Limited. The final decision on any claim solely rests with Tata-AIG General Insurance Company Limited.

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