MediCare Select Health Insurance

MediCare Select is built around a base cover that you add to. It comes in three versions: MediCare Select (single private room, ₹5 lakh to ₹3 crore), Smart (twin-sharing room, ₹5 lakh to ₹20 lakh) and Elite (any room, ₹25 lakh to ₹3 crore).

MediCare Select allows policyholders to customise their health insurance coverage according to their healthcare requirements.

Choose a sum insured of ₹5, 7.5, 10, 15, 20, 25, 50 or 75 lakh, or ₹1, 2 or 3 crore. The term can be 1, 2, 3, 4 or 5 years. Cover can be individual, multi-individual or family floater.

The plan provides configurable sum insured options so customers can select coverage appropriate to their needs.

The policy provides lifelong renewal subject to the applicable policy conditions.

A floater covers you, your spouse, up to 3 dependent children, up to 2 parents and up to 2 parents-in-law. A multi-individual policy can also cover a partner, grandparents, grandchildren, siblings, uncle, aunt, nephew, niece, employees, domestic help and a legal guardian. The proposer must be 18 or above.

Pays medically necessary treatment in a hospital for an admission that needs inpatient care, up to the sum insured. Medical expenses directly related to the hospitalisation are payable.

Eligible medical expenses incurred before and after hospitalisation are covered according to the policy terms.

Pays medical expenses for up to 90 days before admission and up to 90 days after discharge, up to the sum insured.

Eligible daycare procedures are covered subject to the applicable policy conditions.

Pays all day care treatments taken in a hospital or day care centre during the policy period, up to the sum insured.

Eligible AYUSH treatment is covered in accordance with the applicable policy terms.

Pays the donor's medical expenses for an organ transplant surgery, solely towards the harvesting of the donated organ, up to the sum insured.

Pays treatment taken at home when it goes beyond three consecutive days, up to the sum insured.

Pays in-patient and day care treatment taken in an AYUSH hospital or AYUSH day care centre, including pre and post hospitalisation expenses, up to the sum insured.

Pays transport of the insured person in a registered ambulance, up to the sum insured.

Reinstates the base sum insured if the sum insured and any cumulative bonus are not enough to pay an admissible hospitalisation claim. The benefit table shows unlimited restorations during a policy year.

Pays a fixed ₹1,200 a day if you stay in a twin-sharing room, or ₹1,500 a day in a multi-sharing room, for each continuous and completed 24 hours, over and above the base sum insured.

Choose one. A cumulative bonus adds 50% of the base sum insured for every claim-free year, up to 100%, and is reduced by 50% in the year after a claim. Or take a 1% discount on renewal premium for every claim-free year, if you renew without a break.

MediCare Select pays for a Single Private Room, Smart for a Twin-sharing room, and Elite for Any Room. The optional Room Category Select lets you change the entitlement to Any Room or Twin sharing on MediCare Select.

Long term: 5% for 2 years, 7.5% for 3 years, 8% for 4 years and 9% for 5 years, on single premium only. Family floater: 22% for 2 members, up to 28% for 3 members with a child, and up to 32% for 3 or more members with at least 2 children. Multi-individual 5%, professional (salaried) 7.5%, young family 10% for life, and favourable experience 20% at the start.

Premium depends on where you live. Zone A is Mumbai, Delhi NCR, Ahmedabad, Surat, Baroda and Hisar. Zone B is Hyderabad, Bengaluru, Kolkata, Indore, Gwalior, Chennai, the Chandigarh tricity, Pune and parts of Gujarat. Zone C is the rest of India.

Pre-existing diseases and their direct complications are covered after 36 months of continuous cover with Tata AIG, if you declared them and Tata AIG accepted them.

Thirty-five listed conditions and procedures, such as hernia, gall bladder stones, joint replacement, cataract, hysterectomy and tonsillectomy, wait 24 months. The full list is in the illnesses section.

Tests depend on your age and sum insured. Up to age 45, a tele or video medical examination is needed only if you declare a medical condition. Older ages and larger sums insured need a tele or video examination, and the highest ones need a fuller set of tests such as blood count, liver and kidney function, lipid profile, HbA1c and ECG.

For a planned admission, seek cashless authorisation at least 48 hours before, and for an emergency inform Tata AIG within 24 hours. For reimbursement, inform within 7 days of finishing treatment and send the claim form and documents within 15 days. Tata AIG settles or rejects a claim within 15 days of the last document.

Pay yearly, half-yearly, quarterly or monthly, or choose a limited premium paying term. On a 1-year policy the loading is 5% for monthly, 4% for quarterly and 2.5% for half-yearly payment. It rises to 13%, 12% and 11% on a 3-year policy.

The policy renews for life, renewal cannot be refused because you claimed, and no loading applies for your own claims. The grace period is 30 days, or 15 days for monthly payment. After 5 continuous years of cover, no policy or claim can be contested for non-disclosure or misrepresentation, except for established fraud.

There is a 30-day free look period. You can port in by applying at least 30 days before, but not earlier than 60 days from, your renewal date. You can migrate to another Tata AIG health plan at least 30 days before renewal, with credit for waits and bonus.

Maternity care and the specified consumables benefit are not in the base plan. You add them for extra premium, except consumables on Elite where it is built in.

The base plan pays for the room category of your version. If you take a higher category, the associated medical expenses are cut in proportion to the eligible room.

Outpatient treatment and preventive health check-ups are not covered by this plan.