TATA AIG Medicare Plan Review

Health insurance policies have always been a popular financial product, considering the expenses involved during hospitalisation that may cause stress to your savings. However, after the pandemic, this demand has increased significantly. Subsequently, multiple new health insurance providers surfaced with a host of customised policies to suit policyholders' tailored health and financial requirements.

Despite the emergence of niche-specific plans and new insurers, some traditional, “brand-first”, and comprehensive health insurance plans remain the favourites among policyholders. One such policy is the Tata AIG Medicare plan - an affordable policy with few restrictions, wholesome coverage, and a well-known brand name - making it a solid pick. Additionally, the provider, TATA AIG, has decent numbers across its Claim Settlement ratio, Incurred Claim Ratio, complaint volume, and network hospitals, establishing its credibility.

Now, much like any other health insurance plan in the market, this policy is not without caveats. So, we need to decide whether the caveats are reasonable enough for the plan to be purchased or whether you should steer clear of the TATA AIG Medicare policy. Let’s delve into the details to find out more!

Quick Verdict on TATA AIG Medicare Plan

Tata AIG Medicare is a flagship product from the stable and remains a popular choice among TATA’s policyholders. However, the limited range of coverage, a 3 three-year waiting period for pre-existing medical conditions, and the presence of global coverage as an in-built feature are some hurdles you need to consider. However, its Accidental Death Benefit add-on is a unique feature that deserves a mention. On the other hand, despite having a solid brand backup and a couple of decades in the industry, TATA AIG has yet to become a top choice as a health insurance provider.

Overall, TATA AIG Medicare is an average pick owing to its affordability and comprehensiveness (when pitted against its cons).

TATA AIG Medicare Plan: Brief Overview

TATA AIG, founded in 2001 as a collaboration between the TATA Group and American International Group, is a popular name in the health insurance industry. While the insurer’s brand name indeed gave it the required edge during the commencement of its operations, it earned its credibility over appreciable operational proficiency reputations, which is reflected in its metrics data:

• Claim Settlement Ratio (CSR) of 89.07% (the industry average is 90.97%)
• Incurred Claim Ratio (ICR) of 77.38% (the industry average is  82.96%)
• Complaint Volume of 9.48 (the industry average is  24.029)

(P.S. The numbers above are average data from the years 2020 to 2023. This gives you insight into the consistency of the insurer regarding its operational metrics that help determine its credibility.) While a CSR above our recommended threshold of 90% would have been excellent, the insurer is on the right track when it comes to Incurred Claim Ratio and complaint volume. In general, plans from this stable have never offered industry-first features but have always been comprehensive, considering they cover most bases. Another persistent issue with the insurer has been their slightly expensive policies compared to others in their class from other stables. Yet, despite this, the insurer has a solid policyholder base - thanks to brand loyalty.

Coming to TATA AIG Medicare policy, the plan offers coverage ranging from ₹3 lakhs to ₹20 lakhs. While the upper limit seems a tad bit low compared to what other top-notch health insurance policies offer, this range makes it a relatively affordable policy from the stable of TATA AIG. If you are brand loyal and looking for a plan with a lower cover amount, it doesn’t get better.

The plan covers most bases - a decent waiting period on pre-existing medical conditions, an optimum No-Claim Bonus, restoration perks, no room rent restrictions, no copayments, no disease-wise sub-limits, domiciliary and daycare coverage, AYUSH coverage, modern treatment coverage and pre/post-hospitalisation. Apart from this, the plan also offers global coverage and bariatric coverage as in-built features and Accidental Death Benefit as an add-on, which is rare among policies with such premiums. However, we will get into detail about some concerns over these unique offerings later.

First, let’s take a quick look at some of the highlighted features of this policy -

Features of TATA AIG Medicare Plan

Should You Buy the TATA AIG Medicare Plan?

1. TATA AIG as an insurer: With a nationwide network of 10,000+ partner hospitals, TATA AIG has grown strong roots in the Indian health insurance industry. The insurer’s brand name, combined with its diverse health insurance plans crafted for niche-specific clients, has made it a popular name. While its credibility is reflected in its decent Claim Settlement Ratio, good Incurred Claim Ratio, and low complaint volume - the insurer still fails to stand out as the best provider in the market. Unfortunately, multiple new players have superseded this insurer due to their premiums, feature-rich policies, and minimum restrictions.
   While TATA AIG Medicare is still a decent pick from the line-up of TATA AIG’s health insurance plans, unfortunately, it is the only one. Others usually have issues with missing features, multiple limitations, expensive premiums, and more. And even Medicare, despite being comprehensive and economical, falls short in a couple of areas that are very well covered by other healthy insurance plans (from other insurers) in its category.

2. Copayment, Disease-wise sub-limit, and Room rent restrictions: These are the 3 priorities when choosing a health insurance policy. In terms of these, TATA AIG Medicare checks out since it has no co-payments or disease-wise sub-limits.
   However, when it comes to room rent restriction, the policy has a small clause involved. While there are no room rent or type restrictions, if you have opted for the shared accommodation perk in your policy document and had to get admitted to a better accommodation (private/AC, etc.), you are looking at paying 10% of the admissible claim amount.

3. Waiting period: When it comes to the waiting period, Medicare is an average pick because the plan has a 36-month waiting period involved in cases of pre-existing medical conditions. Among the other types of waiting periods involved are - 30 days of initial waiting period and 24 months of specified illness waiting period.

4. Restoration Perk: While Medicare offers a 100% restoration benefit, this only kicks in once during a policy year with a cooling-off period of 45 days for the same illness. Considering the restrictive capping on the coverage provided by the policy (₹20 lakhs), this might become an issue if you are looking at some high-end surgeries at speciality hospitals. Additionally, also remember that the restoration feature doesn’t work when it comes to global coverage. With health expenses being higher abroad compared to India, this limitation might be a significant concern for those banking on this international coverage perk.

5. Free annual health check-ups: Much like any other health insurance plan, Medicare also offers free health check–ups. However, these free check-ups are available only once every 2 years. This restriction on the perk frequency is not common among top-notch health insurance plans, making Medicare an average pick.

6. Global Coverage as an in-built feature: Global coverage is an excellent feature if you have plans for scheduled treatments and/or are frequent travellers abroad. Subsequently, it would have been much better if the global coverage was offered as a health insurance add-on and not as a built-in feature since it would allow policyholders to opt for it per their preference. Moreover, international coverage often increases the premiums significantly since it involves a high risk of a sizeable payout. Thus, if this perk was offered as an add-on rather than as a built-in feature, you could have been looking at more affordable premiums.

7. Accidental Death Benefit as a health insurance add-on: Commonly offered with term insurance policies, the Accidental Death Benefit add-on is genuinely an industry first. In the case of this rider, if the policyholder has an accident and passes away within 365 days of the day of the accident due to reasons that are solely and directly related to the accident, the insurer pays the policyholder’s family the entire base sum insured. The exclusion to this perk is dependent children (in the case of family floater policies).

8. Bariatric Surgery Coverage: Bariatric surgery (medically required procedures to curb issues caused by being overweight) is covered under the TATA AIG Medicare policy. However, there are a few conditions. The reasonable and customary expenses of such surgeries are covered only if

• The procedure is medically advised,
• The patient is 18+ years
• The Body Mass Index is 35 or above, and the less invasive methods of weight loss haven't worked out due to conditions like Obesity-related cardiomyopathy, Coronary heart disease, Severe sleep apnea, or Uncontrolled Type 2 Diabetes / The Body Mass Index is 40 and above

What’s Unique About the TATA AIG Medicare Plan?

The TATA AIG Medicare plan is comprehensive overall with a few rarely available features like global coverage (at such affordable premiums) and an Accidental Death Benefit add-on. Yes, despite such features and the credibility of its insurer, the plan has some cons that need serious consideration before you make the purchase.

Conclusion

TATA AIG is a brand name that has significantly become popular over the years, and despite several new launches, its Medicare policy remains a popular choice. However, the plan’s 3-year waiting period on pre-existing medical conditions, free health check-ups every alternate year, and redundant inclusion of global coverage (since it’s a niche-specific feature) are a significant concern, as is the tweak in TATA AIG Medicare’s room rent restriction feature and the restrictive upper limit on its coverage (₹20 lakhs). Given such limitations and restrictions, unless you are loyal to the brand, we would recommend you look around for other health insurance policies.