Plan Overview

TATA Mediprime is a comprehensive health insurance plan which boasts of claim settlement within 4 hours of intimation. The plan has no co-pay clause, provides an all-inclusive coverage feature and also comes at competitive rates of premiums. There are special child-care benefits as well inbuilt in the plan like daily cash allowance and coverage of vaccination expenses.

Benefits included

Hospitalization means any impatient treatment (min. 24 hrs stay) as well as the named 140 day care procedures.

  • Accident related hospitalisation are covered from day 1.
  • Other hospitalisations are covered after 30 days. Cover starts after 30 days, except accidents which are covered from day 1
  • Exceptions : Any pre-existing diseases (PED) which are covered after 4 years and some specified diseases which are covered after 2 years from the policy start date.

Other additional benefits :

  • Cover restoration
  • No claim bonus
  • Free Health Check-up
  • Ambulance charges
  • Daily cash allowance
  • 30 days pre-hospitalisation
  • 60 days post hospitalisation
  • Organ donor expenses
  • Maternity
  • New-born treatment
  • Home treatment
  • Outpatient
  • Ayush treatments
  • Recovery allowance

Out of pocket expenses

  • You will bear all the expenses not covered by the policy. Refer to the list of such expenses in the Policy Exclusions section below
  • Besides, you will have to pay more if you stay in a room category above N.A.

Policy Exculsion

  • Cosmetic surgery
  • Birth defects
  • Medical expenses due to drugs/alcohol abuse
  • Self-inflicted injury
  • Hazardous sports or war related injuries
  • HIV or AIDS
  • Sexually Transmitted Disease(STDs)
  • Consumables
  • Mental illness
  • Genetic disorders
  • Dental treatment / Surgery
  • Eye disorders & lasik laser treatment
  • Hospitalization for only diagnostic purpose
  • Diagnostic Charges
  • Hospital registration or admission fees
  • Administrative Charges
  • Non medical expenses

Claims settlement

  • If you go to a non-network hospital, you will have to get the claim settled on reimbursement basis by providing the original bills and documents to the insurer.
  • If you get admitted to a network hospital, you can get a cashless authorization from the insurer and then the insurer will settle the expenses directly with the hospital. See the list of the network hospitals near you below

Most frequently asked questions

Q. What is the limit on dental treatments?

A. If dental treatments are availed on an in-patient basis due to an accidental injury, it would be covered up to the Sum Assured. For OPD treatments, the limit is up to Rs.5000 or Rs.7500 depending on the Sum Assured selected.

Q. Which members are eligible for family floater option?

A. Self, spouse, dependent parents and dependent children can be covered under the floater option.

Q. What is the eligibility condition to avail free heath check-ups?

A. Free health check-ups are provided only after a period of 4 claim-free continuous policy years.

Q. Is there any other waiting periods apart from the pre-existing one?

A. Yes, a 30-day waiting period for all diseases except accidental injuries and a 2-year waiting period for specific diseases are applicable.

Q. WHat is the daily cash payable for accompanying a minor child?

A. The daily cash benefit payable would be Rs.300 per day for Sum Assured up to Rs.4 lakhs and Rs.500per day for higher levels to a maximum of Rs.9000 and Rs.15, 000 per hospitalization respectively.

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