Tata AIG
MediCare
Plan & insurer snapshot
Incurred Claim Ratio
80.65%
Claims paid vs premium collected.
Claims Settled
81.42%
Approved by number of claims.
Settled < 30 Days
80.55%
How quickly claims are paid.
Complaints
0.10%
On overall claims — lower is better.
Expert Verdict
MediCare is an individual health insurance plan from Tata AIG. It stands out for no co-payment, no disease sub-limits and built-in restoration. On the downside, the premium sits at the higher end — worth weighing before you buy. On the insurer side, it reports 81.42% of claims settled by count and a 12,000+ cashless hospital network.
Pros
- No co-payment — the insurer pays the full approved claim, with nothing deducted as your share.
- No disease-wise sub-limits — covered treatments are paid up to your full sum insured rather than a smaller per-illness cap.
- Restoration is included — the sum insured refills once in a policy year, triggered on full exhaustion of sum insured & bonus, for a unrelated illness (available after 45 days for related illness).
- Cover grows by 50% for each claim-free year, up to 100% of the base sum insured; the accumulated bonus is reduced if you make a claim.
- Modern treatments such as robotic surgery and other advanced procedures are covered, usually up to a specified limit.
- Day-care procedures that take under 24 hours — cataract, dialysis, chemotherapy and similar — are covered.
Cons
- Room rent is limited to Capped — choosing a costlier room can trigger proportionate cuts across the whole bill.
- Premium positioning is on the expensive side of the market.
Key Features
Room Rent
Limited to Capped; a costlier room can reduce the rest of the claim.
ICU Charges
No separate cap on ICU charges.
Co-Payment
None — the insurer bears the full approved claim.
Disease Sub-limit
None — treatments are paid up to your full sum insured.
Restoration of CoverStandout
The sum insured refills once in a policy year, triggered on full exhaustion of sum insured & bonus, for a unrelated illness (available after 45 days for related illness).
No-Claim Bonus
Cover grows by 50% for each claim-free year, up to 100% of the base sum insured; the accumulated bonus is reduced if you make a claim.
Pre & Post Hospitalisation
Pre-hospitalisation 60 days and post-hospitalisation 90 days of connected medical costs are covered.
Day Care Treatment
Procedures under 24 hours, such as cataract and dialysis, are covered.
Modern Treatments
Advanced procedures like robotic and laser surgery are covered, usually up to a limit.
Consumables
Non-medical items like gloves, syringes and PPE are paid, not deducted.
Organ Donor
Donor hospitalisation costs are covered (Yes (up to sum insured)).
Domiciliary Cover
At-home treatment is covered when hospital admission is not possible.
Waiting Periods
Initial Waiting: 30
No cover in this window except for accidental hospitalisation.
Specific Illness: 2
Named conditions such as cataract, hernia and joint replacements wait this long.
Pre-existing Diseases: 3
Conditions you already have are covered only after this period.
Common Exclusions
Typical across most Indian health plans — always confirm the exact exclusions in MediCare's policy wording.
Cosmetic or aesthetic treatment, unless needed to reconstruct after an accident or burns.
Self-inflicted injuries and conditions arising from alcohol or substance abuse.
Treatment arising from war, nuclear or allied perils.
Admissions purely for investigation, evaluation or bed rest with no active treatment.
Unproven or experimental treatments not backed by established medical practice.
Frequently Asked Questions
Does MediCare have a co-pay?
No. MediCare does not require a co-payment under the base cover.
Is there a room rent limit on MediCare?
Room rent under MediCare is Capped. Choosing a costlier room can reduce the rest of your claim.
What is the pre-existing disease waiting period for MediCare?
3. Claims for conditions you already had are covered only after this waiting period.
Does MediCare restore the cover if it runs out?
Yes. MediCare refills the sum insured after it is exhausted (once in a policy year).
Are day care treatments covered under MediCare?
Yes. MediCare covers day care procedures that take under 24 hours, such as cataract surgery or dialysis.
How many cashless hospitals does MediCare offer?
12,000+ cashless network hospitals are reported for MediCare, where the insurer settles bills directly.
Does MediCare cover modern treatments?
Yes. MediCare covers modern treatments such as robotic surgery, usually up to a specified limit.