New India Mediclaim health insurance

Overview of new India Mediclaim policy

• Who can buy New India Mediclaim health insurance?

  • All the persons proposed for this Insurance should be between the age of 18 years and 65 years.
  • Children between the age of 3 months and 18 years are covered provided one or both parents are covered concurrently.
  • Children between 18 years to 25 years can be covered provided they are financially dependent on the parents and one or both parents are covered simultaneously.

  Eligibility of New India Mediclaim health insurance for Family Members

  • Proposer
  • Proposer’s Spouse
  • Proposer’s Children
  • Proposer’s Parents

• Salient Features of New India Mediclaim health insurance

  Some of the key salient features of New India Mediclaim health insurance include:
  • No Zonewise Premium rating – rating only based on age and sum insured
  • Lifelong Renewal subject to there not being a break in the renewal of the policy
  • Pre Acceptance Medical Check up only for insureds beyond 50 years of age
  • No Loading for Adverse Claims Experience
  • No Loading for Diabetes & Hypertension
  • Policy covers 139 Day Care Treatments
  • Free Look Period of 15 days

• Benefits of New India Mediclaim Policy

  Coverage Details	Sum Insured
  Sum Insured options available : (Proportionate deduction on the other expenses incurred at the Hospital, with the exception of cost of medicines, if Room Rent / ICU / ICCU charges exceeds the aforesaid limit. (Waived if No proportionate deduction option is Opted))	1,00,000 2,00,000 3,00,000 5,00,000 8,00,000 10,00,000 12,00,000 15,00,000
  Room Rent, Boarding and Nursing expenses as provided by the Hospital	Not exceeding 1.0 % of the Sum Insured per day
  Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses	Not exceeding 2.0 % of the Sum Insured per day.
  Pre Hospitalisation expense – expenses incurred days prior to the date of Hospitalisation.	30 days
  Post Hospitalisation – expenses incurred post the date of discharge	60 days
  Cataract (The said limit shall be applicable per event for all the Policies of Our Company including Group Policies. Even if two or more Policies of New India are invoked, sublimit of the Policy chosen by Insured shall prevail and our liability is restricted to stated sublimit.)	20% of Sum Insured subject to a maximum of Rs. 50,000
  Ayurvedic / Homeopathic / Unani Treatment	Up to 25% of the Sum Insured
  Hospital cash (This benefit will reduce the Sum Insured. This benefit is payable only if the Hospitalisation is for more than 24 hours. This benefit is applicable only if the Sum Insured of the Insured Person is more than or equal to three lakhs)	Paid at the rate of 0.1% per day maximum up to 1% of Sum Insured for any one Illness.
  Health Check-up: Cost of health check-up shall be reimbursed to the Insured person after every block of Three Claim Free Years.	Rs. 5000 or 1% of average Sum Insured of proceeding three years whichever is less
  Ambulance service will be Payment under this benefit will reduce the Sum Insured. Ambulance charges will be paid once for Any One Illness for each Insured.	Payable subject to cap 1% of Sum Insured.
  Reinstatement of Sum Insured	This benefit is applicable only if the Sum Insured of the Insured person is more than or equal to Rs. 5 lakhs. After exhausting the Sum Insured as mentioned in the Schedule, the Sum Insured shall stand restored for the remaining Policy Period for non-related illness.
  Optional Covers
  No Proportionate Deduction	This benefit is applicable only if the Sum Insured of the Insured person is more than or equal to Rs. 2 lakhs. On payment of additional premium, proportionate deduction clause shall stand deleted
  Maternity Expenses- This benefit is applicable only if the Sum Insured of the Insured person is more than or equal to Rs. 5 lakhs. (Includes Day 1 New Born Baby cover)	On payment of additional premium, Maternity Expenses up to 10% of the average Sum Insured shall be payable after waiting period of thirty six months. The said limit shall be applicable per event for all the Policies of Our Company including Group Policies. Even if two or more Policies of New India are invoked, sublimit of the Policy chosen by Insured shall prevail and our liability is restricted to stated sublimit.
  Revision in cataract Limit- This benefit is applicable only if the Sum Insured of the Insured person is more than or equal to Rs. 8 lakhs.	On payment of additional premium, additional limit shall be as follows Sum Insured Revised Cataract Limit Rs. 8,00,000 Rs. 80,000 Rs. 10,00,000 Rs. 1,00,000 Rs. 12,00,000 Rs. 1,20,000 Rs. 15,00,000 Rs. 1,50,000
  Voluntary Co-Pay	If the Insured person opts for voluntary co-pay of 20%, a discount of 15% shall be of given on the premium payable for the Insured Person.
  Congenital Internal Diseases	Covered up to the Sum Insured provided the Insured has Continuous Coverage of twenty four months
  Congenital External Diseases	Covered up to 10% of Sum Insured provided the Insured has Continuous Coverage of thirty six months.

  Benefits under new India health insurance plans include:

  Some of the benefits under the New India Health plans are below…
  • Cashless facility – New India processes all cashless claims across 3,500 + quality hospitals in their network across India.
  • This Policy covers In–Patient Hospitalisation Expenses incurred in India. This policy will respond only when the aggregate of all Hospitalisation expenses (except Pre / Post hospitalization expenses) of one or all members of the policy, exceeds the "Threshold" stated in the policy.
  • The policy can be issued on Individual or Floater Sum Insured basis covering up to 6 members of the family. If the policy is to be issued on Individual Sum Insured basis, then separate document will be issued to each Insured.
  • Inpatient Treatment Covered expenses include: Hospital room rent, Boarding expenses and doctor fees, Operation Theatre and Intensive Care charges, Nursing expenses and Medicines that you consume during the hospital stay
  • Cumulative bonus for every two claim free years up to 100% of the base sum insured.
  • Sum Insured Restoration at No Extra Cost : This benefit recharges your exhausted health cover to treat the next hospitalization of a new illness or injury, the recharge is upto 50% of the Sum insured.
  • Cumulative Bonus @25% SI for claim free year with Max 50% of SI.
  • New Born Baby cover
  • Critical Care Benefit - 10% of the Sum Insured.
  • Midterm inclusion of newly married spouse.
  • Cataract claims, up to 10% of Sum Insured or Rs. 50,000 whichever less, for each eye.
  • Ayurvedic/Homoeopathic/ Unani treatments are covered, up to 25% of the Sum Insured
  • Ambulance Charges at the rate of 1% of the Sum Insured.
  • Hospital Cash at the rate of 0.1% Sum Insured per day, up to a maximum of 1% Sum Insured.
  • 139 Day Care procedures are covered.
  • Lifelong Renewability : New India assures you renewability for life without any extra loadings based on the claims
  • Income Tax Exemption under section 80D if the Income Tax Act.
  • Optional Covers
    • I : No Proportionate Deduction
    • II : Maternity Expenses Benefit for Sum Insured 5 Lakhs and Above (Maximum of 10% of the average SI of the Insured Person in the preceding three years)
    • III : Revision in Limit of Cataract (For 8 Lakhs & above SI revised limit for Cataract will be 10% of the Sum Insured)

• How can one Buy a New India Health Insurance policy?

  There are many distribution channels that distribute New India Health insurance products that include Agents, Banks and Brokers. One of the key distributors is the Web Aggregators which are online distributors of insurance and the advantage is that they offer a comparison of all insurance products to the customer, to allow them to compare the plans before opting for a health insurance plan that most suits his/her needs.

  • Step 1- Visit a product comparison website eindiainsurance to review and compare policy benefits, coverage and premium details online
  • Step 2 - Seek information and clarity on the charges, inclusions, exclusions, other terms and conditions under the policy
  • Step 3 - Fill the New India online Health Insurance proposal form stating your personal details and health profile while ensuring the information given is complete and accurate
  • Step 4 – If this is a Straight through proposal, the premium remitted online will be transferred directly to the insurance company, and the policy will be issued, dispatched and will reach you in 7 working days
  • Step 5 – For Non Straight through cases, New India will process the application forwarded to them. Based on the information provided, one may be required to undergo pre-policy tests at designated diagnostic centers or they may just levy a loading based on the health report
  • Step 6 - If the proposal is accepted, the same will be issued accordingly
  • Step 7 - The Policy Schedule, Policy Wordings, Cashless Cards and Health Guide will be sent to the insured’s mailing address mentioned on the proposal form in the prescribed Turn around time.

• Claim Process

  You can contact New India Insurance through:
  • 24 x 7 Toll Free : 1800-209-1415
  For Cashless Hospitalisation
  • Intimate TPA in writing on detection of any Illness/Injury being suffered immediately or forty eight hours before Hospitalisation.
  • Intimate within twenty four hours from the time of Hospitalisation in case of Hospitalisation due to medical emergency.
  • Submit following supporting documents TPA relating to the claim within seven days from the date of discharge from the Hospital:
  • Bill, Receipt and Discharge certificate / card from the Hospital.
  • Cash Memos from the Hospitals (s) / Chemists (s), supported by proper prescriptions.
  • Receipt and Pathological test reports from Pathologist supported by the note from the attending Medical Practitioner / Surgeon recommending such Pathological tests / pathological.
  • Surgeon's certificate stating nature of operation performed and Surgeons' bill and receipt.
  • Attending Doctor's/ Consultant's/ Specialist's / Anesthetist's bill and receipt, and certificate regarding diagnosis.
  • In case of Post-Hospitalisation treatment (limited to sixty days), submit all claim documents within 7 days after completion of such treatment.
  • Provide TPA with authorization to obtain medical and other records from any Hospital, Laboratory or other agency.
  • The Insured person shall submit to the TPA all original bills, receipts and other documents upon which a claim is based and shall also give the TPA/Us such additional information and assistance as the TPA / We may require.

  Any Medical Practitioner authorised by the TPA/Us shall be allowed to examine the Insured Person, at our cost, if We deem Medically Necessary in connection with any claim.

  For Reimbursement Claims

  In case of treatment in a non–Network Hospital, TPA will reimburse You the amount of bills subject to the conditions of the Policy. You must ensure that the Hospital where treatment is taken fulfills the conditions of definition of Hospital in the Policy. Within twenty four hours of Hospitalisation the TPA should be intimated. The following documents in original should be submitted to the TPA within seven days from the date of Discharge from the Hospital:

  • Claim Form duly filled and signed by the claimant
  • Discharge Certificate from the hospital
  • All documents pertaining to the illness starting from the date it was first detected i.e. Doctor’s consultation reports/history
  • Bills, Receipts, Cash Memos from hospital supported by proper prescription
  • Receipt and diagnostic test report supported by a note from the attending medical practitioner/surgeon justifying such diagnostics.
  • Surgeon’s certificate stating the nature of the operation performed and surgeon’s bill and receipt
  • Attending doctor’s / consultant’s / specialist’s / anesthetist’s bill and receipt, and certificate regarding diagnosis
  • Details of previous policies if the details are not already with TPA or any other information needed by the TPA for considering the claim.

• Exclusions under all New India Health Plans

  What are excluded under this policy? No claim will be payable under this Policy for the following; however kindly refer the policy wordings with the policy kit for the complete list of exclusions:
  • Treatment of any Pre–Existing Condition/Disease, until forty eight months of Continuous Coverage of such Insured Person have elapsed, from the Date of inception of his/her first Policy with Us as mentioned in the Schedule.
  • Any Illness contracted by the Insured person (except Injury) during the first 30 days of the commencement date of this Policy. This exclusion shall not however, apply if the Insured person has Continuous Coverage for more than twelve months.
  • Unless the Insured Person has Continuous Coverage in excess of twenty four months with Us, expenses on treatment of the following Illnesses are not payable:
    • All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps
    • Benign ear, nose, throat disorders
    • Benign prostate hypertrophy
    • Cataract and age related eye ailments
    • Gastric/ Duodenal Ulcer
    • Gout and Rheumatism
    • Hernia of all types
    • Hydrocele
    • Infective Arthritis
    • Piles, Fissures and Fistula in anus
    • Pilonidal sinus, Sinusitis and related disorders
    • Prolapse inter Vertebral Disc and Spinal Diseases unless arising from Accident
    • Skin Disorders
    • Stone in Gall Bladder and Bile duct, excluding malignancy
    • Stones in Urinary system
    • Varicose Veins and Varicose Ulcers
    • Renal Failure
  • Unless the Insured Person has Continuous Coverage in excess of forty eight months with Us, the expenses related to treatment of
    • Joint Replacement due to Degenerative Condition,
    • Age–related Osteoarthritis & Osteoporosis are not payable
  • Injury / Illness directly or indirectly caused by or arising from or attributable to War, invasion, Act of Foreign enemy, War like operations (whether war be declared or not), nuclear weapon/ ionising radiation, contamination by Radioactive material, nuclear fuel or nuclear waste or from the combustion of nuclear fuel.
  • No Coverage for
    • Circumcision unless Medically Necessary for treatment of an Illness not excluded hereunder or as may be necessitated due to an Accident
    • Change of life/sex change or cosmetic or aesthetic treatment (except for burns/Injury) of any description such as correction of eyesight, etc
    • Plastic Surgery other than as may be necessitated due to an Accident or as a part of any Illness.
    • Vaccination and/or inoculation.
    • Cost of braces, equipment or external prosthetic devices, non–durable implants, eyeglasses, Cost of spectacles and contact lenses, hearing aids including cochlear implants, durable medical equipment.
    • Dental treatment or Surgery of any kind unless necessitated by Accident and requiring Hospitalisation.
    • Convalescence, general debility, ’Run–down’ condition or rest cure, obesity treatment and its complications, treatment relating to all psychiatric and psychosomatic disorders, infertility, sterility, Venereal disease, intentional self–Injury and Illness or Injury caused by the use of intoxicating drugs/alcohol.
    • Congenital Internal and External Disease or Defects or anomalies.
    • Bodily Injury due to willful or deliberate exposure to danger (except in an attempt to save human life), intentional self–inflicted Injury, attempted suicide, Illness arising out of non–adherence to medical advice.
    • Treatment of any Bodily Injury or Illness sustained whilst or as a result of active participation in any hazardous sports of any kind.
    • Treatment of any Injury or Illness sustained whilst or as a result of participating in any criminal act.
    • Sexually Transmitted Diseases, any condition directly or indirectly caused to or associated with Human T–Cell Lymphotropic Virus Type III (HTLB – III) or lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or Variation Deficiency Syndrome or any syndrome or condition of a similar kind commonly referred to as AIDS.
    • Charges incurred at Hospital primarily for diagnosis, x–ray or Laboratory examinations or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any Illness or Injury for which confinement is required at a Hospital
    • Maternity Expenses, except abdominal operation for extra uterine pregnancy (Ectopic Pregnancy), which is proved by submission of Ultra Sonographic Report and Certification by Gynaecologist that it is life threatening one if left untreated.