New India Senior Citizen Health Insurance

What does New India Senior citizen Health Insurance Cover?

• Hospitalization expenses incurred for the treatment of illness/injury.
• Pre- and post-hospitalization expenses up to 30 and 60 days respectively.
• Ambulance Charges.
• Limited cover for hospitalizations in government and /or registered Ayurvedic/Homeopathic and Unani hospitals.
• Pre-existing diseases are covered only after 18 months of continuous insurance with our Company.
• Pre-existing conditions like Hypertension, Diabetes mellitus and its complications are covered after 18 months of continuous insurance but only on payment of additional premium.

Exclusions under New India Health insurance

1. 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.
2. 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.
3. 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:
   1. All internal and external benign tumors, cysts, polyps of any kind, including benign breast lumps
   2. Benign ear, nose, throat disorders
   3. Benign prostate hypertrophy
   4. Cataract and age related eye ailments
   5. Gastric/ Duodenal Ulcer
   6. Gout and Rheumatism
   7. Hernia of all types
   8. Hydrocele
   9. Infective Arthritis
   10. Piles, Fissures and Fistula in anus
   11. Pilonidal sinus, Sinusitis and related disorders
   12. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from Accident
   13. Skin Disorders
   14. Stone in Gall Bladder and Bile duct, excluding malignancy
   15. Stones in Urinary system
   16. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus
   17. Varicose Veins and Varicose Ulcers
   18. Renal Failure
   Note: Even after twenty four months of Continuous Coverage, the above Illnesses will not be covered if they arise from a Pre–existing Condition, until 48 months of Continuous Coverage have elapsed since inception of the first Policy with the Company.
4. Unless the Insured Person has Continuous Coverage in excess of forty eight months with Us, the expenses related to treatment of
   1. Joint Replacement due to Degenerative Condition,
   2. Age–related Osteoarthritis & Osteoporosis are not payable.
5. 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.
6. No Coverage for
   1. Circumcision unless Medically Necessary for treatment of an Illness not excluded hereunder or as may be necessitated due to an Accident
   2. Change of life/sex change or cosmetic or aesthetic treatment (except for burns/Injury) of any description such as correction of eyesight, etc
   3. Plastic Surgery other than as may be necessitated due to an Accident or as a part of any Illness.
7. Vaccination and/or inoculation.
8. 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.
9. Dental treatment or Surgery of any kind unless necessitated by Accident and requiring Hospitalisation.
10. 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.
11. Congenital Internal and External Disease or Defects or anomalies.
    However, the exclusion for Congenital Internal Disease or Defects or anomalies shall not apply after twenty four months of Continuous Coverage, if it was unknown to You or to the Insured Person at the commencement of such Continuous Coverage. Exclusion for Congenital Internal Disease or Defects or Anomalies would not apply to a New Born Baby during the year of Birth and also subsequent renewals, if Premium is paid for such New Born Baby and the renewals are effected before or within thirty days of expiry of the Policy. The exclusion for Congenital External Disease or Defects or anomalies shall not apply after thirty six months of Continuous Coverage, but such cover for Congenital External Disease or Defects or anomalies shall be limited to 10% of the average Sum Insured of the Insured Person in the preceding four years.
12. 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.
13. Treatment of any Bodily Injury or Illness sustained whilst or as a result of active participation in any hazardous sports of any kind.
14. Treatment of any Injury or Illness sustained whilst or as a result of participating in any criminal act.
15. 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.
16. 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
17. Expenses on vitamins and tonics unless forming part of treatment for Injury or Illness as certified by the attending Medical Practitioner.
18. 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.
19. Naturopathy and Siddha Treatment
20. External and or durable Medical / Non–medical equipment of any kind used for diagnosis and or treatment including CPAP (Continuous Positive Airway Pressure), CPAD (Continuous Peritoneal Ambulatory Dialysis), Oxygen Concentrator for Bronchial Asthmatic condition, Infusion pump etc. Ambulatory devices i.e., walker, crutches, Collars, Caps, Splints, Elasto crepe bandages, external orthopaedic pads, sub cutaneous insulin pump, Diabetic foot wear, Glucometer / Thermometer and similar related items etc., and also any medical equipment, which is subsequently used at home and outlives the use and life of the Insured Person.
21. Any expenses relating to cost of items detailed in Annexure II (of policy document).
    1. Genetic disorders and stem cell implantation/Surgery.
    2. Domiciliary Hospitalisation.
    3. Acupressure, acupuncture, magnetic therapies
    4. Experimental or unproven treatments/ therapies.
    5. Any kind of Service charges, Surcharges, Luxury Tax and similar charges levied by the Hospital.
    6. Treatment for Age Related Macular Degeneration (ARMD) , treatments such as Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy