|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.|
|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
|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.|
|YEAR||AWARDS WON BY THE COMPANY||AWARDING AUTHORITY|
|2018||INDIA INSURANCE SUMMIT AWARD 2018 : GENERAL INSURANCE COMPANY OF THE YEAR||FINTELEKT|
|2018||INDIA INSURANCE SUMMIT AWARD 2018 : PRODUCT INNOVATOR OF THE YEAR- TITLE INSURANCE POLICY||FINTELEKT|
|2018||OUTLOOK MONEY GOLD AWARD||OUTLOOK MONEY|
|2018||BUSINESS TODAY FINANCIAL AWARD : BEST GENERAL INSURER OF THE YEAR||BUSINESS TODAY|
|2018||SKOCH AWARD CUSTOMER SERVICE ORDER OF MERIT||SKOCH|
|2018||SKOCH AWARD COMPANY OF THE YEAR ORDER OF MERIT||SKOCH|
|2017||GOLDEN PEACOCK BUSINESS EXCELLENCE AWARD||GOLDEN PEACOCK|
|2017||INDIA INSURANCE SUMMIT - INSURANCE COMPANY OF THE YEAR||QUEST CONFERENCES|
|2017||DUN & BRADSTREET BFSI AWARDS - INDIA'S LEADING INSURANCE COMPANY- NON-LIFE PUBLIC SECTOR||DUN & BRADSTREET|
Pre–acceptance medical check–up is required for all the members entering after the age of 50 years. A person also needs to undergo this pre–acceptance medical check–up if he has an adverse medical history or if the health condition of the person/s to be Insured is such that the office in–charge feels that he / she be subjected to a medical examination. The cost of this check–up will be borne by the proposer. But if the proposal is accepted, then 50% of the cost of this check–up will be reimbursed to the proposer.Pre–acceptance medical check–up shall be conducted at designated centers authorized by Us.
Yes. Unless the Insured Person is Hospitalised for a condition warranting Hospitalisation, no claim is payable under the Policy. The Policy does not cover outpatient treatments.
Yes, the Policy covers treatment and/or services rendered only in India.
The Policy is valid during the Period of Insurance stated in the Schedule attached to the Policy. It is usually valid for a period of one year from the date of beginning of insurance.
Yes. If Your Policy is renewed within thirty days of the expiry of the previous Policy, then the Continuity Benefits would not be affected. But even if You renew Your Policy within thirty days of expiry of previous Policy, any disease contracted or injuries sustained or Hospitalisation commencing during the break in insurance is not covered. Therefore it is in Your own interest to see that You renew the Policy before it expires.
No. Your Policy can be renewed, as long as You pay the Renewal Premium before the date of expiry of the Policy. There is an age limit for taking a fresh Policy, but there is no age limit for renewal. However, if You do not renew Your Policy before the date of expiry or within thirty days of the date of expiry, the Policy may not be renewed, and only a fresh Policy could be issued, subject to Our underwriting rules. In such cases, it is possible that a fresh Policy could not be issued by Us. It is therefore in Your interest to ensure that Your Policy is renewed before expiry.
We may refuse to renew the Policy only on rare occasions such as fraud, misrepresentation or suppression or non–cooperation being committed by You or any one acting on Your behalf in obtaining insurance or subsequently in relation thereto. If We discontinue selling this Policy, it might not be possible to renew this Policy on the same terms and conditions. In such a case You shall however have the option for renewal under any similar Policy being issued by the Company, provided the benefits payable shall be subject to the terms contained in such other Policy.
In case of revision or modification or withdrawal of the Policy a notice will be provided to You 90 days before such revision or modification or withdrawal. Renewal can also be refused if the Policy is not renewed before expiry of the Policy or within the Grace Period.
Claims for Illnesses cannot be made during the first thirty days of a fresh Insurance policy. However, claims for Hospitalization due to accidents occurring during the first thirty days are payable. There are certain treatments where the waiting period is two years or four years.
Third Party Administrator (TPA) is a service provider to facilitate service to You for providing Cashless facility for all hospitalizations that come under the scope of Your policy. The TPA also settles reimbursement claims within the scope of the Policy.
Cashless hospitalization is service provided by the TPA on Our behalf whereby you are not required to settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by the TPA on Our behalf. However those expenses which are not admissible under the Policy would not be paid, and You would have to pay such inadmissible expenses to the Hospital. Cashless facility is available only in Networked Hospitals. Prior approval is required from the TPA before the patient is admitted into the Network Hospital. The list of Network Hospitals can also be obtained from the TPA or from their website. You will have full freedom to choose the hospitals from the Network Hospitals and avail Cashless facility on production of proof of Insurance and Your identity, subject to the claim being admissible. The TPA might not agree to provide Cashless facility at a Hospital which is not a Network Hospital. In such cases You may avail treatment at any Hospital of Your choice and seek reimbursement of the claim subject to the terms and conditions of the Policy. In cases where the admissibility of the claim could not be determined with the available documents, even if the treatment is at a Network Hospital, the TPA may refuse to provide Cashless facility. Such refusal may not necessarily mean denial of the claim. You may seek reimbursement of the expenses incurred by producing all relevant documents and the TPA may pay the claim, if it is admissible under the terms and conditions of the Policy.
Yes it is possible to shift to another hospital for reasons of requirement of better medical procedure. However, this will be evaluated by the TPA on the merits of the case and as per policy terms and conditions.
The Policy allows reimbursement of medical expenses incurred before and after admissible Hospitalisation up to a certain number of days. For reimbursement, send all bills in original with supporting documents along with a copy of the discharge summary and a copy of the authorization letter to your TPA. The bills must be sent to the TPA within 7 days from the date of completion of treatment. You must also provide the TPA with additional information and assistance as may be required by the company/TPA in dealing with the claim.
No payment shall be made for any Hospitalisation expenses incurred, unless they form part of the Hospital Bill. However, the bills raised by Surgeon, Anaesthetist directly and not included in the Hospital Bill shall be paid provided a numbered Bill is produced in support thereof, for an amount not exceeding Rs. Ten thousand, where such payment is made in cash and for an amount not exceeding Rs. Twenty thousand, where such payment is made by cheque.
If treatment involves Organ Transplant to Insured Person, then We will also pay Hospitalisation Expenses (excluding cost of organ) incurred on the donor, provided Our liability towards expenses incurred on the donor and the insured recipient shall not exceed the aggregate of the Sum Insured and Cumulative Bonus Buffer, if any, of the Insured Person receiving the organ.
A New Born Baby is covered for any Illness or Injury from the date of birth till the expiry of this Policy, within the terms of this Policy. Any expense incurred towards post natal care, pre–term or pre–mature care or any such expense incurred in connection with delivery of such New Born Baby would not be covered. Congenital External Anomaly of the New Born Baby is also not covered under the policy. No coverage for the New Born Baby would be available during subsequent renewals unless the child is declared for insurance and covered as an Insured Person.
Yes, a claim, which is not covered under the Policy conditions, can be rejected. In case You are not satisfied by the reasons for rejection, you can represent to Us within 15 days of such denial. If You do not receive a response to Your representation or if You are not satisfied with the response, You may write to our Grievance Cell. You also have the right to represent your case to the Insurance Ombudsman. The contact details of the office of the Insurance Ombudsman could be obtained from the IRDAI website.
Yes. Payments made for health insurance in any mode other than cash are eligible for deduction from taxable income as per Section 80 D of the Income Tax Act, 1961. For details, please refer to the relevant Section of the Income Tax Act.
Your ideal sum insured or total coverage would highly depend on factors such as your current age, lifestyle, medical history, income and place of residence. Looking at the medical inflation, most of our customers prefer a health insurance policy with a sum insured of 5 lacs and above.
Absolutely! With employee health cover the major drawbacks come in picture when you leave your job that's when your policy goes out of action and exposes you to health risks. Your new employer may or may not cover you sufficiently. Also, having your own policy means a better buying decision and complete control to buy a cover which suits your requirement from time to time.
New India has an extensive network of 3,500+ network hospitals across India growing steadily over the years. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can get the hospital closest to them by going through the New India network hospital list available on New India Assurance Health insurance
There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.
It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.
Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs
A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.
Factors for medical insurance in India, How much is the premium and the coverage offered by India health insurance plans..Click here to read more