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New India Mediclaim 2007 Policy
| Objective | A health insurance policy that aims to provide for hospitalisation expenses. |
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| Suited for | This policy is suitable for anyone looking out for an ordinary health insurance cover |
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| What does it do? | Like any other basic health insurance policy, it provides for medical bills incurred due to hospitalisation as an inpatient. It also covers day care procedures taken at home. |
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| Pros | It also covers treatment under Ayurvedic/ Homeopathic and Unani system of medicine. |
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| Cons | There is a capping on room rent. |
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| Eligibility | |||||||
| Entry Age (years) | |||||||
| Minimum | 18; 3 months for children | ||||||
| Maximum | 60; 18 years for children | ||||||
| Coverage Type | Individual | ||||||
| Policy Term (years) | 1 | ||||||
| Sum Insured (Rs) | |||||||
| Maximum | 5 lakh | ||||||
| Minimum | 1 lakh | ||||||
| Tax Benefit | Section 80D of the Income Tax Act are applicable | ||||||
| Discount | Family discount if applicable if two or more persons are insured under same policy | ||||||
| No Claim Bonus | Sum Insured under the policy will be increased by 5% for each claim free year till it reaches 30% of basic sum insured. In case a claim is filed during a year, cumulative bonus earned will be withdrawn on subsequent renewal | ||||||
| Pre Policy Medical Check Up | Required | ||||||
| Co Payment Clause | Policyholder who had paid premium for treatment in Zone II but avails treatment in Zone I has to bear 10% of each claim. Likewise, Policyholder who had paid premium for treatment in Zone III but avails treatment in ZoneII or Zone I has to bear 10% and 20% of each claim respectively | ||||||
| Premium Loading on Basis of Claim History | Premium may be hiked by upto 200% of basic insurance premium or a deductible upto 25% may be imposed on basis of adverse claim history. Claim history of 2 years will be accounted for. | ||||||
| Policy Termination | Insurer may cancel the policy by giving a 30 days written notice to policyholder. Policyholder may also cancel the policy at any time by giving a written notice to insurer. In case policyholder cancelling the policy, a certain percentage of premium would be refunded on prorata basis. | ||||||
| Customer Service | The New India Assurance Co. Ltd Jeevan Bharti Building, Corporate Office: 87, M.G Road, Fort, Mumbai 400001; Regional Office: 124 Connaught Circus, New Delhi-110001 | ||||||
| Customer Service | |||||||
| Mail to | |||||||
| Call to | 1800 209 1415 | ||||||
| Network Hospitals | |||||||
| Scope Of Cover | |||
| Cashless Facility | Available at network hospitals | ||
| Reimbursement Facility | Available if treatment taken at any non empanelled hospital | ||
| Pre and post hospitalisation | covers medical expenses upto 30 days immediately prior and 60 days after discharge from hospitalisation | ||
| Inpatient Hospitalisation | Covered | ||
| Room rent/ ICU expenses | Room rent and boarding expenses will be covered upto 1% of Sum Insured per day and ICU expenses will be covered upto 2% of Sum Insured per day | ||
| Surgeon, Anesthetist, Medical Practitioner, Consultant's Specialist fees | Covered upto maximum 25% of Sum Insured if payment made via cheque or a maximum of upto Rs 10000 if fees was paid in cash | ||
| Anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, etc. | Covered | ||
| Day Care Procedures | Covered | ||
| Ayurvedic/ Homeopathic/ Unani treatment | Covered upto maximum 25% of Sum Insured | ||
| Emergency ambulance | Covered upto 1% of Sum Insured subject to a maximum of Rs 2500 | ||
| Expenses for organ donor of transplant | Covered | ||
| Cost of health check up | avaialble upto 1% of Sum Insured once after every 4 claim free years | ||
| Pre existing diabetes, mellitus and hypertension | will be covered after a period of 2 years in the following manner: | ||
| 3rd year | 50% of admissible claim or 50% of sum insured whichever is lower | ||
| 4th year | 75% of admissible claim or 75% of sum insured whichever is lower | ||
| 5th years and onwards | upto 100% of Sum Insured | ||
| Exclusions and Waiting Period | |||
| Pre-existing Diseases/ Illnesses | Covered after a period of 4 claim free years.Pre existing hypertension, diabetes and related conditions will be covered after a period of 2 years upon payment of additional premium | ||
| No claim period | 30 days commencing from inception of policy except for accidental injuries | ||
| Waiting Period | Certain diseases such as hernia, diabetes, mellitus, cataract etc. will be covered after a waiting period of 2 yearsAge related Osteoarthritis and Osteoporosis and joint replacement due to degenerative condition will be covered after a waiting period of 48 months | ||
| General Exclusions | Self inflicted bodily injury Domiciliary TreatmentDental treatment, Cost of spectacles, braces and contact lensesNaturopathy treatmentEngagement in any illegal or criminal activitiesEngagement in adventurous acts such as parachuting, bunjee jumping etc.Bodily injury arising as a result of terrorismbodily injury or disease caused as a result of HIV/ AIDS or any related condition | ||
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