New India Mediclaim 2007 Policy

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New India Mediclaim 2007 Policy

	Objective			A health insurance policy that aims to provide for hospitalisation expenses.
Suited for			This policy is suitable for anyone looking out for an ordinary health insurance cover
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. The policy also pays for homeopathic or ayurvedic treatment and emergency ambulance expenses.
Pros			It also covers treatment under Ayurvedic/ Homeopathic and Unani system of medicine. Premium paid under this policy is eligible for tax benefit under Section 80D.
Cons			There is a capping on room rent. One needs to pay expenses up to the specified deductible for treatment taken in a higher zone, than the zone for which premium is paid.
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 In case a claim is filed during a year, cumulative bonus earned will be withdrawn on subsequent renewal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		health.ho@newindia.co.in
Call to		1800 209 1415
Network Hospitals		Http://newindia.co.in/listofhospitals.aspx

 

	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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