New India Premier Mediclaim Policy (Cashless facility available)
Health Insurance Policy
Health Insurance Policy
We welcome You as Our Customer. This document explains how the NEW INDIA PREMIER POLICY could provide value to You. In the document the word ‘You’, ‘Your’ means all the members covered under the Policy. ‘We’, ‘Our’, ‘Us’ means The New India Assurance Co. Ltd.
New India Premier is a Policy designed to cover Hospitalisation expenses of the Persons You wish to cover under this Policy.
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. On attaining the age of 18 years or ceasing to be financially dependent on the parents, they can, on renewal take a separate Policy. In such an event the benefits on Continuous Coverage can be ported to the new Policy. The upper age limit will not apply to a mentally challenged children and an unmarried dependent daughter(s). The persons beyond 65 years can continue their Insurance provided they are Insured under the Policy with us without any break.
Midterm inclusion is allowed for newly married spouse by charging pro-rata Premium for the remaining period of the Policy. A New Born Baby, born to an Insured mother, will be covered from date of birth till the expiry of the Policy, without any additional Premium. 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. You and Your entire family can be covered under this Policy. The members of the family who could be covered under the Policy are:
Minimum one and maximum six members can be covered in this Policy.
This Policy is designed to give You and Your family, protection against unforeseen Hospitalisation expenses.
This Policy has two plans viz:
The Sum Insured chosen by You and accepted by Us represents Our maximum liability towards all payments admissible under the Policy in respect of all Insured Persons. Only payment under Critical Care Benefit will not reduce the Sum Insured. All other payments in respect of any admissible claim in respect of any Insured Person shall reduce the Sum Insured.
Please select for the right amount of Sum Insured based upon Your current and future needs. Sum Insured once chosen cannot be increased at the time of Renewal, nor is change from Plan A to Plan B permissible.
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 100% 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.
Note: Adverse Medical History means a person:
Policy covers following Hospitalisation Expenses:
Note: Procedures/treatments usually done in OPD are not payable under the Policy even if converted as an in-patient in the Hospital for more than 24 hours or carried out in Day Care Centres (except specifically mentioned under OPD treatments clause).
This Policy provides for payment of Hospital Cash at the rate of INR 2,000 per day for Plan A and INR 4,000 per day for Plan B for Any One Illness. This benefit will be given in case of admissible claim only. The benefit is applicable only where Hospitalisation exceeds twenty four consecutive hours.
The total payment for Any One Illness shall be made for maximum 10 days of Hospitalisation. Payment under this clause will reduce the Sum Insured. Hospital Cash will be payable for completion of every 24 hours and not part thereof.
If during the Period of Insurance any Insured Person is diagnosed for the first time to be suffering from any Critical Illness as listed below, we will pay INR 2,00,000 for Plan A and INR 5,00,000 for Plan B as additional benefit i.e. other than the admissible claim amount:
Any payment under this clause would be in addition to the Sum Insured and shall not deplete the Sum Insured. This benefit will be paid once in lifetime of any Insured Person. This benefit is not applicable for those Insured Persons for whom it is a Pre-existing Disease.
The liability of the company in case of Ayurvedic/Homoeopathic/ Unani treatment will be up to 20 % of Sum Insured provided the treatment is taken in a government Hospital or in any institute recognized by government or accredited by Quality Council Of India or National Accreditation Board on Health, excluding centers for spas, massage and health rejuvenation procedures.
We will pay You the charges incurred towards Ambulance services including Air Ambulance for shifting any Insured Person to Hospital for admission or from one Hospital to another Hospital for better medical facilities maximum up to INR 1,00,000 for Any One Illness.
If an Insured Person after the discharge from the Hospital has to be shifted from Hospital to their place of residence in an Ambulance and is not able to travel otherwise, such expenses will also be reimbursed additionally up to INR 10,000 for Any One Illness, provided the requirement of an Ambulance is certified by the Medical Practitioner.
Yes. After every block of two continuous Claim Free Years, all the members covered in this Policy are entitled for OPD coverage of INR 5,000 for Plan A and INR 10,000 for Plan B cumulatively. The cover can be availed for:
The amount will not be carried forward to the next year.
A claim under OPD Treatment clause will also be treated as a claim for determining Claim Free Year.
Maternity shall be covered provided the Insured mother has Continuous Coverage of thirty six months in New India Premier Mediclaim Policy. Our liability for expenses incurred towards Maternity, shall be restricted to INR 50,000 for Plan A and INR 1,00,000 for Plan B.
Special conditions applicable to Maternity and Child Care Benefit:
For instance: An Insured person has availed Maternity benefit in 2017, and again in 2018, any subsequent claim for Maternity Benefit will not be available to her.
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 and Plan opted without additional premium. Congenital External Anomaly of the New Born Baby is not covered under the Policy.
Any expenses incurred towards pre-term or pre-mature care or expenses incurred in connection with delivery of such New Born Baby are not covered under this clause.
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. We will cover expenses necessarily incurred for treatment of Infertility, including outpatient treatment, subject to a limit of INR 1,00,000 for Plan A and INR 2,00,000 for Plan B. This limit shall be our maximum liability in respect of all Insured persons. If any claim is payable to any Insured Person under this clause in any particular Policy period, the benefit under this clause shall not be available for any subsequent renewals. Any payment under this clause shall be paid after the Insured Person has Continuous Coverage of thirty six months under New India Premier Mediclaim Policy.
Yes. This Policy covers treatment for 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. Any payment under this Clause shall only be made when the Insured Person was not afflicted with any of these conditions at the time of the proposal, and only when such condition is contracted subsequent to this Insurance, regardless of whether the Insured Person was aware or not of the same. The limit for the above cover will be up to :
Plan A: INR 2,00,000 and
Plan B: INR 5,00,000
The Insured needs to be admitted as in-patient for more than 24 hours.
Consultation for the above mentioned conditions is available on OPD basis for INR 20,000 for Plan A and INR 50,000 for Plan B. The OPD limit will be part of the overall limit mentioned above.
Any payment under this clause shall be paid after the Insured Person has Continuous Coverage of thirty six months under New India Premier Mediclaim Policy.
Expenses incurred towards cataract shall be paid as per the following limits:
Plan A: Actual charges up to a maximum ofINR 75,000.
Plan B: Actual charges up to a maximum of INR 1,00,000.
All the Psychiatric and Psychosomatic disorders diagnosed after inception of this Policy will be covered up to 5% of Sum Insured. The Insured needs to be admitted as Inpatient. This treatment will not be covered as a Day-care procedure.
This cover will be available only for Plan B.
Treatment related to or for obesity is covered where BMI>35 and with co-morbidities mentioned below, up to INR 5,00,000
Any payment under this clause shall be paid after the Insured has:
Second opinion for major surgeries:
In case any Insured Person requires to undergo a Surgery as advised by a Medical Practitioner, then the expenses incurred towards consultation with another Medical Practitioner to seek advice on the surgery shall be payable up to INR 5,000 for Plan A and up to INR 8,000 for Plan B. Cashless facility for availing such second opinion will be provided by the TPA with enlisted Network Providers.
This benefit is applicable only for Plan B.
Dietician counseling can be availed by any Insured Person. The cost of such dietician counseling in respect of all Insured Persons in a policy shall be restricted to a maximum of INR 5,000 subject to actuals.
The services provided will be:
In case of omission by the TPA to arrange to provide this service, Our liability for such omission will be limited to INR 5,000 per Hospitalisation.
Conditions:The benefits under this clause shall be applicable only where the Insured Person provides advance notice to TPA as mentioned in the Schedule at least seventy two hours prior to date of Hospitalisation.
No. This Policy does NOT cover ALL cases of Hospitalisation.
The exclusions under the policies are:
The term Pre-existing condition/disease is defined in the Policy. It is defined as:
'Any condition, ailment or Injury or related condition(s) for which the Insured Person had:
Within thirty six months prior to the commencement of the first Policy.” Such a condition or disease shall be considered as Pre-existing. Any Hospitalisation arising out of such Pre-existing Disease or condition is not covered under the Policy until the Insured has thirty six months of Continuous Coverage in this Policy.
When a person is continuously Insured under a New India Premier Mediclaim Policy he is entitled to the benefit of Continuous Coverage. For instance if a person has Continuous Coverage of more than thirty six months, the exclusions relating to treatment of any Pre-existing Condition / Disease will not apply. However, the benefit of Continuous Coverage getting carried over for other Policies will not be available for following Coverage:
Continuous Coverage from the following New India Policies can be carried over to the extent of coverage under such previous policies:
You can also carry over the Continuous Coverage, to the extent of cover, from your existing Policy with any other Insurer to New India Premier Mediclaim, subject to IRDA (Protection of Policyholders’ Interest) Regulations, 2002 and guidelines of IRDAI on Portability of Health Insurance Policies, as amended from time to time. In case of change in Sum Insured during such uninterrupted coverage, the lowest Sum Insured would be reckoned for determining Continuous Coverage.
For instance: A person was covered for four years under Mediclaim 2012 for a Sum Insured of INR Five lakhs, and carries over this Continuous Coverage to New India Premier Mediclaim in 2017. If there is a claim for a Pre-existing Condition in 2017 for an amount of INR Eight lakhs, the claim will be admitted only to the extent of INR five lakhs since this is the amount available under Continuous Coverage for more than three years.
Yes. Unless the Insured Person is Hospitalised for a condition warranting Hospitalisation, no claim is payable under the Policy.
This shall not be applicable to the treatments taken under OPD cover available under clause 3.1.10.
The Policy pays only where the Hospitalisation is for more than twenty four hours. But for certain Day Care Treatments as specified in the Policy, period of stay at the Hospital could be less than twenty four hours. The Day Care Treatments are according to the table given in Point No. 28 below. This shall not be applicable to the treatments taken under Our OPD cover under clause 3.1.10.
Following are the day-care treatments covered under this Policy (treatments done within 24 hours).
|1||Stapedotomy||2||Excision and Destruction Of A Lingual Tonsil|
|3||Stapedectomy||4||Other Operations On The Tonsils and Adenoids|
|5||Revision Of A Stapedectomy||6||Incision On Bone, Septic and Aseptic|
|7||Other Operations On The Auditory Ossicles||8||Closed Reduction On Fracture, Luxation Or Epiphyseolysis With Osteosynthesis|
|9||Myringoplasty (Type -I Tympanoplasty)||10||Suture and Other Operations On Tendons and Tendon Sheath|
|11||Tympanoplasty (Closure Of An Eardrum Perforation/Reconstruction Of The Auditory Ossicles)||12||Reduction Of Dislocation Under Ga|
|13||Revision Of A Tympanoplasty||14||Arthroscopic Knee Aspiration|
|15||Other Microsurgical Operations On The Middle Ear||16||Incision Of The Breast|
|17||Myringotomy||18||Operations On The Nipple|
|19||Removal Of A Tympanic Drain||20||Incision and Excision Of Tissue In The Perianal Region|
|21||Incision Of The Mastoid Process and Middle Ear||22||Surgical Treatment Of Anal Fistulas|
|23||Mastoidectomy||24||Surgical Treatment Of Haemorrhoids|
|25||Reconstruction Of The Middle Ear||26||Division Of The Anal Sphincter (Sphincterotomy)|
|27||Other Excisions Of The Middle and Inner Ear||28||Other Operations On The Anus|
|29||Fenestration Of The Inner Ear||30||Ultrasound Guided Aspirations|
|31||Revision Of A Fenestration Of The Inner Ear||32||Sclerotherapy Etc|
|33||Incision (Opening) and Destruction (Elimination) Of The Inner Ear||34||Incision Of The Ovary|
|35||Other Operations On The Middle and Inner Ear||36||Insufflation Of The Fallopian Tubes|
|37||Excision and Destruction Of Diseased Tissue Of The Nose||38||Other Operations On The Fallopian Tube|
|39||Operations On The Turbinates (Nasal Concha)||40||Dilatation Of The Cervical Canal|
|41||Other Operations On The Nose||42||Conisation Of The Uterine Cervix|
|43||Nasal Sinus Aspiration||44||Other Operations On The Uterine Cervix|
|45||Incision Of Tear Glands||46||Incision Of The Uterus (Hysterotomy)|
|47||Other Operations On The Tear Ducts||48||Therapeutic Curettage|
|49||Incision Of Diseased Eyelids||50||Culdotomy|
|51||Excision and Destruction Of Diseased Tissue Of The Eyelid||52||Incision Of The Vagina|
|53||Operations On The Canthus and Epicanthus||54||Local Excision and Destruction Of Diseased Tissue Of The Vagina and The Pouch Of Douglas|
|55||Corrective Surgery For Entropion and Ectropion||56||Incision Of The Vulva|
|57||Corrective Surgery For Blepharoptosis||58||Operations On Bartholin’S Glands (Cyst)|
|59||Removal Of A Foreign Body From The Conjunctiva||60||Incision Of The Prostate|
|61||Removal Of A Foreign Body From The Cornea||62||Transurethral Excision and Destruction Of Prostate Tissue|
|63||Incision Of The Cornea||64||Transurethral and Percutaneous Destruction Of Prostate Tissue|
|65||Operations For Pterygium||66||Open Surgical Excision and Destruction Of Prostate Tissue|
|67||Other Operations On The Cornea||68||Radical Prostatovesiculectomy|
|69||Removal Of A Foreign Body From The Lens Of The Eye||70||Other Excision and Destruction Of Prostate Tissue|
|71||Removal Of A Foreign Body From The Posterior Chamber Of The Eye||72||Operations On The Seminal Vesicles|
|73||Removal Of A Foreign Body From The Orbit and Eyeball||74||Incision and Excision Of Periprostatic Tissue|
|75||Operation Of Cataract||76||Other Operations On The Prostate|
|77||Incision Of A Pilonidal Sinus||78||Incision Of The Scrotum and Tunica Vaginalis Testis|
|79||Other Incisions Of The Skin and Subcutaneous Tissues||80||Operation On A Testicular Hydrocele|
|81||Cancer Chemotherapy||82||Excision and Destruction Of Diseased Scrotal Tissue|
|83||Local Excision Of Diseased Tissue Of The Skin and Subcutaneous Tissues||84||Plastic Reconstruction Of The Scrotum and Tunica Vaginalis Testis|
|85||Other Excisions Of The Skin and Subcutaneous Tissues||86||Other Operations On The Scrotum and Tunica Vaginalis Testis|
|87||Simple Restoration Of Surface Continuity Of The Skin and Subcutaneous Tissues||88||Incision Of The Testes|
|89||Free Skin Transplantation, Donor Site||90||Excision and Destruction Of Diseased Tissue Of The Testes|
|91||Free Skin Transplantation, Recipient Site||92||Unilateral Orchidectomy|
|93||Revision Of Skin Plasty||94||Bilateral Orchidectomy|
|95||Other Restoration and Reconstruction Of The Skin and Subcutaneous Tissues||96||Orchidopexy|
|97||Chemosurgery To The Skin||98||Abdominal Exploration In Cryptorchidism|
|99||Destruction Of Diseased Tissue In The Skin and Subcutaneous Tissues||100||Surgical Repositioning Of An Abdominal Testis|
|101||Incision, Excision and Destruction Of Diseased Tissue Of The Tongue||102||Reconstruction Of The Testis|
|103||Partial Glossectomy||104||Implantation, Exchange and Removal Of A Testicular Prosthesis|
|105||Glossectomy||106||Other Operations On The Testis|
|107||Reconstruction Of The Tongue||108||Surgical Treatment Of A Varicocele and A Hydrocele Of The Spermatic Cord|
|109||Other Operations On The Tongue||110||Excision In The Area Of The Epididymis|
|111||Incision and Lancing Of A Salivary Gland and A Salivary Duct||112||Epididymectomy|
|113||Excision Of Diseased Tissue Of A Salivary Gland and A Salivary Duct||114||Reconstruction Of The Spermatic Cord|
|115||Resection Of A Salivary Gland||116||Reconstruction Of The Ductus Deferens and Epididymis|
|117||Reconstruction Of A Salivary Gland and A Salivary Duct||118||Other Operations On The Spermatic Cord, Epididymis and Ductus Deferens|
|119||Other Operations On The Salivary Glands and Salivary Ducts||120||Operations On The Foreskin|
|121||External Incision and Drainage In The Region Of The Mouth, Jaw and Face||122||Local Excision and Destruction Of Diseased Tissue Of The Penis|
|123||Incision Of The Hard and Soft Palate||124||Amputation Of The Penis|
|125||Excision and Destruction Of Diseased Hard and Soft Palate||126||Plastic Reconstruction Of The Penis|
|127||Incision, Excision and Destruction In The Mouth||128||Other Operations On The Penis|
|129||Plastic Surgery To The Floor Of The Mouth||130||Cystoscopical Removal Of Stones|
|133||Other Operations In The Mouth||134||Coronary Angiography|
|135||Transoral Incision and Drainage Of A Pharyngeal Abscess||136||Haemodialysis|
|137||Tonsillectomy Without Adenoidectomy||138||Radiotherapy For Cancer|
|139||Tonsillectomy With Adenoidectomy|
Upon the happening of any event which may give rise to a claim under the Policy, You need to intimate the TPA named in the schedule with all the details such as name of the Hospital, details of treatment, patient name, Policy number etc.
In case of emergency Hospitalisation, this information needs to be given to the TPA, within 24 hours from the time of Hospitalisation.
This is an important condition which needs to be complied with.
Yes. We shall pay expenses incurred towards treatment of any Injury or Illness arising out of the following hazardous sports only:
Bobsledding; Bungee Jumping; Canopying; Hang Gliding; Heli-skiing; Horseback Riding; Jet, Snow, and Water Skiing; Kayaking; Martial Arts; Speed Motorcycling; Mountain Biking; Mountain Climbing (under 14,000 feet); Paragliding; Parasailing; Safari; Scuba Diving, Skydiving; Snowboarding; Snowmobiling; Spelunking; Surfing; Trekking; Whitewater Rafting; Wind Surfing; Zip Lining, Equestrian; Fencing; Archery, Hot Air Ballooning; Underwater Sea-walk; Snorkeling; Rugby.
Our liability under this clause shall not exceed 10% of Sum Insured.
Payment under this clause is admissible only if the expenses are incurred in Hospital as In- Patient / Day Care Treatment in India.
Yes. Medical Expenses incurred sixty days prior to the date of Hospitalisation will be paid provided:
Yes. Medical Expenses incurred ninety days after the date of discharge will be paid provided:
Yes. We will pay Hospitalisation expenses up to a limit, known as Sum Insured. In cases where the Insured Person was Hospitalised more than once, the total of all amounts paid
shall not exceed the Sum Insured.
The Sum Insured under the Policy is available for any or all the members covered for one or more claims during the tenure of the Policy.
You are free to choose any Sum Insured from INR 15 lakhs, 25, lakhs, 50 lakhs and 100 lakhs. The premium payable is determined on the following criteria:
You are free to choose any Sum Insured available as specified above. But it is in your own interest to choose the Sum Insured which could satisfy your present as well as future needs as You cannot enhance Your Sum Insured in this Policy.
The Policy is valid for a period of one year from the date of inception. The validity of the Policy will be mentioned in the Schedule attached to the Policy. The entire premium for the mentioned period will be payable at the commencement of the Policy period.
In order to get all Continuity benefits under the Policy, you can renew the Policy within thirty days prior to the expiry of the present Policy. For instance, if Your Policy commences from 2nd October, 2011 date of expiry is usually on 1st October, 2012. You can renew Your Policy by paying the Renewal Premium from 1st September 2012 to 1st October 2012.
There are certain treatments which are payable only after the Insured Person is continuously covered for a specified period. For example, Cataract is covered only after twenty four months of Continuous Coverage. If an Insured took a Policy in October, 2016, does not renew it on time and takes a Policy only in December 2017, and renewed it on time in December 2018, any claim for Cataract would not become payable, because the Insured Person was not continuously covered for twenty four months. If, he had renewed the Policy in time in October 2017 and then in October 2018, then he would have been continuously covered for twenty four months and therefore his claim for Cataract in the Policy beginning from October 2018 would be payable. Therefore, you should always ensure that you pay your renewal Premium before Your Policy expires.
Yes. If Your Policy is renewed within thirty days after the expiry of the previous Policy, then the Continuity Benefits would not be affected. But even if You renew Your Policy within thirty days after expiry of previous Policy, any Illness contracted or Injury 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 under instances such as fraud, misrepresentation or non-disclosure of material facts or non-cooperation by You or any one acting on Your behalf in obtaining insurance or subsequently in relation thereto. If we discontinue selling this Policy, it will 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 as on that date, 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 Hospitalisation due to Accidents occurring even during the first thirty days are payable. There are certain treatments where the waiting period is twelve months and thirty six months are applicable. (Refer Q. No. 22 point 1,2,3 and Q. No. 23 for details)
Health claims are generally processed by Third Party Administrator (TPA). TPA is a service provider to facilitate service to you for providing Cashless facility for all Hospitalisation that come under the scope of the Policy. The TPA also processes reimbursement claims within the scope of the Policy. Payment of reimbursement claims will be effected by Us by transfer to Your bank account.
Cashless Hospitalisation is service provided by the TPA on Our behalf whereby You are not required to settle the Hospitalisation 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 Network Hospitals. Prior approval is required from the TPA before the patient is admitted into the Network Hospital. You may visit our Website at http://newindia.co.in/hospitals-list 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 treatment. 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 his/her 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 TPA in dealing with the claim.
The entire amount of the claim is payable, if it is within the Sum Insured and is related with the Hospitalisation as per Policy conditions and is supported by proper documents, except the expenses which are excluded. The list of such excluded expenses is attached as Annexure II (LIST OF EXPENSES EXCLUDED ('NON-MEDICAL')) to the Policy.
Yes. A claim, which is not covered under the Policy conditions, can be rejected. Claims may also be rejected in the event of misrepresentation, mis-description or nondisclosure of any material fact/particular. 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, the details of which are provided at our website at https://newindia.co.in/grievance You may also call our Call Centre at the Toll free number 1800-209-1415, which is available 24x7.
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 http://www.irda.gov.in/ADMINCMS/cms/NormalData_Layout.aspx?page=PageNo234&mid=7.2
Yes, You can. But the Refund that would be made in case the Policy is cancelled would not be proportionate to the unexpired term of the Policy. Such Refund would be made only if no claim has been made or paid under the Policy, and the Refund would be at our Short Period rate table given below:
|Up to one month||1/4th of the annual rate|
|Up to three months||1/2 of the annual rate|
|Up to six months||3/4th of the annual rate|
|Exceeding six months||Full annual rate|
We may also at any time cancel the Policy on grounds of misrepresentation, fraud, non-disclosure of material fact or non-cooperation by You by sending fifteen days’ notice in writing by Registered A/D to You at the address stated in the Policy. Even if there are several Insured Persons, notice will be sent to You.
On such cancellation, other than on grounds of fraud premium corresponding to the unexpired period of Insurance will be refunded, if no claim has been made or paid under the Policy.
Mid-term Deletion of members will be on short scale basis. In case of death of any of the member the refund will pro rata basis, provided there is no claim on that member in the Policy period.
The free look period shall be applicable at the inception of first Policy.
You will be allowed a period of 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable.
If You have not made any claim during the free look period, then You shall be entitled to:
Yes. Congenital Internal Disease or Defects or Anomalies, except those related to Genetic disorders, shall be covered upto Sum Insured, 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.
Congenital External Disease or Defects or Anomalies shall be covered 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 Sum Insured in preceding thirty six months.
If two or more policies are taken by Insured Person during a period from one or more Insurers to indemnify treatment costs, Insured Person shall have the right to require a settlement of his claim in terms of any of the policies.
Note: The Insured Person must disclose such other insurance at the time of making a claim under this Policy.
None of the provisions of this Clause shall apply for payments under Hospital Cash Benefit and Critical Care Benefit.
The Company may offer an option to migrate to similar Health Insurance Policy once the child / children become financially independent.
|<20||₹ 12,519||₹ 15,399||₹ 27,953||₹ 35,243|
|21-25||₹ 15,958||₹ 20,107||₹ 35,022||₹ 45,521|
|26-30||₹ 16,171||₹ 20,396||₹ 35,464||₹ 46,154|
|31-35||₹ 17,767||₹ 22,540||₹ 38,773||₹ 50,852|
|36-40||₹ 21,985||₹ 28,204||₹ 47,527||₹ 63,264|
|₹ 32,971||₹ 56,219||₹ 74,139|
|46-50||₹ 33,803||₹ 43,308||₹ 72,114||₹ 96,168|
|51-55||₹ 46,867||₹ 60,199||₹ 98,232||₹ 131,971|
|56-60||₹ 63,906||₹ 82,176||₹ 132,047||₹ 178,281|
|61-65||₹ 86,147||₹ 110,321||₹ 176,701||₹ 237,877|
|65-70||₹ 113,908||₹ 147,546||₹ 234,348||₹ 319,475|
|<20||₹ 9,309||₹ 11,451||₹ 20,786||₹ 26,206|
|21-25||₹ 11,866||₹ 14,951||₹ 26,042||₹ 33,849|
|26-30||₹ 12,025||₹ 15,166||₹ 26,370||₹ 34,320|
|31-35||₹ 13,211||₹ 16,761||₹ 28,831||₹ 37,813|
|36-40||₹ 16,348||₹ 20,972||₹ 35,341||₹ 47,043|
|41-45||₹ 19,252||₹ 24,517||₹ 41,804||₹ 55,129|
|46-50||₹ 25,135||₹ 32,203||₹ 53,623||₹ 71,510|
|51-55||₹ 34,850||₹ 44,763||₹ 73,045||₹ 98,132|
|56-60||₹ 47,520||₹ 61,105||₹ 98,189||₹ 132,568|
|61-65||₹ 64,058||₹ 82,034||₹ 131,393||₹ 176,883|
|65-70||₹ 84,701||₹ 109,714||₹ 174,259||₹ 237,558|