Health Insurance 435 views August 21, 2020

There is a constant increase in the price of healthcare in India, and with the rising cases of COVID-19, health insurance today becomes an absolute necessity for an individual to have. It will keep your savings intact by providing you with the sum for medical treatment of diseases and conditions. Of the many health insurance companies, there’s one New India Assurance Company Limited that offers a mediclaim policy that pays for your medical expenses. The insurance company can reimburse the expenses incurred from illness or injury to the hospital directly. And this New India Mediclaim Policy can be offered on an individual or family floater basis. The policy comes with two plans.

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Plan A: The insured can get a sum of INR 15,00,000 and 25,00,000.

Plan B: The insured is eligible to claim a sum of INR 50,00,000 and 100,00,000.

You can get the cover for the sum insured. The sum which is insured cannot be increased at renewal, nor the insurance plan will change from Plan A to Plan B. Here in this post, we will discuss the New India Mediclaim Policy Plan A where the sum is insured upto INR 15 lakh. So, read further to know more about the scheme.

What are the Expenses Covered Under the New India Mediclaim Policy?

New India Mediclaim Policy covers the following hospitalization expenses:

  1. Hospital Room Rent
  2. Boarding or Nursing Expenses

Other Expenses

As specified in the policy, it includes the sum upto 1% of the insured amount per day that includes the following.

  1. Nursing Care
  2. RMO Charges
  3. IV Fluids
  4. Blood Transfusion
  5. Injection administration charges

But it does not include the cost of materials. The policy covers expenses of ICU up to 2% of Sum Insured per day. It also includes Surgeon, Anaesthetist, Medical Practitioner, Doctor Consultant, or Specialists Fees.

Expenses Related to the Following Treatment & Operations

  1. Anesthesia
  2. Blood
  3. Oxygen
  4. Operation Theatre (OT) Charges
  5. Surgical Appliances
  6. Medicines & Drugs
  7. Dialysis
  8. Chemotherapy
  9. Radiotherapy
  10. Artificial Limbs
  11. Cost of Prosthetic devices that are used during surgical procedures, such as a pacemaker, Relevant Laboratory, Diagnostic test, X-Ray, and other medical expenses related to the treatment.
  12. Excluding the cost of an organ regarding an organ transplant

Cataract Operation

The insurance company will restrict the claim amount upto 10% of Sum Insured or INR 50,000, whichever is less, for each eye treatment. This will apply to procedures or treatments done in the Outpatient Department (OD). Under the New India Mediclaim Policy, even if you are converted as an in-patient for 24 hours or more, then also you are not eligible to claim the policy. But you can get 139 days Daycare Expenses covered in this policy.

Hospital Cash

The policy provides Hospital Cash payment to the insurer at the rate of 0.1% of the Sum Insured per day. The benefit, which is capped to 1% of the sum insured, will be provided for every admissible claim to each member. This benefit is provided directly by the TPA or underwriting office.

Critical Illness Treatment

During the insurance period, if you discover that you are suffering from Critical Illness as listed below, the insurance company will pay a flat 10% of the Sum Insured as additional benefit other than the admissible claim for:

  1. Cancer
  2. First Heart attack of specified severity
  3. Open chest CABG
  4. Open Heart replacement or repair of Heart valves
  5. Coma of specified severity
  6. Kidney failure requiring regular dialysis
  7. Stroke resulting in permanent symptoms
  8. Major organ or bone marrow transplant
  9. Permanent paralysis of limbs
  10. Motor neurone disease with permanent symptoms
  11. Multiple sclerosis with persisting symptoms

This will be applicable only if the Hospitalisation is more than 24 hours. Any payments under this clause would be in addition to the Sum Insured and don’t reduce from the Sum Insured. This benefit will be provided once in the lifetime of any Insured Person. This benefit is not applicable to Insured Persons having pre-existing diseases and
conditions.

Maternity Expenses

Maternity Expenses are also covered in this scheme. You can get this benefit if your Sum Insured is INR 5 lakh and above. A maximum of 10% of the average Sum Insured can be claimed for maternity treatments in the preceding 3 years of the policy. It, however, excludes the Maternity Expenses or treatment arising from or traceable to pregnancy, miscarriage, abortion or complications, except the abdominal operation for Ectopic Pregnancy proved by the submission of Ultrasonography Report and certified by Gynaecologist.

What are the Expenses Excluded Under the New India Mediclaim Policy?

No claim will be provided to the individual for the following illness or treatments. Look at the pointers below.

  1. Treatment of any Pre-existing Disease or Condition until 48 months
  2. Any illness contracted during the first 30 days of the commencement date. The exclusion isn’t applicable if you have continuous coverage of more than 12 months with the insurance company.

All internal and external stage 1

  1. Tumors
  2. Cysts
  3. Polyps of any kind, including breast lumps
  4. Ear disorders
  5. Nose disorders
  6. Throat disorders
  7. Prostate hypertrophy

Other Treatments

  1. Cataract and eye ailments related to old age
  2. Congenital Internal Disease
  3. Diabetes Mellitus
  4. Gastric or Duodenal Ulcer
  5. Gout and Rheumatism
  6. Hernia
  7. Hydrocele
  8. Infective Arthritis
  9. Piles
  10. Fissures
  11. Fistula in anus
  12. Pilonidal sinus
  13. Sinusitis and related disorders
  14. Prolapsed interVertebral Disc
  15. Spinal Diseases unless it is due to an accident
  16. Skin Disorders
  17. Stone in Gallbladder
  18. Bile duct
  19. excluding malignancy
  20. Stones in Urinary system
  21. Treatment for Menorrhagia
  22. Fibromyoma
  23. Myoma
  24. Prolapsed uterus
  25. Varicose Veins
  26. Varicose Ulcers
  27. Renal Failure
  28. Joint Replacement due to Degenerative Condition and Age-related Osteoarthritis & Osteoporosis ( if you don’t have continuous coverage of 48 months with the insurance company)
  29. Injury or illness caused by War
  30. Vaccination
  31. Inoculation
  32. Circumcision unless medically necessary for treatment
  33. Change of sexes, cosmetic, or aesthetic treatment except for burns and Injury.
  34. Plastic Surgery is other than necessitated due to an accident or if it is a part of illness treatment.

Coverage of Pre- and Post- hospitalization Expenses

To meet your relevant medical expenses before hospitalization, you can make a claim on your New India Mediclaim Policy for a period of maximum 30 days before the date of Hospitalisation. The medical expenses include medicines, doctor fees, etc, required for the treatment of the disease at a hospital. You can also get a post-hospitalization claim under your insurance policy which covers expenses for up to 60 days from the date of admission till discharge.

What is the Right Age to Buy New India Mediclaim Policy?

There is a common question that might cross your mind – what is the right age to go for New India Mediclaim Policy? Well, there’s not a definite answer to it. But if you buy a health insurance policy at an early age, it will be beneficial for you cost-wise at least. How? Well, the premium for a health policy increases with the individual age because of the associated health risks. The premium amount for your New India Mediclaim Policy is determined by the age, medical history, city of residence, etc.

All the individuals who are eager to buy this insurance policy should be between the age of 18 years and 65 years. Your entire family can be covered under the New India Mediclaim Policy. The members of the family who are eligible to be covered under the Policy are the insured person, spouse, dependent children aged (3 months to 18 years or 18 to 25 years), and also dependent parents of the insured. A minimum of one and a maximum of six members can be covered in the New India Mediclaim Policy.

On attaining the age of 18 years, if your children are financially independent, they can take a separate policy at the time of renewal. In such a case, the benefits of a continuous cover can be ported to the new policy. There is no upper age limit for mentally challenged children and an unmarried dependent daughter as per the terms and conditions of the policy.

If you are newly married, the spouse can be added to the insurance policy for which the New India Assurance Company Limited charges a pro-rata premium for the remaining period of the policy. A newborn baby to an Insured mother will be covered from the date of birth until the expiry of policy without any additional premium charges. There would be no coverage for the newborn baby during subsequent policy renewals unless the child is declared covered under the New India Mediclaim Policy.

New India Mediclaim Policy Premium

You are free to choose your insurance amount from INR 2 lakhs to 15 lakh. And the premium payable to the policy is determined by the following criteria.

  1. The premium for the eldest member of the family (if you choose New India Floater Mediclaim)
  2. The premium for additional members to be covered in this policy. Spouse or Newborn baby can be added to the policy.
  3. Sum insured
  4. If you pay a premium for a lower zone and get treatment in a higher zone, the insurance company can provide 80% of the admissible claim amount

Policy Validity: It is usually valid for a period of 1 year from the date of the beginning of insurance.

Renewal: You need to renew the New India Mediclaim Policy Sum Insured upto INR 15 lakh before the expiry of the policy.

How to Make New India Mediclaim Policy Claims?

On immediate hospitalization, you need to contact the Third Party Administrator (TPA) within 24 hours. With this, you can easily make your policy claims by providing the details of your insurance policy, such as the Policy Number, Name of the hospital, and where treatment is undertaken. This is an important condition of the policy that you need to follow to get an instant cashless claim.

Cashless Policy Claim

Your TPA on the insurance company’s behalf settles the hospitalization expenses at the time of discharge. The cashless facility will be available to you only at the Network Hospitals, which you can find on the official website of the insurance company or your policy manual. Prior approval is required from the TPA before you are admitted to the hospital. For this procedure of insurance claim, your identity proof and other additional documents would be required. Submit the following documents to TPA within 7 days from the date of discharge from the Hospital:

  1. Hospital Bill
  2. Bill Receipt
  3. Discharge certificate
  4. Cash memos from the Hospitals or Chemists with proper prescriptions.
  5. Receipt and Pathological test reports from Pathologist supported by the note from Doctor or Surgeon who recommended such Pathological tests
  6. Surgeons’ bill and receipt.Surgeon’s certificate stating the nature of the operation
  7. Attending Doctor bill, receipt, and certificate regarding the diagnosis

Reimbursement

The TPA doesn’t provide you a Cashless facility at a non-network hospital. In such cases, you can claim the policy at any hospital via reimbursement. To seek reimbursement of the medical expenses, provide the relevant documents to TPA.

  1. Duly Filled Claim Form signed by the claimant
  2. Discharge Certificate from the hospital
  3. All documents about the illness
  4. Doctor’s consultation reports
  5. Bills
  6. Receipts
  7. Cash Memos from hospital
  8. Receipt and diagnostic test report
  9. Surgeon’s certificate stating the operation has been performed
  10. Surgeon’s bill and receipt
  11. Attending doctor, consultant, specialist, or anesthetist bill and receipt with the patient certificate regarding diagnosis
  12. Details of your previous health insurance policies if the details are not provided to TPA or any other information that the TPA will require to process the claim amount.

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