Insurance Plans August 27, 2020

People aged above 60 years can be susceptible to diseases more than their younger counterparts. And their hard-earned savings might be lost if they don’t have a health insurance plan. Senior Citizen Health Insurance can aid them in such times. Today, there are various health insurance policies specially designed for Senior Citizens from several companies, which might leave you wondering which will be better for you. Amongst the options you have, a Senior Citizen Mediclaim policy from New India Assurance is the one you could think of having. It offers the cover for a wide range of diseases and conditions and has different sum insured plans for you to choose from. So, if you are a senior citizen, you should read about New India Senior Citizen Mediclaim Policy and see whether it is worth paying the premium towards it.

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Sum Insured

Health insurance for senior citizens in New India is offered to individuals who are aged 60 to 80 years. The New India Senior Citizen Mediclaim Policy can be availed by children as well who want to give health insurance to their aged parents or senior citizens in the family. The insurance policy has a sum insured of

  1. INR 2,00,000
  2. INR 3,00,000
  3. INR 5,00,000

Inclusions in New India Senior Citizen Mediclaim Policy are:

  1. Room Rent subject to 1% of the Sum Insured per day.
  2. Intensive Care Unit (ICU) charges to 2% of the Sum Insured per day
  3. Nursing care
  4. RMO charges
  5. IV fluids
  6. Blood transfusion
  7. Injection
  8. Administration charges
  9. Surgeon, Anaesthetist, Medical Practitioner, Consultants, or Specialists Fees up to 25% of the Sum Insured and Cumulative Bonus Buffer per illness or injury the insured suffers from.

Fees for Equipment Used During Treatments/Surgeries

  1. Anesthesia
  2. Blood
  3. Oxygen
  4. OT charges
  5. Disposable surgical appliances
  6. Medicines
  7. Drugs
  8. Diagnostic material
  9. X-Ray,
  10. Dialysis
  11. Chemotherapy
  12. Radiotherapy
  13. Artificial limbs
  14. And implants other than Orthopedic.

The maximum limit for all these expenses as per New India Senior Citizen Mediclaim Policy terms and conditions is 50% of the aggregate of Sum Insured and Cumulative Bonus Buffer per illness or injury.

Treatments/Surgeries Covered Under New India Senior Citizen Mediclaim Policy

  1. Angiography, but excluding CT Angiogram
  2. Cataract for each eye
  3. Hydrocele Surgery
  4. Dialysis with a limit of INR 1,500 per sitting
  5. Fissurectomy
  6. Fistulectomy
  7. Surgery of Hernia
  8. Appendectomy
  9. Transurethral resection of the prostate (TURP)
  10. BPH surgery
  11. Hysterectomy
  12. Cholecystectomy
  13. Arthroscopic Surgery
  14. Haemorrhoidectomy
  15. Renal stones related surgical procedures
  16. All major Surgical and Medical Treatment for Fractures and Dislocations
  17. PID-Discectomy
  18. PTCA
  19. Joint Replacement for Major Joints (Per Joint)
  20. Major Spinal Surgeries
  21. Cancer Surgeries
  22. Organ Transplant including living donor expenses
  23. Coronary Artery Bypass Graft (CABG)

In case of your multiple surgeries in one sitting, for the same illness or injury, highest grade surgery will be approved at 100%, the second surgery at 50% and the third surgery at 25% of the capped amount.

Exclusions from New India Senior Citizen Mediclaim Policy are:

  1. All internal and external benign tumors
  2. Cysts
  3. Polyps of any kind
  4. Benign breast
  5. Lumps
  6. Benign ear, nose and throat disorders
  7. Benign prostate hypertrophy
  8. Cataract and age related-eye ailments
  9. Gastric or Duodenal Ulcer
  10. Gout and Rheumatism
  11. Hernia of all types
  12. Hydrocele
  13. Infective Arthritis
  14. Piles
  15. Fissures and Fistula in anus
  16. Pilonidal sinus
  17. Sinusitis and related disorders
  18. Prolapsed intervertebral Disc and Spinal Diseases unless it is due to an accident
  19. Skin Disorders
  20. Stone in Gallbladder and Bile duct
  21. Stones in the Urinary system
  22. Treatment for Menorrhagia or Fibromyoma
  23. Myoma and Prolapsed uterus
  24. Varicose Veins and Varicose Ulcers
  25. Renal Failure
  26. Stem Cell Implantation
  27. Domiciliary Hospitalisation
  28. Acupressure, Acupuncture and Magnetic Therapies
  29. Experimental Treatments or Therapies
  30. Age-related Macular Degeneration
  31. Rotational Field Quantum Magnetic Resonance
  32.  External Counter Pulsation
  33. Enhanced External Counter Pulsation
  34. Hyperbaric Oxygen Therapy
  35. Joint Replacement Due to Degenerative Condition
  36. Age-related Osteoarthritis & Osteoporosis
  37. Injury or Illness Due to War
  38. Plastic Surgery unless advised by a Doctor for the treatment of injury or illness.
  39. Vaccination or Inoculation
  40. Cost of Braces
  41. Dental treatment unless caused due to an accident
  42. Congenital Internal and External anomalies
  43.  Bodily Injury due to extreme sports and suicide attempt
  44. Sexually Transmitted Diseases
  45. Naturopathy
  46. Siddha Treatment
  47. AYUSH Treatment
  48. Maternity Expenses

Pre & Post Hospitalization Expenses

The insurance company or Third Party Administrator (TPA) pays the Pre & Post Hospitalization expenses of 30 or 60 days, which may be subject to the maximum limit of 10% of the Sum Insured.

Waiting Period

To get claims for New India Senior Citizen Mediclaim Policy for Illnesses, accidents and certain treatments, you need to conform to the following criteria

  1. Insured can’t get a claim for illness for the first 30 days of the policy
  2. Accident claims are payable during the first 30 days of the policy
  3. For certain treatments, the waiting period is 2 to 4 years.

Cashless Claim

TPA, on behalf of the insurance company, provides the insured person a cashless facility with which the insured can pay the hospitalization expenses at the time of discharge. The settlement will be made directly by the TPA. However, the expenses that are not covered in the Policy would not be paid, and the insured would have to pay such charges to the hospital. You can get this cashless facility only in Network Hospitals approved by the TPA. Before you get admitted to the network hospital, you should get approval from TPA for a cashless facility.

You can visit the TPA website to select the network hospital. To avail the cashless facility your ID proof is required.

Reimbursement Claim

In case you get the treatment at a non-network hospital, you are not eligible to claim the cashless facility on your New India Senior Citizen Mediclaim Policy. In that situation, you will need to pay from your end and file a reimbursement claim. Within 24 hours of hospitalization, you should inform TPA and submit the following documents (original) within seven days from the date of discharge.

  1. Claim Form duly filled and signed
  2. Discharge Certificate
  3. All documents pertaining to the illness
  4. Doctor’s consultation reports
  5. Illness or injury history
  6. Bills
  7. Receipts
  8. Cash Memos with proper prescription
  9. Receipt and diagnostic test report attended by a medical practitioner/surgeon
  10. Surgeon’s certificate stating the nature of the operation performed
  11. Surgeon’s bill and receipt
  12. Attending doctor, consultant, specialist, anesthetist’s bill and receipt
  13. Certificate regarding diagnosis
  14. Details of the previous policies if you haven’t submitted to TPA or any other additional information needed by the TPA for considering the claim.

Optional Cover in New India Senior Citizen Mediclaim Policy

If you want to opt for a voluntary co-pay of an extra 10%, which is a total co-pay of 20%, the insurance company will allow you a discounted premium. You shall bear a Co-Payment of 10% of the final claim admissible amount and the company liability shall be restricted to the payment of the balance amount, which is the Sum Insured and Cumulative Bonus Buffer or 90% of the admissible claim amount, whichever is less.

But when you opt for voluntary co-pay of extra 10%, the company’s liability will be:

  • Sum Insured and Cumulative Bonus Buffer
  • Or 80% of the admissible claim amount

Note: In case of unfortunate death of the insured, the other person can continue the policy even if he/she is below 60years of age. If the co-insured person is a woman, she might get a 5% discount on premium payment as per the policy terms and conditions

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