Main Highlight of the plan
This plan offers coverage to entire family under one sum insured on a shared basis. Although this policy does not cover maternity expenses, this plan covers new born up to the renewal of the existing policy. This plan has premium loading up to 2% per year after age 65 years depending in the premium between age 60 years and 65 years.
Scope of cover
Note: Pre-policy medical check-up are required for all the individuals above age 50 years to be covered under this policy or for individuals having medical history at the time of buying the health policy.
The pre-policy medical check-up would be reimbursed up to 50% after policy is issued.
Coverage: Benefits & Features
Most Important
CO-PAYMENT
This plan has co-payment of 20% of claimable expenses for treatment in different zone depending on the sum insured opted. Note: This plan has premium loading up to 2% per year after age 65 years depending in the premium between age 60 years and 65 years.
NO-CLAIM BENEFITS
This plan does not offer no-claim benefits.
SUB-LIMITS
This plan covers up to 10% of sum insured or INR 50,000 for cataract treatment for each eye. External congenital diseases would be covered up to 10% of the sum insured up to a maximum of average sum insured for the 4 preceding policy years.
Good to have
PRE/POST HOSPITALIZATION
30 days of pre-hospitalization and 60 days of post hospitalization are provided in this plan.
RESTORE BENEFITS
This plan does not offer restore benefit.
HEALTH CHECK-UP
This plan does not offer health check-up benefit.
Value Adds
AMBULANCE CHARGES
This plan provides coverage for ambulance expense up to 1% of sum insurance per hospitalization.
EYE COVER
This plan does not cover expenses for eye treatments.
DOMICILIARY HOSPITALIZATION
This plan does not offer coverage for domiciliary expenses.
OUTPATIENT BENEFITS
This plan does not cover out-patient treatment expenses.
CRITICAL ILLNESS COVERAGE
This plan provides additional coverage for listed critical illnesses up to 10% of sum insured once in lifetime.
ALTERNATIVE PRACTICE This plan covers non-allopathic treatments (Ayurvedic, Unani and Homeopathic treatments) up to 25% of sum insured.
Note: The above mentioned treatments should be with government hospital, hospital or institute recognized by government or accredited by Quality Council of India/ National Accreditation board on health.
DENTAL COVER
This plan does not cover expenses on dental treatments.
DAILY CASH
This plan offers daily cash allowance post 24 hours of hospitalization up to 0.1% of sum insured up to a maximum of 1% of sum insured.
ORGAN DONOR COVER
This plan offers coverage for medical expenses up to sum insured, on harvesting organ for the insured or for the donor and for transplantation.
CONVALESCENCE BENEFIT
This plan does not have any convalescence benefit.
MATERNITY COVER
This plan does not cover maternity expenses.
Note: However, this plan covers new born expenses up to the expiry of the policy period in which he/she was born.
Exclusions
A cooling off period of 30 days is applicable on buying a policy for the first year. No claims (other than claims related to an accident) can be made in this cooling off period. There is no cooling off period applicable on renewal of this policy.
Waiting period of 2 years is applicable for specified ailments while that of 4 years for treatments like joint replacement, osteoarthritis, etc. Refer to the New India Assurance Health policy wordings for the list of these specified ailments.
Waiting period of 4 years is applicable for pre-existing diseases.
Waiting period of 2 years is applicable for internal congenital diseases undiagnosed till the time of buying an insurance.
Waiting period of 4 years for external congenital diseases.
Note: The congenital disease is applicable only for new born covered under this health insurance policy.
PERMANENT EXCLUSIONS
Cosmetic surgery, Lasik eye treatments, drugs or alcohol abuse, genetic disorders, self-inflicted injuries, war related injuries, etc. are some of the permanent exclusions. For the detailed list of please refer the policy document.
