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New India Assurance - Senior Citizens Mediclaim Policy

New India Assurance Co Ltd. is a Government multinational general insurance company having its headquarters in Mumbai and a global presence in more than 27 countries. Sir Dorabji Tata founded the company in 1919 and since then it has been ruling the market in the non-life insurance business.

New India's tailor-made plan for the senior citizen proposes a maximum coverage towards the well-being of the elderly. It covers crucial areas with lucrative benefits like no claim bonus and free health check-ups.

Highlights of Senior Citizens Mediclaim Policy

Offers 5% cumulative bonus for every claim free (renewal) year up to a maximum of 30%.
Adding spouse on the policy will provide 10% family discount on the premium. Also, opting for a voluntary deductible of Rs.10,000 will fetch another 10% rebate on the premium.
Migration to a Senior Citizen Mediclaim is possible for those senior citizens who already have an existing health plan.
Payment towards the cost of Health Check every four claim free years.
Income Tax Benefit for the premium paid under Section 80D of Income Tax Act.

Scope of cover

Indivdual Plan

Entry Age

For children :

Adults :

Minimum : 60

Maximum : 80

Number of Members Covered

Maximum Members : 2

Maximum Adults : 2

Maximum Children :

Sum Insured

1 lakh and 1.5 lakh

discount

Family discount

Policy Periods Available

1 year

Pre-Policy Medical Check-up

Above 60 years

Family Floater Plan

Entry Age

For children :

Adults :

Minimum : 60

Maximum : 80

Number of Members Covered

Maximum Members : 2

Maximum Adults : 2

Maximum Children :

Sum Insured

1 lakh and 1.5 lakh

discount

Family discount

Policy Periods Available

1 year

Pre-Policy Medical Check-up

Above 60 years

Important Features

Day Care Treatments

Definition

Day Care Treatments

Includes surgical processes conducted using local or general anaesthesia which requires less than 24 hours of hospitalization because of technological advancement in healthcare. Each company has a specific list of processes which are covered under this category.

Due to scientific progress, some procedures/treatments do not require you to be hospitalized for a minimum of 24 hours to raise a claim. This plan covers such procedures.

No-Claim Benefits

Definition

No-Claim Benefits

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For every claim free year, you will earn a no claim bonus of 5% up to a maximum of 30%.

Organ Donor Cover

Definition

Organ Donor Cover

Includes coverage for in-patient hospitalization expenses, offered to an organ donor for his/her treatment on harvesting an organ for the insured.

If you ever have to opt for organ donation, the hospitalization expenses (excluding the cost of the organ) on the procedure for the donor will be covered up to the sum insured.

Pre Hospitalization

Definition

Pre Hospitalization

Medical expenses incurred immediately before the insured individual is hospitalized are covered under this benefit. Usually, expenses up to 30 to 90 days before hospitalization are covered under the policy only after the in-patient hospitalization claim is accepted by the insurance company.

The insurance company will compensate you for the medical expenses related to your hospitalization 30 days before the hospitalization up to a maximum of 5% of the hospital bill.

Post Hospitalization

Definition

Post Hospitalization

Medical expenses incurred immediately after the hospitalization are covered under this benefit.The coverage under this benefit would be available only for approved in-patient hospitalization claim is accepted by the insurance company. Usually, expenses up to 30 to 180 days post discharge are covered under the policy.

The insurance company will pay you for the medical expenses related to your hospitalization 60 days post hospitalization up to a maximum of 10% of the hospital bill.

Good to Have Benefits

Health Check-up

Definition

Health Check-up

Includes complimentary health check-up provided by the insurance companies for certain health insurance plans.

You are entitled to a health check up every four claim free years. This amount can be reimbursed up to a maximum limit of 1% of the average sum insured.

Non- Allopathic Treatment Expense Cover

Definition

Non- Allopathic Treatment Expense Cover

Includes coverage for expenses on treatment which do not use allopathic methods like Aurveda, Homeopathy, etc. The terms and conditions are different for different policies. This benefit is also refered to as Ayush benefit or Alternative treatment by some the insurers.

You can claim for any treatment sought through alternate medicine like Ayurveda, Unani or Homeopathy up to a maximum of 25% of the sum insured. This claim will be honored as per the policy terms only if you seek the stated treatment in a Government Hospital or any institute duly recognized by the Government or any other governing body.

Emergency Ambulance

Definition

Emergency Ambulance

Includes coverage for expenses on ambulance for hospitalization of the insured.

This plan provides ambulance cover for Rs.1,000.

Value Adds

FREE LOOK PERIOD

Definition

FREE LOOK PERIOD

For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within ten days from the date of receipt of the policy document.

Terms & Conditions

Room Rent / Room Category

Definition

Room Rent / Room Category

Hospitals have a fixed tariff or rate chart for all rooms. Mediclaim depends on the amount of room rent limit specified in the policy document. The amount varies depending on the type of room category chosen.

You can claim for the hospitalization basis the following limits:

Room rent/boarding/nursing expenses up to a maximum of 1% of sum insured per day
ICU charges up to 2% of sum insured per day
The overall limit should not exceed more than 25% of the sum insured

Co-Payment

Definition

Co-Payment

The fixed amount the policyholder has to pay for covered services when they get the service. When both insured and insurer pay part of the medical expenses, it is called as cost sharing. This is applicable based on the policy you choose.

For every admissible claim, the insurer has to bear a co-payment of 10%.

Sub-Limits

Definition

Sub-Limits

Includes the limits up to which specific conditions are covered under your policy. These limits are applicable for packaged treatments or some specific ailments listed in the policy.

SURGEON, ANESTHETIST, MEDICAL PRACTITIONER, CONSULTANTS, SPECIALISTS FEES, NURSING EXPENSES: Overall limit 25% of sum insured
ANESTHESIA, BLOOD, OXYGEN, OT CHARGES, SURGICAL APPLIANCES, MEDICINES, DRUGS, DIAGNOSTIC MATERIAL & X-RAY, DIALYSIS, CHEMOTHERAPY, RADIOTHERAPY, COST OF PACEMAKER, ARTIFICIAL LIMBS, COST OF STENTS & IMPLANTS: Overall limit 50% of sum insured

Waiting Period

Cooling Off Period

Definition

Cooling Off Period

The period begins right after commencement of the policy within which you cannot claim for any illness except claims related to accident. This period is not applicable for subsequent renewals.

A 30 days cooling off period for all claims except any arising out of accidental injuries.

Specific Illnesses

Definition

Specific Illness

The ailments of specific severity listed in the policy document are included under this category.

The policy covers some specific diseases/treatments only after 18 or 24 months. These include Stone in Gall Bladder & Bile duct, Cataract, Hysterectomy, Myomectomy for Fibroids, and so forth.

Pre-Existing Illnesses

Definition

Pre-Existing Illnesses

The ailments that the insured was already diagnosed with before taking the policy.

You can claim for any pre-existing conditions after a waiting period of 48 months from the policy start date.

Add-on Covers

WAIVER OF WAITING PERIOD FOR DIABETES MELLITUS AND HYPERTENSION:

Definition

WAIVER OF WAITING PERIOD FOR DIABETES MELLITUS AND HYPERTENSION

At an additional premium, you can opt to waive the usual waiting period for any illness arising out of Diabetes mellitus and Hypertension. The same can be covered from the inception of the policy.

Eligibility Criteria for New India Senior Citizen Mediclaim Policy

Product Name	Senior Citizen
Minimum Age of Entry	60 years
Maximum Age of Entry	80 years
Sum Insured	Rs.1 lakh to Rs.1.5 lakh
Policy Tenure	1 year
Family Definition	Individual – self, spouse
Premium Calculated on Basis of	Age (i.e. sum insured chosen)

Document Required Buy New India Senior Citizen Mediclaim Policy

The below documents are required to buy New India Senior Citizen Mediclaim Policy:

Proof of age and address and a recent photograph

Document Required For Claim Policy

The below documents are required to file New India Senior Citizen Mediclaim Policy:

Claim Form, duly filled up by the policyholder
Doctor's certificate and treatment reports
Bank details for transfer of the claim amount
Discharge summary
Bills and Prescriptions
Advance and final receipts
Diagnostic test reports, X Ray, scan, ECG and other films

Further documents may be called upon for by the claim processing team if requirement for the same arises.

Tax Benefits of New India - Senior Citizen Mediclaim Policy

Offers tax rebate under Section 80D of the Income Tax Act, 1961 on payment of the premium of the Senior Citizen Mediclaim Policy.

Permanent Exclusions

The Plan will not cover any liabilities towards the treatments of following conditions-

Whose signs or symptoms first occur within 30 days of the policy period
Attempted suicide
Use of alcohol or drug
AIDS
Pregnancy, childbirth, miscarriage, and abortion
Infertility and in vitro fertilization.
Vaccination & Inoculation
Hospitalization out of war, riot, strike and nuclear weapons

Note: The complete list of what is omitted from the scope of coverage forms a part of the policy wordings. Kindly refer the same for additional reference.

Review of New India Assurance - Senior Citizens Mediclaim Policy

New India's Senior Citizen Mediclaim policy is a tailor-made product that covers you against medical costs due to specific critical illnesses, ailments, injuries or accidents. With useful features like a complimentary health checkup, no claim bonus and an option to include Diabetes and Hypertension from day one is what makes the policy unique. On a flip-side, a limit on the room rent and sub-limit on some of the procedures along with a co-payment clause can be a bit discouraging.

**Reviews and ratings are based only on Benefits and Conditions. Things like Claim Settlement Ratio, Hospital Network have not been covered under product ratings. These are covered under Company ratings.

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