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  • New India Assurance Top Up Mediclaim Policy

    New India Health Insurance

    New India Top-Up Mediclaim policy covers hospitalization expenses including In-Patient hospitalization expenses incurred within the country. This policy is offered on a floater or individual basis and will cover up to 6 family members. It can be taken along with another health insurance policy.

    Features of New India Top-Up Mediclaim Policy:

    Primary Insured The proposer need not be considered as the primary member - eldest family member will be considered the primary member and the others are considered as additional members under the New India Top-Up Mediclaim Policy.
    Tenure of the policy This policy is valid for 12 months from the date of inception.
    Pre-acceptance health check-ups Pre-acceptance health check-ups are conducted for individuals who are more than 50 years old or for those who have an adverse claim history. If an individual who is more than 50 years owns a health insurance policy from New India Insurance and has had no claims registered in the past 2 years, the pre-acceptance health check-ups are not required.
    Cover This policy covers hospitalization expenses such as:
    • Room Rent – Nursing and boarding expenses are covered under this policy. The maximum cap is Rs. 5,000 each day for a threshold of Rs. 5, 00,000 and Rs. 8,000 each day for a threshold of Rs. 8, 00,000.
    • ICU (Intensive Care Unit)/ ICCU (Intensive Cardiac Care Unit) expenses – The maximum cap is Rs. 10,000 each day for a threshold of Rs. 5, 00,000 and Rs. 16,000 each day for a threshold of Rs. 8, 00,000.
    • Fees for Consultants, Specialists, Medical Practitioners, Anesthetist and Surgeons.
    • Dialysis, chemotherapy, anesthesia, oxygen, blood, surgical appliances, operation theatre charges, radiotherapy, medicines and drugs, artificial limbs, relevant laboratory tests, X-Ray and other medical expenses related to the treatment.
    • Cost of organ transplant incurred by the donor, excluding the cost of the organ.
    • Get Well Benefit – This benefit is paid out to the insured for the initial 4 admissible claims. The maximum cap is Rs. 5,000 each day for a threshold of Rs. 5, 00,000 and Rs. 8,000 each day for a threshold of Rs. 8, 00,000 and is paid for any one illness.
    • Ambulance Expenses – The maximum cap is Rs. 5,000 each day for a threshold of Rs. 5, 00,000 and Rs. 8,000 each day for a threshold of Rs. 8, 00,000, and is paid for any one illness.
    • Daily cash allowance for hospitalization – The maximum cap is Rs. 5,000 each day for a threshold of Rs. 5, 00,000 and Rs. 8,000 each day for a threshold of Rs. 8, 00,000.
    • Cataract treatment – Claim related to cataracts in each eye will be covered. The maximum amount paid for cataract in each eye is Rs. 50,000.
    • AYUSH treatments – The expenses related to AYUSH treatments are covered if it has been done through a government hospital or an institution recognized by the government or is accredited by the National Accreditation Board on Health/ Quality Council of India.
    Exclusions
    • Pre-existing diseases and treatment of the same.
    • Any illness or disease contracted within 30 days from the date of commencement of the policy.
    • If the insured individual does not have continuous coverage in excess of 24 months of the policy, the following medical conditions are not covered:
      • Benign ENT (Ear, Nose and/or Throat) disorders.
      • External or internal benign cysts, tumors, polyps, breast lumps, etc.
      • Benign hypertrophy
      • Congenital Internal Disease
      • Cataract and age related eye ailments
      • Diabetes Mellitus
      • Gout and Rheumatism
      • Gastric/ Duodenal Ulcer
      • Hernia of all types
      • Hypertension
      • Hydrocele
      • Non Infective Arthritis
      • Pilonidal sinus, Sinusitis and related disorders
      • Piles, Fissures and Fistula in anus
      • Prolapsed Inter Vertebral Disc and Spinal Diseases that are not caused by an accident
      • Stone in Gallbladder and Bile duct, excluding malignancy
      • Skin Disorder
      • Stones in Urinary system
      • Varicose Veins and Varicose Ulcers
      • Treatment for Menorrhagia/ Fibromyoma, Myoma and Prolapsed uterus.
    • If the insured individual does not have continuous coverage in excess of 48 months of the policy, the following medical conditions are not covered:
      • Degenerative condition causing joint replacement
      • Osteoporosis and Osteoarthritis caused by old age.
    • Other exclusions are:
      • Pre-hospitalization and Post-hospitalization expenses
      • Expenses related to naturopathic treatment, acupuncture, acupressure, magnetic therapy, etc.
      • Invasion, war, act of foreign enemy, nuclear weapons, war-like operations, radioactivity, contamination by ionizing radiation, nuclear waste or nuclear fuel, etc.
      • Circumcision, cosmetic surgery or treatment, vaccination, general debility/ convalescence, infertility, self-injury, self-harm, venereal disease, psychosomatic disorders, etc.
      • Illness or injury caused due to influence of alcohol or drugs.
      • Injury due to participation in a criminal act.
      • Sexually transmitted diseases
      • Maternity expenses or expenses related to pregnancy, miscarriage, abortion, etc.
      • Stem Cell surgery or genetic disorders
      • Registration charges, surcharges, service charges, etc.
      • All non-medical expenses
      • Treatment availed outside India, etc.

    Eligibility Criteria for New India Top-Up Mediclaim Plan:

    Minimum age of entry 18 years
    Maximum age of entry 65 years
    Minimum age of entry for family members 3 months
    Maximum age of entry for family members 65 years
    Other conditions Only the spouse, dependent parents and dependent children are considered as “family” and can be added to the policy cover. Children should fall within the age group of 18 years – 25 years.

    Documents Required:

    The following documents have to be submitted at the inception of the policy:

    • Duly filled proposal form, which is signed by the insured individual or group of individuals.
    • Details of previous health insurance policies as well as current health insurance policies are to be provided in the proposal form along with the clam history.
    • Copy of the expired policy/ the current mediclaim policy can be attached to the form.
    • A copy of the Prospectus, which is signed by the insured.

    Claims Procedure for New India Top-Up Mediclaim Policy:

    In order to avail the cashless hospitalization facility, the insured must send a pre-authorization request to the TPA (Third Party Administrator) upon admission in the hospital. The payment will be made directly to the hospital by the insurance provider. In case of reimbursement claims, the insured must inform the TPA about the hospitalization as soon as possible. The claim bills have to be submitted within 7 days of discharge from the hospital.

    For planned hospitalization, the TPA must be informed 48 hours before hospitalization and for emergency hospitalization, the TPA should be informed within 48 hours of hospitalization of the insured member(s).

    Frequently Asked Questions (FAQs):

    1. What is an Adverse Medical History?

      An Adverse Medical History is categorized as the following conditions suffered by the prospective policyholder:

      • In the past 2 years, if the individual has undergone more than 2 hospitalizations.
      • Suffers from conditions such as diabetes, hypertension or chronic illnesses such as cancer, renal failure, Parkinson’s disease, Diabetes Mellitus type II, etc.
    2. What are the tests conducted during the pre-acceptance health check-ups?

      The following tests are conducted during the pre-acceptance health check-ups:

      Routine urine test, CBC, ECG, Blood Sugar, X-Ray Chest PA view, SGPT, Physician check-up, SGOT, HDL Cholesterol, Cholesterol, Eye check-up for Glaucoma and Cataract and Triglycerides.

    3. Do I have to pay for the pre-acceptance health check-ups?

      Yes, the proposer has to pay the expenses incurred during the pre-acceptance health check-ups. If the policy proposal is accepted, 50% of this expense will be reimbursed by the insurance provider.

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