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:
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| Exclusions |
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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):
- 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.
- 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.
- 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.
