New India Top Up Mediclaim Plan

What is not Covered?

1. Pre-existing diseases and treatment of the same. 

1. Any illness or disease contracted within 30 days from the date of commencement of the policy. 

1. If the insured individual does not have continuous coverage in excess of 24 months of the policy, the following medical conditions are not covered: 

1. Benign ENT (Ear, Nose and/or Throat) disorders. 

1. External or internal benign cysts, tumors, polyps, breast lumps, etc. 

1. Benign hypertrophy 

1. Congenital Internal Disease 

1. Cataract and age related eye ailments 

1. Diabetes Mellitus 

1. Gout and Rheumatism 

1. Gastric/ Duodenal Ulcer 

1. Hernia of all types 

1. Hypertension 

1. Hydrocele 

1. Non Infective Arthritis 

1. Pilonidal sinus, Sinusitis and related disorders 

1. Piles, Fissures and Fistula in anus 

1. Prolapsed Inter Vertebral Disc and Spinal Diseases that are not caused by an accident 

1. Stone in Gallbladder and Bile duct, excluding malignancy 

1. Skin Disorder 

1. Stones in Urinary system 

1. Varicose Veins and Varicose Ulcers 

1. Treatment for Menorrhagia/ Fibromyoma, Myoma and Prolapsed uterus. 

1. If the insured individual does not have continuous coverage in excess of 48 months of the policy, the following medical conditions are not covered: 

1. Degenerative condition causing joint replacement 

1. Osteoporosis and Osteoarthritis caused by old age. 

1. Other exclusions are: 

1. Pre-hospitalization and Post-hospitalization expenses 

1. Expenses related to naturopathic treatment, acupuncture, acupressure, magnetic therapy, etc. 

1. Invasion, war, act of foreign enemy, nuclear weapons, war-like operations, radioactivity, contamination by ionizing radiation, nuclear waste or nuclear fuel, etc. 

1. Circumcision, cosmetic surgery or treatment, vaccination, general debility/ convalescence, infertility, self-injury, self-harm, venereal disease, psychosomatic disorders, etc. 

1. Illness or injury caused due to influence of alcohol or drugs. 

1. Injury due to participation in a criminal act. 

1. Sexually transmitted diseases 

1. Maternity expenses or expenses related to pregnancy, miscarriage, abortion, etc. 

1. Stem Cell surgery or genetic disorders 

1. Registration charges, surcharges, service charges, etc. 

1. All non-medical expenses 

1. Treatment availed outside India, etc.

Eligibility Criteria for New India Top-Up Mediclaim Plan

Documents Required

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

1. Duly filled proposal form, which is signed by the insured individual or group of individuals.
2. 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.
3. Copy of the expired policy/ the current mediclaim policy can be attached to the form.
4. 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).

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.