New India Mediclaim Policy

New India Mediclaim Plan - Product Overview

The New India Mediclaim Plan is a comprehensive health insurance policy provided by New India Assurance Company Limited. This plan is designed to offer you and your loved ones peace of mind by ensuring access to necessary medical care without the concern of unexpected financial burdens from medical expenses. The New India Mediclaim Plan comes with a range of features, benefits, and optional add-ons, all tailored to accommodate your unique healthcare needs. With this policy, you can confidently navigate the uncertainties of health-related expenses, securing a reliable and customizable coverage solution.

Eligibility Criteria For The New India Mediclaim Plan

• Minimum Age:
  Adults: The minimum age for entry for adults is 18 years
  Dependent Children: Dependent children can be enrolled from the age of 1 year.

• Maximum Age:
  Adults: The maximum entry age for adults is 80 years.
  Dependent Children: The maximum entry age for dependent children is 60 years.

Benefits and Coverage Overview of The New India Mediclaim Plan

In addition to covering inpatient hospitalisation expenses, which include room boarding, nursing charges, medical practitioner’s fees, cost of prescribed medicines and drugs, ICU charges, and other related expenses for hospital stays exceeding 24 hours, the New India Mediclaim Plan encompasses various other expenses. Here's a brief overview of some additional covered expenses:

• Pre & Post Hospitalisation Expenses
  Rest easy if your doctor deems it necessary to conduct a series of diagnostic tests before or after your hospitalisation – your insurer has you covered. The policy extends coverage for these expenses, offering support up to the sum insured for a reasonable duration of 30 days preceding your hospitalisation and 60 days following your discharge. It's important to note that these expenses will be covered by the insurer only if they are directly linked to the medical condition for which you are hospitalised, and approval for these claims must be granted as part of the inpatient hospitalisation coverage. This feature ensures comprehensive financial support, not just during the hospital stay but also during the critical periods before and after, contributing to your overall healthcare needs.
   
• Daycare Treatment Coverage
  Under the New India Mediclaim Plan, daycare treatment is an inclusive feature designed to cater to medical procedures or surgeries that historically demanded prolonged hospital stays but can now be efficiently completed within 24 hours, thanks to advancements in medical technology. The plan covers 226 specific daycare procedures without imposing any limit on the expenses. This means that the expenses incurred for these daycare treatments will be covered up to the sum insured.
   
• Organ Donor Coverage
  The Plan goes a step further by offering coverage for organ donor expenses, specifically when the insured individual is the recipient. This feature encompasses the inpatient expenses of the donor associated with organ transplantation, ensuring financial support for a crucial and often complex medical procedure. The coverage extends up to the sum insured selected under the plan.
   
• Modern Treatment Coverage
  As healthcare continues to advance rapidly through innovative technologies, modern treatments that were once considered impossible are now becoming a reality. The New India Mediclaim Plan is crafted to align with the dynamic landscape of healthcare. This plan is structured to keep pace with these innovations, providing coverage for the expenses associated with modern treatments. This plan includes modern treatment coverage though there are sub-limits applicable to various treatments.
   
• No Claim Bonus
  The No Claim Bonus is a commendable incentive designed to acknowledge and appreciate individuals who prioritise their health and refrain from making insurance claims. It serves as a way to give back to those who have not utilised their insurance benefits in the form of claims during the policy year. Under the New India Mediclaim Plan, you are eligible for a No Claim Bonus as a reward for maintaining a claim-free record during a policy year. This bonus amounts to 25% of the sum insured annually, up to a maximum of 50% of the sum insured. The accumulated bonus will decrease at the same rate at which it was accrued if a claim is made in the future.
   
• Restoration Benefit
  Restoration benefit is a feature designed to replenish your sum insured when it is fully depleted within a policy year. This benefit activates upon the complete utilisation of both the base sum insured and cumulative bonus (if applicable). It allows for the restoration of the sum insured, making it available for subsequent claims during the same policy year. Notably, the restoration benefit can be utilised once in every policy year for claims related to unrelated illnesses. This feature  is accessible to individuals who opt for a sum insured of 5 Lakhs or above.
   
• Room Rent Limit
  The New India Mediclaim Plan includes a room rent limit, which represents the maximum amount covered by the insurance company for the hospital room during hospitalisation. If you choose a room within your plan's specified limit, you won't incur any out-of-pocket expenses. However, opting for a room with a higher rent than your eligibility will result in a proportionate deduction, requiring you to cover a share of the entire bill rather than just the difference in room rent.
  The plan imposes a room rent limit of up to 1% of the sum insured per day. Nevertheless, by selecting an add-on, you have the option to waive off these limits. This means you can freely choose any room without restrictions, and the insurer won't scrutinise your choice of room.
   

Other Important Features of The Product

The New India Mediclaim Plan comes with many additional key features that include –

• Day One Baby Cover
  The New India Mediclaim Plan offers a special provision known as "Day One Baby Cover," ensuring immediate coverage for newborns from the very first day of their birth until the expiration of the policy. This feature encompasses all medical expenses related to the newborn, including coverage for external defects, up to the sum insured allocated for the mother, provided the waiting period has been fulfilled by her. To extend health coverage for your child beyond the initial period, it is essential to add the baby to the policy during the renewal process. This thoughtful inclusion aims to safeguard the health and well-being of the newborn from the outset.
   
• Maternity Benefit
  Anticipating the concerns of expectant parents, which can be many, the New India Mediclaim Plan introduces the Maternity Expenses Benefit, ensuring that the financial aspects of childbirth are taken care of. This optional cover provides coverage for expenses related to childbirth, extending up to 10% of the average sum insured over the preceding three years. This benefit can be availed by paying an additional premium and opting for a sum insured of 5 Lakhs and above, following a specified waiting period. However, certain terms and conditions related to coverage apply, and it's advisable to review these for a thorough understanding of the maternity-related benefits within the policy.
   
• Specific Coverages
  The New India Mediclaim Plan covers specific medical conditions, demonstrating its comprehensive approach to healthcare. The plan takes care of expenses associated with disorders such as puberty and menopause, Age Related Macular Degeneration (ARMD), genetic diseases, and mental illness, providing support up to specified limits. Furthermore, the plan includes coverage for expenses related to artificial life maintenance for individuals in a vegetative state, up to a defined limit, with a maximum coverage period of 15 days per policy period for covered illnesses. This emphasis on specific coverages stands out in the plan and reflects its commitment to addressing a diverse range of health conditions and ensuring that you receive tailored support for your unique healthcare needs.
   

Understanding Waiting Periods

Following the purchase of a health insurance policy, it's important to be aware of the waiting period, a specific duration during which coverage for certain illnesses and diseases is not applicable. Once this waiting period concludes, you become eligible to make claims for these conditions. Various types of waiting periods exist. These include-

• Initial Waiting Period
  The initial waiting period spans 30 days for all medical conditions, excluding accidents. During this initial 30-day period, you will not be eligible to make claims for hospitalisation, except in cases of accidents.
   
• Waiting Period For Pre-existing Diseases
  In the context of the New India Mediclaim Plan, a waiting period of 48 months is applied to pre-existing diseases. Pre-existing diseases are defined as any medical condition or illness that you have experienced in the 48 months preceding the application for the health insurance policy. During this waiting period, which spans 48 months from the commencement of the policy, the plan will not cover any expenses related to pre-existing diseases.
   
• Waiting Period For Specific Diseases
  Waiting period for specific diseases is slightly different from pre-existing diseases. This waiting period applies to a specified list of medical conditions or illnesses determined by the insurer. Importantly, this waiting period is not contingent on your current health status and is solely determined by the insurer. Under the New India Mediclaim Plan, the waiting period for specific diseases varies, spanning durations of 3, 24, 36, or 48 months, depending on the nature of the diseases in question.
   

What is Not Covered Under The Plan?

Exclusions are situations not covered by your health insurance policy. They include –

• Standard Permanent Exclusions: The IRDAI has set 'standard permanent exclusions' enforced by all insurers. Some of these include –
  • Investigation And Evaluation: Hospital admission just for observation or monitoring.
  • Rest Cure, Rehabilitation, And Respite Care: Admission for bed rest without active treatment.
  • Obesity/Weight Control: Treatment or surgery for any measures for weight control or obesity.
  • Change Of Gender Treatment: Treatments for altering the body's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Surgeries/treatments to modify body characteristics or appearance.
  • Profession In Hazardous Or Adventure Sports: Treatment costs while professionally participating in activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Breach Of Law: Expenses for treating a person who committed or attempted a breach of law with criminal intent.
  • Excluded Providers: Treatment from a practitioner or hospital excluded by the insurance company.
  • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
  • Treatments In Establishments For Domestic Purposes: Expenses for treatment in health spas, nursing homes, or similar places arranged for domestic reasons.
  • Dietary Supplements, Substances Without Prescription: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Costs of correcting refractive errors up to 7.5 diopters for better eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven effective.
  • Birth Control, Sterility and Infertility Costs: Contraception, sterilisation, artificial insemination and all advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, etc.
  • Maternity Expenses: Pre/post-natal costs and any childbirth-related hospitalisation expenses, etc.
• Additional Permanent Exclusions: Apart from the standard permanent exclusions mentioned earlier, insurers may add more exclusions for specific situations or medical conditions. If you have certain diseases or severe medical conditions that insurers find risky to cover, they might permanently exclude them from your policy. However, it is important to know that insurers can only apply permanent exclusions for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
• Non-Standard Exclusions (Specific Exclusions): These are specific exclusions that go beyond the standard permanent exclusions listed by the IRDAI. These exclusions can differ between insurance companies and may depend on the policy terms and conditions. Here is a list of some top specific exclusions under the New India Mediclaim Plan –
  • Alternative Therapies: Treatment methods such as acupressure, acupuncture, and magnetic therapies are excluded from coverage.
  • Home Treatment Expenses: Costs related to receiving medical care at home instead of in a hospital are not covered.
  • Intentional Injury or Exposure: Injuries or illnesses resulting from willful exposure to danger, intentional self-harm, or attempted suicide are not covered, except in cases of attempting to save human life.
  • Circumcision: Coverage for circumcision is limited to cases deemed medically necessary or those necessitated by an accident.
  • Recovery and General Weakness: Expenses related to convalescence or general debility are excluded.
  • Prosthetic Devices and Aids: Costs of braces, prosthetic devices, eyeglasses, contact lenses, and hearing aids are not covered.
  • Dental Treatment: Dental procedures are covered only if necessitated by an accident and requiring hospitalisation.
  • Naturopathy: Treatment under naturopathy is not eligible for coverage.
  • Specific Therapies: Treatments like RFQMR, ECP, EECP, and HBOT are excluded.
  • Vaccinations: Costs associated with vaccinations or inoculations are not covered.
  • War and Civil Disturbances: Injuries or illnesses resulting from war, civil disturbances, rebellions, or similar events are not covered under the policy.
     

Summary

The OG Reading Material For Your Reference

• Policy Wording: https://www.newindia.co.in/assets/docs/know-more/health/new-india-mediclaim-policy/PolicyClauseNewIndiaMediclaimPolicy(NIAHLIP23187V052223).pdf

FAQs

1. What is the maximum coverage offered under the New India Mediclaim Plan?
   The New India Mediclaim Plan provides a health cover of up to INR 15 Lakhs.
    
2. Does the New India Mediclaim Plan cover domiciliary treatments?
   Unfortunately, no. The plan does not cover expenses associated with domiciliary treatment, i.e., treatment taken at home.
    
3. Are there room rent restrictions under the New India Mediclaim Plan?
   It depends on whether you have opted for an add-on or not. Without add-on, there is a maximum room rent limit of up to 1% of the sum insured per day. However, with an add-on, there are no restrictions on the type of room you choose.
    
4. Does the New India Mediclaim Plan cover AYUSH treatments?
   Yes, it does. The plan covers expenses associated with AYUSH Treatments like Ayurveda, Homeopathy, and Unani, up to 25% of the sum insured.
    
5. Are maternity benefits provided by the New India Mediclaim Plan?
   Yes, the New India Mediclaim Plan covers expenses associated with pregnancy up to a certain limit as specified in the policy if you choose a sum insured above 4 Lakhs and opt for an add-on.