Objective

A health insurance policy that can cover a family for hospitalisation expenses, including Ayurvedic and Homeopathic treatment, on a floater basis.

Suited for

This is suitable for young individuals looking to insure entire family under a single health policy. Anyone between 18 to 60 years can take this policy.

What does it do?

Although limited to 25 per cent of sum insured, the cover for Ayurvedic, Homeopathic and Unani treatment is the specialty of this policy. It also covers hospitalisation expenses, pre and post hospitalisation expenses with capping on maximum sum insured. It also pays for treatments that do not require overnight stay in hospital, Emergency ambulance and organ donor hospitalisation expenses.
This policy has a co-pay clause under which the policyholder is required to pay some portion of medical bills if certain conditions are fulfilled. The conditions are as below:
Those paying premium for Zone I treatment are allowed to take treatment in any zone and can claim entire sum insured.
Policyholders paying premium for treatment in Zone II may avail treatment in Zone II and Zone III up to 100 per cent of sum insured. One needs to pay 10 per cent of the admissible claim, if treatment is taken in Zone I.
Persons paying premium for treatment in Zone III, are eligible to claim entire sum insured for treatment taken in Zone III. A compulsory deductible of 10 per cent in case of treatment in Zone II and that of 20 per cent in case of treatment in Zone I is applicable.

Pros

Loyalty discount is available. It covers non-allopathic treatment as well. Policyholder is allowed to avail treatment in any lower zone without a co-payment clause.
Premium paid under this policy qualifies for deduction under section 80D of Income Tax Act.

Cons

In case of adverse claim history, there are chances of increase in premium or imposing a deductible.
Hospitalisation expenses are covered with sub limits.
Co-payment clause applies when one takes treatment in a higher zone.

Our View

You should avoid insurance policies that cover with sub-limits on certain charges. Prefer policies with least exclusions and without sub-limits. If you are young and healthy it will be easy for you to buy such a policy.

Eligibility

Entry Age (years)

Minimum

18: 3 months for children

Maximum

60; 18 years for children

Maximum Policy Renewal Age (years)

Lifelong renewal

Coverage Type

Family Floater (Self+Spouse+2 dependent children)

Policy Term (years)

1

Sum Insured (Rs)

Maximum

5 lakh

Minimum

2 lakh

Tax Benefit

Section 80D of the Income Tax Act are applicable

Discount

Loyalty discount is applicable

Pre Policy Medical Check Up

Required

Co Payment Clause

Policyholder who had paid premium for treatment in Zone II but avails treatment in Zone I has to bear 10% of each claim. Likewise, Policyholder who had paid premium for treatment in Zone III but gets treatment in ZoneII or Zone I has to bear 10% and 20% of each claim respectively

Policy Termination

Insurer may cancel the policy by giving a 30 days written notice to policyholder. Policyholder may also cancel the policy at any time by giving a written notice to insurer. In case policyholder canceling the policy, a certain percentage of premium would be refunded on prorata basis.

Customer Service

Address

The New India Assurance Co. Ltd Jeevan Bharti Building, Corporate Office: 87, M.G Road, Fort, Mumbai 400001; Regional Office: 124 Connaught Circus, New Delhi-110001

Mail to

health.ho@newindia.co.in

Call to

1800 209 1415

Network Hospitals

Http://newindia.co.in/listofhospitals.aspx

Scope of Cover

Cashless Facility

Available at network hospitals

Reimbursement Facility

Available if treatment taken at any non empanelled hospital

Pre-hospitalisation

covers medical expenses upto 30 days immediately prior to hospitalisation

Post-hospitalisation

covers medical expenses upto 60 days immediately post discharge from hospital

Inpatient Hospitalisation

Covered

Room rent/ ICU expenses

Room rent and boarding expenses will be covered upto 1% of Sum Insured per day and ICU expenses will be covered upto 2% of Sum Insured per day

Surgeon, Anesthetist, Medical Practitioner, Consultant's Specialist fees

Covered upto maximum 25% of Sum Insured if payment made via cheque or a maximum of upto Rs 10000 if fees was paid in cash

Anesthesia, blood, oxygen, OT charges, surgical appliances, medicines, etc.

Covered

Day Care Procedures

Covered

Ayurvedic/ Homeopathic/ Unani treatment

Covered upto maximum 25% of Sum Insured

Emergency ambulance

Covered upto 1% of Sum Insured subject to a maximum of Rs 2500

Expenses for organ donor of transplant

Covered

Pre existing diabetes, mellitus and hypertension

will be covered after a period of 2 years in the following manner:

3rd year

50% of admissible claim or 50% of sum insured whichever is lower

4th year

75% of admissible claim or 75% of sum insured whichever is lower

5th years and onwards

upto 100% of Sum Insured

Exclusions and Waiting Period

Pre-existing Diseases/ Illnesses

Covered after a period of 48 months

No claim period

30 days commencing from inception of policy except for accidental injuries

Waiting Period

Certain diseases such as hernia, diabetes, mellitus, cataract etc. will be covered after a waiting period of 2 years.Pre existing hypertension, diabetes and related conditions will be covered after a period of 2 years upon payment of additional premium.Age related Osteoarthritis and Osteoporosis and joint replacement due to degenerative condition will be covered after a waiting period of 48 months

Claim loading and deductible

Premium may be hiked by upto 200% of basic insurance premium or a deductible upto 25% may be imposed on basis of adverse claim history. Claim history of 2 years will be accounted for.

General Exclusions

Self inflicted bodily injury Domiciliary TreatmentDental treatment, Cost of spectacles, braces and contact lensesNaturopathy treatmentEngagement in any illegal or criminal activitiesEngagement in adventurous acts such as parachuting, bunjee jumping etc.Bodily injury arising as a result of terrorismbodily injury or disease caused as a result of HIV/ AIDS or any related condition