Objective

A health insurance policy that aims to provide for hospitalisation expenses.

Suited for

This policy is suitable for anyone looking out for an ordinary health insurance cover

What does it do?

Like any other basic health insurance policy, it provides for medical bills incurred due to hospitalisation as an inpatient. It also covers day care procedures taken at home.
The policy also pays for homeopathic or ayurvedic treatment and emergency ambulance expenses.

Pros

It also covers treatment under Ayurvedic/ Homeopathic and Unani system of medicine.
Premium paid under this policy is eligible for tax benefit under Section 80D.

Cons

There is a capping on room rent.
One needs to pay expenses up to the specified deductible for treatment taken in a higher zone, than the zone for which premium is paid.

Eligibility

Entry Age (years)

Minimum

18; 3 months for children

Maximum

60; 18 years for children

Coverage Type

Individual

Policy Term (years)

1

Sum Insured (Rs)

Maximum

5 lakh

Minimum

1 lakh

Tax Benefit

Section 80D of the Income Tax Act are applicable

Discount

Family discount if applicable if two or more persons are insured under same policy

No Claim Bonus

Sum Insured under the policy will be increased by 5% for each claim free year till it reaches 30% of basic sum insured. In case a claim is filed during a year, cumulative bonus earned will be withdrawn on subsequent renewal

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 avails treatment in ZoneII or Zone I has to bear 10% and 20% of each claim respectively

Premium Loading on Basis of Claim History

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.

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 cancelling the policy, a certain percentage of premium would be refunded on prorata basis.

Customer Service

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

Customer Service

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 and post hospitalisation

covers medical expenses upto 30 days immediately prior and 60 days after discharge from hospitalisation

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

Cost of health check up

avaialble upto 1% of Sum Insured once after every 4 claim free years

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 4 claim free years.Pre existing hypertension, diabetes and related conditions will be covered after a period of 2 years upon payment of additional premium

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 yearsAge related Osteoarthritis and Osteoporosis and joint replacement due to degenerative condition will be covered after a waiting period of 48 months

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