New India Family Floater Mediclaim Policy

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New India Family Floater Mediclaim Policy

	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

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