New India Health Insurance

• 139 daycare procedures: Under New India health insurance, the policyholder can avail treatment at any medical facility for the rectification of an illness that requires less than 24 hours to get completely operated. Treatment such as Radiotherapy, Tonsillectomy, Chemotherapy, Operations On-ear, eyes, Cataract, Skin Transplantation, Angiography, etc.
• Quick Claim Settlement Process: New India Assurance ensures that the customer does not confront any hassle during the process of raising a claim and settling it. The online process of submitting a claim has made the process more simple and effortless. The policyholder can easily gather information about claim status by visiting the website New India Health insurance.
• No pre-policy Medical check-up: New India Health insurance does not mandate the requirement of medical examination before purchasing the policy for individuals who are less than 50 years of age. The policyholder who is above the age of 50 years may have to appear for the medical checkup.
• Effective Customer Service: Customer satisfaction must for the development of the company and shows the attentiveness of the company is towards its customer claims and queries. New India Assurance with the separate team for claim, queries which resolve each and every query through toll free number and email ID. To have a direct interaction with the New India customer service team, call on 1800 209 1415.
• Rating of the company: New India Assurance has been rated AAA/Stable by CRISIL. CRISIL is an organization that give honest rating to companies based on their financial accountability. This rating displays credibility of the company to honour each authorized claim with actual amount of claim arrived.
• Awards and Accolades: New India Assurance have collected many awards like General Insurance company of the Year, Business Excellence Award, Innovative product Service by Golden Peacock, Best health insurer by Outlook Money.
• Tax exemptions: A person purchasing New India health insurance will get tax benefits in the annual payment of the Income Tax by insured person. Exemptions up to a maximum of Rs 1.5 lakhs and minimum 25,000 thousand is granted if premiums are submitted positively with the company.

New India Premier Mediclaim Policy

The New India health insurance premier policy that promises coverage to family members including spouse, children, dependent parents. The health policy will cover all basic as well as advance medical expenses.

What are medical cost and benefits are covered?

• In-patient Treatment cost is included in the coverage that consists of following expenses

1. Room Rent, including boarding and nursing expenses, are fully paid equal to the actual cost.
2. Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expenses are completely paid with respect to the actual cost incurred.
3. Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialist fees.
4. Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like pacemaker, Relevant Laboratory/Diagnostic test, X-Ray and other medical expenses related to the treatment.

• Hospital Cash which gives the privilege to insured of availing specialized treatment without any obligation to arrange payment out of pocket. On arrival of any illness, the insured will get Rs 2,000 per day under Plan A and Rs. 4,000 per day under Plan B. Also, the payment will be made for 10 days maximum and will be paid after the completion of 24 hours in a day.
• Critical Care Benefit for those life insured who got detected with critical illness by a medical specialist who has confirmed the traces of disease in the body of insured. On raising a claim and acceptance of same by the company, the insured will receive Rs 2,00,000 under Plan A and Rs. 5,00,000 under Plan B. The payment made will not affect the sum insured but on the contrary will enhance the sum

1. Multiple sclerosis with persisting symptoms
2. Kidney failure requiring regular dialysis
3. Open chest CABG
4. Open Heart replacement or repair of Heart Valves
5. Coma of specified severity
6. First Heart attack of specified severity
7. Permanent paralysis of limbs
8. Stroke resulting in permanent symptoms
9. Major organ/bone marrow transplant
10. Motor neuron disease with permanent symptoms
11. Cancer

• Ayurvedic/Homoeopathic/Unani treatment will be covered by New India health insurance and an amount equal to 20 % of Sum Insured is paid to the insured. The facility must be availed in the hospital or medical institute operating under the authorization and guidelines of government.
• Ambulance charges, as well as Air Ambulance charges, are covered to facilitate the transportation of Insured Person to the nearest hospital for betterment of health condition.
• OPD expenses such as dental treatment, health check-up, consultation with a Medical Practitioner, Drugs and Medicines and medical detection as suggested by the Medical Practitioner are compensated by New India Assurance according to the sum insured. An amount of Rs. 5,000 for Plan A and Rs. 10,000 for Plan B if the no claims have been made for two constant years.
• Maternity expenses will be covered for a maximum of two deliveries and payment will be made if the female insured has been admitted to hospital for in-patient treatment. To avail this coverage the insured have to pay regular premiums for thirty six months. The amount reserved for Maternity expenses is Rs. 50,000 for Plan A and Rs. 1,00,000 for Plan B.
• New Born Baby expenses that will include illness or injury resulting during the policy term are covered from the date of birth. This cover will remain effective till the date of maturity without any extra premium.
• Medical Second opinion for major surgeries can be availed on the advice of medical expert. The company will pay up to Rs.5,000 for Plan A and up to Rs. 8,000 for Plan B.
• Obesity treatments are included for insured person whose BMI is more than 35 and have other miserable medical conditions related to obesity. Other conditions may involve-

1. Pickwickian syndrome (obesity hypoventilation syndrome),Obstructive sleep apnea,
2. left ventricular hypertrophy, Coronary artery disease, coronary pulmonale, accelerated atherosclerosis, obesity-associated cardiomyopathy, and pulmonary hypertension of obesity

• Treatment of cataract where the company will pay actual cost arrived on operating the disease. The actual charges up to a maximum of Rs. 75,000 in Plan A and Rs. 1,00,000 for Plan B. Insured has to constantly pay the premium and renew the policy for 36 months to avail this coverage.
• Psychiatric and psychosomatic disorders are covered up to 5% of the sum Insured.
• HIV/AIDS or other which are transferred sexually to insured person body will be covered. An amount equal to Rs. 2,00,000 in Plan A and Rs. 5,00,000 in Plan B is given. Insured must be submitted in a hospital for inpatient treatment to get coverage and the facility of consultation under OPD is given for Rs. 20,000 in Plan A and Rs. 50,000 in Plan B.
• Treatment for infertility cases is also included and paid up to a limit of Rs. 1,00,000 for Plan A and Rs. 2,00,000 for Plan B. The treatment can also be availed on inpatient or outpatient basis and will be valid for once in the whole policy term.
• Continuity Benefit will be provided to those who keep their policy running for 36 months through continuous submission of premium and subject to timely renewal
• Dietician counseling is applicable to plan B and the insured will receive Rs 5000 for the consultation/ counseling taken from the dietician.

Eligibility Criteria

Intimation Process

For Planned Hospitalization: The TPA or insurance provider must be informed within 48 hours before the hospitalization for accident/ illness as investigated by the attending medical doctor.

For Emergency/Unplanned Hospitalization: The TPA or the insurance provider should be supplied with proper information of the emergency medical event within 24 hours after the hospitalization took place for an illness/ accident/ injury.

• Intimate the TPA assigned for New India Health insurance policy about the kind and nature of claim. The information must be in written format furnished on the email ID.
• Collect and Submit the related and important documents for the claim within a time limit of seven days applicable from the discharge date of the insured from treating Hospital.
• Also, submit the claim intimation form with supporting documents.
• In case of Post-Hospitalisation treatment (limited to sixty days), submit all claim documents within 7 days after completion of such treatment.
• Provide TPA with authorization to obtain medical and other records from any Hospital, Laboratory or other agency.

The Insured person shall submit to the TPA all original bills, receipts and other documents upon which the claim is based and shall also give the TPA/Us such additional information and assistance as the TPA / We may require.

Any Medical Practitioner authorized by the TPA/Us shall be allowed to examine the Insured Person, at our cost, if We deem Medically Nec

Documents Required for Claim Settlement Process

• Claim Form duly filled and signed by the claimant
• Bill, Receipt and Discharge certificate/ card from the attending hospital.
• Prescriptions papers and cash memos from the hospitals/ chemist.
• Pathological test reports supported by a recommendation note by the attending Medical practitioner/pathologists.
• Surgeon’s bill and receipt, certificate providing the nature of operation performed.
• Treating Doctor/ Consultant/ Specialist/ Anesthetist’s fee written over bills and receipts, and other certificates regarding diagnosis.

• Diseases contracted within 30 days of insurance.
• Dental treatment except treatment arising out of an accident.
• Debility and General Run Down Conditions.
• Sexually transmitted diseases and HIV (AIDS) except New India Premier Policy
• Cosmetic surgery/ plastic surgery
• Vaccination and Inoculation
• Cost of spectacles and contact lenses,
• Injuries resulting from wars, Act of foreign enemy, ionizing radiation and nuclear bombing.

The exclusions are common to each but the policyholders are requested to check each and every plan specific exclusion.