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The New India Medical Assurance |
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Additional Features
1) Definition of Family:
a) Self (Primary Insured).
b) Spouse.
c) Dependent Children (i.e. legitimate or legally adopted children). Children above 18 years, if employed, cannot be covered. Male children, if not employed, but a bonafide student can be covered upto age of 25 years. Female children, if not employed, can be covered until the time she is married.
d) Dependent parents.
All members of the family must be covered under one policy.
2) Entry Age:
This insurance is available to a person between the age of 18 to 59 years. However, the Policy can be renewed upto the age of 80 years as stipulated in the premium chart above.
a) Children above the age of 3 months can be covered provided parents are covered concurrently and suitable premium is paid. If the child above 18 years is employed or if the girl child is married, he or she shall cease to be covered under the policy. However male child can be covered upto the age of 25 years if he is a bonafide regular student and fully dependent on primary insured. Female child can be covered upto the time, she is unmarried.
b) If the insured has taken continuous Mediclaim insurance policy with us for at least 5 years prior to attaining the age of 80 years the policy can be renewed beyond the age of 80 upto the age of 90 years as a special case with the approval of Regional In charge on case to case basis. The premium chargeable shall be 10% of the premium for 75-80 years age slabs for proposer's above 85 and 20% of the premium for 75-80 age slabs for proposer's above 90.
c) No inclusion of family member during currency of policy is permissible except for a newborn child between the age of 3 months to 6 months and newly married spouse within 60 days of marriage. Otherwise inclusion of family member shall be allowed only at the time of renewal. Prorata premium shall be charged for such inclusion during the currency of the policy for the unexpired period.
3) Sum Insured:
Minimum sum insured shall be Rs 50,000/- and can be increased in multiples of Rs 25,000/- upto Rs 5 lacs. The sum insured must be identical for primary insured and the dependents. However, the children may be covered for 50% Sum Insured as per item no. 2 above.
4) TPA option:
The premium includes cashless facility through TPA. If the policyholder does not require cashless facility then 6% discount on premium may be given.
5) Pre -Acceptance Health Checkup:
Pre acceptance health check-up is mandatory when age is 50 years and above and he/she is seeking insurance cover for the first time as an individual or as member of a family where there is break in Insurance increase in sum insured on renewal.
Proposer/Insured Person will be required to undergo the following Medical Check-up or any other medical test as required by the Company either on his/her own or from its authorized Network Diagnostic Centre in prescribed format. The cost shall be borne by the insured.
Exclusions
The most important exclusion relates to pre-existing illness. If the insuring person had a health condition, existing prior to taking the policy, which required medical treatment, the same gets automatically excluded in the policy. To ensure that in subsequent renewals medical conditions incepting since the policy was taken do not get excluded, the insuring person must renew the policy without break.
The other exclusions for illustrative purposes are: -
a) Exclusion of certain named diseases in the first year of the policy.
b) Congenital external disease, sterility, venereal disease, intentional self-injury, use of drugs, alcohol, rest cure etc.
c) AIDS
d) Charges primarily for diagnostic, laboratory examinations, and not related to any treatment in hospital. So also for vitamins and tonics unless prescribed for treatment.
e) Dental treatment not requiring hospitalization.
f) Treatment arising from or traceable to pregnancy, childbirth, including caesarean.
g) Naturopathy treatment.
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