National Insurance National Mediclaim Policy

• Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
• 10,000+ hospitals for cashless treatment
• Claim up to Rs. 55,000 deduction under section 80D**

The New India Assurance Co. Ltd. is a multinational general insurance company that was established in the year 1919. It hosts an array of insurance products from Motor and Travel insurance plans to Rural plans like farmers insurance, cattle insurance, etc. Under the health insurance section, senior citizen and cancer-specific plans can be found. An exclusive Overseas Mediclaim Policy for corporate travellers is also offered. The Family Floater Mediclaim Policy is a unique plan designed to cover the hospitalisation expenses of all family members with a single sum insured amount.

Eligibility for the Family Floater Mediclaim Policy

The insurer defines certain parameters that should be met in order to avail the policy.

• Individuals between ages 18 years and 65 years can purchase this policy.
• Financially dependent children from the age of 3 months to 25 years can be covered provided one or both parents are covered by the same policy.
• Individuals above the age of 65 years can continue with the same policy provided there was no break in coverage previously.

Features of the Family Floater Mediclaim Policy

This policy offers financial protection to the policyholder and his/her family members from medical expenses incurred on hospitalisation.

• A minimum of 2 and a maximum of 6 family members can be included in a single policy.
• The minimum sum insured option is Rs.2 lakh and the maximum is Rs.8 lakh.
• Individuals purchasing the policy after the age of 50 years will have to undergo a pre-acceptance medical check-up. A person with an adverse medical history will also have to undergo the check-up.
• The waiting period for coverage of cataract treatment is 24 months.
• The waiting period for congenital internal defects or anomalies is 24 months.
• Claims can be made only when the insured is hospitalised. OPD is not covered under this policy.
• The insured is required to be hospitalised for a minimum period of 24 hours unless he/she undergoes a treatment specified in the policy that does not require 24 hours of hospitalisation.
• Claims can be made only after the first 30 days of the policy unless an injury is suffered due to an accident.
• If the claim event occurs within 2 policy periods, the sum insured available in both policies and deductibles in each policy period are considered before the claim amount is provided.
• Only treatments in India are covered.
• The grace period permitted for renewal of the policy is 30 days.
• A 15-day free-look period is provided to the policyholder to review the policy. The policy can be returned if the policyholder is unsatisfied with the terms and conditions. The premiums paid will be refunded in such cases.
• The sum insured may be enhanced at the time of renewal of the policy.
• Tax benefits can be availed under Section 80D of the Income Tax Act, 1961.

Benefits of the Family Floater Mediclaim Policy

The many benefits the policy offers makes it affordable and beneficial to policy buyers.

Exclusions of the Family Floater Mediclaim Policy

Certain conditions and treatments are not covered under the policy or require a certain waiting period.

• Pre-existing diseases or conditions until completion of 48 months of the policy term.
• Joint replacement due to degenerative condition and age-related osteoarthritis and osteoporosis until completion of 48 months of the policy term.
• Injury or illness caused by war or war-like situations.
• Circumcision or plastic surgery unless necessitated due to an accident.
• Cosmetic or aesthetic treatment, or change of life.
• Vaccination or inoculation.
• Cost of spectacles, contact lenses, braces, prosthetic devices, hearing aids and durable medical equipment.
• Dental treatment unless requirement arose due to an accident.
• Convalescence, general debility, and rest cure.
• Treatment of obesity and its complications, psychiatric and psychosomatic disorders, sterility, venereal diseases and infertility.
• Intentional self-injury, injury caused by intoxication, wilful exposure to danger, and attempted suicide.
• Injury caused by participation in hazardous sports activities or acts amounting to a crime.
• Treatment of AIDS or conditions caused by HIV.
• Diagnostic or laboratory examinations and X-ray.
• Cost of vitamins and tonics unless required to treat the illness/injury for which the insured is hospitalised.
• Maternity expenses, miscarriage, abortions and its complications.
• Naturopathy treatment.
• Medical or non-medical equipment used for treatment or medical equipment used at home.
• Stem cell implantation and genetic disorders.
• Domiciliary hospitalisation.
• Experimental or non-standard treatments.
• Acupressure, magnetic therapy, or acupuncture.
• Change of system of treatment unless recommended by the medical practitioner.
• Service charges, luxury charges, surcharges levied by the hospital.

Claim Procedure

The Third Party Administrator (TPA) settles claims on behalf of New India Assurance. The policyholder should hence intimate the TPA about the hospitalisation to make the claim.

Cashless treatment: Cashless hospitalisation is available only in the network hospitals of New India Assurance. The TPA should be intimated about the hospitalisation. The facility can be availed by submitting the proof of insurance and the insured person’s identity.

Reimbursement claims: For reimbursement of hospitalisation expenses, the TPA should be intimated within 24 hours of admission to the hospital. After discharge, the claim form, discharge document, reports, bills, receipts, cash memos, etc. should be submitted within seven days. The TPA will then pay the claim.