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The New India Assurance, the largest state-owned general insurance company in India, offers a range of insurance products in various categories. In the health insurance domain, the company has various products to provide comprehensive coverage for its customers. The Top-Up Mediclaim Policy is developed to provide extra coverage in addition to an existing health insurance plan. The insured can choose between two different threshold options and avail benefits for expenses incurred over the threshold. Coverage from this top-up policy will kick in once the medical expenses cross the threshold limit.
The following eligibility criteria must be met for policyholders to enroll themselves in New India Top-Up Mediclaim Policy:
Some of the key features of New India Top-Up Mediclaim Policy can be given as follows:
|Benefits||Extent of cover|
|Room rent, boarding, and nursing expenses||Up to Rs.5,000 (for threshold Rs.5 lakh) Up to Rs.8,000 (for threshold Rs.8 lakh)|
|Intensive care unit charges||Up to Rs.10,000 (for threshold Rs.5 lakh) Up to Rs.16,000 (for threshold Rs.8 lakh)|
|Hospitalisation expenses||Up to the sum insured limit|
|Get well benefit||Up to Rs.5,000 (for threshold Rs.5 lakh) Up to Rs.8,000 (for threshold Rs.8 lakh)|
|Emergency ambulance cover (for one hospitalisation)||Up to Rs.5,000 (for threshold Rs.5 lakh) Up to Rs.8,000 (for threshold Rs.8 lakh)|
|Hospital cash||Rs.500 (for threshold Rs.5 lakh) per day Rs.800 (for threshold Rs.8 lakh) per day|
|Cataract claims||Up to Rs.50,000|
|Day care treatment||Expenses covered for treatments like dialysis, chemotherapy, radiotherapy, eye surgery, dental surgery, etc.|
|AYUSH Treatment||Covered for treatments undertaken in any hospital recognized by the government|
The list of exclusions applicable for New India Top-Up Mediclaim Policy can be given as follows:
The claims made by policyholders are settled with the help of a third-party administrator (TPA). The TPA must be informed 48 hours before a planned hospitalisation or within 48 hours of emergency hospitalisation. Cashless treatment is available subject to pre-authorisation by the TPA. The cashless claim form along with the required documents can be sent to the TPA through fax and approval can be obtained.
Reimbursement claims can be made after discharge from the hospital. In order to make the reimbursement claim, various documents like medical bills, diagnostic reports, discharge summary, physician certificate, etc. must be submitted to the TPA. Once the documents are submitted, the TPA will verify the claim and provide the reimbursement amount within a maximum of 30 days.
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