New India Top-Up Mediclaim Policy

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.

• 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**

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Eligibility for New India Top-Up Mediclaim Policy

The following eligibility criteria must be met for policyholders to enroll themselves in New India Top-Up Mediclaim Policy:

• The age of the proposer must be between 18 years and 65 years.
• Dependent children between the age of 3 months and 18 years can avail this cover provided both their parents are concurrently covered.
• A maximum of 6 family members can avail this policy cover.
• Lifetime renewability option is available for people entering this policy cover.

Features of New India Top-Up Mediclaim Policy

Some of the key features of New India Top-Up Mediclaim Policy can be given as follows:

• The sum insured options for this top-up policy cover ranges from Rs.5 lakh to Rs.22 lakh.
• Policyholders can choose between the threshold (deductible) options of Rs.5 lakh and Rs.8 lakh.
• The sum insured amount and the threshold limit can be enhanced only at the time of renewal.
• Sum insured enhancement will not be available for people renewing this cover after 65 years of age.
• Pre-insurance medical examination is mandatory for people entering the policy over the age of 50 years.
• The medical examination taken for this policy is valid for a maximum of 30 days.
• Following the acceptance of a proposal, the company will reimburse 50% of the medical examination costs.
• Any pre-existing conditions will not be covered for up to 4 years of continuous policy coverage.
• There is a general waiting period of 30 days before coverage can begin under this policy.
• Certain conditions like cataract, hernia, congenital internal disease, hypertension, hydrocele, etc. have a waiting period of 2 years.
• Joint replacement surgery, age-related osteoporosis, and osteoarthritis have a waiting period of 4 years.
• Pre and post hospitalisation expenses are not covered under this top-up policy.
• This policy can be ported to other insurers within the guidelines provided by the Insurance Regulatory and Development Authority of India (IRDAI).
• There is a free look period of 15 days to review the terms and conditions of this cover.

Benefits of New India Top-Up Mediclaim Policy

Exclusions of New India Top-Up Mediclaim Policy

The list of exclusions applicable for New India Top-Up Mediclaim Policy can be given as follows:

• Pre hospitalisation and post hospitalisation expenses
• Illnesses or injuries caused by war, invasion, or any warlike activities
• Cosmetic or aesthetic treatments including circumcision, plastic surgery, etc.
• Any kinds of dental treatment unless arising out of an accident
• Expenses related to vaccination or inoculation
• Convalescence, general debility, or run down condition
• Expenses related to domiciliary hospitalisation
• Treatment for congenital diseases, birth defects, etc.
• Expenses incurred for any kinds of psychiatric or mental disorders
• Injuries or illnesses caused while breaking the law with criminal intent
• Any kinds of sexually transmitted diseases
• Cost of medical equipment such as braces, crutches, contact lens, spectacles, hearing aids, etc.
• Any kinds of unproven or experimental treatments
• Expenses related to pregnancy, miscarriage, childbirth, abortion, etc.
• Expenses incurred for domiciliary treatment
• Any kinds of non-medical expenses incurred during a hospital stay
• Expenses for treatment taken outside the country

Claim Procedure

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.