New India Senior Citizen Mediclaim Policy Health Insurance

One of the most popular plans provided by New India Assurance is its Senior Citizen Mediclaim policy. This plan offers coverage for hospitalization charges in cases of treatments, surgeries, or accidental injuries to senior citizens. To avail of this policy, senior citizens must be between the ages of 60 years to 80 years.

If the renewal of this policy is done without any break, then one can enjoy the coverage of this policy till 90 years of age! It should be noted that customers have to undergo a pre-acceptance health check-up before purchasing this policy. This is done to identify any pre-existing illness that one might be suffering from.

The cost of the pre-acceptance health check-up is first borne by the customer. But this value is reimbursed after the customer completes four claim-free years with the organization under this policy.

The benefits that are offered by this policy include Ayurvedic, Homeopathic, and Unani treatment coverage at hospitals and medical facilities recognized by the organization. The cover is also provided for pre-existing medical conditions after a waiting period.

Beyond this, one can also get in-patient hospitalization cover for costs incurred due to blood transfer, anesthesia administration, room boarding charges, and medications. This policy is specifically designed for senior citizens to protect them during their time of need.

The plan also covers crucial lucrative benefits like free health check-ups and no claim bonus. Other highlights associated with the New India Assurance Senior Citizens Mediclaim policy are:

• A 5% cumulative bonus is provided to policyholders for every claim-free year at the time of renewal up to a maximum of 30% bonus
• If one adds his or her spouse to the policy, then he or she can get a 10% family discount on the premium value
• Getting a voluntary deductible of Rs.10,000 will also provide access to a 10% rebate on the premium
• If a senior citizen already has an existing health insurance plan, then he or she can simply migrate to the Senior Citizen Mediclaim plan
• Health check-ups are provided every four years if there have been no claims made during that time
• Income tax benefits are also provided for the amount of premium. This is in accordance with the Section 80D of the Income Tax Act at the extant rates specified in the Finance Bill.

Let’s look at the scope of this policy by referring to the table mentioned below.

For a better understanding of this policy, we have also prepared a list of important features associated with this policy. This list is given below.

• Day-Care Treatments: There are some treatment methods that do not require hospitalization of 24 hours or more. Those types of treatments are also covered in this policy.

• No Claim Bonus (NCB): In the case of every claim-free year, the policyholder can get a no-claim bonus of 5%. This discount can be up to a maximum of 30%.

• Organ Donor Cover: If the policyholder has opted for organ donor cover, then the hospitalization expenses, excluding the cost of the organ, will be covered under this policy. This coverage will be up to the total sum insured amount.

• Pre-Hospitalization Benefit: All medical expenses incurred up to a maximum of 30 days before being admitted to the hospital are covered and compensated by the insurance provider. This value is calculated up to a maximum of 5% of the total hospital bill.

• Post-Hospitalization Benefit: The New India Senior Citizen Mediclaim policy will also cover all medical expenses incurred 60 days after being discharged from the hospital. This will be calculated up to a maximum of 10% of the hospital bill.

• Health Check-Up Cover: The insured is entitled to a health check-up every four years if no claims have been made during that time. This amount can be reimbursed up to a maximum of 1% of the average sum insured in the policy.

• Non-Allopathic Treatment Expense Cover: If you wish to seek alternative medicines like Homeopathy, Unani, or Ayurveda, then you can do so with this policy. These alternative treatments are covered up to a maximum of 25% of the sum insured value.

Note: The benefits of this claim will only be honored if the individual seeks these treatments at an institution or hospital recognized by the government. The recognition can also be from a governing body of the government.

• Emergency Ambulance Charge Cover: A maximum of Rs.1,000 is provided for ambulance cover benefit.

• Free Look Period Feature: If for any reason, a policyholder decides not to carry forward with the policy, then he or she can place a return and refund request for the same. This request should be placed within ten days of receiving the receipt of the policy document, subject to certain conditions.

• Room Rent Benefit: In this plan, policyholders can claim for room rent, boarding, and nursing expenses up to a maximum of 1% of the total sum insured value per day. ICU charges up to a maximum of 2% of the sum insured per day are available. It should be noted that the overall limit should not exceed more than 25% of the total sum insured.

• Co-Payment Feature: The insurer has to bear a co-payment of 10% for every admissible claim.

• Sub-Limit Feature: There are some sub-limits that are applicable to this policy. These sub-limits are:
  • An overall limit of 25% of the sum insured is stipulated for charges related to surgeon’s fees, anesthetist’s fees, medical practitioner’s fees, consultant’s fees, specialist’s fees, and nursing expenses
  • An overall limit of 50% of the sum insured value is placed for expenses related to blood, oxygen, OT charges, surgical appliances, anesthesia, drugs, medicines, dialysis, diagnostic material, medicinal drugs, chemotherapy, cost of a pacemaker, radiotherapy, artificial limbs, radiotherapy, cost of implants, and cost of stents

• Cooling-off Period: A cooling off period of 30 days is applicable for all claims made in this policy. The only exceptions to this rule are charges that are incurred due to accidental injuries.

• Specific Illnesses Waiting Period: There are some diseases and treatments that can only be availed of after waiting for 18 months or 24 months. These treatments or illnesses are Gallbladder issues, bile duct issues, cataracts, myomectomy for fibroids, and hysterectomy.

• Pre-Existing Illnesses Cover: A waiting period of 48 months is applicable for making any claims related to pre-existing medical conditions. This waiting period is calculated from the policy start date.

As mentioned before, there are some add-on features associated with the Senior Citizen Mediclaim policy that you can get to enhance the coverage. We will be looking at these add-on covers now.

• Waiver of Waiting Period for Hypertension: After paying an additional premium, policyholders can waive off the usual waiting period for getting coverage for hypertension treatment. This is valid from the date of inception of the policy.

• Waiver of Waiting Period for Diabetes Mellitus: Policyholders can waive off the usual waiting period and get coverage for treatment of diabetes mellitus from the date of issuance of the policy. This add-on feature is available at an additional cost to the premium paid.

Let’s look at the eligibility criteria for enrolling in the New India Senior Citizen Mediclaim policy.

You should also be familiar with the fact that if you want to purchase this policy, then you need the following documents.

• Proof of age
• Proof of address
• A recent photograph

In case of making a claim for the New India Senior Citizen Mediclaim policy, the following documents will be required.

• A duly filled claim form by the policyholder
• Treatment reports
• Certificates provided by the doctor
• Bank details in which one wishes to receive the claim amount
• Discharge summary
• Prescriptions
• Bills
• Advance receipts
• Final receipts
• Diagnostic test reports, including X-ray, scans, ECG, and other films

If other documents are required to make a claim, then the policyholder will also have to provide those documents.

A few key inclusions that are applicable to this policy are:

• Ambulance charge benefit of up to Rs.1,000
• Pre-hospitalization charges for up to 30 days before being admitted to the hospital
• AYUSH treatment feature limited to 25% of the total sum insured
• Post-hospitalization expenses for up to 60 days after being discharged from the hospital
• Organ donor expenses incurred during organ transplantation

The benefits or factors that are excluded from this policy are:

• Domiciliary hospitalization benefit
• Global treatments taken
• Inoculation charges
• Vaccination charges
• Dental treatments that arise from any other condition than an accident
• Naturopathy treatments
• No liabilities are covered in cases where the signs and symptoms were first observed during the first 30 days of the policy period
• Any medical charges due to attempted suicide
• Medical costs incurred due to use of alcohol or drugs
• Treatment of AIDS
• Charges related to childbirth, pregnancy, abortion, or miscarriage
• Expenses related to in vitro fertilization and infertility
• Charges incurred due to hospitalization because of war, riot, nuclear weapons, or strike