Main Highlight of the plan
This policy offers basic individual and floater coverage to the entire family.
Scope of cover
|
Plan |
Entry Age |
Maximum Number of Members |
Sum Insured Range |
Discount on premium |
|
Individual coverage |
Children 3 months to
25 years Adults 18 years to 65
years |
- |
INR 2,00,000 to INR 8,00,000 |
For each individual
cover a discount of 10% is applicable. |
|
Family Floater |
Children 3 months to
25 years (excluding mentally challenged children or unmarried daughters) Adults 18 years to 65
years |
Adults – 2 Children – 2 (at least daughters) |
INR 2,00,000 to INR 8,00,000 |
Discount in the range
of 11% to 18% is offered in this plan depending on the number of members covered
and the sum insured opted. |
Coverage: Benefits & Features
Most Important
ROOM RENT/ ROOM CATEGORY
This plan does have limits for coverage of room expenses.
- For normal hospitalization, room-rent up to 1% of sum insured is covered.
- For ICU hospitalization, room-rent up to 2% of sum insured is covered.
CO-PAYMENT
This plan has zonal co-pay of 20% of claimable expense is applicable on claims depending on the zone of treatment.
NO-CLAIM BENEFITS
This plan does not offer any no-claim benefits. However, in case there is no-claim credit under Mediclaim 2007 policy it would preserved as cumulative bonus buffer.
SUB-LIMITS
This plan covers cataract treatment up to 20% of sum insured for a maximum of INR 24,000 for each eye.
- For individual opting for this policy above age 55 years only up to 80% of the claimable expenses would be covered until the individual under consideration, has continuous four claim free years.
Good to have
PRE/POST HOSPITALIZATION
30 days of pre-hospitalization and 60 days of post hospitalization are provided in this plan.
RESTORE BENEFITS
This plan does not offer restore benefit.
HEALTH CHECK-UP
This plan offers health check-up benefit equal to 1% of sum insured up to a maximum of INR 5000 every 3 claim free years.
Value Adds
AMBULANCE CHARGES
This plan provides coverage for ambulance expense up to 1% of sum insurance per hospitalization.
EYE COVER
This plan does not cover expenses for eye treatments.
DOMICILIARY HOSPITALIZATION
This plan does not offer coverage for domiciliary expenses.
OUTPATIENT BENEFITS
This plan does not cover out-patient treatment expenses.
CRITICAL ILLNESS COVERAGE
This plan does not offer additional coverage in case of critical illnesses.
ALTERNATIVE PRACTICE
This plan covers non-allopathic treatments (Ayurvedic, Unani and Homeopathic treatments) up to 25% of sum insured.
- Note: The above mentioned non-allopathic treatments should be with government hospital, hospital or institute recognized by government or accredited by Quality Council of India/ National Accreditation board on health.
DENTAL COVER
This plan does not cover expenses on dental treatments.
DAILY CASH
This plan offers daily cash allowance up to 0.1% of sum insured up to a maximum of 1% of sum insured. This allowance is however paid after completion of 24 hours of hospitalization.
ORGAN DONOR COVER
This plan offers coverage for medical expenses up to sum insured, on harvesting organ for the insured or for the donor and for transplantation.
CONVALESCENCE BENEFIT
This plan does not have any convalescence benefit.
MATERNITY COVER
This plan does not cover maternity expenses.
Exclusions
A cooling off period of 30 days is applicable on buying health insurance policy for the first year. No claims (other than claims related to an accident) can be made in this cooling off period. There is no cooling off period applicable on renewal of this policy.
Waiting period of 2 years is applicable for specified ailments while that of 4 years for treatments like joint replacement, osteoarthritis, etc. Refer to the policy wordings for the list of these specified ailments.
All the pre-existing diseases are excluded in this policy.
Waiting period of 4 years is applicable in case of pre-existing illnesses.
PERMANENT EXCLUSIONS
Cosmetic surgery, Lasik eye treatments, drugs or alcohol abuse, genetic disorders, self-inflicted injuries, war related injuries, etc. are some of the permanent exclusions. For the detailed list of please refer the New India Assurance policy document.
