New India Assurance Floater Mediclaim Plan for Family

The largest general insurance provider in India is New India Assurance. The company provides a variety of insurance products across a number of industries, such as health, motor, travel, etc. The company has a wide range of products to offer financial security against different health risks in the area of health insurance.  In India, the New India Mediclaim Insurance is the most widely used health insurance plan.

A comprehensive medical insurance plan that provides defense against many dangers is the New India Mediclaim Policy. Depending on the needs of the customer, either an individual cover or a family floater Cover plan can be purchased for this policy.

New India Mediclaim Policy Eligibility

The following is a list of some of the requirements set forth by the company for being eligible to subscribe to the New India Mediclaim Policy.

  • This policy cover is available to anyone between the ages of 18 and 65.

  • This coverage is available to dependent children from the age of three months to eighteen years as long as both of their parents are simultaneously covered.

  • If the policy is continuously and uninterruptedly renewed each year without a break, a lifetime renewability option is available.

  • This policy’s coverage is available for the self, the spouse, the dependent parents, and the dependent children if the entire family is purchased.

  • A family may have a maximum of six members covered under this policy.

The New India Mediclaim Policy’s Features

The following is a list of the main characteristics of the New India Mediclaim Policy as described by the company.

  • The available sum insured for this policy ranges from one lakh to fifteen lakh rupees.

  • The age of the insured person affects the premiums for this policy.

  • Members who enroll in this policy after turning 50 must undergo a pre-acceptance medical examination. But if the proposal is approved, 50% of the checkup costs will be covered.

  • Outpatient treatment is not covered by this policy, and hospitalization is required in order to file a claim.

  • The one-year policy term requires annual renewal in order to remain in effect.

  • At the time of renewal, the sum insured amount may be increased, but individuals over the age of 65 will not be taken into consideration.

  • Under the terms of this policy, all pre-existing conditions have a 48-month waiting period.

  • A 24-month waiting period is required for certain illnesses, including benign prostatic hypertrophy, hydrocele, ENT disorders, renal failure, gall bladder stones, etc.

  • This policy has a 30-day waiting period before any claim can be made, except for accidents, which are not subject to this waiting period.

  • Pre-hospitalization medical costs are compensated for up to 30 days prior to the date of hospitalization.

  • Medical costs incurred after being hospitalized are reimbursed for up to 60 days following hospital discharge.

  • In exchange for a voluntary 20% copay, policyholders receive a 15% discount on their premium costs.

  • If a claim is successful and the sum insured is Rs. 5 lakh or more, the exhausted sum insured amount may be reinstated.

  • According to Section 80D of the Income Tax Act, the premium payments made for this policy are eligible for income tax relief.

Positive aspects of the New India Mediclaim Policy

The following table contains a list of the various benefits provided by the New India Mediclaim Policy.

Rent for a room, boarding costs, and medical costs1% maximum of the insured amount
Intensive care facility fees2% maximum of the insured amount
medical payment0.1% of the sum insured per day, up to a total of 1% of the sum insured (for sums insured over Rs. 3 lakh only).
medical costs associated with an organ transplantaccessible for all hospitalization costs
Limit of cataractThe limit for cataract treatment may be increased with the aid of an additional cover, up to 20% of the sum insured, but no more than Rs. 50,000.
payment for medical examinationsFor each year without a claim, up to 1% of the insured amount, up to a maximum of Rs. 5,000, is made available.

Optional Covers

No proportionate deductions were made.For those who chose a sum insured of $2 lakh or more, this is an option. Those who choose this cover will not be subject to the proportionate deduction based on room rent.
II. Maternity costs and benefitsFor those who selected an insurance sum of at least Rs. 5 lakh, this is available. For this policy to take effect, a 36-month waiting period is required. This policy covers up to two children’s maternity costs. Prenatal and postnatal costs are not, however, covered.
III. Changes to the cataract limitThe cost of cataract treatment is limited to Rs. 50,000 under the original policy. By purchasing this extra cover, you can raise the limit. Only insurance amounts of Rs. 8 lakh and higher are eligible for this. The maximum limit under this is Rs. 1.5 lakh (for the sum insured, Rs.
IV. optional co-paymentPolicyholders can get a 15% discount on their premium costs by choosing a 20% voluntary copayment.

New India Mediclaim Policy Exclusions

For some exclusions, New India Assurance is not required to offer the insured any kind of compensation. These are a few of the exclusions that can be made:

  • Medical costs associated with war or combative behavior

  • Everything that is cosmetic or aesthetic

  • Any fees associated with getting vaccinated or immunized

  • Recovery, overall ill health, or a worn-out state

  • Treatments for overweight people or weight loss

  • All costs incurred because of birth anomalies or defects

  • Cost of cochlear implants, prosthetic devices, prosthetic eyes, contact lenses, crutches, and other accessories.

  • Incidents of injuries brought on by engaging in risky sports

  • Accidents caused by breaking the law or taking part in a criminal activity

  • Treatments using Siddha and naturopathy

  • Costs associated with inpatient care at home

  • Any type of unproven or experimental medicine

  • Costs associated with vitamins and tonics, unless they are the primary component of a treatment

Claims Process

With the New India Mediclaim Policy, you can only use network hospitals to receive cashless hospitalization. The organization’s website provides access to the list of network hospitals. With the aid of a third-party administrator (TPA), this service is made available. Before the treatment can start, the TPA must grant permission for this facility.

Additionally, policyholders may be reimbursed for their medical expenses. The policyholder must provide all the paperwork pertaining to the costs incurred for medical care when filing reimbursement claims. Within seven days of the end of the treatment, all bills and related paperwork must be submitted. The business will start the claim procedure as soon as the documents are turned in. After the paperwork has been verified, the insured will receive the claim payment.

Who may enroll in this Policy?

A person between the ages of 18 and 60 may purchase this insurance. If an individual is continuously covered by our company’s Mediclaim policy and is over 60 years old, they may continue their insurance.

  1. FLOATER BENEFIT indicates that, during the term of the policy, any or all members of the proposer’s family may use the Sum Insured, as specified for the proposer under the policy, for one or more claims.
  2. The following family members are covered by the Family Floater Mediclaim Policy, which can be issued to persons up to 60 years of age:

A. Oneself

B. One’s spouse

 C. Dependent kids up to two

  • Even if they reside with the proposer, siblings, parents, and parents-in-law are not covered under the Family Floater Mediclaim Policy.

  • A minimum of Rs. 2 lacs and a maximum of Rs. 5 lacs are the insured amounts.

  • Individual Mediclaim Policy of 2007 applies to the premium. The base premium will be determined by the oldest family member. Apply a 25% loading for each additional dependent child and a 50% loading for the spouse.

What is Covered by This Policy?

For the treatment of illness or injury, the policy will pay hospitalization costs as long as the stay is longer than 24 hours. It is also necessary to pay for pre-hospitalization costs for 30 days and post-hospitalization costs for 60 days.

  • Day-care treatment: The cost of specialized, technologically advanced day-care procedures or surgeries when a hospital stay of 24 hours is not necessary.

  • Ambulance-  Up to the limits stated in the policy, costs associated with transferring the insured from home to hospital are covered.

  • Provided that the treatment is received in a Registered Hospital, 25% of the Sum Insured is covered for Ayurvedic, Homeopathic, and Unani systems of medicine.

  • Pre-existing conditions are only covered after four consecutive free renewals with our company.

  • Following two years of continuous insurance coverage and the payment of an additional premium, pre-existing conditions like hypertension, diabetes, and their complications are covered.

Exclusions

  • Diseases acquired within 30 days of insurance, to start.

  • Aside from dental emergencies brought on by accidents

  • Conditions of debility and general deterioration.

  • HIV (AIDS) and other sexually transmitted illnesses.

  • Unless necessary to treat an injury or illness, avoid having a circumcision, cosmetic surgery, or plastic surgery.

  • Vaccinations and immunizations.

  • Childbirth and pregnancy.

  • Nuclear weapons, ionizing radiation, war, and an act of a foreign enemy.

  • Medical care outside of India.

  • Natural medicine.

  • Treatment at home

  • Treatment that is experimental or unproven.

  • All external devices, including cochlear implants, contact lenses, etc.

Important Attractions

The list of essential characteristics of the Floater Mediclaim policy is longer than anticipated. With the policy in hand, you can be covered for a variety of expenses, including inpatient care, pre-and post-hospitalization costs, daycare costs, and more. The newborn is covered up until the existing policy is renewed, despite the fact that the policy does not cover maternity expenses. You can completely protect your family with the Floater Mediclaim policy. The following are some of the main draws:

  • Unmarried daughters and children with mental disabilities are exempt from the upper age limit.
    •  Over 65s can continue to use their insurance.
    •  A newlywed spouse can be included in the midterm by paying a pro-rata premium.
    •  Insurance coverage for serious ailments like cancer, heart attacks, CABG, open heart surgery, and kidney failure
    •  Coma, stroke, major organ transplant, paralysis, MS, motor neuron, etc. are additional conditions for which the cover is available.
    •  ambulance costs up to 1% of SI or actual, whichever is less, will be covered
    •  up to 25% of the Sum Insured for Ayurvedic, Homoeopathic, or Unani treatments

What Is Left?

  • Additionally, Floater Mediclaim offers hospital cash benefits of 0.1% of the sum insured per day of hospitalization, providing a method for receiving cashless treatment throughout India. It also makes it simpler to raise the insured sum at renewal time. Here are a few more advantages of the policy:
    • Features of the policy’s lifetime renewal
    •  The policy may be cancelled within 15 days of purchase.
    •  Using section 80D of the Income Tax to reduce taxes
    •  TPA service with a focus on customers
    •  30 days’ grace period before the policy must be renewed

Expert Review of New India Floater Mediclaim

  • The Floater Mediclaim policy from New India covers hospitalization costs for every member of the family under a single sum insured on a pro rata basis. Insofar as it covers the proposer, the proposer’s spouse, dependent children, and dependent parents (less than or equal to 60 years old), it is a suitable plan.

  • The maximum amount that the entire family may spend during the policy year is Rs. 10 Lakh if you purchase this policy with Rs. 10 Lakh as the sum insured for 6 members of your family. The minimum and maximum entry ages for the Floater Mediclaim policy are 3 months and 65 years, respectively. Its ability to cover dependent children up to age 25 makes it an appropriate choice.

  • Additionally, the policy includes coverage for 11 specific critical illness diseases, allowing the policyholder to receive 10% of the Sum Insured in addition to the admissible claim as a benefit. In terms of coverage and cost, the Floater Mediclaim by New India might be your best option.

Conclusion

Overall, the Floater Mediclaim policy offered by New India is the best choice for protecting your family from unforeseen events. In addition to providing basic coverage, it is a one-stop policy that also covers newborns and serious illnesses.

FAQs on Floater Mediclaim Health Insurance Plan

Who is eligible for this policy’s coverage?

This policy is available to anyone between the ages of 18 and 65. If at least one parent is covered by the policy, children who are financially dependent and are between the ages of 3 months and 25 can also be covered.

Can my family members be covered by this policy?

Yes. A single Sum Insured can be used to obtain coverage for the entire family. Spouse, Dependent Children, and Parents (aged 60 or less if they are dependent on the Proposer) are the members who may be present in addition to the Proposer.

Does this policy offer the policyholders a cash hospital benefit?

Yes, the policy offers a hospital cash benefit for each hospitalization lasting longer than 24 straight hours at a rate of 0.1% of the Sum Insured.

Does this policy provide coverage for critical illnesses?

Yes. For 11 specific critical illnesses, the policy offers critical illness coverage. In the event that the insured contracts any of the 11 listed critical illnesses, 10% of the Sum Insured will be paid to the insured as an additional benefit in addition to the admissible claim.

Is hospitalization always necessary to get a claim?

Yes, hospitalization is required in order to file a claim under this policy; outpatient costs are not covered.

How long must the insured person be hospitalized before filing a claim?

Only those who have been hospitalized for at least 24 hours may file a claim. However, hospitalization may even last less than 24 hours for some specific treatments.

What services are covered by this policy for daycare centers?

● The 139 daycare treatments that are covered by the policy, which are those that are completed within a 24- hour period, include:
● Stapedotomy
● Surgical removal and eradication of a lingual tonsil
● Stapedectomy
● Additional procedures on the tonsils and adenoids
● Lithotripsy
● Cancer Chemotherapy
● Amputation of the penis
● Haemodialysis
● Palatoplasty
● Glossectomy

Do pre-hospitalization costs fall under the purview of this policy?

● Yes, the policy pays for pre-hospitalization costs up to 30 days before admission to the hospital.

Do post-hospitalization costs fall under the purview of this policy?

● Yes, the policy provides post-hospitalization coverage for up to 60 days following hospital discharge.

Am I eligible for treatment under this policy anywhere in India?

● Yes, treatment anywhere in India is covered by this policy.

How much does a family floater policy cost annually in Indian rupees?

Each member’s share is not predetermined. Therefore, if one family member files a claim, the coverage for the others is reduced by that amount. If five members are covered by a floater health insurance policy worth Rs. 10 lakh, it is not fixed at Rs. 2 lakh per member.

What does New India Assurance not cover?

The Policy does not cover Congenital External anomalies of the Newborn Baby. This clause does not apply to any costs associated with pre-term or premature care or costs related to the delivery of such a new baby.