Whereas, the group health insurance policy will be issued in the name of the Group/Association or Institution as the policyholder, along with the name of the other insured persons or family members as part of the policy.
For claim procedures, a certificate of Below Poverty Line would be required as proof thereof issued by a state government official above or equal the rank of B.D.O. / Executive Magistrate of the tehsil.
Key Features & Benefits of New India Assurance Universal Health Insurance Plan
Here’s why this plan is suitable for Below the Poverty Line:
- Compensation is provided in case of death or disabilities caused to the earning head of the family
- 15 days of free look period
- Easy grievance redressal at regional cells
- Policy period is one year, which is renewable
Inclusions of New India Assurance Universal Health Insurance Plan
Following medical expenses shall be covered under this plan:
- Hospitalization benefits including room charges and boarding expenses up to a limit of 0.5% of sum assured to be reimbursed per day
- ICU expenses to be reimbursed up to a limit of 1% of sum assured per day
- Up to 15% of sum assured to be reimbursed for fees charged by Medical Practitioner, Surgeon, Consultants, Anesthetist, and Specialists Fees etc.
- Up to 15% of sum assured to be reimbursed for Nursing Expenses, Anesthesia, Blood, Medicines & Drugs, Oxygen, Surgical Appliances, OT Charges, Pacemaker, Diagnostic Tests, X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost Of Organ Replacement, Artificial Limbs And Similar Expenses.
- After a waiting period of one year, maternity cover is provided (only one delivery or child is covered). For normal delivery, the limit is kept up to Rs.2500 and for the caesarean limit is kept up to Rs. 5000. Maximum maternity benefits shall not exceed the limit of Rs.30, 000 per family or person during the policy period.
- Personal accident cover up to Rs. 25,000 in case of death of the main policyholder
- In the case of hospitalization of the earning head of the family, Rs.50 will be compensated on a daily basis. Compensation will be provided from the fourth day of hospitalization and this is subjected to a maximum period of 15 days per policy period.
- All the coverages will be eligible in a government-owned nursing home or hospital and should have a minimum of 15 patient beds.
Sum Insured Options
- Hospitalization benefit per family is Rs.30, 000
- Accident death benefit for the Earning Head of the family is Rs.25, 000
- Disability Compensation of Rs. 50 is provided in case of hospitalization of the only earning member of the family for a maximum of 15 days during the policy term with a time excess of 3 days
Exclusions of New India Assurance Universal Health Insurance Plan
The insurer will not cover claims arising due to any of the below-mentioned circumstances:
- Hospitalization or treatment required due to war conditions, nuclear attacks, terrorist activities etc.
- Regular dental treatment
- Treatment for HIV, AIDS and other STDs
- Congenital and Venereal diseases
- Self-inflicted injuries and treatment of depression /mental conditions
- An overdose of alcohol and drugs
- Expenses of naturopathy treatment
- Cost of vitamins and supplements prescribed by the physician
- Cost of purchasing contact lenses, hearing aids, and spectacles during or after the treatment
- Death resulting from pregnancy complications
Eligibility Criteria of New India Assurance Universal Health Insurance Plan
- For adults, the age limit is 5-70 years
- The age limit for children is 3months-5 years (provided either or both the parents are already covered)
- Sum Assured (Rs.): Hospitalization benefit per family is provided up to Rs.30, 000 during a policy period. It included maternity cover of Rs.2500 in case of normal delivery and Rs. 5000 in case of caesarean delivery
- Total claim limit for any one illness or disease is restricted to Rs.15,000 (apart from maternity expenses)
- Accidental death cover of Rs 25,000 to the earning head of the family
Claim Process of New India Assurance Universal Health Insurance Plan
You need to follow the below mentioned procedure to get compensation for your hospitalization expenses:
- Immediately inform the TPA department about the hospitalization
- In case of medical emergencies, notify the insurer within 24 hours of hospitalization. Also, you would need to furnish the following documents:
- Medical prescriptions
- All the invoices, receipts, discharge and admission certificate from the hospital
- Medical reports with doctor’s recommendation
- Doctor’s certificate validating the nature of treatment, operation, and surgery
- In-hospitalization receipts including room charges, anesthesia, and doctor’s consultation
- For post-hospitalization treatment, submit all the required documents within a week of the medical treatment
Cashless hospitalization is available in the network hospitals if you provide your identity proof, the proof of New India Assurance Health Insurance policy. This facility is available only after the insurer approves your claim.