New India Senior Citizen Mediclaim Insurance Policy

A mediclaim policy compensates for hospitalization expenses incurred on treatment, surgery or accidental injury. A Mediclaim differs from health insurance in some ways. While the former covers expenses pertaining to hospitalization, the latter is more comprehensive and covers medical expenses which might include services beyond hospitalization.

In layman terms, for filing a Mediclaim, an actual hospitalization has to take place and for filing a health insurance claim, a medical eventuality is required which necessarily does not mean that an actual hospitalization has to happen. A normal mediclaim policy will cover expenses arising out of hospitalization.

The minimum age at which a Mediclaim can be applied for is 5 years and the upper age limit is 60 years. Mediclaim draws a staunch line and does not cover dental expenses, cosmetic surgeries, pregnancy, childbirth or sexually transmitted diseases.

New India Assurance Senior Citizen Mediclaim for Senior Citizen

With the ever-rising healthcare costs, senior citizen mediclaim policy for the elderly is almost inevitable. Generally, the entry age for senior citizen health insurance is 61 years and many insurance providers limit the entry age to 69 years. Thus, sooner you get a Mediclaim policy, better the benefits would be. The chances of the policy getting rejected would also be less. After a two-year waiting period, cover for pre-existing diseases will also be offered.

The cover for alternative medical treatment methods like Ayurveda and Homeopathy can be added to the policy plan as add-ons. The premium of senior citizen Mediclaim is generally high since the entry age is high and the premium amount varies according to the pre-existing disease. Some companies offer life-long cover for senior citizens while others may not require medical tests until the age of 69, based on some terms and conditions.

New India Assurance Senior Citizen Mediclaim plan offers medical protection to people aged between 60-80 years.

New India Assurance Senior Citizen Features & Benefits

• Renewability up to 90 years of age
• Medical Screening to identify any pre-existing illnesses is mandatory
• Cashless claim settlement facility

Inclusions of New India Assurance Senior Citizen Mediclaim Plan

• Sum Assured Amount ranges from INR 1 lakh to 1.5 lakhs
• Hospitalization expenses incurred on treatment of the specified illnesses or injury
• 30 days of pre-hospitalization expenses and up to 60 days of post-hospitalization expenses
• It also covers emergency ambulance expenses
• Up to 1% of sum assured is reimbursed for boarding and expenses as charged by the hospital
• ICU charges are also compensated and the maximum limit is up to 2% of the sum assured
• Fees charged by the doctor, surgeon, medical practitioner, consultants, and anesthetist etc. and the limit is 25% of the Sum Insured amount.
• It covers Anesthesia charges, OT charges, medications, blood, X-Ray, radiotherapy, oxygen, dialysis, cost of Pacemaker, chemotherapy, stents, Cataract surgeries, angiography, Tonsillectomy, prostate treatment, Arthroscopy, Kidney stone/lithotripsy, Hernia- Ventral/Incisional etc. up to 50% of the sum assured and are subjected to limits specified as per policy documents
• It covers non-allopathic treatments up to a specified limit. It includes expenses incurred on Ayurveda, Unani and Homeopathic treatment at government-certified hospitals

Exclusions of New India Assurance Senior Citizen Mediclaim Plan

• Any type of diseases or illness diagnosed within 30 days from the policy issuance date
• Pre-existing diseases are covered on completion of 18 months of continuous insurance
• Pre-existing ailments like diabetes, complications related to diabetes mellitus hypertension, are covered after 18 months of continuous insurance. There is an additional premium cost attached to it.
• Cost of cosmetic surgeries apart from accidental cases
• Pregnancy and childbirth complications
• Treatment for STDs and HIV

New India Assurance Senior Citizen Mediclaim Plan Premium (Rs.) 

• For insured members between the age group of 81 and 85 years, loading of 10% is applicable
• For insured members between the age group of 86 and 90 years, loading of 20% is applicable
• To get coverage for pre-existing disease such as diabetes mellitus, hypertension, an additional premium of 10% will be charged.

Discounts Applicable

10% for voluntary deductibles of Rs.10, 000/-

If your spouse is covered you get a family discount of 10% 

Special Features of New India Assurance Senior Citizen Mediclaim Plan

• Repayment of the cost of medical check-ups once after completion of 4 claims-free years
• Tax saving benefits U/S 80D of the Income Tax Act

How to File a Claim for New India Assurance Senior Citizen Mediclaim Plan?

If the policyholder intends to file a claim under this plan:

• Upon diagnosis of any illness or injury immediately inform the TPA department in writing at least 48 hours before the hospitalization
• Notify within 24 hours in case of emergency hospitalization
• Present the following supporting documents to the TPA department when filing a claim within 7 days of getting discharged from the Hospital:       
  
  
  • Surgeon'/ Doctor’s certificate mentioning the nature of the surgery performed
  • Surgeons receipt and bills are also required
  • Hospital bills, receipts, and discharge certificate
  • Cash memos from the chemist and hospital with the doctor’s prescriptions
  • Pathological test reports and receipts from Pathologist along with a supporting note from the attending doctor/surgeon suggesting such pathological tests
  • Attending anesthetists/doctor's/ specialist's / consultant's bill and receipt, and the certificate of diagnosis
• Submit all the necessary document within 7 days of the post-hospitalization treatment (up to a maximum of 60 days)  
• Submit the authorization form to obtain medical reports and other medical records from the laboratory or the Hospital or other agency

The policyholder shall submit all the original bills, documents, and receipts to the TPA upon which the claim is based. You need to furnish all the information, additional information and any other assistance as required by the TPA.  

Medical Practitioner sanctioned by the third-party Administrator shall be permitted to examine the policyholder or the insured members if it is required as part of the claim (subjected to the case and type of claim and illness). The cost of assessment shall be borne by the insurer itself)