New India Assurance Universal Health Insurance APL

New India Assurance Universal Health Insurance APL

The Government of India devised a plan like the New India Assurance Universal Health Insurance APL to mitigate the economic woes and ensure quality healthcare to the APL (Above Poverty Line) sections of the society to individuals, families, and groups. The New India Assurance Universal Health Insurance APL Policy coverers hospitalisation expenses arising out of an accident or illness.

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New India Assurance Universal Health Insurance APL: Key Highlights

Coverage Offered

The policy provides both cashless and reimbursement of medical expenses incurred during hospitalization. The primary coverage of the policy includes:

• In-patient Hospitalization: All expenses are covered subject to applicable sub-limits detailed below:
• Room and Boarding Expenses:  It is limited to 0.5% of the sum insured
• ICU Charges: The limit is 1% of the sum insured
• Surgeon/Anesthetic/Nurse Fees: The cover is for 15% of the sum insured per hospitalization
• Expenses for Pharmacy, Diagnostics, and Equipment, etc.: Coverage is 15% of the sum insured per hospitalization
• Total Cover: The total expenses per illness or injury should not exceed Rs 15, 000
• Support to the Earning Head of the Family: A Disability Compensation of Rs 25, 000 is paid to the family's earning head for accidental injury leading to death within six months of the event.
• Disability Compensation paid to Earning Head of the Family: Rs 50 per day is paid to the family's earning head for a maximum of 15 days per policy year for hospitalization for any illness or accidental injury (with an excess of 3 days)

Inclusions of the Plan

Apart from the above-mentioned coverage, the policy also covers:

Maternity Cover: The amount is limited to Rs 2, 500 for normal childbirth and Rs 5,000 for Caesarean Section. The facility is available in only one pregnancy. The overall cover is limited to a maximum of Rs 30, 000 per family during the policy period.

Exclusions of the Plan

Waiting periods are applied in the policy for the following situations during which related claims are not accepted:

• Waiting Period:
• Initial Waiting Period: Claims are not accepted during the first 30 days from policy inception, except accidental injury.
• Specific Waiting Period: Claims for a few diseases are not accepted before the expiry of 12 months waiting period.
• Pre-existing Diseases: The waiting period for this category of diseases is 48 months.
• Permanent Exclusions: The list of exclusions in this category is long. It includes exclusions like, no coverage for illness or injury due to:
  • Self-harm or Suicide attempt
  • Participation in war, riots, military operations, terrorist activities, etc.
  • Alcohol or drug abuse
  • Participation in adventurous or hazardous activities
  • Nuclear reactions or radioactivity, etc.

The insured must consult the policy document for a detailed list and understand their impact on claim settlement.

Features & Benefits of the Plan

People should buy New India Assurance Health Insurance under Universal Health Insurance Scheme as the premium is the bare minimum, which is affordable for all. Some of the other salient features of this policy are:

• Policy Term: One year with lifelong renewability
• Family Composition: Individual proposer, Spouse, Parents, and a maximum of three dependent children
• Sum Insured: Coverage of a maximum of Rs 30,000 per family

Tax Benefit: Premium for the New India Assurance Universal Health Insurance APL Policy is entitled to tax exemption under Section 80D of the Income Tax Act, 1961.  

Eligibility Criteria

The minimum eligibility conditions to buy this plan are:

Cancellation Terms of the Policy

The insurer is entitled to cancel the New India Assurance Universal APL Health Insurance policy after serving a 30-day notice to the insured. Likewise, the insured can cancel the policy due to disagreement at any time within the policy term.