New India Top Up Mediclaim

SALIENT FEATURES OF THE POLICY

• This Policy covers In–Patient Hospitalisation Expenses incurred in India.
• This policy will respond only when the aggregate of all Hospitalisation expenses (except Pre / Post hospitalization expenses) of one or all members of the policy, exceeds the “Threshold” stated in the policy.
• This Policy will respond for each and every Hospitalisation after the Threshold has been exceeded by previous Hospitalisation expenses subject only to the Sum Insured stated in the Policy.
• The Sum Insured is the maximum liability of the company for all members of the policy.
• Thus, this Policy offers protection in excess of any Primary Health Policy/Benefit scheme that the Insured may have.
• If there is any expense in excess of Threshold, receivable from any other entity, the Insured Person has an option to recover it from either that entity or this policy, but not both.
• However, the Sum Insured under the policy will be available over and above any reimbursement received from any other entity if such amounts exceed the Threshold.

WHO CAN TAKE THE POLICY

• Any person fulfilling the eligibility norms given below.
• The person may or may not have any other Health Insurance Policy.
• This policy can be taken in addition to any other Health Insurance Policy.

ELIGIBILITY

The policy can be issued on Individual or Floater Sum Insured basis covering up to 6 members of the family. If the policy is to be issued on Individual Sum Insured basis, then separate document will be issued to each Insured. Family comprises of Self, Legal Spouse, dependent Children and dependent Parents.

Age of Entry:
Proposer : 18 to 65 years.
Other members : 3 month to 65 years.

• There is no cover ceasing age in case of renewal.
• Children between the age of 3 months and 18 years are covered provided either or both parents are covered concurrently. Children between the age of 18 years and 25 years are covered only if either or both the parents are also covered and they are financially dependent on the parents. But this upper limit is not applicable for Unmarried Daughter and Mentally Challenged Children. Exclusion for treatment related to Psychiatric and Psychosomatic disorder will apply for such Mentally Challenged Children regardless of Continuous Coverage.

 PROCEDURE FOR TAKING A POLICY

The following are to be submitted–

• Proposal form duly completed & signed and details of Insured Person/s.
• The details of existing and previous Health Insurance policies in respect of each Insured Person are to be provided without fail in the proposal form along with claim history. Copy of current/expiring policy may be attached.
• Signed copy of Prospectus.

Pre–acceptance health check–ups will be required in the following instances:

1. For persons above 50 years of age OR
2. For persons with Adverse Medical/claims history.

Note: No Pre–acceptance Health Check–up for persons above 50 years of age, if the person has Health insurance policy from our company and there is no claim for previous two years.

A person is said to have Adverse Medical History if he/she:

1. Has / Have undergone more than two hospitalisation in previous two years,
2. Is Suffering from incurable/chronic diseases needing recurring treatment of any kind, such as Renal Failure, Cancer, Parkinson’s disease, and Diabetes Mellitus type II
3. Is Suffering from Hypertension / Diabetes.
4. is not in good health and free from Physical and mental diseases or infirmity or medical complaints.

Following are the test to be carried out as pre–acceptance health check–up:

he above tests will have to be carried out at proposer’s cost. However if the proposal is accepted then 50% of such cost will be reimbursed to the proposer.

The tests have to be taken not more than 30 days prior to the date of submission of the proposal.

This policy will be valid for a period of one year from the date of inception.

SUM INSURED

The Sum Insured available are:

“Proposers are advised to exercise care in choosing the amount of Threshold, as such choice will have an impact on benefits available under the Policy such as Room Rent limit, Hospital Cash, Ambulance Charges, and Get Well Benefit.”

THRESHOLDS

The following Hospitalisation expenses incurred in respect of all the Insured members shall be considered for determining the Threshold under the Policy:

• The admission in the Hospital should have happened during the policy period.
• The Insured should have been admitted as an inpatient (outpatient treatments are not to be considered).
• The Hospitalisation should be for an Injury or Illness.
• Pre–Hospitalisation and Post–Hospitalisation expenses will not be considered.

 ENHANCEMENT OF SUM INSURED AND THRESHOLD

• Enhancement of Sum Insured and Threshold will not be considered during the currency of the Policy.
• Enhancement of Sum Insured and Threshold is available only at the time of renewal.
• Sum Insured can be enhanced only to next band.
• Enhancement of Sum Insured will not be considered for persons
  • Over 65 years
  • Suffering from Diabetes, Hypertension, any chronic Illness, any recurring Illness, Any Critical Illness.
  • who have preferred any claim under this policy in the previous two policy periods.

 PAYMENT OF PREMIUM

As per table attached.

 PREMIUM COMPUTATION

Note: The Proposer may not be the primary member. For further information click http://www.newindia.co.in/newindia-topupmed.htm