Mediclaim Policy of New India Assurance is one of the earliest and most well-known health Insurance products available in Indian markets. Much like Xerox has become synonymous with photocopying and used interchangeably, for the layman the word Mediclaim is a synonym of health insurance. The policy offers coverage of hospitalisation expenses for a wide variety of conditions, some of which are subject to a waiting period. The prospectus of the Mediclaim policy of New India Assurance Mediclaim policy[1] states that the policy is available for persons from the age of 18 years to 65 years. Dependent children from the age of 3 months to 25 years may also be covered under the policy. The policy offers a lifetime renewal feature, i.e. once purchased before the age of 65, you may renew the policy continuously after the age of 65, provided there is no break in between. Like most health insurance policies there are some permanent exclusions as well. Maternity expense coverage is one of them, except in the case of life-threatening ectopic pregnancy. In order for claims related to such ectopic pregnancies to be honoured, one must submit necessary proof by way of an UltraSonographic report and certification from a gynaecologist that the condition is life-threatening.
While most maternity benefits are not available under the basic mediclaim policy, it does cover expenses related to the treatment of the newborn for some conditions. As per the terms of the policy, a babyborn to an insured mother, during the term of the policy, will be automatically covered from the day of birth till the policy expires for any hospitalisation related to illness or injury. No additional premium is required to be paid. However, expenses related to the treatment of external congenital anomaly of the newborn baby does not get covered under the mediclaim policy of New India Assurance. It must be noted that on expiry of the policy term the newborn baby will find cover only if she or he is included as an insured person in the policy.
However, other maternity benefits can be availed through an optional cover. One may purchase the optional cover only if the sum insured under the policy is INR 5 lakh or more.
Maternity Benefits Provided Under the Optional Cover
Quantum of Coverage: New India Assurance commits to pay a maximum of 10% of the average sum insured (SI) during the three years preceding the claim. This sub-limit is calculated per event.
Kind of Expenses Covered: The optional cover provides coverage of in-patient hospitalisation in India related to claims against expenses for normal or caesarian deliveries as well as if the abdominal operation is required in case of extra uterine pregnancy. Claims may be made for a maximum of two deliveries.
Waiting Period: There is a compulsory waiting period of three years even with the optional cover. This may be relaxed in certain circumstances, such as abortion/miscarriage as a result of an accident or emergency.
Pre and Post-natal Expenses: These expenses are only covered if such treatment necessitates hospitalisation admission and if the treatment is carried out as in-patient treatment. Any expenses incurred in connection with the delivery of a preterm or premature baby and expenses related to the care of such a baby do not find coverage under the policy.
Premium: In case of a group Mediclaim or family floater policy, a separate premium will be charged for each person who opts for this additional cover.
Exclusions: The optional maternity benefit cover does not cover expenses related to MTP or medical termination of pregnancy.
Other Highlights of the Basic Policy
The basic mediclaim policy offers a cumulative bonus at the rate of 25% for every claim-free year, subject to a maximum of 50% of the SI. It also offers a health check-up benefit once every three claim-free years. Treatment in AYUSH institutions is also covered up to 25% of the SI. Hospital Cash facility is also offered up to 1% of the SI and at a rate of 0.1% per day of hospitalization. A total of 139 day care procedures are also covered under the basic health insurance plan of New India Assurance Co. Ltd.
Thus, if you are of child-bearing age and plan on bearing children, it would be good to consider the optional maternity cover offered by New India Assurance, in addition to the basic mediclaim health insurance policy. Plan early as this entails a waiting period of at least 36 months in normal circumstances, to avail of benefits provided under the optional cover.
