While living your golden days, you don’t want to be in any financial trouble whatsoever. Health emergencies are something very common during that period. But if you have Senior Citizen Mediclaim Plan of New India Assurance, a renowned health insurer in India, you are at least financially secure against the medical expenses. The premium of this health insurance policy may be higher compared to the ones used by the younger counterparts, but features may still be worth considering. From covering you against wide-ranging health conditions to offering you reasonable premiums, this health insurance plan of New India Assurance is something to look forward to.
Salient Features of the Senior Citizen Mediclaim Plan
1. Scope of Coverage
The policy covers hospitalisation expenses as well as pre and post hospitalisation expenses subject to certain limits.
Hospitalisation Expenses
Sl. No. | Type of Expense | Limit | Other Conditions |
1 | Room rent in case of ICU | Total limited to 1% of total sum insured per day | Overall limit of 25% of total sum insured |
2 | Room Rent Other than ICU | Total limited to 2 % of total sum insured per day | |
3 | Fees of surgeon, anaesthetist, nursing, Doctors etc | Total limited to 25% of total sum insured |
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4 | Cost of Anaesthesia, implants, stents, artificial limbs, surgical appliances, OT charges and the like | Total limited to 50% of total sum insured |
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Apart from the above-mentioned stipulations the policy also names 19 procedures, against which a standard package is offered as coverage. This ranges from INR 7000/- for a tonsillectomy to INR 36,000/- for a radical mastectomy. Charges beyond those mentioned as the limit against each procedure, during the period of hospitalisation will have to be borne by the patient herself/himself.
Pre-hospitalisation Expense
Pre-hospitalisation expenses relating to the procedures/illnesses for which the insured person is hospitalised will be covered up to a prior period of 30 days, and 5% of the insured amount.
Post-hospitalisation Expense
Post-hospitalisation expenses relating to the procedure/illness for which the insured person is hospitalised will be covered up to a period of 60 days after discharge and 10% of the insured amount.
Coverage for Some Diseases
One major advantage of this policy is that it also offers coverage of expenses related to Ayush, Unani and Homeopathy, subject to the treatment being carried out in a facility recognised by the Government of India (GoI) or accredited by the National Accreditation Board of Health. However, this is limited to 25% of the sum insured. In addition, the policy also covers certain disorders of adult personality and nuero-developmental disorders up to a sub-limit of 25% of the insured amount.
Some conditions, such as age-related macular degeneration (ARMD), genetic disorders, stress, mental illness and neuro-degenerative disorders, however, are only covered after a waiting period of four years. In addition, ARMD is subject to a limit of INR 15,000/- or 10% of the sum insured during the policy period, depending on which is lesser. Coverage of genetic disorders, mental illness and neuro-degenerative disorders is limited to 25% of the sum insured. Allied conditions requiring palliative therapy, counseling or psychotherapy, not requiring hospitalisation will not be covered under the policy.
Day Care Procedures Covered
Senior Citizen Mediclaim Policy offered by New India Assurance also covers certain day-care procedures subject to a sub-limit of 10% of the sum insured during the policy term. These include balloon sinuplasty, several procedures related to cancer treatment or removal of tumours, such as oral chemotherapy, immunotherapy, and stereotactic radio surgeries, robotic surgeries, bronchial thermoplasty, vaporisation of the prostrate and stem cell therapy
2. Standard Exclusions
As with any health insurance plan there are some standard exclusions, i.e. treatment categories or costs which will only be covered under some circumstances, such as fulfilling the pre-defined waiting period, or will never be covered during the lifetime of the health insurance policy.
For example, cardiac conditions under this policy have a waiting period of 90 days. Benign ear/nose/throat disorders, cataract or hernia have a waiting period of 18 months, while joint replacements and genetic disorders have a waiting period of as much as 48 months. Internal congenital diseases are covered after a waiting period of eighteen months while external congenital diseases are covered after a waiting period of 48 months. Such cover for congenital external disease or defects or anomalies shall be limited to 10% of the average sum insured.
However, if a policy has been ported as per the existing Insurance Regulatory and Development Authority of India (IRDAI) norms, the waiting period will reduce to the extent of the prior coverage period of the previous policy. Porting defined by the IRDAI here is the right accorded to individual health insurance policyholders (including all members under family cover) to shift his/her policy to another insurance company along with transfer of credit gained for pre-existing conditions and time bound exclusions[1]
Treatment for obesity, cosmetic surgery, change of gender treatment, treatment necessary due to participation in adventure sports such as mountaineering or rock-climbing, motor racing, as well as domiciliary hospitalisation (i.e. when a hospital-like arrangement is made at home due to exigencies of circumstance) are part of the exclusions.
Premium Costs
The premium varies according to age- bracket (60-65, 66-70, 71-75 etc) as well as the coverage secured. Some discount is offered if more than one person is covered under the policy.
To conclude, Senior Citizen Mediclaim plan offered by New India Assurance is specially tailored for those above 60 years of age. Should you already have an existing health insurance policy and feel that this policy is more suited to your needs, you may consider shifting to this policy. However, be sure that the shift is treated as a porting of policy and not as a new policy purchase.
