New India Floater Mediclaim

New India Floater Mediclaim Policy is a health insurance policy offered by New India Assurance Company Limited.  

The New India Floater Mediclaim plan stands out for its affordability compared to other options available. It covers hospitalisation and related medical expenses and even allows the addition of a newly-married spouse during the policy period. 

It is essential to note that the plan does not offer comprehensive coverage. There is no benefit of replenishing the sum insured if it is used up within a policy year. Additionally, there are certain limits on crucial benefits such as modern treatment coverage and common treatments like cataract treatment. Also, you should keep in mind that the option to pay premiums on a monthly basis is not available.

On the bright side, purchasing the policy and making claims are likely to be pleasant experiences. The insurer has a good track record of settling claims and receives fewer complaints regarding policy purchases, which reflects positively on their service quality.

What are the benefits offered by the New India Floater Mediclaim Policy?

• Inpatient hospitalisation coverage:  The New India Floater Mediclaim Policy covers expenses for inpatient hospitalisation. This means it takes care of the costs when you are admitted to the hospital for more than 24 hours. The coverage includes various expenses like room charges, nursing fees, doctor's fees, prescribed medicines, ICU charges, and other related costs.
• Pre-hospitalization coverage: Pre-hospitalization charges are the medical expenses you incur before being admitted to the hospital. These expenses include consultations, tests, checkups, and lab reports. The insurer will cover these expenses up to the sum insured, only if they are related to the medical condition that leads to your hospitalisation. To get coverage, your claim for pre-hospitalization charges must be approved as part of the inpatient hospitalisation coverage. The New India Floater Mediclaim Policy covers pre-hospitalization expenses up to 30 days before hospitalisation up to the sum insured.
• Post-hospitalization coverage: Post-hospitalization expenses are the medical costs you incur after being discharged from the hospital. These expenses include follow-up visits to your doctor, medical check-ups, rehabilitation sessions, physiotherapy, etc. To get coverage for these expenses, they must be related to the condition for which you were hospitalised, and your claim should be approved as part of the inpatient hospitalisation coverage. With the New India Floater Mediclaim Policy, your post-hospitalization expenses are covered for up to 60 days after your hospital stay up to the sum insured.
• Daycare treatment coverage: Daycare treatment refers to medical procedures or surgeries that used to require a long hospital stay but can now be done within 24 hours due to advances in medical technology. The New India Floater Mediclaim Policy covers 139 daycare procedures. And you should know that there is no limit on any daycare treatment expenses, which means they will be covered up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments are medical treatments that need to be done at the hospital but are administered at home when the patient is too sick or injured to travel to the hospital safely or if there are no hospital beds nearby. The New India Floater Mediclaim Policy does not cover the costs of domiciliary treatments.
• Organ donor coverage: Under the New India Floater Mediclaim Policy, you will also get coverage for organ donor expenses. It covers inpatient expenses related to organ donation (where the insured is the recipient) up to the sum insured you have chosen under your policy.
• Modern treatment coverage: Healthcare is advancing quickly due to technology, and this has led to the creation of modern treatments that were once unimaginable. These treatments, like radio surgeries, stem cell therapy, etc., aim to cure diseases that were considered incurable before. The New India Floater Mediclaim Policy is designed to keep up with these progressions and provides coverage for the expenses of modern treatments. However, there are specific sub-limits for different types of treatments.
• Non-medical expenses coverage: Non-medical expenses include the cost of consumables like gloves, nebulization kits, oxygen masks, and other necessary items used in treatment. These consumables can be costly and quickly burn a hole in your wallet. However, the New India Floater Mediclaim Policy does not cover these expenses.
• No Claim Bonus: With the New India Floater Mediclaim Policy, you can get a No-Claim Bonus as a reward if you don't make any claims during the policy period. This bonus amounts to 25% of the sum insured. The maximum bonus you can accumulate under this plan is 50% of the sum insured. However, if you make a claim during the policy period, the accumulated bonus will decrease. 
• Super No Claim Bonus: The Super No Claim Bonus is an accelerated version of the regular No Claim Bonus, and it functions in the same way. However, the New India Floater Mediclaim Policy does not offer a Super No Claim Bonus. 
• Restoration Benefit: The Restoration Benefit is a useful feature that restores your sum insured to its original amount if it gets used up within a policy year. However, the New India Floater Mediclaim Policy does not offer the benefit of refilling the sum insured.

Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured. 

New India Floater Mediclaim Policy: Financial Limits

• Room rent limit: The room rent limit is the maximum amount that your insurance company will cover for the hospital room you choose during your stay in the hospital. If you select a room within this limit, you won't have to pay any extra charges. However, if you go for a room with a higher rent than your eligibility, you will need to bear a proportionate deduction. This means you will be responsible for paying a proportionate share of the total bill, not just the difference in room rent. In the New India Floater Mediclaim Policy, the room rent limit is set at 1% of the sum insured per day. 
• ICU rent limit: The ICU rent limit is the highest amount that your health insurance policy will cover for your stay in the Intensive Care Unit (ICU) of a hospital. The ICU rent limit is set at 2% of the sum insured per day under the New India Floater Mediclaim Policy.
• Copayment: A copayment, also known as a copay, is the portion of the approved claim amount that you have to pay yourself. Once you pay the copay, the insurance company will take care of the rest of the claim amount. The New India Floater Mediclaim Policy does not have any copayment limit. 
• Deductible: A deductible is the amount you have to pay from your own pocket before your health insurance starts covering your medical expenses. Under the New India Floater Mediclaim Policy, there is no deductible limit.
• Limits on surgeries/treatments: This is the highest amount that your health insurance policy will cover for particular medical procedures or treatments. Some policies may have limits for certain procedures, while others may not. In the New India Floater Mediclaim Policy, cataract treatment expenses are covered up to Rs 1 lakh per eye per policy year (as an option). However, there is no limit on joint replacement surgery expenses. This means the policy covers the entire cost of joint replacement surgery without any cap.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs. 

New India Floater Mediclaim Policy: Waiting Periods & Exclusions

👉Waiting period

When you buy a health insurance policy, there is a waiting period during which certain illnesses and diseases may not be covered. Once this waiting period is over, you can claim for these conditions. There are different types of waiting periods such as - 

• Initial waiting period: For all medical conditions except accidents, there is an initial waiting period of 30 days. This means you won't be able to make any claims for hospitalisation during the first 30 days, except in the case of accidents. 
• Waiting period for pre-existing diseases: A pre-existing disease refers to any medical condition or illness you had in the 48 months before applying for the health insurance policy. In the New India Floater Mediclaim Policy, there is a waiting period of 48 months for pre-existing diseases. This means that during this period, the policy will not cover any expenses related to your pre-existing conditions. 
• Waiting period for specific diseases: Insurers may have a list of medical conditions or illnesses, apart from your pre-existing conditions, which will have a waiting period. This waiting period is fixed by the insurer and does not depend on your current health condition. In the New India Floater Mediclaim Policy, the waiting period for specific diseases can be 3, 24, or 48 months, depending on the disease. 

👉Exclusions

Exclusions are certain circumstances that will not be covered by your health insurance policy. These include - 

• Standard permanent exclusions: There is a list of 'standard permanent exclusions' outlined by the IRDAI (Insurance Regulatory and Development Authority of India). All insurance companies must adhere to it. Some of these include - 

1. Investigation and evaluation: Hospital admission for observation or monitoring purposes only.
2. Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest with no active treatment.
3. Obesity/weight control: Treatment or surgery meant for weight control or obesity.
4. Profession in hazardous or adventure sports: Treatment expenses incurred while engaging as a professional in risky activities like mountaineering, river rafting, snorkelling, scuba diving, horse racing, etc.
5. Breach of law: Expenses related to the treatment of a person who has committed or attempted to commit a violation of law with criminal intent.
6. Excluded providers: Treatment from a medical practitioner or hospital not covered by the insurance company.
7. Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
8. Change of gender treatment: Treatment to change the body's characteristics to those of the opposite sex.
9. Plastic/cosmetic surgery: Treatment or surgery for changing body characteristics or appearance.
10. Dietary supplements, substances purchased without prescription: Vitamins, minerals, etc. not prescribed by a medical practitioner.
11. Refractive error: Expenses associated with correcting refractive errors of up to 7.5 diopters for vision improvement.
12. Unproven treatments: Surgeries, medical procedures, or treatments that are not proven to be successful.
13. Expenses related to birth control, sterility infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
14. Treatments in establishments arranged for domestic purposes: Expenses of treatment administered in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
15. Maternity expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.

• Additional permanent exclusions: Apart from the standard permanent exclusions mentioned earlier, insurance companies might exclude specific situations or medical conditions from coverage. If you have certain diseases or severe medical conditions that insurers consider risky to cover, they may permanently exclude them from your policy. However, it's essential to know that insurers are restricted to a list of illnesses specified by the Insurance Regulatory and Development Authority of India (IRDAI) for which they can impose a permanent exclusion. They cannot apply permanent exclusions to illnesses or diseases not enclosed in this list.
• Non-standard exclusions (Specific exclusions): These are particular exclusions that go beyond the standard permanent exclusions set by the IRDAI. These exclusions can differ among insurance companies and depend on the policy's terms and conditions. Here is a list of some of the specific exclusions under the New India Floater Mediclaim Policy - 

1. Acupressure, acupuncture, magnetic therapies
2. Domiciliary hospitalisation expenses
3. Treatment for intentional self-inflicted injury or attempted suicide. But, failure to seek or follow medical advice or treatment is covered with a sub-limit of 10% of the sum insured.
4. Circumcision, unless necessary for treating a disease or injury
5. Treatment for general debility and convalescence
6. Costs of spectacles and contact lenses (beyond what is specifically provided), hearing aids, walkers, crutches, wheelchairs, and similar equipment
7. Dental treatment, except for treatment required due to an accident
8. Naturopathy treatment
9. Injuries or illnesses due to nuclear, chemical, or biological attacks or weapons
10. Stem cell therapy, except for hematopoietic stem cells used for bone marrow transplants to treat haematological conditions
11. Hyperbaric Oxygen Therapy, Enhanced External Counter Pulsation, Rotational Field Quantum Magnetic Resonance, External Counter Pulsation
12. Expenses related to vaccination and/or inoculation
13. Injuries or diseases due to war, invasion, acts of foreign enemies, warlike operations, etc.

What to expect in terms of claims experience if you buy from New India Assurance Company Limited?

• Speed of claims: New India Assurance Company Limited has settled 74.22% of claims within 30 days. This means there's a possibility that you may have to wait a bit longer to receive the claim amount.
• Claim-related complaints: Based on our research, we discovered that New India Assurance Company Limited has received 0.05% complaints on overall claims. They have received very few complaints compared to other insurance companies.
• Claims incurred ratio: The claims incurred ratio is a measure of the financial performance of insurance companies. It shows the total amount of claims paid out by the insurer relative to the total amount of premiums they collected. For New India Assurance Company Limited, the claims incurred ratio is 103.33%. 
• Claim settlement ratio: The claim settlement ratio indicates the percentage of claims that an insurer has settled compared to the total number of claims received in a financial year. New India Assurance Company Limited has a claim settlement ratio of 93.13%.
• Network hospitals: New India Assurance Company Limited has a wide network of hospitals, including 5,500+ hospitals. This extensive network allows you to benefit from cashless treatments at various healthcare providers in different locations.

How is the customer service of New India Assurance Company Limited?

• Policy purchase-related complaints: New India Assurance Company Limited has received a minimal percentage of complaints related to its after-sales service at 0.00%. So, you will have a stellar experience in this aspect.

About New India Assurance Company Limited 

New India Assurance Company Limited is among India's oldest general insurance companies. It offers a variety of insurance products to meet customer needs, including health insurance, motor insurance, travel insurance, marine insurance, and more. Established in 1919, the company is headquartered in Mumbai, Maharashtra. The current CMD is Ms. Neerja Kapur.