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Mediclaim 2007 Policy of New India Assurance Co. Ltd.: A personal insurance policy
The following article deals with the Mediclaim 2007 Policy of New India Assurance Co. Ltd. The policy provides Reimbursement facility and Cashless facility for the treatment of the insured. It is one of the popular insurance policies of the company.
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About Mediclaim 2007 Policy
The Mediclaim 2007 policy of New India Assurance Co. Ltd. is a policy under the Personal Insurance category for providing benefit and financial security to clients insured with the policy. It is a 1 year policy with all admissible claims payable in Indian Currency. One of the largest non-life insurance companies, New India Assurance Co. Ltd. is the first insurance company to be totally owned by India in India.
Eligibility to take Mediclaim 2007 Policy:
Any person in the age group of 18-60 years can apply for the policy.
If there is continuity of a person insured with the policy without any break, he/she can be insured under the policy beyond 60 years.
Children in the age group of 3 months-18 years can also be covered provided their parents are also covered under the policy.
Area of coverage for the Mediclaim 2007 Policy
For person suffering from illness or injury, the hospitalization expenses including fees for room, boarding, nursing, ICU, medical practitioners, chemicals etc will be covered by the policy as per the policy guidelines. The policy also has scope for pre-hospitalization expenses for 30 days and post hospitalization expenses for 60 days.
The Mediclaim 2007 Policy also covers daycare treatment whereby medical treatment /surgical procedure will be rendered to enable the insured patient to be discharged on the same day.
The policy bears the transportation cost of the insured while shifting from residence to hospital which may be 1% of the sum insured or actuals, whichever is less, subjected to a maximum of Rs. 2,500.
If the insured person undergoes Ayurvedic/Homeopathic/Unani Treatment, up to 25% of the sum insured will be provided. However, treatment should be conducted in a registered hospital.
Cashless facility: According to the facility, the TPA is responsible for providing the admissible claim directly to a network hospital on the event of a request from the insured. A network hospital is one which has agreed to the cashless treatment with the TPA.
Physical examination: In case of hospitalization due to illness or injury, the insured person should be allowed to be examined by a medical practitioner approved by the TPA /Company. Failure to do so will end in rejection of his/her claim.
Cumulative Bonus: For each claim free year of insurance, there is going to be a 5% increase of the sum insured under the policy at each renewal. However, the cumulative increase is subjected to a maximum of 30%.
Health Check Up benefit: For 4 consecutive years of no claims of insurance, the policy entitles the insured to reimbursement of cost of medical checkup once at the end of the 4 years.
As far as misrepresentation or nondisclosure of any relevant fact/particulars, it will immediately result in termination of the policy for insurance.
Third Party Administrator
TPA or Third Party Administrator deal with providing the cashless service and/or reimbursement of claim to the insured persons under the policy. New India Assurance Co. Ltd. has collaborated with the TPA for a fee or remuneration for the service.
These TPA are licensed by Insurance Regulatory and Development Authority (IRDA). They maintain a database of policy holders as well as provide them with unique identification numbers. All the post policy matters including claim settlements are also covered by them. Anyone anywhere throughout the country can access them 24 hours a day through their toll free number for insurance.
All in all, 18 TPAs have tied up which are:
Mediassist India Pvt. Ltd.
M D India Helthcare Services (P) Ltd.
E Meditek Solutions Ltd.
Heritage Health Service Pvt. Ltd.
Universal Medi-Aid Services Ltd.
Focus Healthcare
Medicare TPA Services (I) Pvt. Ltd.
Raksha TPA Pvt. Ltd.
TTK Health care Services Pvt. Ltd.
East West Assist Pvt. Ltd.
Alankit Health Care Limited
Health India
Good Health Plan Ltd.
Vipul Med Corp TPA Pvt. Ltd.
Safeway Mediclaim Services Pvt. Ltd.
Anmol Medicare Ltd.
Dedicated Health care Services (India) Ltd.
Genins India Ltd.
How to procure a claim?
There are 2 ways to administer a claim through TPA: Reimbursement facility and Cashless facility.
Claim through Reimbursement facility:
1. A preliminary claim has to be made in which particulars relating to Policy Number, name of insured person, nature of illness/injury and name and address of the attending medical practitioner/hospital/nursing home should be given to the Insurance Company/TPA within 7 days from the date of hospitalization.
2. A final claim has to be made in which hospital receipted original bills/cash memos, claim form and list of documents as listed in the claim form etc. along with other necessary information should be submitted to the Policy issuing Office/TPA within 30 days of discharge from the hospital.
Claim through Cashless facility:
1. The insured person should let the appropriate TPA/ a network provider know about the medical condition.
2. The concerned TPA shall verify the eligibility of the insured person to claim under the policy.
3. The TPA shall provide a pre-authorization letter / guarantee of payment letter to the hospital /nursing home after successful verification.
4. Commencement of treatment.
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