1. Group Mediclaim Policy
An in-depth review
22 August 2019
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

2. First, our sincere thanks to you for choosing us as your official insurer and also giving us this exciting opportunity
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

3. WHY THIS POLICY ? CASHLESS TREATMENT IF TAKEN IN NETWORK HOSPITALS
FOR REIMBURSEMENT OF HOSPITALISATION EXPENSES IF TAKEN IN NON NETWORK HOSPITAL
ONLY FOR ILLNESS & DISEASES CONTRACTED / INJURY SUSTAINED BY THE INSURED PERSON DURING THE POLICY PERIOD
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

4. WHAT IS HOSPITALISATION ?
STAY AS INPATIENT
IN A HOSPITAL OR NURSING HOME
FOR A MINIMUM PERIOD OF 24 HOURS EXCEPT IN SPECIFIED CASES
IN ANY HOSPITAL IN INDIA FOR INDOOR CARE AND TREATMENT
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

5. WHAT IS A HOSPITAL ? REGISTERED AS SUCH WITH THE LOCAL AUTHORITIES
AND IS UNDER THE SUPERVISION OF A REGD MEDICAL PRACTITIONER
WHICH HAS SPECIFIED MINIMUM NUMBER OF BEDS,OPERATION THEATRE
AND ROUND THE CLOCK QUALIFIED DOCTORS AND NURSES
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

6. WHAT IS NOT A HOSPITAL? A CLINIC TO TREAT OUT-PATIENTS A PLACE OF REST
A PLACE FOR THE AGED
A PLACE FOR DRUG ADDICTS / ALCOHOLICS
A HOSTEL
ANY OTHER SIMILAR PLACE
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

7. WHO IS A MEDICAL PRACTITIONER ?
A PERSON WHO HOLDS A DEGREE OR DIPLOMA OF A RECOGNISED MEDICAL INSTITUTION
AND IS REGISTERED AS A MEDICAL PRACTITIONER BY THE MEDICAL COUNCIL
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

8. HOSPITALISATION EXPENSES PAYABLE
EXPENSES REASONABLY AND NECESSARILY INCURRED FOR
ROOM, BOARDING, AND NURSING
SURGEON, ANAESTHETIST, MEDICAL PRACTITIONER, CONSULTANT AND SPECIALIST FEES
ANAESTHESIA, BLOOD, OXYGEN
OPERATION THEATRE CHARGES, SURGICAL APPLIANCES
MEDICINES AND DRUGS, DIAGNOSTIC CHARGES, X-RAY
COST OF ORGANS, PACEMAKERS, ARTIFICIAL LIMBS
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

9. HOSPITALISATION EXPENSES PAYABLE
PRE-HOSPITALISATION EXPENSES:
BEING RELEVANT MEDICAL EXPENSES INCURRED DURING THE PERIOD UPTO 30 DAYS PRIOR TO HOSPITALISATION
POST HOSPITALISATION EXPENSES:
BEING RELEVANT MEDICAL EXPENSES INCURRED DURING THE PERIOD UPTO 60 DAYS AFTER HOSPITALISATION
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

10. HOSPITALISATION EXPENSES PAYABLE
TREATMENT OF SPECIFIED AILMENTS SUCH AS CATERACT, HYSTERECTOMY, HERNIA, HYDROCELE, FISTULA, PILES, SINUSITIES, ETC.,
Expenses for the above are payable though they do not require hospitalization and may be treated under day care procedure
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

11. EXPENSES WHICH ARE NOT PAYABLE
COST OF SPECTACLES, CONTACT LENSES, HEARING AIDS
DENTAL TREATMENT OR SURGERY OF ANY KIND UNLESS REQUIRING HOSPITALISATION (MOSTLY DUE TO AN ACCIDENT)
VACCINATION, INOCULATION, CHANGE OF LIFE, OR COSMETIC OR AESTHETIC TREATMENT OF ANY DESCRIPTION
CIRCUMCISION, PLASTIC SURGERY UNLESS NECESSITATED DUE TO AN ACCIDENT
EXPENSES FOR CONVALESCENCE
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

12. EXPENSES WHICH ARE NOT PAYABLE
GENERAL DISABILITY, RUN-DOWN CONDITION, REST CURE
CONGENITAL EXTERNAL DISEASES / DEFECTS
STERILITY, VENERAL DISEASE
INTENTIONAL SELF INJURY OR USE OF INTOXICATING DRUGS / ALCOHOL
EXPENSES DIRECTLY / INDIRECTLY RELATED TO TREATMENT OF AIDS & HIV
DIAGNOSTIC, X-RAY OR LAB EXAMINATION OR OTHER DIAGNOSTIC STUDIES INCURRED AS ROUTINE CHECK UP AND/OR OBSERVATION PURPOSES
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

13. EXPENSES WHICH ARE NOT PAYABLE
EXPENSES ON VITAMINS AND TONICS UNLESS FORMING PART OF TREATMENT OF INJURY OR DISEASE AS CERTIFIED BY THE ATTENDING PHYSICIAN
TREATMENT ARISING FROM OR TRACEABLE TO PREGNANCY, INFERTILITY TREATMENT AND ABORTION (unless medically advised)
NATUROPATHY TREATMENT
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

14. COVERAGE DETAILS TOTAL FAMILIES – 750 SUM INSURED
Rs. 100,000 for 1599 Members
Rs. 200,000 for Members
Rs. 300,000 for Members
FAMILY DEFINED AS
1+5
SELF
SPOUSE
2 CHILDREN
2 DEPENDENT PARENTS
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

15. COVERAGES IN THE POLICY
PRE-EXISTING DISEASES COVERED
NO WAITING PERIOD (Usually 30 days)
1ST AND 2ND YEAR EXCLUSIONS WAIVED
MATERNITY COVER
NORMAL DELIVERY – Rs. 25,000
CAESARIAN – Rs. 50,000
NEW BORN FROM DAY ONE
MATERNITY WAITING PERIOD OF 9 MONTHS WAIVED
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

16. COVERAGES IN THE POLICY
For Employees with S.I. Rs.1.00 lakh Room Rent agreed is the actual incurred but not exceeding Rs.3,000- per day and ICU Charges not exceeding Rs respectively
For Employees with S.I. Rs.2.00 lakh Room Rent agreed is the actual incurred but not exceeding Rs.4,000- per day and ICU Charges not exceeding Rs.8,000- respectively
For Employees with S.I. Rs.3.00 lakh Room Rent agreed is the actual incurred but not exceeding Rs.5,000- per day and ICU Charges not exceeding Rs.10,000- respectively
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

17. ADDITIONAL FEATURES
ADDITIONS AND DELETIONS WILL BE DONE ON A MONTHLY BASIS AND PREMIUM CHARGED IS ON PRO RATA BASIS
DELETIONS IF ANY IS PERMISSIBLE PROVIDED THERE ARE NO CLAIMS REGISTERED/SETTLED FOR THAT PARTICULAR INDIVIDUAL
UPON INTIMATION OF THE NEW BORN CHILD FOR DAY ONE COVER AND FOR ADDITIONS THE PREMIUM SHALL BE DEBITED FROM THE ADVANCE PREMIUM DEPOSIT ACCOUNT(APD).
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

18. ADDITIONAL FEATURES
No Mid Term interchange of parents shall be allowed during the currency of the policy.
No increase/decrease of Sum Insured shall be allowed during the currency of the policy.
CASHLESS FACILITY EXTENDED SUBJECT TO APPROVAL OF TPA (TTK HEALTHCARE SERVICES)
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

19. Claims Procedure Cashless Reimbursement Pre-authorization
Post Cashless
Post-authorization
Full reimbursement
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

20. Cashless – Planned / Emergency admission
Planned admission
Identify
Network
hospital
Approach hospital
Billing dept. 24 hrs
Prior to admission
Cashless facility
Provided.
You may still have to
Pay for non-medical
expenses
Approaches TPA for approval in given format
Maximum 6 hours
In case of emergency, please request the billing department to send TPA the request immediately
TPA panel doctor scrutinizes
And approves
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

21. Original receipts, reports,
Reimbursement claims
Non-network
Admission or
Not/Partially
availed
cashless
Ensure that all
Original receipts, reports,
Prescriptions and
discharge
Summary is attached
Use the
CLAIM FORM.
Ensure to
Claim
Within 30 days
Of discharge
Reimbursement
TPA will
Process within
15 working days
Settlement Cheque
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai

22. ASSISTANCE & ESCALATION
Divisional
Manager
Highest Level
Branch
Manager
Second level
First Level
NIA
Dev.Officer
TTK
Ground level
Presented by New India Assurance Company Limited, Divisional Office, Tarapore Towers, Chennai