(Sponsored article from New India Assurance)
The existing Mediclaim and Health Plus Medical expenses policies have been discontinued and Mediclaim Policy (2007) is introduced.
The salient features and underwriting guidelines of the Mediclaim policy (2007) are as under.
- Effective date or commencement of Mediclaim policy (2007) is 16.08.2007.
- TPA option: Proposer can opt for servicing of policy through TPA or directly through Company, Proposer who do not opt for TPA's service will have their claims settled directly by Underwriting Offices on reimbursement basis. There will not be any discount in premium for not availing TPA services.
- Age: The policy is available for persons between the age of 18 and 60 years. However children between 3 months to 18 years can be covered only if the parents are also covered under the policy. The Insured may renew their policies beyond the age of 60 years provided there is no break in insurance.
- Persons above 45 years of age, opting for Mediclaim policy for the first time will have to undergo the prescribed pre health check up from an empanelled doctor. The cost of the pre acceptance health check up will be borne by the proposer.
- Proof of age must be obtained, especially for persons on the borderline of age band requiring medical examination and /or higher premium.
- The revised proposal form along with pre acceptance health check up form duly completed in all respects is mandatory.
- Non-disclosure of material facts may result in rejection of claim. In case of discrepancy in age declaration the claim will be settled as under:
- If the actual age is within the same age band where there is no premium difference, waive collection of additional premium and settle the claim without any penalty.
- If the actual age is in such group where there is a difference in premium because of the higher age i.e. one step upward, collect 3 years penalty premium and settle upto 75% of the claim amount.
- If the actual age requires medical selection procedure for entry into the scheme then the claim is to be rejected.