Careers
Renewal
(Sponsored article from New India Assurance)
Renewal of Mediclaim policy should not be rejected on grounds other than bad moral hazard. In case of adverse claims experience the premium can be suitably loaded up to 200% of basic premium for the relevant age band and if required also deductible/excess up to 25% of the sum insured may be imposed. This loading/excess should be applied only after completion of minimum of two-policy period.
Imposition of loading and excess will be applicable provided the average claim experience during two policy years exceed 10% of Sum insured for any Individual person covered under the policy. This claim experience will be taken for two previous policy
ie expiring policy and one immediate earlier to that. The loading and co payment under the policy will be as under:
Renewal of Mediclaim policy should not be rejected on grounds other than bad moral hazard. In case of adverse claims experience the premium can be suitably loaded up to 200% of basic premium for the relevant age band and if required also deductible/excess up to 25% of the sum insured may be imposed. This loading/excess should be applied only after completion of minimum of two-policy period.
Imposition of loading and excess will be applicable provided the average claim experience during two policy years exceed 10% of Sum insured for any Individual person covered under the policy. This claim experience will be taken for two previous policy
| % of Sum Insured claimed for any individual person covered under the policy | Loading | Co-payment (Excess) |
| 0-10 | Nil | Nil |
| More than 10 up to 20 | 25% | Nil |
| More than 20 upto 30 | 50% | Nil |
| More than 30 upto 50 | 100% | Nil |
| More than 50 upto 75 | 100% | 15% |
| More than 75 upto 90 | 100% | 20% |
| More than 90 | 200 | 25% |
| 1 | Room, boarding and nursing expenses as provided by the Hospital/nursing home not exceeding 1% of the sum insured (without cumulative bonus)per day or actuals, whichever is less |
| 2 | Intensive Care Unit (ICU)/ Intensive Cardiac Care Unit (ICCU) expenses not exceeding 2% of the sum insured per day or actuals, whichever is less. |
| 3 | Expenses incurred for Ayurvedic/ Homeopathic/ Unani treatment are admissible upto 25% of the sum insured provided the treatment is taken in a Government Hospital. |
| 4 | Ambulance Services-!% of the sum insured or actuals, whichever is less, subject to a maximum of Rs2,500/- shall be reimbursed in case patient has to be shifted from residence to hospital for admission in Emergency ward or ICU or from one hospital/nursing home to another hospital/nursing home by fully equipped ambulance for better medical facilities. |
Advertisement
Most Popular On Medindia:
Related Links
Can the insurance company throw light on circular by IRDA not to restrict claim for cataract operation to Rs.24,000.00
It is saddening to hear that New India Assurance is not doing the above two policy because they don't find viability due to less premium and more work. They don't get anything in these two policies hence don't want to do. Even speak to NOIDA Branch, Regional Head,No reply . Pawan Kumar Singh , Founder President Purvanchal Vikas Foundation,www.purvanchalvikas.org. Right Now Organization is working with Migrant wage workers in Delhi/NCR and we want all workers are covered under social security. Mor than 100 workers are registered with us and adding per day.
hai, my Aunty she and her daughter go for checkup in KIMS hospital in Thiruvananthapuram and they didn't claim for the checkup and they don't know about it. Actaully they take the Mediclaim Policy 2007[Hospitalization benefit Policy] on 2009 and they renew it. The policy number in 2013 to 2014 is 76090434120100000041. So far they didn't claim. So Can I know whether they can claim for the checkup
can anyone tell me there is any new circular regarding this policy which declare that mimimum limit of mediclaim is compulsary of rs.2 lakh.please guide me urgently.
i have a mediclaim polciy 2007 from new india assurance co. ltd. for Rs 300000/- this years which started from 75000/- in 2007-08 , 2008-09 100000/- onwards 300000/- for 3 consecutive years with any break sixth renewal falling on 14-09-0-12 . i have major heart stroke on 30-06-12 got addmitted to sahara hospital where i was done angioplasty following the ecg and angiography by the hsopital. when lodged the claim the raksha tpa only paid 127500/- quoting that the i have been having htn hipertension for last 12 yers so was restricted to the sum ensured of Rs 127500/- equal the SI before 4 complete policy years total expense was 210415/- ..is it justfiable on the part of the raksha tpa or the insruance company when the polciy does not speak clearly about the curtailing the claim amount like this. please guide me to get the balance of sum ensured. ashutosh gupta lakhimpur kheri UP
If you have been a heart patient / Blood Pressure and if this info was not provided earlier, TPA action is justified. In fact, it is good on their part that they have given youalmost 60% of your expenses. However, many times either the agent misguides or our ignorance plays a role but to save on few Rs of Premium, such things are not disclosed to Insurance companies. But still I think since you are a loyal customer for several years, you should contest this decision first by escalating it to higher authorities in Insurance company [See their web-site], if no response, you can file a case in consumer court, if not satisfied.