| 6- Senior Citizens Mediclaim Policies - The New India Assurance Co. Ltd. |
|
| Whereas the Insured named in the Schedule has by a Proposal and declaration, which shall be the basis of this Contract and is deemed to be incorporated herein, has applied to THE NEW INDIA ASSURANCE COMPANY LTD. (hereinafter called the COMPANY) for Senior Citizens Mediclaim Insurance in respect of person(s) named in the Schedule hereto (hereinafter called the INSURED PERSONS) and has paid premium as consideration for such insurance, |
|
| 1.0 Coverage: NOW THIS POLICY WITNESSES that subject to the terms, conditions, exclusions and definitions contained herein or endorsed or otherwise expressed hereon, the Company undertakes that, if during the period stated in the Schedule or during the continuance of this policy by renewal, any Insured Person shall contract any disease or suffer from any illness (hereinafter called DISEASE) or sustain any bodily injury through accident (hereinafter called INJURY) and if such disease or injury shall require any such Insured Person, upon the advise of a duly qualified Physician / Medical Specialist / Medical Surgeon (hereinafter called SURGEON) to incur Hospitalisation Expenses ( herein defined) for medical / surgical treatment at Nursing Home / Hospital in India (hereinafter called Hospital / Nursing Home/ Day-Care Centre) as an inpatient, the TPA will pay to the Hospital /Nursing Home/ Day Care Centre, or reimburse the insured person the expenses listed in 2.1 to 2.6 below that are necessarily incurred in the treatment of such disease or injury but not exceeding in any one period of insurance the amount stated hereunder. |
|
| 2.0 SCOPE OF COVER |
|
Hospitalisation Expenses
In the event of a claim becoming admissible, the Company will pay the expenses listed below that are reasonably and necessarily incurred by or on behalf of such Insured Person but not exceeding, in aggregate, the Sum Insured mentioned in the Schedule. |
|
| 2.10 |
|
| |
Hospitalisation Benefits |
Limits |
| A |
(i) Room, Boarding expenses charged by the Hospital/ Nursing Home
(ii) If admitted in IC Unit |
Up to 1% of Sum Insured per day
Up to 2% of Sum Insured Per day Overal limit: 25% if the Sum Insured. |
| B |
Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses |
Overall limit: 25% of Sum Insured |
| C |
Anesthesia, Blood, Oxygen, OT charges, Surgical appliances, Medicines, Drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Stents & Implants |
Overall limit 50% of Sum Insured |
|
|
| 2.1.1Claims in respect of the following illnesses / operations, will be subject to the following limits: |
|
| Name of Illness / Operation |
Maximum Charges Inclusive of Room/ ICU/OT Charges/ Surgeons. Anesthetist, doctors fees, medicines, internal appliances and other charges incurred during hospitalisation period |
| Cataract with imported foldable lens |
10000/- |
| Hysterectomy |
22000/- |
| Appendicectomy |
16000/- |
| Cholecystectomy |
18000/- |
| Prostate |
18000/- |
| Hemia- Inguinal |
16000/- |
| Hernia- Ventral / Incisional |
20000/- |
| Septoplasty |
9000/- |
| Haemarrhoidcctomy |
8000/- |
| Fissurectomy |
9000/- |
| Fistulectomy |
10000/- |
| Angiography |
12000/- |
| Tonsillectomy |
7000/- |
| Tympanoplasty |
13000/- |
| Kidney stone/ lithotripsy |
13000/- |
| Arthoscopy |
10000/- |
| PID-Disectomy |
31000/- |
| Mastectomy (Radical) |
36000/- |
| Exploratory Laprotomy |
18000/- |
|
|
2.2 Actual pre-hospitalisation medical charges of up to 30 days period immediately before the insured’s admission to hospital for that illness, subject to maximum 5% of hospital bill.
2.3 Actual post-hospitalisation medical charges of up to 60 days period immediately after the insured’s discharge from a hospital for that illness or injury, subject to maximum of 10% of hospital bill.
2.4 Expenses incurred for Ayurvedic/Homeopathic/Unani Treatment subject to a maximum limit of 25% of the sum insured per illness, provided the treatment is taken in a Government Hospital.
2.5 Ambulance charges, subject to a maximum of Rs. 1000/-
2.6 Hospitalisation Expenses (excluding cost of organ) incurred on the donor during the course of organ transplant to the Insured. The Company’s liability towards expenses incurred on the donor and the Insured recipient together shall not exceed the sum insured of the latter |
|
|
|
|
