{"uin":"NIAHLIP25041V032425","name":"Tertiary Care Insurance(Individual) (Cashless Facility Available)","url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425","insurer":{"slug":"new-india-assurance","name":"The New India Assurance Company Limited","url":"https://indiainsurances.com/insurer/new-india-assurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"Tertiary Care Insurance - Individual is an indemnity health policy with individual sum insured for listed major illness or injury hospitalisation and domiciliary treatment in India. It has a 30-day initial waiting period, a 36-month pre-existing disease waiting period, a 60-month moratorium, cashless service available, and a cumulative bonus of 5% for each claim-free policy period.","analysis":{"state":"machine","analysed_at":"2026-10-19 21:59:53.320029+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"No named plan variants are stated in the provided documents.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"One policy year, as mentioned in the schedule.","display":"one policy year","note":null,"quote":"POLICY PERIOD means period of one policy year as mentioned in the schedule for which the Policy is issued","sources":[{"clause":"2.43","heading":"POLICY PERIOD","page":9,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-43"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"Notice with full particulars must be sent within 7 days from the date of injury, hospitalisation or domiciliary hospitalisation. The preliminary notice of claim should include policy number, insured person's name, nature of major illness or injury and attending medical practitioner or hospital details.","display":"Within 7 days from the date of Injury, Hospitalisation / Domiciliary Hospitalisation","note":null,"quote":"Upon the happening of any event which may give rise to a claim under this Policy notice with full particulars shall be sent to the Company within 7 days from the date of Injury, Hospitalisation / Domiciliary Hospitalisation. ... Preliminary notice of claim with particulars relating to Policy Numbers, Name of insured person in respect of whom claim is made, Nature of major Illness / Injury and Name and Address of the attending Medical Practitioner/Hospital should be given to the Insurance Company/TPA within seven days from the date of Hospitalisation/Injury/Death.","sources":[{"clause":"5.11","heading":"Upon the happening of any event which may give rise to a claim under this Policy notice","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-11"},{"clause":"5.16","heading":"NOTICE OF CLAIM: Preliminary notice of claim with particulars relating to Policy","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-16"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Bill, Receipt and Discharge certificate / card from the Hospital","Cash Memos from the Hospitals (s) / Chemists (s), supported by proper prescriptions","Receipt and Pathological test reports from Pathologist supported by the note from the attending Medical Practitioner / Surgeon recommending such Pathological tests / pathological","Surgeon's certificate stating nature of operation performed and Surgeons’ bill and receipt","Attending Doctor's / Consultant's / Specialist's / Anesthetist’s bill and receipt, and certificate regarding diagnosis","Certificate from attending Medical Practitioner / Surgeon that the patient is fully cured","all original bills, receipts and other documents upon which a claim is based","such additional information and assistance as the Company may require"],"display":"Hospital bill, receipts, discharge certificate/card, cash memos with prescriptions, test reports, surgeon and doctor bills/certificates, cured certificate, originals and any additional information required","note":null,"quote":"Final claim along with documents as listed below should be submitted to the company within 30 days of discharge from the Hospital:\ni) Bill, Receipt and Discharge certificate / card from the Hospital.\nii) Cash Memos from the Hospitals (s) / Chemists (s), supported by proper prescriptions.\niii) Receipt and Pathological test reports from Pathologist supported by the note from the attending Medical Practitioner / Surgeon recommending such Pathological tests / pathological.\niv) Surgeon's certificate stating nature of operation performed and Surgeons’ bill and receipt.\nv) Attending Doctor's / Consultant's / Specialist's / Anesthetist’s bill and receipt, and certificate regarding diagnosis.\nvi) Certificate from attending Medical Practitioner / Surgeon that the patient is fully cured. ... The Insured Person shall obtain and furnish the Company with all original bills, receipts and other documents upon which a claim is based and shall also give the Company such additional information and assistance as the Company may require in dealing with the claim.","sources":[{"clause":"5.12","heading":"Final claim along with documents as listed below should be submitted to the company","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-12"},{"clause":"5.13","heading":"The Insured Person shall obtain and furnish the Company with all original bills, receipts","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-13"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"Claims other than cashless shall be settled within fifteen days from submission of claim. If payment is delayed, interest is payable from the date of receipt of the last necessary document to the date of payment at 2% above the bank rate.","display":"Within fifteen days from submission of claim; delay interest from last necessary document at 2% above the bank rate","note":null,"quote":"Settlement of claims (other than cashless) shall be settled within fifteen days from submission of claim. ... In the case of delay in the payment of a claim, We shall be liable to pay interest from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.","sources":[{"clause":"5.17(i)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-17-i"},{"clause":"5.17(c)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-17-c"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months","Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident","Expenses related to any admission primarily for diagnostics and evaluation purposes","Expenses for cosmetic or plastic surgery or any treatment to change appearance","Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof","Dietary supplements and substances that can be purchased without prescription","Bodily Injury or Illness due to willful or deliberate exposure to danger","intentional self-inflicted Injury and attempted suicide","Nuclear, chemical or biological attack or weapons","War (whether declared or not) and war like occurrence","Treatment taken outside the geographical limits of India","Stem cell implantation/Surgery for other than those treatments mentioned in clause h.7","All other conditions not defined as major Illness / Injury in this policy"],"display":"PED for 36 months; first 30 days illness; diagnostics/evaluation; cosmetic/plastic surgery; alcohol/drug abuse; non-prescription supplements; wilful exposure; self-inflicted injury/attempted suicide; nuclear/chemical/biological attack; war; treatment outside India; other stem cell surgery; conditions not defined as major illness/injury","note":null,"quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months ... Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident ... Expenses related to any admission primarily for diagnostics and evaluation purposes. ... Expenses for cosmetic or plastic surgery or any treatment to change appearance ... Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. (Code- Excl12) ... Dietary supplements and substances that can be purchased without prescription ... Bodily Injury or Illness due to willful or deliberate exposure to danger ... intentional self-inflicted Injury and attempted suicide. ... Nuclear, chemical or biological attack or weapons ... War (whether declared or not) and war like occurrence ... Treatment taken outside the geographical limits of India ... Stem cell implantation/Surgery for other than those treatments mentioned in clause h.7 ... All other conditions not defined as major Illness / Injury in this policy.","sources":[{"clause":"4.1","heading":"PRE-EXISTING DISEASES (Code- Excl01)","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-1"},{"clause":"4.2","heading":"FIRST THIRTY DAYS WAITING PERIOD (Code- Excl03)","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-2"},{"clause":"4.3","heading":"INVESTIGATION & EVALUATION (Code- Excl04)","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-3"},{"clause":"4.4","heading":"COSMETIC OR PLASTIC SURGERY (Code- Excl08)","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-4"},{"clause":"4.5","heading":"Treatment for, Alcoholism, drug or substance abuse or any addictive condition and","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-5"},{"clause":"4.6","heading":null,"page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-6"},{"clause":"4.7","heading":"Bodily Injury or Illness due to willful or deliberate exposure to danger (except in an","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-7"},{"clause":"4.8","heading":"Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-8"},{"clause":"4.9","heading":"War (whether declared or not) and war like occurrence or invasion, acts of foreign","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-9"},{"clause":"4.10","heading":"Treatment taken outside the geographical limits of India","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-10"},{"clause":"4.11","heading":"Stem cell implantation/Surgery for other than those treatments mentioned in clause h.7","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-11"},{"clause":"4.12","heading":null,"page":14,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-12"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"For a grievance relating to the insurance, contact any of the Grievance Cells at the Company's Regional Offices. The policy also refers to the Insurance Ombudsman and gives a senior citizen email address.","display":"Grievance Cells at Regional Offices of the Company","note":null,"quote":"In the event of Insured person having any grievance relating to the insurance, he/she may contact any of the Grievance Cells at Regional Offices of the Company or Office of the Insurance Ombudsman under the jurisdiction of which the Policy Issuing Office falls. ... Senior Citizens may write to seniorcitizencare.ho@newindia.co.in","sources":[{"clause":"5.7","heading":"GRIEVANCE REDRESSAL: In the event of Insured person having any grievance relating","page":16,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-7"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"not-stated","value":null,"display":null,"note":"The policy says the sum insured is shown in the Schedule, but the documents provided do not state selectable sum insured options.","quote":null,"sources":[],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply to accident claims, provided they are covered; does not apply if the insured person has continuous coverage for more than twelve months.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":"4.2","heading":"FIRST THIRTY DAYS WAITING PERIOD (Code- Excl03)","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-2"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"quote-verified","value":{"unit":"months","amount":36},"display":"36 months","note":"For an enhanced sum insured, the exclusion applies afresh to the extent of the increase; prior continuous coverage under portability norms reduces the waiting period.","quote":"Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with us.","sources":[{"clause":"4.1","heading":"PRE-EXISTING DISEASES (Code- Excl01)","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-1"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["Genetic diseases or disorders","Congenital Internal Disease or Defects or anomalies","Congenital External Disease or Defects or anomalies"],"display":"Genetic diseases or disorders; Congenital Internal Disease or Defects or anomalies; Congenital External Disease or Defects or anomalies","note":null,"quote":"Genetic diseases or disorders are covered with a sub-limit of 25% of Sum Insured per policy period with 36 months waiting periods. ... Congenital Internal Disease or Defects or anomalies shall be covered after Twenty- F o u r months of Continuous Coverage. Congenital External Disease or Defects or anomalies shall be covered after Thirty-Six months of Continuous Coverage","sources":[{"clause":"3.0(I)(g)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-g"},{"clause":"3.0(I)(i)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-i"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced sums insured, sixty continuous months applies from the date of enhancement only on the enhanced limit.","quote":"After completion of sixty continuous months of coverage (including portability and migration in health insurance policy), no policy and claim shall be contestable by the insurer on grounds of non-disclosure , mis-representation except on grounds of established fraud . This period of sixty continuous months is called as Moratorium period.","sources":[{"clause":"5.8","heading":"MORATORIUM PERIOD: After completion of sixty continuous months of coverage","page":16,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-8"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The policy can be ported to other insurers by applying at least 30 days before, but not earlier than 60 days from, the policy renewal date; credits for sum insured, no claim bonus, specific waiting period for pre-existing diseases and moratorium period can be transferred if continuously covered without lapses.","display":"Can port to other insurers, applying at least 30 days before but not earlier than 60 days from renewal date","note":null,"quote":"You will have the option to port the policy to other Insurers by applying to such Insurer to port the entire policy along with all the members of the family, if any, at-least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability. ... policyholder can transfer the credit gained to the extent of the sum insured, no claim bonus, specific waiting period for pre-existing diseases, moratorium period etc. from the existing insurer to the acquiring insurer in the previous policy.","sources":[{"clause":"5.6","heading":"PORTABILITY AND MIGRATION","page":16,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-6"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"not-stated","value":null,"display":null,"note":"The wording states ordinary renewability except on fraud or misrepresentation, but does not state lifelong renewal or absence of a maximum renewal age.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"No loading applies on renewal based on individual claims experience, and renewal shall not be denied because the insured person made a claim in preceding policy years.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"Renewal shall not be denied on the ground that the insured person had made a claim or claims in the preceding policy years. ... No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"5.4","heading":"RENEWAL CLAUSE","page":15,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The policyholder may cancel at any time during the term by giving 7 days' written notice. For terms up to one year, proportionate premium for the unexpired policy period is refunded if no claim is made; no refund is made where any claim has been admitted or lodged or any benefit availed.","display":"7 days’ notice; proportionate premium for unexpired period if term up to one year and no claim","note":"For policies with term more than 1 year, premium for unexpired policy years is refunded where risk coverage for those policy years has not commenced.","quote":"The policyholder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. ... refund proportionate premium for unexpired policy period, if the term of policy up to one year and there is no claim (s) made during the policy period. ... no refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed by the insured person under the policy.","sources":[{"clause":"5.3","heading":"CANCELLATION CLAUSE","page":14,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-3"},{"clause":"5.3(a)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-3-a"},{"clause":"5.3(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-3-b"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"Coverage is in India only; treatment outside the geographical limits of India is excluded.","display":"India only","note":null,"quote":"Hospitalisation expenses for medical/surgical treatment at any Hospital in India ... On Domiciliary treatment in India under Domiciliary Hospitalisation ... Treatment taken outside the geographical limits of India","sources":[{"clause":"3.0(I)(a)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-a"},{"clause":"3.0(I)(b)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-b"},{"clause":"4.10","heading":"Treatment taken outside the geographical limits of India","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-10"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Applicable on new individual health insurance policies, except policies of less than a year, renewals, or porting/migrating.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.\nA period of 30 days (from the date of receipt of the policy document) is available to the policyholder to review the terms and conditions of the policy.","sources":[{"clause":"5.5","heading":"FREE LOOK PERIOD","page":15,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-5"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":15},"display":"15 days for monthly mode; 30 days in all other cases","note":"The renewal clause also says the policy can be renewed within the Grace Period of 30 days to maintain continuity of benefits.","quote":"The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases.","sources":[{"clause":"2.11","heading":"GRACE PERIOD","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-11"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state the youngest or oldest entry age.","quote":null,"sources":[],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"The grace-period definition refers to monthly and other payment modes, but the provided documents do not state which premium payment modes are available for this product.","quote":null,"sources":[],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["boarding and lodging expenses in the hospital for one of the family members or next of kin who accompanies the Insured Person during the period of Hospitalisation"],"display":"Optional additional cover: up to Rs. 500/- per week for boarding and lodging of one accompanying family member or next of kin, for up to 52 weeks","note":"This optional cover is available by endorsement and subject to payment of additional premium.","quote":"In consideration of the payment of additional premium amounting to Rs. ... expenses not exceeding Rs. 500/- per week shall be reimbursed towards the boarding and lodging expenses in the hospital for one of the family members or next of kin who accompanies the Insured Person during the period of Hospitalisation. The weekly compensation shall not be payable for more than 52 weeks in respect of any one covered major Illness / Injury / policy period.","sources":[{"clause":null,"heading":"ENDORSEMENT FOR ADDITIONAL COVER","page":20,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-endorsement-for-additional-cover"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Coverage is not available during the grace period for which no premium is received.","display":"Coverage is not available during the Grace Period","note":null,"quote":"Coverage is not available during the period for which no premium is received. ... Coverage is not available during the Grace Period.","sources":[{"clause":"2.11","heading":"GRACE PERIOD","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-11"},{"clause":"5.4","heading":"RENEWAL CLAUSE","page":15,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-4"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"quote-verified","value":"Room and boarding expenses are covered, and the CIS states sub-limit/co-payment/deductible/any other limit as applicable is not applicable. Overall liability for all claims is limited to the sum insured with cumulative bonus.","display":"No separate room-rent sub-limit stated; room and boarding expenses covered subject to sum insured","note":"Policy wording is silent on a daily rupee room-rent cap or room type.","quote":"Room, Boarding Expenses as provided by the Hospital which includes Registration & Admission Fees. ... Company’s Liability in respect of all claims admitted during the period of insurance shall not exceed the Sum Insured (with Cumulative Bonus) per person per annum ... Sub-limit/ Co- Payment/ Deductible/ Any Other limit as applicable | Not Applicable","sources":[{"clause":"3.0(I)(c)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-c"},{"clause":"Row 8","heading":"Financial Limit of Coverage","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-row-8"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state a permitted room category such as shared room or single private room.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state a separate ICU per-day limit.","quote":null,"sources":[],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state a proportionate deduction for choosing a room above an allowed limit.","quote":null,"sources":[],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"quote-verified","value":"Not applicable.","display":"Co-Payment: Not Applicable","note":"The policy wording itself does not state a co-payment percentage.","quote":"Sub-limit/ Co- Payment/ Deductible/ Any Other limit as applicable | Not Applicable","sources":[{"clause":"Row 8","heading":"Financial Limit of Coverage","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-row-8"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"quote-verified","value":"Not applicable.","display":"Deductible: Not Applicable","note":"The policy wording contains only a standard definition of deductible and does not state any product deductible.","quote":"Sub-limit/ Co- Payment/ Deductible/ Any Other limit as applicable | Not Applicable","sources":[{"clause":"Row 8","heading":"Financial Limit of Coverage","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-row-8"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"conflicting","value":["Artificial life maintenance, including life support machine use: up to 10% of Sum Insured and maximum 15 days per policy period","Genetic diseases or disorders: sub-limit of 25% of Sum Insured per policy period with 36 months waiting periods","Congenital External Disease or Defects or anomalies: limited to 10% of the average Sum Insured in the preceding three years","Deep Brain stimulation: Up to 10% of Sum Insured","Oral chemotherapy: Up to 10% of Sum Insured","Immunotherapy- Monoclonal Antibody to be given as injection: Up to 10% of Sum Insured","Robotic surgeries: Up to 10% of Sum Insured","Stereotactic radio surgeries: Up to 10% of Sum Insured","IONM - (Intra Operative Neuro Monitoring): Up to 10% of Sum Insured","Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered: Up to 10% of Sum Insured","Treatment for any symptoms, Illness, complications arising due to physiological conditions for which aetiology is unknown: Sub-Limit of upto 10% of Sum Insured per policy period","Failure to seek or follow medical advice or failure to follow treatment: sub-limit of 10% of Sum Insured per policy period"],"display":"Policy sub-limits include 10% of SI for artificial life maintenance, modern treatments and specified conditions; 25% of SI for genetic diseases; 10% of average preceding 3-year SI for congenital external disease","note":"Policy wording states these sub-limits. CIS says: 'Sub-limit/ Co- Payment/ Deductible/ Any Other limit as applicable | Not Applicable'.","quote":"Artificial life maintenance, including life support machine use ... is covered up to 10% of Sum Insured and for a maximum of 15 days per policy period ... Genetic diseases or disorders are covered with a sub-limit of 25% of Sum Insured per policy period with 36 months waiting periods. ... Congenital External Disease or Defects or anomalies shall be covered after Thirty-Six months of Continuous Coverage, but such cover for Congenital External Disease or Defects or anomalies shall be limited to 10% of the average Sum Insured in the preceding three years. ... Deep Brain stimulation. | Up to 10% of Sum Insured\nh.2 | Oral chemotherapy. | Up to 10% of Sum Insured\nh.3 | Immunotherapy- Monoclonal Antibody to be given as injection. | Up to 10% of Sum Insured\nh.4 | Robotic surgeries. | Up to 10% of Sum Insured\nh.5 | Stereotactic radio surgeries. | Up to 10% of Sum Insured\nh.6 | IONM - (Intra Operative Neuro Monitoring). | Up to 10% of Sum Insured\nh.7 | Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered. | Up to 10% of Sum Insured ... Treatment for any symptoms, Illness, complications arising due to physiological conditions for which aetiology is unknown is not excluded. It is covered with a Sub-Limit of upto 10% of Sum Insured per policy period. ... Failure to seek or follow medical advice or failure to follow treatment is not excluded. It is covered with a sub-limit of 10% of Sum Insured per policy period.","sources":[{"clause":"3.0(I)(f)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-f"},{"clause":"3.0(I)(g)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-g"},{"clause":"3.0(I)(i)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-i"},{"clause":"3.0(I)(h)","heading":"COVERAGE FOR MODERN TREATMENTS or PROCEDURES","page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-h"},{"clause":"4.3","heading":"INVESTIGATION & EVALUATION (Code- Excl04)","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-3"},{"clause":"4.7","heading":"Bodily Injury or Illness due to willful or deliberate exposure to danger (except in an","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-4-7"},{"clause":"Row 8","heading":"Financial Limit of Coverage","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-row-8"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":null,"quote":"PRE-HOSPITALISATION MEDICAL EXPENSES mean Medical Expenses incurred during 30 days immediately before the Insured Person is Hospitalised, provided that:\ni) Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required, and\nii) The Inpatient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company.","sources":[{"clause":"2.27","heading":"PRE-HOSPITALISATION MEDICAL EXPENSES mean Medical Expenses incurred during 30","page":8,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-27"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"60days","note":null,"quote":"POST-HOSPITALISATION MEDICAL EXPENSES mean Medical Expenses incurred during 60days immediately after the Insured Person is discharged from the Hospital provided that:\ni) Such Medical Expenses are incurred for the same condition for which the Insured Person’s Hospitalisation was required, and\nii) The Inpatient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company.","sources":[{"clause":"2.28","heading":"POST-HOSPITALISATION MEDICAL EXPENSES mean Medical Expenses incurred during","page":8,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-28"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"The policy covers specified procedures/treatments that may require less than twenty-four hours, including Dialysis, Chemotherapy and Radiotherapy, and the listed modern treatments when medically indicated either as inpatient or as day care treatment. Treatment normally taken on an out-patient basis is not included.","display":"Specified day-care treatments covered; OPD not included","note":"The modern treatment list is Deep Brain stimulation, Oral chemotherapy, Immunotherapy- Monoclonal Antibody, Robotic surgeries, Stereotactic radio surgeries, IONM, and specified hematopoietic stem cell therapy.","quote":"HOSPITALISATION means admission in a Hospital for a minimum period of twenty-four In-patient Care consecutive hours except for specified procedures / treatments i.e. Dialysis, Chemotherapy, Radiotherapy; where such admission could be for a period of less than twenty-four consecutive hours. ... The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to the limit specified against each procedure during the policy period. ... Treatment normally taken on an out-patient basis is not included in the scope of this definition.","sources":[{"clause":"2.13","heading":"HOSPITALISATION","page":3,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-13"},{"clause":"3.0(I)(h)","heading":"COVERAGE FOR MODERN TREATMENTS or PROCEDURES","page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-h"},{"clause":null,"heading":"2.8DAY CARE TREATMENT","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-8day-care-treatment"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary treatment in India is covered under domiciliary hospitalisation where the illness, disease or injury would normally require hospital care but treatment is taken at home because the patient cannot be removed to hospital or because of non-availability of a room.","display":"Covered in India under Domiciliary Hospitalisation","note":"Only for covered major illness/injury under the policy.","quote":"DOMICILIARY HOSPITALISATION: Domiciliary Hospitalisation means medical treatment for an Illness/disease/Injury which in the normal course would require care and treatment at a Hospital but is actually taken while confined at home under any of the following circumstances:\n- The condition of the patient is such that he/she is not in a condition to be removed to a Hospital, or\n- The patient takes treatment at home on account of non-availability of room in a hospital. ... On Domiciliary treatment in India under Domiciliary Hospitalisation (herein defined), the Company will pay to the Insured Person the amount of such expenses as are Reasonable and Customary, and Medically Necessary incurred in respect thereof by or on behalf of such Insured Person.","sources":[{"clause":"2.10","heading":"DOMICILIARY HOSPITALISATION: Domiciliary Hospitalisation","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-10"},{"clause":"3.0(I)(b)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-b"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"Expenses for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems are covered up to 100% of the sum insured during each policy year as specified in the policy schedule.","display":"AYUSH covered up to 100% of the Sum Insured during each policy year","note":null,"quote":"COVERAGE UNDER AYUSH TREATMENT Expenses incurred for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy system of medicines is covered up to 100% of the Sum Insured during each policy year as specified in the policy schedule.","sources":[{"clause":"3.0(I)(j)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-j"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"quote-verified","value":"Seven modern treatments/procedures are covered where medically indicated, either as inpatient or day care treatment in a hospital, each up to 10% of the sum insured per policy period.","display":"Deep Brain stimulation, Oral chemotherapy, Immunotherapy, Robotic surgeries, Stereotactic radio surgeries, IONM and specified Stem cell therapy: each up to 10% of Sum Insured","note":null,"quote":"COVERAGE FOR MODERN TREATMENTS or PROCEDURES: The following procedures will be covered (wherever medically indicated) either as in patient or as part of day care treatment in a hospital up to the limit specified against each procedure during the policy period.\nS No | Treatment or Procedure | Limit (Per Policy Period)\nh.1 | Deep Brain stimulation. | Up to 10% of Sum Insured\nh.2 | Oral chemotherapy. | Up to 10% of Sum Insured\nh.3 | Immunotherapy- Monoclonal Antibody to be given as injection. | Up to 10% of Sum Insured\nh.4 | Robotic surgeries. | Up to 10% of Sum Insured\nh.5 | Stereotactic radio surgeries. | Up to 10% of Sum Insured\nh.6 | IONM - (Intra Operative Neuro Monitoring). | Up to 10% of Sum Insured\nh.7 | Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered. | Up to 10% of Sum Insured","sources":[{"clause":"3.0(I)(h)","heading":"COVERAGE FOR MODERN TREATMENTS or PROCEDURES","page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-h"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"quote-verified","value":"Hospitalisation expenses reasonably, customarily and medically necessarily incurred on a person donating an organ to the insured person during an organ transplant operation are covered, subject to limits available during the policy period.","display":"Donor hospitalisation expenses covered subject to limits available during the policy period","note":null,"quote":"Hospitalisation expenses, which are Reasonable and Customary, and Medically Necessarily incurred on person donating the organ to the insured person during the course of organ transplant operation subject to limits available during the policy period.","sources":[{"clause":"3.0(I)(e)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-e"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Reasonable expenses for ambulance within city limits are covered at the time of admission and discharge only.","display":"Ambulance within city limits at admission and discharge only","note":null,"quote":"Reasonable expenses incurred for ambulance within city limits at the time of admission and discharge only.","sources":[{"clause":"3.0(I)(c)","heading":null,"page":10,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-3-0-i-c"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state any restoration or refill of sum insured after use.","quote":null,"sources":[],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"The sum insured increases by 5% for each claim-free policy period, up to a maximum accumulation of 10 claim-free years. After a claim, the increased percentage is reduced by 5% of sum insured at the next period of insurance or renewal, while the basic sum insured is maintained.","display":"5% per claim-free Policy Period, maximum 10 claim-free years; reduced by 5% after a claim","note":"The policy also offers an option of premium discount at renewal in lieu of accrued cumulative bonus.","quote":"CUMULATIVE BONUS: Sum insured under the policy shall be progressively increased by 5% in respect of each claim free Policy Period, subject to maximum accumulation of 10 claim-free years of insurance. ... In case of a claim under the policy in respect of insured person who has earned the cumulative bonus the increased percentage will be reduced by 5%of sum insured at the next period of insurance in case of long-term policies (or renewal in case of annual policies). However, basic sum insured will be maintained and will not be reduced.\nCumulative bonus will be lost if policy is not renewed on or within 30 days from the date of expiry of this policy.","sources":[{"clause":"5.19","heading":"CUMULATIVE BONUS: Sum insured under the policy shall be progressively increased by","page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-19"},{"clause":"5.20","heading":"In case of a claim under the policy in respect of insured person who has earned the","page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-20"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"Items in List I are not covered, including non-medical and consumable items such as gloves, masks and nebulisation kit. Some items are to be subsumed into room charges, procedure charges or costs of treatment as listed in Annexure I.","display":"List I items not covered; other listed items subsumed into room/procedure/treatment costs","note":null,"quote":"The expenses that are not covered in this policy are placed under List-I of Annexure-I. The list of expenses that are to be subsumed into room charges, or procedure charges or costs of treatment are placed under List-II, List-III and List-IV of Annexure-I respectively. ... List I – Items for which coverage is not available in the policy ... 56 | GLOVES\n57 | NEBULISATION KIT ... 60 | MASK","sources":[{"clause":"5.24","heading":null,"page":19,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-24"},{"clause":"Annexure I","heading":null,"page":21,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-annexure-i"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state maternity or childbirth cover.","quote":null,"sources":[],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state newborn baby cover.","quote":null,"sources":[],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state inpatient treatment cover for mental illness.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"quote-verified","value":"The insured is entitled to reimbursement of the cost of medical check-up once at the end of every block of four policy periods, provided there are no claims during the block, up to 1% of the average sum insured during that block.","display":"Once at the end of block of every four Policy Periods, if no claims; up to 1% of average Sum Insured","note":null,"quote":"the insured shall be entitled for reimbursement of cost of medical check-up once at the end of block of every four Policy Periods provided there are no claims reported during the block. The cost so reimbursable shall not exceed the amount equal to 1 % of the average Sum Insured during the block of four continuous claims free Policy Periods. ... Health Check-up benefit will be accrued after completion of four years continuous claim free insurance.","sources":[{"clause":"5.21","heading":"COST OF HEALTH CHECK-UP: In addition to cumulative bonus, the insured shall be","page":19,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-21"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD treatment is not covered; treatment normally taken on an outpatient basis is not included, and procedures or treatments usually done in the outpatient department are not payable even if converted to inpatient for more than twenty-four hours.","display":"OPD not payable","note":null,"quote":"Treatment normally taken on an out-patient basis is not included in the scope of this definition. ... Procedures/treatments usually done in outpatient department are not payable under the Policy even if converted as an in-patient in the Hospital for more than twenty-four consecutive hours.","sources":[{"clause":null,"heading":"2.8DAY CARE TREATMENT","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-8day-care-treatment"},{"clause":null,"heading":"Note","page":3,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-note"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":"The provided documents do not state zone or city-based premium or co-pay.","quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless service is available, where the insurer pays the network provider directly to the extent of pre-authorisation approved. Network hospital details are available on the website and policy schedule.","display":"Cashless Service and Reimbursement-Available; network hospital details on website and policy schedule","note":null,"quote":"CASHLESS FACILITY means a facility extended by Us to You where the payments, of the costs of treatm0ent undergone by You in accordance with the policy terms and conditions, are directly made to the Network provider by Us to the extent of pre-authorization approved. ... Cashless Service and Reimbursement-Available ... Network hospital details-Available on website and on policy schedule","sources":[{"clause":"2.4","heading":"CASHLESS FACILITY","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-2-4"},{"clause":null,"heading":"CUSTOMER INFORMATION SHEET/KNOW YOUR POLICY","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-customer-information-sheet-know-your-policy-2"},{"clause":"Row 9(i)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-row-9-i"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims may be notified to the Insurance Company/TPA, and hospitalisation claim documents are to be furnished to the TPA as mentioned in the schedule.","display":"Insurance Company/TPA; TPA as mentioned in the Schedule","note":null,"quote":"Preliminary notice of claim with particulars relating to Policy Numbers, Name of insured person in respect of whom claim is made, Nature of major Illness / Injury and Name and Address of the attending Medical Practitioner/Hospital should be given to the Insurance Company/TPA within seven days from the date of Hospitalisation/Injury/Death. ... All necessary claim documents pertaining to Hospitalisation should be furnished by the Insured Person in original to the TPA (as mentioned in the Schedule), within seven days from the date of discharge from the Hospital.","sources":[{"clause":"5.16","heading":"NOTICE OF CLAIM: Preliminary notice of claim with particulars relating to Policy","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-16"},{"clause":"5.17(iii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476#c-5-17-iii"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":false,"display":"Individual Sum insured","note":"The provided CIS describes individual sum insured basis, not a shared family floater sum insured.","quote":"Name of the Insurance Product/Policy | TERTIARY CARE INSURANCE - INDIVIDUAL ... Sum Insured Basis | Individual Sum insured. Member name A – Sum insured name B – Sum insured","sources":[{"clause":"Row 1","heading":"Name of the Insurance Product/Policy","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-row-1"},{"clause":"Row 4","heading":"Sum Insured Basis","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472#c-row-4"}],"law":[]}],"documents":[{"kind":"wording","label":"Policy Clause Tertiary Care Policy - Individual","pages":25,"fetched_at":"2026-10-17 19:52:17+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/tertiary-care-insurance-individual/Policy%20Clause%20Tertiary%20Care%20Policy%20-%20Individual.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13476"},{"kind":"cis","label":"Customer Information Sheet Sheet","pages":3,"fetched_at":"2026-10-17 19:52:08+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/tertiary-care-insurance-individual/Customer%20Information%20Sheet%20TERTIARY%20CARE%20INSURANCE%20-%20INDIVIDUAL.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/13472"},{"kind":"premium","label":"Premium Table Tertiary Care Policy - Individual","pages":null,"fetched_at":"2026-10-17 19:51:14+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/tertiary-care-insurance-individual/Tertiary%20Care%20Insurance%20Premium%20Chart.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425/document/30476"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"New India Assurance official website","url":"https://www.newindia.co.in/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.newindia.co.in/grievance","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Tertiary Care Insurance(Individual) (Cashless Facility Available) (UIN NIAHLIP25041V032425), IndiaInsurances, https://indiainsurances.com/policy/new-india-assurance/tertiary-care-insurance-individual-cashless-facility-available-niahlip25041v032425"}