{"uin":"NIAHLIP25048V042425","name":"New India Premier Mediclaim Policy (Cashless facility available)","url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425","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":"New India Premier Mediclaim Policy is a health indemnity policy with Plan A and Plan B on individual or floater sum insured. It covers hospitalisation in India with 60 days pre-hospitalisation, 90 days post-hospitalisation, cashless at network hospitals, and sum insured options from Rs. 15,00,000 to Rs. 1,00,00,000.","analysis":{"state":"machine","analysed_at":"2026-10-19 21:58:16.748852+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":"quote-verified","value":["Plan A","Plan B"],"display":"Plan A and Plan B","note":null,"quote":"This Policy has two plans viz: ... a) Plan A: offers Sum Insured of Rs. 15,00,000 and 25,00,000. ... b) Plan B: offers Sum Insured of Rs. 50,00,000 and 100,00,000.","sources":[{"clause":"4","heading":"WHAT ARE THE PLANS OFFERED IN THIS POLICY?","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-4"},{"clause":"4(a)","heading":"Plan A","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-4-a"},{"clause":"4(b)","heading":"Plan B","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-4-b"}],"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":"The policy is valid for one year from inception.","display":"One year from the date of inception","note":"From the prospectus; the policy wording defines the policy period by reference to the Schedule.","quote":"The Policy is valid for a period of one year from the date of inception. The validity of the Policy will be mentioned in the Schedule attached to the Policy.","sources":[{"clause":"37","heading":"HOW LONG IS THE POLICY VALID?","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-37"}],"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":"For planned hospitalisation, intimate the TPA in writing immediately on detection of illness or injury or 48 hours before hospitalisation. For emergency hospitalisation, intimate the TPA within 24 hours from the time of hospitalisation.","display":"Planned: immediately or 48 hours before hospitalisation; emergency: within 24 hours from hospitalisation","note":null,"quote":"a) Intimate TPA in writing on detection of any Illness/Injury being suffered immediately or forty-eight hours before Hospitalisation. ... b) In case of Hospitalisation due to medical emergency, intimate TPA within twenty-four hours from the time of Hospitalisation.","sources":[{"clause":"5.5(a)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-5-a"},{"clause":"5.5(b)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-5-b"}],"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","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","all original bills, receipts and other documents upon which a claim is based","authorization to obtain medical and other records"],"display":"Hospital bills/receipts/discharge card, pharmacy cash memos with prescriptions, pathology reports with doctor’s note, surgeon’s certificate and bill, attending doctors’ bills and diagnosis certificate, originals and authorisation for records","note":"Hospitalisation claim documents are to be submitted within 7 days from discharge; post-hospitalisation documents within 7 days after completion of treatment.","quote":"c) Submit following supporting documents TPA relating to the claim within seven days from the date 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. ... e) Provide TPA with authorization to obtain medical and other records from any Hospital, Laboratory or other agency. ... You shall submit to the TPA all original bills, receipts and other documents upon which a claim is based","sources":[{"clause":"5.5(c)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-5-c"},{"clause":"5.5(e)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-5-e"},{"clause":"5.6","heading":null,"page":24,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-6"}],"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":"Reimbursement claims are to be settled within 15 days from submission of claim. After acceptance of the claim for settlement, payment of the admissible amount is to be made within 7 working days, which is stated to be part of a 30 days period for settlement of claim.","display":"Settlement within 15 days from submission of claim; payment within 7 working days after acceptance, part of 30 days period","note":null,"quote":"Settlement of claims (other than cashless) shall be settled within fifteen days from submission of claim. On receipt of the duly completed documents either from You or Hospital the claim shall be processed as per the conditions of the Policy. Upon acceptance of claim by You for settlement, we shall make payment of admissible amount within seven working days (which will be a part of thirty days period for settlement of Claim).","sources":[{"clause":"5.21","heading":"PAYMENT OF CLAIM","page":27,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-21"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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 grievances relating to the policy, contact the Grievance Cells at the Regional Offices of the Company. Senior citizens may write to seniorcitizencare.ho@newindia.co.in; the Insurance Ombudsman route is also mentioned.","display":"Company Regional Office Grievance Cells first; senior citizens: seniorcitizencare.ho@newindia.co.in","note":null,"quote":"In the event of Your having any grievance relating to this Policy, you may contact any of the Grievance Cells at the Regional Offices of the Company or Office of the Insurance Ombudsman under the jurisdiction of which the Policy Issuing Office falls. The contact details of the office of the Insurance Ombudsman are provided in the Annexure III. Senior Citizens may write to seniorcitizencare.ho@newindia.co.in","sources":[{"clause":"5.23","heading":"GRIEVANCE REDRESSAL","page":28,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-23"}],"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":"quote-verified","value":"Plan A offers Rs. 15,00,000 and Rs. 25,00,000. Plan B offers Rs. 50,00,000 and Rs. 100,00,000.","display":"Plan A: Rs. 15,00,000 and Rs. 25,00,000; Plan B: Rs. 50,00,000 and Rs. 100,00,000","note":"From the prospectus; the policy wording refers to the Sum Insured mentioned in the Schedule.","quote":"a) Plan A: offers Sum Insured of Rs. 15,00,000 and 25,00,000. ... b) Plan B: offers Sum Insured of Rs. 50,00,000 and 100,00,000.","sources":[{"clause":"4(a)","heading":"Plan A","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-4-a"},{"clause":"4(b)","heading":"Plan B","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-4-b"}],"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 if the insured person has Continuous Coverage for more than twelve months; applies afresh to enhanced sum insured.","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":18,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#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 enhancement of Sum Insured, the exclusion applies afresh to the increased Sum Insured; portability credit may reduce 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":17,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#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":"quote-verified","value":{"unit":"days","amount":90},"display":"90 Days","note":"The policy also has 24 Months and 36 Months waiting periods for listed conditions; not applicable for accident claims, and portability credit may reduce it.","quote":"i) 90 Days Waiting Period\n1. Diabetes Mellitus\n2. Hypertension\n3. Cardiac Conditions ... ii) 24 Months waiting period ... (iii) 36 Months waiting period","sources":[{"clause":"4.3(e)(i)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-e-i"},{"clause":"4.3(e)(ii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-e-ii"},{"clause":"4.3(b)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-b-2"}],"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":["Diabetes Mellitus","Hypertension","Cardiac Conditions","All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps","Benign ear, nose, throat disorders","Benign prostate hypertrophy","Cataract and age related eye ailments","Gastric/ Duodenal Ulcer","Gout and Rheumatism","Hernia of all types","Hydrocele","Non Infective Arthritis","Piles, Fissures and Fistula in anus","Pilonidal sinus, Sinusitis and related disorders","Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident","Renal Disorders","Skin Disorders","Stone in Gall Bladder and Bile duct, excluding malignancy","Stones in Urinary system","Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus","Varicose Veins and Varicose Ulcers","Puberty and Menopause related Disorders","Behavioural and Neuro-Developmental Disorders","Disorders of adult personality","Disorders of speech and language including stammering, dyslexia","Internal Congenital Diseases","Joint Replacement due to Degenerative Condition","Age-related Osteoarthritis & Osteoporosis","Treatment of mental illness, stress or psychological disorders and neurodegenerative disorders","Age Related Macular Degeneration (ARMD)","Genetic diseases or disorders","External Congenital Diseases"],"display":"90 days: Diabetes Mellitus, Hypertension, Cardiac Conditions. 24 months: listed benign tumours/cysts/polyps, ENT disorders, prostate hypertrophy, cataract/age-related eye ailments, ulcer, gout/rheumatism, hernia, hydrocele, arthritis, piles/fissures/fistula, pilonidal sinus/sinusitis, PIVD/spinal diseases, renal disorders, skin disorders, gall/bile stones, urinary stones, menorrhagia/fibromyoma/myoma/prolapsed uterus, varicose veins/ulcers, puberty/menopause disorders, behavioural/neuro-developmental disorders and internal congenital diseases. 36 months: joint replacement due to degenerative condition, age-related osteoarthritis/osteoporosis, mental illness/stress/psychological/neurodegenerative disorders, ARMD, genetic diseases/disorders and external congenital diseases.","note":null,"quote":"i) 90 Days Waiting Period\n1. Diabetes Mellitus\n2. Hypertension\n3. Cardiac Conditions ... ii) 24 Months waiting period\n1. All internal and external benign tumours, cysts, polyps of any kind, including benign breast lumps\n2. Benign ear, nose, throat disorders\n3. Benign prostate hypertrophy\n4. Cataract and age related eye ailments\n5. Gastric/ Duodenal Ulcer\n6. Gout and Rheumatism\n7. Hernia of all types\n8. Hydrocele\n9. Non Infective Arthritis\n10. Piles, Fissures and Fistula in anus\n11. Pilonidal sinus, Sinusitis and related disorders\n12. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident\n13. Renal Disorders\n14. Skin Disorders\n15. Stone in Gall Bladder and Bile duct, excluding malignancy\n16. Stones in Urinary system\n17. Treatment for Menorrhagia/Fibromyoma, Myoma and Prolapsed uterus\n18. Varicose Veins and Varicose Ulcers\n19. Puberty and Menopause related Disorders\n20. Behavioural and Neuro-Developmental Disorders: ... a) Disorders of adult personality ... b) Disorders of speech and language including stammering, dyslexia\n21. Internal Congenital Diseases ... (iii) 36 Months waiting period\n1. Joint Replacement due to Degenerative Condition\n2. Age-related Osteoarthritis & Osteoporosis\n3. Treatment of mental illness, stress or psychological disorders and neurodegenerative disorders.\n4. Age Related Macular Degeneration (ARMD)\n5. Genetic diseases or disorders\n6. External Congenital Diseases","sources":[{"clause":"4.3(e)(i)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-e-i"},{"clause":"4.3(e)(ii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-e-ii"},{"clause":"4.3(a)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-a-2"},{"clause":"4.3(b)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-b-2"}],"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 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":"5.16","heading":"MORATORIUM PERIOD","page":26,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-16"}],"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":"You may port the policy to another insurer by applying at least 30 days before, but not earlier than 60 days from, the policy renewal date. If continuously covered without lapses under a health insurance policy with an Indian General or Health Insurer, credit for sum insured, no claim bonus, specific waiting period for pre-existing diseases and moratorium period can be transferred to the acquiring insurer.","display":"Porting allowed to other insurers; apply at least 30 days before and 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. If policyholder is presently covered and has been continuously covered without any lapses under any Health Insurance policy with an Indian General or Health Insurer, then 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":"5.19","heading":"PORTABILITY","page":27,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-19"}],"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":"quote-verified","value":true,"display":"Yes, no age limit for renewal","note":"From the prospectus; the wording says renewal is ordinarily renewable except on grounds of fraud or misrepresentation.","quote":"No. Your Policy can be renewed, as long as you pay the Renewal Premium before the date of expiry of the Policy. There is an age limit for taking a fresh Policy, but there is no age limit for renewal.","sources":[{"clause":"41","heading":"IS THERE AN AGE LIMIT UPTO WHICH THE POLICY WOULD BE RENEWED?","page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-41"}],"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":"not-stated","value":null,"display":null,"note":null,"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 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":"You may cancel at any time during the term by giving 7 days’ written notice. If the policy term is up to one year and no claim has been made, the insurer refunds proportionate premium for the unexpired policy period; no refund is made if 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; no refund if any claim admitted/lodged/benefit availed","note":"For policies with term more than 1 year, refund is for unexpired policy years where risk coverage has not commenced.","quote":"The policyholder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. ... a) refunds 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":"5.12","heading":"CANCELLATION CLAUSE","page":25,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-12"},{"clause":"5.12(a)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-12-a"},{"clause":"5.12(b)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-12-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":"The policy covers only medical or surgical treatment taken in India, and treatment outside India is excluded.","display":"India only","note":null,"quote":"This Policy covers only medical/surgical treatment taken in India. Any expense incurred outside India would not be covered under this Policy. ... Treatment taken outside the geographical limits of India.","sources":[{"clause":"5.3","heading":"PLACE OF TREATMENT AND PAYMENT","page":22,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-3"},{"clause":"4.4.15","heading":null,"page":21,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-4-15"}],"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":"Applies to new individual health insurance policies, except policies of less than a year, renewals or at the time of 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. A 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":"5.13","heading":"FREE LOOK PERIOD","page":25,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-13"}],"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":30},"display":"30 days","note":"The product prospectus says the entire premium is payable at commencement; the definition states fifteen days where premium payment mode is monthly and thirty days in all other cases.","quote":"At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30 days to maintain continuity of benefits without break in policy. Coverage is not available during the Grace Period. ... 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":"5.10","heading":"RENEWAL CLAUSE","page":24,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-10"},{"clause":"2.15","heading":"GRACE PERIOD","page":6,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-2-15"}],"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":"quote-verified","value":"Fresh entry is for persons between 18 years and 65 years. Children between 3 months and 18 years are covered if one or both parents are covered concurrently; children 18 to 25 years can be covered if financially dependent and one or both parents are covered simultaneously.","display":"Adults: 18 years to 65 years; children: 3 months to 18 years with parent covered; dependent children: 18 years to 25 years","note":"From the prospectus; upper age limit does not apply to mentally challenged children and unmarried dependent daughter(s), and persons beyond 65 years can continue if already insured without break.","quote":"All the persons proposed for this Insurance should be between the age of 18 years and 65 years. Children between the age of 3 months and 18 years are covered provided one or both parents are covered concurrently. Children between 18 years to 25 years can be covered provided they are financially dependent on the parents and one or both parents are covered simultaneously.","sources":[{"clause":"1","heading":"WHO CAN TAKE THIS POLICY?","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["entire premium for the mentioned period will be payable at the commencement of the Policy period"],"display":"Entire premium payable at commencement of the Policy period","note":"The documents do not list monthly, quarterly or half-yearly payment options for this product.","quote":"The entire premium for the mentioned period will be payable at the commencement of the Policy period.","sources":[{"clause":"37","heading":"HOW LONG IS THE POLICY VALID?","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-37"}],"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":["Durable Medical Devices","Non - Medical Expenses","Modern Treatment Rider","Pre - Post Hospitalisation - 90 / 180 days","Critical Illness Benefit"],"display":"Extra riders: Durable Medical Devices; Non - Medical Expenses; Modern Treatment Rider; Pre - Post Hospitalisation - 90 / 180 days; Critical Illness Benefit","note":"From the lower-priority brochure; base policy fields are not answered from these riders.","quote":"EXTRA RIDERS FOR ENHANCEMENT OF COVER O Durable Medical Devices O Non - Medical Expenses O Modern Treatment Rider O Pre - Post Hospitalisation - 90 / 180 days O Critical Illness Benefit","sources":[{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13419#c-s1"}],"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.","display":"No coverage during the Grace Period","note":null,"quote":"At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30 days to maintain continuity of benefits without break in policy. Coverage is not available during the Grace Period.","sources":[{"clause":"5.10","heading":"RENEWAL CLAUSE","page":24,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-10"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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-applicable","value":null,"display":null,"note":"The room limit is not expressed as a room category; the documents state room rent and ICU expenses are actually incurred.","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":"quote-verified","value":"ICU/ICCU expenses are covered as actually incurred, subject to policy terms and the Sum Insured.","display":"Room Rent and ICU expenses actually incurred","note":"The wording lists Intensive Care Unit (ICU) / Intensive Cardiac Care Unit (ICCU) expense as reimbursable.","quote":"Room Rent and ICU expenses actually incurred.","sources":[{"clause":"Row 5","heading":"Policy Coverage (What Policy Covers?)","page":1,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13422#c-row-5"}],"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-applicable","value":null,"display":null,"note":"No room category or per-day room rent cap is stated; the CIS states room rent and ICU expenses are actually incurred.","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":"Co-payment is not applicable.","display":"Not Applicable","note":null,"quote":"ii.Co- Payment/ Deductible /Any Other limit as applicable | Not Applicable","sources":[{"clause":"Row 5(i)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13422#c-row-5-i"}],"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":"Deductible is not applicable.","display":"Not Applicable","note":null,"quote":"ii.Co- Payment/ Deductible /Any Other limit as applicable | Not Applicable","sources":[{"clause":"Row 5(i)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13422#c-row-5-i"}],"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":"quote-verified","value":["Cataract for each eye: Plan A Actual or Rs. 75,000, whichever is less; Plan B Actual or Rs. 1,00,000, whichever is less","Puberty and Menopause related Disorders: sub-limit of up to 25% of Sum Insured","Age Related Macular Degeneration (ARMD): sub- limit of Rs. 1,00,000 per policy period","Genetic diseases or disorders: sub-limit of 25% of Sum Insured per policy period","Psychiatric and Psychosomatic disorders: Plan B only, up to 5% of Sum Insured","Obesity treatment: Plan B only, up to Rs. 5,00,000"],"display":"Cataract: Plan A Rs. 75,000, Plan B Rs. 1,00,000 per eye; puberty/menopause disorders up to 25% of SI; ARMD Rs. 1,00,000; genetic diseases/disorders 25% of SI; psychiatric/psychosomatic disorders Plan B up to 5% of SI; obesity Plan B up to Rs. 5,00,000","note":"Psychiatric/psychosomatic disorders and obesity are under Part II, available only for Plan B.","quote":"Our liability for payment of any claim within the Period of Insurance, relating to Cataract for each eye shall not exceed the limit as per following table:\nPlan A | Actual or Rs. 75,000, whichever is less\nPlan B | Actual or Rs. 1,00,000, whichever is less ... Puberty and Menopause related Disorders: Treatment for any symptoms, Illness, complications arising due to physiological conditions associated with Puberty, Menopause such as menopausal bleeding or flushing is covered only as Inpatient procedure after 24 months of continuous coverage. This cover will have a sub-limit of up to 25% of Sum Insured. ... Age Related Macular Degeneration (ARMD) is covered after 36 months of continuous coverage only for Intravitreal Injections and anti - VEGF medication. This cover will have a sub- limit of Rs. 1,00,000 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. ... All the Psychiatric and Psychosomatic disorders diagnosed for the first time during the Continuous Coverage under the New India Premier Mediclaim Policy will be covered up to 5% of Sum Insured. ... Hospitalisation for treatment related to or for obesity is covered up to Rs. 5,00,000 where Body Mass Index of the Insured Person is greater than 35","sources":[{"clause":"3.1.12","heading":"LIMIT ON PAYMENT OF CATARACT","page":14,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-12"},{"clause":"3.1.16(c)","heading":"Puberty and Menopause related Disorders","page":16,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-16-c"},{"clause":"3.1.16(d)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-16-d"},{"clause":"3.1.16(f)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-16-f"},{"clause":"3.2.1","heading":"COVER FOR PSYCHIATRIC AND PSYCHOSOMATIC DISORDERS","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-2-1"},{"clause":"3.2.2","heading":"TREATMENT FOR OBESITY","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-2-2"}],"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":60},"display":"upto sixty days","note":"Expenses must be for the same condition for which hospitalisation was required and the inpatient hospitalisation claim must be admissible.","quote":"Pre-Hospitalisation Medical Expenses, upto sixty days","sources":[{"clause":"Row 1","heading":"Room Rent, including boarding and nursing expenses.","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-row-1"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"Listed day care procedures in Annexure I are covered when admission is for less than 24 hours because of technological advancement and the treatment would otherwise have required hospitalisation for more than 24 hours. The list includes examples such as Operation Of Cataract, Parenteral Chemotherapy, Haemodialysis and Radiotherapy For Cancer.","display":"Specified/listed day care procedures in Annexure I, including cataract, chemotherapy, haemodialysis and radiotherapy","note":"Treatment normally taken on an out-patient basis is not included in the day care definition.","quote":"DAY CARE TREATMENT refers to medical treatment or Surgery which are:\n- undertaken under general or local anesthesia in a Hospital/ Day Care Centre in less than 24 hours because of technological advancement, and\n- which would have otherwise required a Hospitalisation of more than 24 hours. ... 75 | Operation Of Cataract ... 81 | Parenteral Chemotherapy ... 136 | Haemodialysis\n137 | Tonsillectomy Without Adenoidectomy | 138 | Radiotherapy For Cancer","sources":[{"clause":null,"heading":"2.12DAY CARE TREATMENT","page":5,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-2-12day-care-treatment"},{"clause":"Row 1","heading":"Stapedotomy","page":29,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-row-1-2"},{"clause":"Annexure I","heading":"LIST OF DAY CARE PROCEDURES","page":31,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-annexure-i-2"}],"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 hospitalisation is excluded.","display":"Not covered: Any expenses incurred on Domiciliary Hospitalization","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization.","sources":[{"clause":"4.4.14","heading":null,"page":21,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-4-14"}],"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":"AYUSH hospitalisation expenses for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy are covered up to 100% of the Sum Insured during each policy year.","display":"AYUSH covered up to 100% of the Sum Insured","note":null,"quote":"We will provide coverage for 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":"3.1.2","heading":"AYUSH TREATMENTS","page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-2"}],"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":"Modern treatments/procedures are covered where medically indicated, as inpatient or day care treatment in a hospital, with per-policy-period limits for each listed procedure.","display":"Covered with sub-limits: Uterine Artery Embolization and HIFU Rs. 2 Lakh; Balloon Sinuplasty Rs. 2 Lakh; Deep Brain stimulation Rs. 5 Lakh; Oral chemotherapy Rs. 1 Lakh; Immunotherapy Rs. 2 Lakh; Intravitreal injections Rs. 75,000; Robotic surgeries Rs. 5 Lakh; Stereotactic radio surgeries Rs. 3 Lakh; Bronchial Thermoplasty Rs. 2.5 Lakh; Vaporisation of the prostrate Rs. 2.5 Lakh; ONM Rs. 50,000; Stem cell therapy Rs. 2.5 Lakh","note":null,"quote":"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\n3.1.17.1 | Uterine Artery Embolization and HIFU (High intensity focused ultrasound) | Upto Rs. 2 Lakh\n3.1.17.2 | Balloon Sinuplasty | Upto Rs. 2 Lakh\n3.1.17.3 | Deep Brain stimulation | Upto Rs. 5 Lakh\n3.1.17.4 | Oral chemotherapy | Upto Rs. 1 Lakh\n3.1.17.5 | Immunotherapy- Monoclonal Antibody to be given as injectio | Upto Rs. 2 Lakh\n3.1.17.6 | Intravitreal injections | Upto Rs. 75,000\n3.1.17.7 | Robotic surgeries | Upto Rs. 5 Lakh\n3.1.17.8 | Stereotactic radio surgeries | Upto Rs. 3 Lakh\n3.1.17.9 | Bronchial Thermoplasty | Upto Rs. 2.5 Lakh\n3.1.17.10 | Vaporisation of the prostrate (Green laser treatment or holmium laser treatment) | Upto Rs. 2.5 Lakh\n3.1.17.11 | ONM - (Intra Operative Neuro Monitoring) | Upto Rs. 50,000\n3.1.17.12 | Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered | Upto Rs. 2.5 Lakh","sources":[{"clause":"3.1.17","heading":"COVERAGE FOR MODERN TREATMENTS OR PROCEDURES: The following procedures will be","page":16,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-17"}],"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":"If treatment involves organ transplant to the insured person, the policy also pays the donor’s hospitalisation expenses, excluding the cost of the organ, within the available Sum Insured.","display":"Yes, donor hospitalisation expenses excluding cost of organ, within available Sum Insured","note":null,"quote":"If treatment involves Organ Transplant to Insured Person, then We will also pay Hospitalisation Expenses (excluding cost of organ) incurred on the donor, provided Our liability towards expenses incurred on the donor and the Insured recipient shall not exceed the available Sum Insured.","sources":[{"clause":"3.1.1","heading":null,"page":12,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-1-2"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Ambulance services including air ambulance are covered up to Rs. 1,00,000 for any one illness for shifting to hospital for emergency ward or ICU admission or from one hospital to another for better facilities. After discharge, ambulance to the place of residence is additionally covered up to Rs. 10,000 for any one illness if certified by the medical practitioner.","display":"Ambulance including Air Ambulance up to Rs. 1,00,000 for Any One Illness; post-discharge ambulance home up to Rs. 10,000","note":null,"quote":"We will pay You the charges incurred towards Ambulance services including Air Ambulance, Reasonably, Customarily and Medically Necessarily incurred for shifting any Insured Person to Hospital for admission in emergency ward or ICU, or from one Hospital to another Hospital for better medical facilities maximum up to Rs. 1,00,000 for Any One Illness. However, if an Insured Person, after the discharge from the Hospital, has to be shifted from Hospital to their place of residence in an Ambulance, such expenses will also be reimbursed additionally up to Rs. 10,000 for Any One Illness, provided the requirement of an Ambulance is certified by the Medical Practitioner.","sources":[{"clause":"3.1.4","heading":"PAYMENT OF AMBULANCE CHARGES","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-4"}],"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":null,"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":"not-stated","value":null,"display":null,"note":"The documents mention Claim Free Year for OPD eligibility and refer to no claim bonus in portability/migration, but do not state that this policy's cover grows by a cumulative bonus.","quote":null,"sources":[],"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":"The policy lists many non-medical items as excluded, while some specified consumables are payable only in stated circumstances. For example, band aids, bandages, sterile injections, needles and syringes are not payable as separate consumables, sterilized gloves are payable, and unsterilized gloves are not payable.","display":"Many non-medical items excluded; sterilized gloves payable, unsterilized gloves not payable; needles and syringes not payable as separate consumables","note":null,"quote":"S.NO | LIST OF EXPENSES EXCLUDED (\"NON-MEDICAL\") | SUGGESTIONS ... BAND AIDS, BANDAGES, STERLILE INJECTIONS, NEEDLES, SYRINGES | Not Payable - Part of Dressing charges ... GLOVES Sterilized | Gloves payable / unsterilized gloves not payable ... EXAMINATION GLOVES | Not payable ... MASK | Not Payable","sources":[{"clause":"Annexure II","heading":"LIST OF EXPENSES EXCLUDED (\"NON-MEDICAL\")","page":32,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-annexure-ii"},{"clause":null,"heading":"ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE SEPARATE CONSUMABLES ARE NOT PAYABLE BUT THE SERVICE IS","page":34,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-items-which-form-part-of-hospital-services-where"},{"clause":null,"heading":"ADMINISTRATIVE OR NON - MEDICAL CHARGES","page":35,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-administrative-or-non-medical-charges"},{"clause":null,"heading":"OTHERS","page":38,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-others"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity expenses are covered after 36 months of Continuous Coverage in New India Premier Mediclaim Policy, with limits of Rs. 50,000 for Plan A and Rs. 1,00,000 for Plan B. Benefits are admissible only for inpatient hospital expenses in India and not after two maternity claims have been paid for that insured person.","display":"After 36 months; Plan A Rs. 50,000, Plan B Rs. 1,00,000","note":null,"quote":"Maternity Expenses shall be covered after thirty-six months of Continuous Coverage in New India Premier Mediclaim Policy. Our liability for expenses incurred towards Maternity Expenses, shall be restricted to Rs. 50,000 for Plan A and Rs. 1,00,000 for Plan B. Special conditions applicable to Maternity and Child Care Benefit:\ni) These benefits are admissible only if the expenses are incurred in Hospital as in patient in India.\nii) Claim under this Clause shall not be admissible if, in respect of any Insured Person, two claims for Maternity have been paid by Us in the preceding / existing New India Premier Mediclaim policies.","sources":[{"clause":"3.1.6","heading":"COVERAGE FOR MATERNITY & CHILD CARE","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-6"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"A newborn baby is covered for any illness or injury from the date of birth until policy expiry, within the terms of the policy and plan opted. Congenital external anomaly, pre-term or premature care, and expenses connected with delivery of the newborn are not covered under this clause; renewal cover requires declaring and insuring the child.","display":"Covered from date of birth till policy expiry for illness or injury; exclusions apply","note":null,"quote":"A New Born Baby is covered for any Illness or Injury from the date of birth till the expiry of this Policy, within the terms of this Policy and Plan opted. Congenital External Anomaly of the New Born Baby is not covered under the Policy. Any expense incurred towards pre-term or pre-mature care or any expense incurred in connection with delivery of such New Born Baby is not covered under this Clause. No coverage for the New Born Baby would be available during subsequent renewals unless the child is declared for Insurance and covered as an Insured Person.","sources":[{"clause":"3.1.7","heading":"NEW INDIA BABY COVER","page":13,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-7"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"quote-verified","value":"For Plan B, psychiatric and psychosomatic disorders diagnosed for the first time during continuous coverage are covered up to 5% of Sum Insured, requiring inpatient admission and not as day-care. Treatment of mental illness, stress or psychological disorders and neurodegenerative disorders has a 36 months waiting period.","display":"Plan B only: inpatient psychiatric and psychosomatic disorders up to 5% of Sum Insured; 36 months waiting period for mental illness/stress/psychological/neurodegenerative disorders","note":null,"quote":"Part II (COVER AVAILABLE ONLY FOR PLAN B) ... All the Psychiatric and Psychosomatic disorders diagnosed for the first time during the Continuous Coverage under the New India Premier Mediclaim Policy will be covered up to 5% of Sum Insured. The Insured needs to be admitted as in-patient. This treatment will not be covered under a Day-care procedure. ... 36 Months waiting period\n1. Joint Replacement due to Degenerative Condition\n2. Age-related Osteoarthritis & Osteoporosis\n3. Treatment of mental illness, stress or psychological disorders and neurodegenerative disorders.","sources":[{"clause":"Part II","heading":"(COVER AVAILABLE ONLY FOR PLAN B)","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-part-ii"},{"clause":"3.2.1","heading":"COVER FOR PSYCHIATRIC AND PSYCHOSOMATIC DISORDERS","page":17,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-2-1"},{"clause":"4.3(b)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-4-3-b-2"}],"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":"Health check-up is available as part of the OPD cover after every block of two continuous claim-free years, with aggregate OPD cover of Rs. 5,000 for Plan A and Rs. 10,000 for Plan B.","display":"After every 2 continuous Claim Free Years, OPD cover includes Health Check-up: Plan A Rs. 5,000, Plan B Rs. 10,000","note":null,"quote":"After every block of two continuous Claim Free Years, You and all the members covered in this Policy are entitled for OPD coverage for an aggregate amount of Rs. 5,000 for Plan A and Rs. 10,000 for Plan B. The cover can be availed for:\n1. Dental Treatment.\n2. Health Check-up.","sources":[{"clause":"3.1.10","heading":"OPD COVER","page":14,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-10"}],"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":"After every block of two continuous claim-free years, all members are entitled to aggregate OPD coverage of Rs. 5,000 for Plan A and Rs. 10,000 for Plan B, usable for dental treatment, health check-up, consultation, prescribed drugs and medicines, and prescribed investigations. The amount is not carried forward.","display":"After every 2 continuous Claim Free Years: Plan A Rs. 5,000, Plan B Rs. 10,000 for dental, health check-up, consultation, drugs/medicines and investigations","note":null,"quote":"After every block of two continuous Claim Free Years, You and all the members covered in this Policy are entitled for OPD coverage for an aggregate amount of Rs. 5,000 for Plan A and Rs. 10,000 for Plan B. The cover can be availed for:\n1. Dental Treatment.\n2. Health Check-up.\n3. Consultation with a Medical Practitioner.\n4. Drugs and medicines as prescribed by a Medical Practitioner.\n5. Investigations as prescribed by a Medical Practitioner. The amount will not be carried forward to the next year.","sources":[{"clause":"3.1.10","heading":"OPD COVER","page":14,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-3-1-10"}],"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":null,"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 facility is available through network providers, where the insurer/TPA pays the network provider directly to the extent of pre-authorisation approved. Payment is made directly to the network provider if cashless is applied for before treatment and accepted by the TPA; denial of cashless does not by itself deny the claim.","display":"Cashless at Network Providers, subject to pre-authorisation approval and TPA acceptance","note":null,"quote":"CASHLESS FACILITY means a facility extended by Us to the Insured Person where the payments of the costs of treatment undergone by the Insured Person in accordance with the Policy terms and conditions are directly made to the Network Provider by Us to the extent of pre-authorization approved. ... Payment shall be made directly to Network Provider if Cashless Facility is applied for before treatment and accepted by TPA. ... Denial of Cashless Facility would not imply denial of claim.","sources":[{"clause":"2.6","heading":"CASHLESS FACILITY","page":2,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-2-6"},{"clause":"5.3","heading":"PLACE OF TREATMENT AND PAYMENT","page":22,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-3"}],"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 and cashless services are handled by the TPA for communications and processing, with reimbursement payment effected by the insurer.","display":"TPA processes cashless and reimbursement claims; reimbursement payment by the insurer","note":null,"quote":"You must send all communications and papers regarding a claim to the TPA at the address shown in the Schedule. ... Health claims are generally processed by Third Party Administrator (TPA). TPA is a service provider to facilitate service to you for providing Cashless facility for all Hospitalisation that come under the scope of the Policy. The TPA also processes reimbursement claims within the scope of the Policy. Payment of reimbursement claims will be effected by Us by transfer to Your bank account.","sources":[{"clause":"5.4","heading":"COMMUNICATION","page":23,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429#c-5-4"},{"clause":"44","heading":"WHO WILL SETTLE THE CLAIM?","page":18,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-44"}],"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":true,"display":"Yes, individual as well as floater basis","note":"Minimum one and maximum six members can be covered in this policy.","quote":"This policy is issued on Individual as well as Floater basis. If the Policy is issued on Individual basis (Separate Sum Insured for each member), Premium for all member will be calculated from Primary member premium Table. If the Policy is issued on Floater basis (Single Sum Insured for each member), Premium for the eldest member will be calculated from Primary member premium Table and for rest of the members from Additional member Premium tables","sources":[{"clause":"8","heading":"HOW IS PREMIUM CHARGED AND TYPE OF POLICY?","page":4,"url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423#c-8"}],"law":[]}],"documents":[{"kind":"wording","label":"Policy Clause for New India Premier Mediclaim","pages":42,"fetched_at":"2026-10-17 19:50:13+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/new-premier-mediclaim-claim-policy/Policy%20Clause%20New%20India%20Premier%20Mediclaim.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13429"},{"kind":"prospectus","label":"Prospectus","pages":23,"fetched_at":"2026-10-17 19:50:16+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/new-premier-mediclaim-claim-policy/Prospectus%20New%20India%20Premier%20Mediclaim%20UPDATED.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13423"},{"kind":"cis","label":"Customer Information Sheet","pages":3,"fetched_at":"2026-10-17 19:50:12+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/new-premier-mediclaim-claim-policy/Customer%20Information%20Sheet%20New%20India%20Premier%20Mediclaim%20Policy.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13422"},{"kind":"brochure","label":"Policy Brochure","pages":2,"fetched_at":"2026-10-17 19:50:10+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/new-premier-mediclaim-claim-policy/1%20Primier%20Mediclaim%20Pamphlet.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/13419"},{"kind":"premium","label":"Premium for New India Premier Mediclaim","pages":null,"fetched_at":"2026-10-17 19:50:17+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/new-premier-mediclaim-claim-policy/New%20India%20Premier%20mediclaim%20premium%20chart.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/30467"},{"kind":"proposal","label":"Proposal Form","pages":null,"fetched_at":"2026-10-17 19:50:15+00","source_url":"https://www.newindia.co.in/assets/docs/know-more/health/new-premier-mediclaim-claim-policy/New%20India%20Premier%20Mediclaim%20Proposal%20Form.pdf","url":"https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425/document/30466"}],"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":"New India Premier Mediclaim Policy (Cashless facility available) (UIN NIAHLIP25048V042425), IndiaInsurances, https://indiainsurances.com/policy/new-india-assurance/new-india-premier-mediclaim-policy-cashless-facility-available-niahlip25048v042425"}