Overview
The New India Assurance Senior Citizen Mediclaim plan is tailored for individuals aged 60 to 80 years, offering sum insured options typically ranging from ₹1 lakh to ₹1.5 lakh. It features a relatively short waiting period of two years for pre-existing diseases, lifelong renewability, and benefits for mental health and genetic disorders with sub-limits. It aims to provide affordable health protection for senior citizens with moderate coverage.
Experts Review
Written by Nikhil Nair
Senior Writer
The New India Assurance Senior Citizen Mediclaim plan is a basic health insurance option for seniors, notable for its relatively short two-year waiting period for pre-existing diseases, which is an advantage over many competitors requiring three years. The policy covers a range of treatments including mental illness, genetic disorders, and physiological conditions related to aging, albeit with massive sub-limits (typically 10-25% of sum insured). It also includes domiciliary hospitalization and alternative medicine coverage as add-ons.
However, the sum insured options are quite low (₹1-1.5 lakh), which is quite insufficient given the rising healthcare costs for senior citizens. The policy imposes room rent limits (usually 1% of sum insured per day), which can lead to out-of-pocket expenses if higher room categories are chosen. Coverage for certain conditions like Age-Related Macular Degeneration and behavioral disorders comes with waiting periods and sub-limits, restricting full benefit access. The policy excludes treatment for injuries due to suicidality and has specific conditions for mental health coverage.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No coverage if you are forced to hospitalize at home, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some. Need to opt add-on for maternity cover.
Doctor consultations are not covered, which is a key feature.
New India Assurance
Key Insights
Founded
1919
New India Assurance was established 106 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
99% claims settled in 30 Days
New India Assurance settles 99% of all claims it receives demonstrating strong credibility.
Network Hospitals
3,700+
New India Assurance has a limited network of 3,700 hospitals, which may restrict access to cashless services for policyholders.
Complaints
5 complaints per 10,000 claims registered
New India Assurance maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Bad
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Customisable
Choose a co-payment of 20% to reduce premiums.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for cataracts, modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Consumables
Recommended
Covers list of 68 non-medical items as per list I upto ₹15,000; available for sum insured 8 lakhs and above.
Maternity Benefits
Coverage for maternity expenses i.e. childbirth and newborn expenses upto 10% of sum insured with a waiting period of 3 years.
Voluntary Co-Payment
Choose a co-payment of 20% to reduce premiums.
No Proportionate Deduction
Removes the clause of proportionate deduction from the room rent benefit.
Cataract limit
Cataracts limit will be revised from 10% of base sum insured; maximum up to ₹50,000 to 10% of base sum insured. Treatments under this benefit can be availed post completion of 3 years of this add-on.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Convalescence and General debility
Expenses incurred for Rotational Field Quantum Magnetic Resonance (RFQMR)
External Counter Pulsation (ECP)
Enhanced External Counter Pulsation (EECP)
Hyperbaric Oxygen Therapy
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 3 years.
All internal and external benign tumours, cysts, polyps of any kind (including benign breast lumps)
Benign ear, nose, and throat disorders
Benign prostatic hypertrophy
Cataract and age-related eye ailments
Gastric / Duodenal Ulcer
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No coverage if you are forced to hospitalize at home.
Maternity benefits not offered. Need to opt add-on for maternity cover.
Doctor consultations are not covered.
Customer Reviews
A
Ajay Kumar
Cumulative bonus of 25% per claim-free year (up to 50%) is good.
S
Sneha Patel
Newborn baby coverage is included, which is a plus.
R
Rajesh Singh
Free health check-ups every three claim-free years is a nice preventive benefit.
R
Ritu Agarwal
Premiums are 10-15% higher than similar basic plans for the benefits offered.
R
Rakesh Jain
While daycare treatments are covered, the absence of domiciliary coverage felt like a gap.
D
Divya Joshi
Pre- and post-hospitalization expenses are covered.
Compare Policies
Still confused?
Talk to our expert
advisor for
instant clarity
Frequently Asked Questions
Does Mediclaim have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- There’s a 2 to 3-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Mediclaim have room rent restrictions?
Does Mediclaim offer a restoration benefit?
TALK TO OUR ADVISORS
Get real help from advisors who listen, guide and go the extra mile for you.