Overview
The New India Assurance Mediclaim policy is a traditional health insurance plan offering sum insured options from ₹1 lakh to ₹15 lakhs, designed for individuals and families aged 18 to 65 years. It provides benefits like cumulative bonuses up to 50% for claim-free years and newborn baby coverage. The policy offers lifelong renewability and cashless treatment at a network of hospitals, as well as a restoration benefit once a year for a different ailment, making it a basic yet reliable option for health protection.
Experts Review
Written by Ishita Jain
Editor
The New India Assurance Mediclaim policy is a conventional health insurance plan providing essential coverage for hospitalization and related expenses. Its key features include cumulative bonuses of 25% per claim-free year (up to 50%), coverage for newborn babies, free health check-ups every three claim-free years, and inclusion of 226 daycare procedures, meeting evolving healthcare needs.
Room rent is typically restricted to a percentage of the sum insured, and disease-wise limits apply for cataracts, modern treatments, and other conditions, potentially raising out-of-pocket costs if higher room categories are chosen. The waiting period for pre-existing conditions is three years, longer than some competitors offering reduced waiting periods via add-ons.
Premiums are generally 10–15% higher than comparable basic plans without proportionate benefits. Maternity benefits are optional for sums above ₹5 lakhs, capped at 10% of the average sum insured in the preceding three years. Optional covers include no proportionate deduction to maximize claim payouts, increased cataract limits for higher sums insured, a 15% premium discount with voluntary 20% co-pay, and consumables coverage for larger sums insured.
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
Anything below twin sharing room
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
Maternity Benefits
Voluntary Co-Payment
Choose a co-payment of 20% to reduce premiums.
Consumables
With this add-on, you also get extended coverage for generally excluded items like syringes, gloves, PPE kits etc. upto ₹15,000. This add-on is avaialble only for sum insured of 8 lakhs and above.
Maternity
With this add-on, you get added coverage for maternity expenses i.e. childbirth and newborn expenses. However, the coverage is limited to 10% of the base Sum Insured. But Remember, you have to wait for 3 years to be eligible for this benefit.
Co-payment
This benefit helps to opt for co-payment.
No Proportionate Deduction
With this paid add-on, the insurer will remove the clause of proportionate deduction the room rent benefit.
Cataract limit
With this paid add-on, the cataracts limit will be revised from 20% 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
Treatments such as Rotational Field Quantum Magnetic Resonance (RFQMR), External
Counter Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric
Oxygen Therapy.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
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.
24-Month Waiting Period:
All internal and external benign tumors, cysts, polyps of any kind (including benign breast lumps)
Benign ear, nose, throat disorders
Benign Prostatic Hypertrophy
Cataract and age-related eye ailments
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.
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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.
- Specific Illness Waiting Period: There’s a 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?
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