Overview
The New India Assurance Sixty Plus Mediclaim plan is designed specifically for senior citizens aged 60 and above, offering sum insured options of ₹2 lakhs, ₹3 lakhs, and ₹5 lakhs. It includes benefits like daily hospital cash allowance and attendant expenses, with a mandatory 10% co-payment. While the plan offers essential coverage tailored for seniors, it comes with sub-limits on angiography, joint replacement, and major cancer surgeries, among a few other diseases. If only single women senior citizen gets covered under the policy, then a discount of 5% will be given on the primary member’s premium.
Experts Review
Written by Ishita Jain
Editor
New India Assurance’s Sixty Plus Mediclaim is a practical option for senior citizens, especially those who may find it difficult to secure coverage elsewhere due to age or pre-existing conditions. Its key USPs include coverage for daycare treatments, daily hospital cash allowance, and attendant expenses, which provide additional financial support during hospitalization. The policy also covers organ donor expenses and offers cashless treatment at over 3,700+ network hospitals.
However, the plan has several limitations. The sum insured options are relatively low (₹2-5 lakhs), which may not suffice given the rising healthcare costs for seniors. There are significant sub-limits on conditions like age-related macular degeneration (10% of sum insured) and menopause-related disorders (25% of sum insured), restricting full claim potential.
The policy mandates a 10% co-payment, which can increase out-of-pocket expenses. While the average claim settlement ratio for New India Assurance stands at 99%, the operational process may still pose challenges for some policyholders.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, 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 policy will only cover 90% of the final bill. The rest is on you. They call this a co-payment.
Room Rent
Anything below twin sharing room
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Angiography, Joint replacement, major cancer surgeries 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 upto 10% of sum insured for about 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Convalescence, General debility and Venereal disease.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is 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 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
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 Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
No coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
R
Ramesh Chandra
Covers daycare treatments, which is good for seniors.
S
Sunita Devi
Daily hospital cash allowance and attendant expenses provide extra financial support.
A
Alok Kumar
Organ donor expenses are covered.
T
Tanvi Jain
Significant sub-limits on conditions like AMD (10% of SI) and menopause disorders (25% of SI).
G
Geeta Mishra
Low sum insured options (₹2-5 lakhs) may not be adequate for serious conditions.
D
Divya Sharma
I appreciated that AYUSH treatments are covered—adds an extra layer of comfort for traditional care preferences.
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Frequently Asked Questions
Does Sixty Plus 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 Sixty Plus Mediclaim have room rent restrictions?
Does Sixty Plus Mediclaim offer a restoration benefit?
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