Mediclaim in one table
| Insurer | The New India Assurance Company Limited |
|---|---|
| Sum insured | ₹1 lakh to ₹15 lakh. ₹4 lakh, ₹6 lakh and ₹7 lakh are renewal-only and cannot be bought fresh |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What Mediclaim covers
These are the terms that decide what you are actually paid when you claim. Room rent, co-pay and restoration do more to shape a settlement than the sum insured does, and they are read from New India Assurance's own policy wording.
| Feature | This plan | What good looks like |
|---|---|---|
| Co-payment | None if you are treated in the zone you paid for. A Zone 2 policyholder treated in Zone 1 – Maharashtra or Gujarat – bears 20%, except for an emergency accident admission | No Co-payment |
| Room Rent Limit | 1% of sum insured a day · ICU 2%. A dearer room triggers a proportionate deduction on the associated medical expenses | No room rent capping |
| What the proportionate deduction spares | Pharmacy and consumables, implants and medical devices, and diagnostics are exempt, as are hospitals that do not bill differently by room category | Deduction limited in scope |
| Disease sub-limit | Cataract capped at 20% of sum insured or ₹50,000 an eye. Mental illness and genetic disorders at 25% of sum insured each, macular degeneration at 10% up to ₹75,000, artificial life maintenance at 10% for 15 days | No sub-limit |
| No Claim Bonus | Sum insured rises 25% at each claim-free renewal, to a ceiling of 50%. A claim year strips it back at the same rate | 50% each year (Minimum upto 100%) |
| Restoration Benefit | Reinstated once per insured person a year, but only on a sum insured of ₹5 lakh or more, not for a condition already claimed, and not usable for the listed modern treatments | 100% restoration once in a year |
| Pre-Hospitalization | 30 days | At least 60 days |
| Post-Hospitalization | 60 days | At least 120 days |
| Consumables | Medical consumables billed as part of an admission are paid. The non-payable items in the policy's List I are not, and the add-on that used to buy them back was withdrawn in the current version | Consumables covered |
| Hospital cash | 0.1% of sum insured a day on ₹3 lakh and above, capped at 1% of sum insured for any one illness. It is paid out of the sum insured, not on top of it | Included |
| Day-Care Procedures | Listed day care procedures covered | Covered without a capped list |
| AYUSH Treatment | Covered up to 100% of the sum insured | Included |
| Modern treatments | Twelve listed procedures covered. They cannot be paid from the reinstated sum insured | Covered |
| Road ambulance | Up to 1% of the sum insured per insured event | Included |
| Health check-up | At the end of every three claim-free years – ₹5,000 or 1% of the average sum insured of the preceding three years, whichever is lower | Included |
| Entry age | 18 to 65. Children from 3 months, and to 25 while financially dependent. Above 65 you can renew but not join | No maximum entry age |
Mediclaim add-ons you can buy with it
Each of these costs extra and each has its own conditions. Some are genuinely worth it; several exist to patch a gap in the base plan. Ask what each one adds before it goes on your quote.
Mediclaim discounts you can ask for
Published discounts on this plan. Most are applied at quote stage rather than offered, so it is worth naming the ones you qualify for. Every figure is a ceiling, not a promise - what you actually get depends on the case.
| Discount | Worth | When it applies |
|---|---|---|
| Long-term policy | Up to 5% or 7% | 5% on a two-year policy term and 7% on three years. Sum insured and sub-limits reset each policy year and do not carry forward. |
| Voluntary co-pay | Up to 15% | Off the premium for that insured person, in exchange for a 20% co-payment on every claim they make. |
From the plan prospectus. The voluntary co-pay is a trade rather than a saving – you buy a lower premium with a fifth of every claim.
Mediclaim waiting periods: when each part of the cover starts
Waiting periods run from the day cover began, not from the day you fall ill, and they run in parallel rather than one after another.
| Initial Waiting Period | 30 days |
|---|---|
| Diabetes, hypertension and cardiac conditions | 90 days |
| Named specific illnesses | 24 months |
| Joint replacement, mental illness, genetic disorders, congenital external disease | 36 months |
| Pre-Existing Disease | 36 months |
The named illnesses that wait 90 days to 36 months, depending on the condition
Three tiers run alongside the 30-day and pre-existing waits. Diabetes, hypertension and cardiac conditions wait 90 days. The list below waits 24 months. Joint replacement for a degenerative condition, age-related osteoarthritis and osteoporosis, mental illness, macular degeneration, genetic disorders and congenital external disease wait 36 months. An accident is covered from day one. The list is indicative – the policy clauses carry the full set.
Mediclaim exclusions: what the plan will not pay for
Every policy carries exclusions, and they are the clauses people read for the first time at claim stage. These are the ones worth knowing before you buy.
Where Mediclaim falls short
No plan is right for everyone, and a page that only lists strengths is not much use to you. These are the gaps we would raise on a call before recommending it.
Mediclaim questions, answered
When does the 20% co-payment apply?
New India rates this policy across two zones: Zone 1 is Maharashtra and Gujarat, Zone 2 is the rest of India. Buy at Zone 1 rates and you can be treated anywhere in India with no co-payment. Buy at Zone 2 rates and get treated in Zone 1 and you bear 20% of the claim. The exception is an emergency admission following an accident, where no co-payment is charged. You choose the zone at proposal and can change it only at renewal, so if you live outside Maharashtra or Gujarat but would travel to Mumbai for major treatment, price the Zone 1 upgrade before you decide.
Is the sum insured restored after a claim?
Once for each insured person during the policy period, and only where the sum insured is ₹5 lakh or more. It takes effect after discharge from the admission that exhausted the cover, and it cannot be used for an illness or injury already claimed in that period. Two further limits matter: the order of use is sum insured, then cumulative bonus, then the reinstated amount, and the reinstated amount cannot pay for the twelve listed modern treatments such as robotic surgery, oral chemotherapy or stem cell therapy.
Are consumables covered?
Medical consumables that form part of a hospital's bill for an admission are paid, and they are also exempt from the proportionate deduction if you take a room above your eligibility. The non-payable items in the policy's List I are not covered, and the optional cover that used to pay up to ₹15,000 towards them on a sum insured of ₹8 lakh and above no longer appears in the current filing. If a quote still offers it, ask which version of the product is being sold.
What is the cataract limit?
Each eye is limited to 20% of your sum insured or ₹50,000, whichever is less, and it waits 24 months. On a sum insured of ₹8 lakh and above you can buy the Revision in Limit of Cataract optional cover, which adds ₹80,000 to ₹1.5 lakh depending on the sum insured, but that add-on itself does not pay until 36 months after you take it. The limit applies per event across every New India policy you hold, so a second policy does not double it.
How fast does the cover grow if I do not claim?
The sum insured is increased by 25% at each claim-free renewal, up to a maximum of 50%. So two clean years take ₹10 lakh to ₹15 lakh, and it stops there. A claim reduces the accumulated bonus at the same 25% rate, and the whole bonus is lost if you renew more than 30 days after expiry. You can also swap the accrued bonus for a premium discount at renewal, but doing so zeroes the bonus.
What happens to my cover after five years?
A five-year moratorium applies. Once you have held continuous cover for five years, New India cannot contest a claim on the grounds of non-disclosure or a pre-existing condition, except where fraud is established or the treatment is permanently excluded under the policy. That protection follows the sum insured, so an increase later restarts the clock on the increased portion.
Read it from the insurer
We summarise. The policy wording is the contract, and it is the only document that settles a dispute. These links go to the insurer's own pages.
Understand the terms before you commit
A plan page tells you what this policy does. These explain why each term matters and what it costs you when it is missing.
Other New India Assurance plans we have read
New India Assurance files these separately, and the terms differ between them. If you are choosing within the range, compare the waiting periods and the exclusions rather than the sum insured.