New India Premier Mediclaim Policy

1. Introduction

The New India Premier Mediclaim Policy (NIPMP) is a flagship healthinsurance product launched by the Government of India in partnership with leading private insurers. It is designed to provide affordable, comprehensive coverage for hospitalisation, surgery, and related medical expenses for individuals and families across the country. The policy aims to bridge the gap between rising healthcare costs and the financial capacity of the average Indian household.

2. Key Features

• Coverage for Hospitalisation: Up to12lakh per family per year for room charges, ICU, medicines, diagnostics and surgery.
• Pre and PostHospitalisation: 30 days of prehospitalisation and 60 days of posthospitalisation expenses covered.
• NoClaim Bonus: 5% increase in sum insured for every claimfree year, up to a maximum of 25%.
• DayCare Procedures: Fully covered without a minimum hospital stay.
• Cashless Hospitalisation: Network of over12,000empanelled hospitals nationwide.
• Family Floater: One sum insured shared by the entire family (maximum 4 members).
• Ayush Treatment: Coverage for AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, Homeopathy) therapies when prescribed by a qualified practitioner.
• Renewal Guarantee: Guaranteed renewal for the lifetime of the insured, provided premiums are paid.
• Online Services: Easy claim filing, premium payment and policy management via the dedicated portal and mobile app.

3. Eligibility & Enrollment

The policy is open to Indian citizens aged 1865 years at the time of enrolment. A family can enroll as a unit, with the eldest member acting as the primary policyholder. Enrollment can be done through:

• Official website (newindiamediclaim.gov.in)
• Authorized insurance agents
• Participating banks and post offices (via the PMJanaKalyan scheme)
• Mobile app (available on Android and iOS)

4. Premium Structure

Premiums are calculated based on the sum insured, family size, age of the primary holder and location (urban/rural). The government subsidises up to 30% of the premium for families whose percapita income is below the poverty line, making the final outofpocket cost as low as 1,200per annum for a sum insured of 5lakh.

5. Claim Process

5.1 Cashless Claim (Preferred)

1. Present your New India Premier Mediclaim card at the empanelled hospital.
2. Hospital submits a preauthorization form electronically to the insurer.
3. Once approved, the hospital settles the bill directly with the insurer.

5.2 Reimbursement Claim

1. Pay the hospital bill and collect all original documents (discharge summary, itemised bill, receipts).
2. Log in to the portal or mobile app and upload the scanned documents.
3. The insurer reviews the claim and, if approved, reimburses the amount within 15working days.

6. Benefits Over Traditional Mediclaim Plans

7. Frequently Asked Questions

Q1: What if I need to be treated abroad?

The policy provides limited overseas coverage (up to 2lakh) for emergency hospitalisation, subject to a preapproval from the insurer. It is not intended for routine elective treatment abroad.

Q2: Can I add a newborn to the policy?

Yes. A newborn can be added free of charge within 30days of birth. The addition will be effective from the date of birth and the sum insured will be shared with the rest of the family.

Q3: What happens if the sum insured is exhausted?

Once the annual limit is reached, the insurer will not pay further expenses for that policy year. However, you can purchase a topup rider for an additional 3lakh at a nominal premium.

Q4: Are preexisting conditions covered?

Preexisting conditions are covered after a waiting period of 24months from the policy start date, provided the condition was not disclosed or treated before enrolment.

8. How to Compare Policies Before Buying

• Sum Insured vs. Premium: Larger sum insured means higher premium; assess your family's medical profile.
• Network Hospitals: Verify that top hospitals in your city are empanelled.
• Exclusions & Waiting Periods: Read the fine print for exclusions such as cosmetic surgery, infertility, and certain chronic diseases.
• Claim Settlement Ratio: Choose insurers with a settlement ratio above 90% for smoother claim experiences.

9. Impact on Public Health

By extending affordable health coverage to millions of households, the New India Premier Mediclaim Policy aims to:

• Reduce outofpocket health expenditures, thereby lowering the incidence of medicalpoverty.
• Encourage preventive health checkups through tieups with diagnostic centres.
• Strengthen the overall healthcare delivery system through increased utilisation of empanelled hospitals.

10. Conclusion

The New India Premier Mediclaim Policy represents a significant step towards universal health coverage in India. Its blend of high sum insured, family floater benefits, government subsidy, and robust digital infrastructure makes it a compelling choice for families seeking financial protection against healthrelated risks. Prospective policyholders should evaluate their individual needs, compare available riders, and use the online portal to keep their policy uptodate.

For the latest updates, forms and detailed terms and conditions, visit official website.