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New India Premier Mediclaim Policy: Full Review

Ann Tresa Jais

Written by Ann Tresa Jais

Insurance Writer

Ishita Jain

Reviewed by Ishita Jain

IRDAI-Certified Expert at Ditto

SP0738675913

Certified
New India Premier Mediclaim Policy: Full Review

Overview

The New India Premier Mediclaim Policy is a high-sum-insured plan from New India Assurance Company Limited. It is available on both individual and family floater bases.

Plan Variants & Sum Insured Options

  • Plan A: ₹15 lakh and ₹25 lakh.
  • Plan B: ₹50 lakh and ₹1 crore.

Key Policy Features

  • Room Rent & Co-Payment: No standard room-rent cap or mandatory co-payment.
  • Pre- And Post-Hospitalization: 60 days before and 90 days after hospitalization.
  • Inbuilt Benefits: Includes maternity cover, infertility treatment, outpatient department cover, hospital cash, and a Critical Care benefit, subject to applicable limits, waiting periods, and conditions. 
  • Eligibility: Adults can enter between ages 18 and 65, with lifelong renewability.

Key Limitations to Keep in Mind

  • No Restoration or Cumulative Bonus: The policy does not automatically refill or increase your base cover.
  • Treatment Sub-Limits: Several modern treatments have fixed monetary caps.
  • No Domiciliary Hospitalization: Treatment taken at home under domiciliary hospitalization is not covered.

₹1 crore in health insurance coverage sounds reassuring. But how much of that coverage actually works the way you expect?

New India Premier Mediclaim policy offers hospitalization cover of up to ₹1 crore, along with maternity, newborn, infertility treatment, critical care, and specified hazardous sports cover. However, several of these benefits come with waiting periods, fixed limits, and sub-limits.

In this review, we compare Plan A vs. Plan B, and look at premiums, maternity and infertility benefits, major exclusions, and the limitations that actually matter before you buy.

Not sure whether the New India Premier Mediclaim policy fits your healthcare needs? Book a free call or chat with a Ditto advisor on WhatsApp.

What Is the New India Premier Mediclaim Policy?

Among New India Assurance mediclaim options, New India Premier Mediclaim is positioned as a higher-cover policy available in two variants.

Key Details of New India Premier Mediclaim

ParameterDetails
Policy TypeIndividual and family floater
Base Sum Insured Options₹15 lakh, ₹25 lakh, ₹50 lakh, and ₹1 crore 
Adult Entry Age18 to 65 years 
Child Entry Age 3 months to 25 years, subject to parental coverage and financial dependency conditions 
Exit Age for Children25 years, provided financially dependent. No specified upper age limit for unmarried dependent daughters and mentally challenged children
Family Floater Structure Up to 6 members, including the proposer, spouse, dependent children, and dependent parents
Waiting PeriodsThe initial waiting period is 30 days, except for accidents, diabetes, hypertension, and cardiac conditions, which have 90 days, listed illnesses have 24 to 36 months, and pre-existing diseases have 36 months 
Co-Payment, Room Eligibility, and Sub-Limits No separate room-rent cap or standard co-payment. But certain treatments have applicable sub-limits 
Pre- and Post-Hospitalization 60 and 90 days respectively 
Day Care and AYUSH Coverage Covered up to sum insured

New India Premier Mediclaim: Plan A vs. Plan B

FeaturePlan APlan B
Sum Insured ₹15 lakh or ₹25 lakh₹50 lakh or ₹1 crore
Hospital Cash (in-built feature of fixed daily payout during eligible hospitalization) ₹2,000 per day, for a maximum of 10 days for any one illness₹4,000 per day, for a maximum of 10 days for any one illness
Critical Care Benefit (in-built feature of one-time lump sum for specified critical illnesses) ₹2 lakh ₹5 lakh 
Outpatient Department Cover (in-built feature available after two continuous claim-free years) Up to ₹5,000 in aggregate for all insured members Up to ₹10,000 in aggregate for all insured members
HIV/AIDS Cover Up to ₹2 lakh, including Outpatient Department (OPD) cover of up to ₹20,000 within this limit Up to ₹5 lakh, including OPD cover of up to ₹50,000 within this limit
Cataract Treatment Up to ₹75,000 per eye Up to ₹1 lakh per eye 
Second Opinion Up to ₹5,000Up to ₹8,000
Obesity Treatment and Dietitian Counseling Not Available Obesity treatment up to ₹5 lakh, subject to eligibility conditions, and dietitian counseling up to ₹5,000

Source: New India Premier Mediclaim policy wording and prospectus.

Maternity and Newborn Cover Under New India Premier Mediclaim

New India Premier Mediclaim includes maternity, newborn, and infertility benefits, but these covers come with important waiting periods, limits, and claim restrictions. 

Maternity Cover 

The maternity benefit covers expenses related to childbirth, complicated deliveries, cesarean sections, and lawful medical termination of pregnancy.

    • Waiting Period: 36 months of continuous coverage under New India Premier Mediclaim
    • Plan A Limit: Up to ₹50,000
    • Plan B Limit: Up to ₹1 lakh
    • Where It Applies: Only for inpatient hospitalization in India

Note

  • If you port from another health insurance policy, the previous coverage period does not reduce this 36-month waiting period.
  • After two maternity claims have been paid for an insured person under New India Premier Mediclaim, no further maternity claim is available to that person.

Newborn Baby Cover 

A baby born to an insured mother during the policy period is covered for illness or injury from the date of birth until the policy expires, without an additional premium.

However, the newborn benefit does not cover:

    • Congenital external anomalies
    • Expenses incurred towards pre-term or premature care or in connection with the delivery of such newborn baby

To continue the child's coverage after the current policy expires, the baby must be declared and added as an insured member at renewal.

Infertility Treatment

Infertility treatment, including outpatient treatment, is covered after 36 months of continuous coverage. 

    • Plan A: Up to ₹1 lakh
    • Plan B: Up to ₹2 lakh

One-Time Benefit: The limit is shared across all insured members. Once an infertility claim becomes payable for any member, this benefit is unavailable in subsequent renewals.

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Other Key Features of New India Premier Mediclaim

Ambulance Cover

Background Image

01

Ambulance Cover

Road and air ambulance expenses are covered up to ₹1 lakh per illness for emergencies, ICU admissions, and hospital transfers.

02

Post-Discharge Transport

Up to an additional ₹10,000 is covered for medically necessary ambulance transport from the hospital to your residence.

Organ Donor Expenses

For an insured person's organ transplant, the policy covers the donor's hospitalization expenses, excluding the cost of the organ. The donor's and recipient's expenses together cannot exceed the available sum insured. 

Cover for Certain Hazardous Sports

An unusual feature of this policy is that it covers hospitalization arising from certain specified hazardous or adventure sports. These include activities such as bungee jumping, scuba diving, skydiving, trekking, white-water rafting, among others.

The cover is limited to 10% of the sum insured and applies only to listed sports and inpatient hospitalization in India. 

Modern Treatments 

Modern treatments are covered with specific sub-limits. For example, robotic surgery is covered up to ₹5 lakh, oral chemotherapy up to ₹1 lakh, and intravitreal injections up to ₹75,000. Other treatments, such as deep brain stimulation and stereotactic radiosurgery, also have separate limits. See the policy prospectus for the complete list. 

Optional Riders

The policy documents list optional riders for:

    • Durable medical devices
    • Non-medical expenses
    • Modern treatments
    • Extended pre- and post-hospitalization cover of 90 and 180 days
    • Critical illness benefits

What Is Not Covered Under New India Premier Mediclaim?

Apart from the waiting periods and limits discussed earlier, some key exclusions include:

    • Diagnostic-only hospitalizations and admissions that are not medically necessary.
    • Cosmetic or change-of-gender treatments, except where specifically allowed under the policy.
    • Treatment related to alcohol or substance abuse.
    • Domiciliary hospitalization and treatment received outside India.
    • Unproven treatments, acupuncture, acupressure, and magnetic therapies.
    • Many non-medical expenses and external or durable medical equipment, such as Continuous Positive Airway Pressure (CPAP) machines, oxygen concentrators, walkers, crutches, and glucometers.
    • Intentional self-injury, attempted suicide, war, and nuclear, chemical, or biological events.

This is not an exhaustive list. Refer to the New India Premier Mediclaim policy wording for all exclusions and item-wise non-medical expenses.

New India Premier Mediclaim Sample Premium Illustration

ProfilesPlan APlan B
(Individual Plan): Age 25₹17,554 ₹38,524 
(Family Floater, 2A): Ages (31, 32)₹34,076₹74,364
(Family Floater, 2A 1C): Ages (35, 34, 5)₹44,316₹97,229
(Family Floater, 2A): Ages (62, 63)₹1,65,226 ₹3,38,903

Note: Here, A stands for adult and C for child. These are indicative annual premiums based on New India Assurance’s official rate chart, using ₹15 lakh cover under Plan A and ₹50 lakh under Plan B. Actual premiums may vary based on age, family composition, medical history, underwriting, discounts, and any optional riders chosen. 

New India Assurance: Performance Metrics

Metrics (FY 2024-26)New India AssuranceIndustry Average
Claim Settlement Ratio (CSR) 98%92.02% 
Incurred Claims Ratio (ICR) (Average FY 2023–25) 103.39%81.88% 
Complaints Received per 10,000 Claims 5.6629.35
Annual Business - (In Crore) ₹20,458₹4,504 
Network Hospitals 2000+10,000+ (Benchmark)

Source: This information comes from IRDAI annual reports and New India Assurance public disclosures; for more data on other insurers, explore Ditto Data Lab.

Pros & Cons of the New India Premier Mediclaim Policy

ProsCons
Covers maternity, newborn care, and infertility treatment, which are uncommon in many standard hospitalization plans.There is no restoration benefit or cumulative bonus to replenish or increase the sum insured. 
There is no standard room-rent cap or mandatory co-payment. Several modern treatments have fixed sub-limits even if you opt for ₹50 lakh or ₹1 crore of cover.
The Critical Care benefit is paid in addition to the base sum insured.Domiciliary hospitalization is not covered. 
Covers psychiatric and psychosomatic disorders up to 5% of the sum insured (only in Plan B). The cashless hospital network is significantly smaller than that of several recommended private insurers. 
-Increasing the sum insured later is restricted for older members and those with certain claim or health histories. 

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Conclusion

New India Premier Mediclaim offers a wider mix of benefits than many traditional PSU health plans, including maternity, newborn, infertility, air ambulance, and hazardous-sports coverage. It also avoids a standard room-rent cap and mandatory co-payment.

However, the plan has clear trade-offs. There is no restoration benefit or cumulative bonus, several modern treatments have sub-limits, and New India Assurance has a relatively small cashless hospital network.

So, the policy can suit buyers who value its specific benefits, but it is worth comparing alternatives before deciding. You can also explore our guide to the best health insurance plans in India to compare other plans on coverage, limits, and features.

Frequently Asked Questions

How long do I need continuous coverage before New India Premier Mediclaim pays a maternity claim?

You need to complete 36 months of continuous coverage under New India Premier Mediclaim before the maternity benefit becomes available. Coverage from a previous health insurance policy does not reduce this maternity waiting period after porting. Once eligible, maternity expenses are covered up to ₹50,000 under Plan A and ₹1 lakh under Plan B, subject to the policy’s hospitalization requirements and other conditions.

What is the difference between Plan A and Plan B under New India Premier Mediclaim?

Plan A offers sum insured options of ₹15 lakh and ₹25 lakh, while Plan B offers ₹50 lakh and ₹1 crore. Plan B also provides higher limits for hospital cash, critical care, OPD expenses, HIV/AIDS treatment, cataract surgery, and second opinions. It additionally includes obesity treatment and dietitian counseling. Both plans share several core hospitalization benefits, waiting periods, exclusions, and treatment-specific sub-limits.

Is a newborn baby automatically covered from birth under this policy?

Yes. A baby born to an insured mother is covered for illness or injury from birth until the policy expires, without an additional premium. However, the newborn benefit excludes congenital external anomalies, preterm or premature care, and expenses connected with the baby’s delivery under this cover. To continue coverage after the current policy period, the child must be declared and added as an insured member at renewal.

Does New India Premier Mediclaim cover air ambulance charges?

Yes. New India Premier Mediclaim covers medically necessary road and air ambulance expenses up to ₹1 lakh per illness for eligible emergency or ICU admissions and transfers between hospitals. The policy also provides up to ₹10,000 for medically necessary ambulance transportation from the hospital to the insured person’s residence after discharge. These benefits remain subject to the conditions and eligibility requirements specified in the policy wording.

How many maternity claims can I make under New India Premier Mediclaim?

The maternity benefit is available for a maximum of two paid maternity claims per insured person under preceding or existing New India Premier Mediclaim policies. Once New India Assurance has paid two maternity claims for that insured person, no further maternity claim is available under this benefit. Each claim must also meet the 36-month continuous coverage requirement, applicable benefit limit, inpatient hospitalization requirement, and other terms stated in the policy.

Is New India Premier Mediclaim the same insurer as National Insurance’s mediclaim plans?

No. The New India Assurance Company Limited and National Insurance Company Limited are separate public-sector general insurance companies. The New India Assurance Company Limited issues New India Premier Mediclaim, while National Insurance offers its own health insurance products. Their policy features, premiums, hospital networks, underwriting rules, and claim processes are separate. Always check the insurer and exact policy name when comparing similarly named Mediclaim products.

What is the difference between New India Mediclaim Policy and New India Floater Mediclaim Policy?

The main difference is how the sum insured is allocated. Under the New India Mediclaim policy, each insured person gets a separate sum insured. Under the New India Floater Mediclaim policy, all covered family members share one common sum insured. Both offer Basic and Uplift plans. The New India Mediclaim policy offers ₹1 lakh to ₹15 lakh under Basic and ₹25 lakh to ₹5 crore under Uplift. The New India Floater Mediclaim policy offers ₹2 lakh to ₹15 lakh under Basic and ₹25 lakh to ₹5 crore under Uplift. 

Does New India Assurance offer health insurance for senior citizens?

Yes. New India Assurance offers the New India Sixty Plus Mediclaim policy, designed primarily for people aged 60 and above. It offers sum insured options of ₹2 lakh, ₹3 lakh, and ₹5 lakh, with a mandatory 10% co-payment. A spouse below 60 can also be covered if at least one insured member is a senior citizen. Fresh policies require a health checkup, with 50% of the checkup cost reimbursed if the proposal is accepted.

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