Overview
The New India Assurance Senior Citizen Mediclaim plan is tailored for individuals aged 60 to 80 years, offering sum insured options typically ranging from ₹1 lakh to ₹1.5 lakh. It features a relatively short waiting period of two years for pre-existing diseases, lifelong renewability, and benefits for mental health and genetic disorders with sub-limits. It aims to provide affordable health protection for senior citizens with moderate coverage.
Experts Review
Written by Ishita Jain
Editor
The New India Assurance Senior Citizen Mediclaim plan is a basic health insurance option for seniors, notable for its relatively short two-year waiting period for pre-existing diseases, which is an advantage over many competitors requiring three years. The policy covers a range of treatments including mental illness, genetic disorders, and physiological conditions related to aging, albeit with massive sub-limits (typically 10-25% of sum insured). It also includes domiciliary hospitalization and alternative medicine coverage as add-ons.
However, the sum insured options are quite low (₹1-1.5 lakh), which is quite insufficient given the rising healthcare costs for senior citizens. The policy imposes room rent limits (usually 1% of sum insured per day), which can lead to out-of-pocket expenses if higher room categories are chosen. Coverage for certain conditions like Age-Related Macular Degeneration and behavioral disorders comes with waiting periods and sub-limits, restricting full benefit access. The policy excludes treatment for injuries due to suicidality and has specific conditions for mental health coverage.
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 coverage if you are forced to hospitalize at home, which could be a drawback for some.
Maternity benefits not offered, 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.
Room Rent
Anything below twin sharing room
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Appendicectomy, Angiography, Tonsillectomy, Hysterectomy, Septoplasty 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 just 1.5 years. It’s probably the best deal you can get to be honest.
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 5% of hospitalisation bill for about 30 days before you are hospitalized and upto 10% of hospitalisation bill for about 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, Dementia, Alzheimer’s disease and Venereal disease.
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.
18-Month Waiting Period:
All internal and external benign tumors, 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
1.5 years Pre-existing disease waiting period
Ditto's Take
◦ ◦
What's missing in the policy
No Restoration Benefit.
No coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
D
Divya Sharma
The 1.5-year waiting period for pre-existing conditions felt reasonable for a senior-focused policy.
M
Meena Sharma
Covers mental illness and genetic disorders, though with sub-limits.
R
Rajesh Iyer
Domiciliary hospitalization and alternative medicine coverage available as add-ons.
V
Varsha Mehta
Sub-limits on many conditions like AMD and behavioral disorders.
G
Geeta Singh
Very low sum insured options (₹1-1.5 lakh), highly insufficient for major illnesses.
D
David P.
Some coverage for age-related conditions is better than none.
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Frequently Asked Questions
Does Senior Citizen 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 1.5-year waiting period for any pre-existing disease you may have while buying the policy.
Does Senior Citizen Mediclaim have room rent restrictions?
Does Senior Citizen Mediclaim offer a restoration benefit?
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