Paul Sanchez
New India Assurance offers a range of health insurance plans with different benefits and features to meet the diverse needs of Indian citizens. The company has a simple and efficient claim procedure, with two options for claim submission: cashless and reimbursement claims. This guide will outline the steps for both types of claims, including important considerations and requirements to ensure a smooth and successful claim process. By understanding the specific conditions and exclusions of your chosen plan, you can effectively utilise your New India Assurance health insurance to access quality healthcare services without financial worry.
How to Claim Medical Insurance from New India Assurance
| Characteristics | Values |
|---|---|
| Eligibility | Persons aged between 18 and 65 years |
| Child Coverage | Children aged between 3 months and 18 years are covered if their parents are covered. Children aged between 18 and 25 years are covered if they are financially dependent on their parents. |
| Family Coverage | Family members can be covered in one policy with separate Sum Insured for each insured person. |
| Sum Insured | The proposer can choose from INR 1,2, 3, 5, 8, 10, 12 and 15 Lakhs. |
| Premium | The premium payable is determined based on the age of the members and the chosen Sum Insured. |
| Discounts | 10% family discount on the total premium amount payable. 11-18% discount for family floater plans. |
| No Claim Bonus | 2-15% for members up to 60 years and 11-18% for family floater plans. |
| Cashless Treatment | Available at network hospitals enlisted by New India Assurance. The policyholder can use the insurance to seek treatment without paying upfront. |
| Reimbursement | The policyholder pays the hospital bills upfront and later claims the expenses from the insurer. |
| Pre-authorization | Required in most cases. The hospital sends the completed form to the insurance provider. |
| Documentation | Medical certificates, diagnosis reports signed by a doctor, reports, discharge summary, original bills, and hospitalization records. |
| Notification | Notify New India Assurance within 24 hours of hospitalization. Inform about hospitalisation within 7 days of discharge. |
| Claim Settlement | The insured sum provides financial assistance for medical care, hospitalisation, and emergency treatment. |
| Coverage | Medical expenses, ambulance charges, hospital cash, organ transplant, maternity expenses, cataract operations, AYUSH treatments, infertility treatment, etc. |
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What You'll Learn
Cashless treatment
New India Assurance has a large network of hospitals where cashless facilities are available across the country. You can avail of cashless treatment at any of these network hospitals by following the steps outlined below:
- Notify the Third-Party Administrator (TPA), or the New India Assurance Company in writing immediately upon detection of an illness/injury, or at least forty-eight hours before hospitalization. In the case of a medical emergency, notification must be made within twenty-four hours of hospitalization.
- Show your New India Assurance ID card at the network hospital's insurance desk. This is crucial for verifying your policy and expediting the approval of your cashless treatment.
- Fill and submit the pre-authorization form along with the doctor’s consultation notes. The network hospital then liaises with New India Assurance to initiate the claim process on your behalf.
- The insurer examines the submitted documents and proceeds to authorize the cashless treatment.
- If required, allow an examination by an Insurer-authorized medical practitioner, with the cost covered by the insurer.
It is important to note that New India Assurance may reject the claim for cashless hospitalisation and treatment. In such cases, the insured individual can claim reimbursement for the expenses incurred for the treatment.
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Reimbursement claims
To file a reimbursement claim with New India Assurance Health Insurance, you must inform the company immediately, or at least 48 hours prior to hospitalisation, upon detecting any illness or injury. You must then report your hospital admission to New India Assurance within 24 hours. It is important to notify the company as soon as possible to ensure a seamless claim process and to avoid any potential delays. After receiving treatment, settle all associated bills at the time of discharge. Before leaving the hospital, gather all necessary medical documents, bills, and receipts.
Next, fill out the claim form, which can be found on the New India Assurance Company’s website. Providing complete and correct information in the claim form is essential for a smooth claim processing experience. After discharge, submit all relevant documents to the insurer within seven days. The documents required include the claim form, a valid photo ID, your policy number, and all pertinent medical history documentation and hospital bills. The policy owner must verify and sign the original bills and keep a photocopy of the entire hospitalisation record.
The insurance company will then assess all submitted documents and process the reimbursement. New India Assurance will then communicate with the relevant bank to update the status of the claim, which could be either acceptance or rejection, or a request for additional information or documentation. Once accepted, the medical bills and costs covered under the policy are settled by New India Assurance, while things that are not covered will have to be taken care of by the patient/cardholder.
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Pre-authorisation forms
To make a claim with New India Assurance, the policyholder must first notify the Third-Party Administrator (TPA) or New India Assurance Company in writing as soon as an illness or injury is detected, or at least 48 hours before hospitalisation. In the case of a medical emergency, notification must be given within 24 hours.
The policyholder must then fill and submit the claims form, providing a photocopy of a valid ID proof and the required medical certificates, including diagnosis reports signed by a doctor. The original reports and discharge summary must also be submitted for verification.
The next step is to submit a pre-authorisation form, which will be created by the insurer and the TPA. This form must be filled in by the hospital, with a signature from the attending doctor, and sent to the insurance provider. The hospital will then send the incurred bills to the insurer.
The policy owner must verify and sign the original bills and keep a photocopy of the entire hospitalisation record. The insurer will then process the reimbursement.
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Documentation
The New India Assurance Co. Ltd. offers a streamlined and effortless claim procedure, with two convenient options for claim submission: cashless and reimbursement claims.
For cashless treatment, the policyholder can use their insurance as money to seek treatment without paying upfront. This is available at any of the network hospitals enlisted by New India Assurance on their website or policy brochure across the country. In this case, the policyholder must notify the Third-Party Administrator (TPA), or the New India Assurance Company in writing, immediately upon detection of an illness/injury, or at least 48 hours before hospitalization. In a medical emergency, notification must be within 24 hours. The policyholder must then show their New India Assurance ID card at the network hospital's insurance desk and fill and submit the pre-authorization form along with the doctor’s consultation notes. The network hospital then liaises with New India Assurance to initiate the claim process.
For reimbursement claims, the policyholder pays the hospital bills upfront and later claims these expenses back from the insurer. In this case, the policyholder must inform New India Assurance immediately or at least 48 hours prior to hospitalization, upon detecting any illness or injury. They must then report their hospital admission to New India Assurance within 24 hours and settle all associated bills at the time of discharge. All necessary medical documents, bills, and receipts must be gathered before leaving the hospital and the claim form must be filled out accurately and submitted to the insurer within seven days of discharge.
In both cases, the policyholder must let the insurer know about hospitalisation within seven days of their discharge. All documents must be submitted within 10 days of the patient's discharge. The policy owner has to also verify and sign the original bills and keep a photocopy of the entire hospitalisation record.
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Notification
New India Assurance offers a streamlined and effortless claim procedure, with the aim of providing swift and satisfactory resolution of health claims. The company provides two options for claim submission: cashless and reimbursement claims.
Cashless Claims
In the case of a medical emergency that results in hospitalization, it is essential to notify New India Assurance within twenty-four hours. For planned hospitalisation, notification should be given at least forty-eight hours in advance.
To initiate a cashless claim, notify the Third-Party Administrator (TPA) or the New India Assurance Company in writing. Show your New India Assurance ID card at the network hospital's insurance desk to verify your policy and expedite the approval of your cashless treatment.
Once the hospital has received approval, you can receive treatment without having to pay any money upfront. After treatment, the hospital will send a pre-authorisation form to the insurance provider, which will then communicate with the relevant bank to update the status of the claim.
Reimbursement Claims
For reimbursement claims, it is also essential to notify New India Assurance within twenty-four hours of hospitalisation, or at least forty-eight hours in advance for planned hospitalisation.
After receiving treatment, you will need to settle all associated bills and gather all necessary medical documents, bills, and receipts before leaving the hospital. After discharge, promptly submit all relevant documents to the insurer within seven days.
Important Information
It is the policyholder's responsibility to ensure that New India Assurance is notified promptly of any hospitalisation. Failure to do so may result in delays in the claim process.
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