Senior Citizen Mediclaim Policy - The New India Assurance Co. Ltd.

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iv. Surgeon's certificate stating nature of operation performed and Surgeons’ bill and receipt.v. Attending Doctor's/ Consultant's/ Specialist's / Anesthetist’s bill and receipt, and certificateregardingdiagnosis.vi. Certificate from attending Medical Practitioner / Surgeon that the patient is fully cured.Waiver: Waiver of period of intimation may be considered in extreme cases of hardships whereit is proved to the satisfaction of the Company/TPA that under the circumstances in which theinsured was placed it was not possible for him or any other person to give such notice or fileclaim within the prescribed time limit. This waiver cannot be claimed as a matter of right.12.0 PROCEDURE FOR AVAILING CASHLESS ACCESS SERVICEClaims in respect of Cashless facility will be through the agreed list of Network Hospital / NursingHome/Day Care Centre and is subject to pre-admission authorization. The TPA shall, upon gettingthe related medical information from the insured person /network provider, verify that theperson is eligible to claim under the policy and after satisfying itself will issue a pre-authorizationletter / guarantee of payment letter to the Hospital /Nursing Home/Day Care Centre mentioningthe sum guaranteed as payable and also the ailment for which the person is seeking to beadmitted as a patient. The TPA reserves the right to deny pre-authorization in case the insuredperson is unable to provide the relevant medical details as required by the TPA. The TPA willmake it clear to the insured person that denial of Cashless facility is in no way construed to bedenial of treatment. The insured person may obtain the treatment as per his /her treatingdoctor’s advice and later on submits the full claim papers to the TPA for reimbursement.13.0 REPUDIATION OF CLAIMSA claim, which is not covered under the Policy conditions, can be rejected. All the documentssubmitted to TPA shall be electronically collected by the Company for settlement and denial ofthe claims by the appropriate authority.With Our prior approval Communication of repudiation shall be sent to You, explicitly mentioningthe grounds for repudiation, through Our TPA.14.0 PAYMENT OF CLAIMThe insurer shall settle the claim, including rejection, within thirty days of the receipt of the lastnecessary document.On receipt of the duly completed documents either from the insured or hospital the claim shallbe processed as per the conditions of the policy. Upon acceptance of claim by the insured forsettlement, the insurer or their representative (TPA) shall transfer the funds within seven workingdays. In case of any extra ordinary delay, such claims shall be paid by the insurer or theirrepresentative (TPA) with a penal interest at a rate which is 2% above the bank rate at the16
eginning of the financial year in which the claim is reviewed.All admissible claims shall be payable in Indian Currency only.15.0 PORTABILITY CLAUSE: This policy is subject to portability guidelines issued by IRDA and isamended from time to time.17.0 ARBITRATION:If the Company admits liability for any claim but any difference or dispute arises asto the amount payable for any claim the same shall be decided by reference to Arbitration.The Arbitrator shall be appointed in accordance with the provisions of the Arbitration andConciliation Act, 1996.No reference to Arbitration shall be made unless the Company has Admitted liability for a claim inwriting.If a claim is declined and within 12 calendar months from such disclaimer any suit or proceedingis not filed then the claim shall for all purposes be deemed to have been abandoned and shall notthereafter be recoverable hereunder.18.0 PERIOD OF POLICY: This insurance policy is issued for a maximum period of one year.19.0 GRIEVANCE REDRESSAL: In the event of Insured Person having any grievance relating to theinsurance, the Insured may contact any of the Grievance Cells at Regional Offices of the Companyor Office of the Insurance Ombudsman under the jurisdiction of which the Policy Issuing Officefalls. The contact details of the office of the Insurance Ombudsman are provided in the AnnexureII.20.0 PROTECTION OF POLICY HOLDERS’ INTEREST: This policy is subject to IRDA (Protection ofPolicyholders’ Interest) Regulation, 2002.17
Page 3 and 4: India / National Accreditation Boar
Page 5 and 6: 3.14.1 HOSPITALISATION:means admiss
Page 7 and 8: Homeopathy set up by the Government
Page 9 and 10: insurance, will not be covered even
Page 11 and 12: 4.4.13 Maternity Expenses, except a
Page 13 and 14: of cancellation. The Insured may at
Page 15: 8.0 COMPANY’S LIABILITY:The Compa
Page 19 and 20: 39 TOOTH PASTE Not Pavable40 TOOTH
Page 21 and 22: 100 TELEVISION & AIR CONDITIONER CH
Page 23 and 24: Payable reasonably169 NOVARAPID Pay
Page 25 and 26: CHENNAINEW DELHIGUWAHATIHYDERABADKO

Senior Citizen Mediclaim Policy - The New India Assurance Co. Ltd.

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