The New India Assurance - Senior Citizens Mediclaim Policy - Terms & Conditions

Terms & Conditions

1. Contract: The proposal form, declaration, pre acceptance Health check-up and the policy issued shall constitute the complete contract of insurance.

2. Communication: Every notice or communication to be given or made under this Policy other than that relating to the claim shall be delivered in writing at the address of the policy issuing office as shown in the schedule. The claim shall be reported to the TPA appointed for providing claim services as per the procedure mentioned in the guidelines circulated by the TPA to the policyholders. In case TPA services are not availed then claim shall be reported to the policy issuing office only.


3. Premium Payment: The premium payable under this policy shall be paid in full and in advance. No receipt for premium shall be valid except on the official form of the company signed by a duly authorized official of the Company. The due payment of premium and the observance and fulfillment of the terms, provisions, conditions and endorsements of this policy by the Insured Person in so far as they relate to anything to be done or complied with by the Insured Person shall be a condition precedent to admission of any liability by the Company to make any payment under the Policy. No waiver of any terms, provisions, conditions and endorsement of this policy shall be valid unless made in writing and signed by an authorized official of the Company.

4. Physical Examination: Any Medical Practitioner authorized by the TPA/Company shall be allowed to examine the Insured Person in case of any alleged disease/illness/injury requiring Hospitalization. Non co-operation by the Insured Person will result into rejection of his/her claim.

5. Fraud, Misrepresentation, Concealment: The policy shall be null and void and no benefits shall be payable in the event of misrepresentation, non-disclosure of any material fact/ particulars if such claim be in any manner fraudulent or supported by any fraudulent means or device whether by the Insured Person or by any other person acting on his/her behalf.

6. Contribution: If at the time when any claim arises under this policy, there is in existence any other insurance (other than Cancer Insurance Policy in collaboration with Indian Cancer Society/Cancer Patient Aid Association), whether it be effected by or on behalf of any Insured Person in respect of whom the claim may have arisen covering the same loss, liability, compensation, costs or expenses, the Company shall not be liable to pay or contribute more than its ratable proportion of any loss, liability, compensation, costs or expenses. The benefits under this Policy shall be in excess of the benefits available under Cancer Insurance Policy as indicated above.

7. Cancellation Clause: The Company may at any time cancel this Policy by sending the Insured 30 days notice by registered letter at the Insured's last known address and in such event the Company shall refund to the Insured a pro-rata premium for un-expired period of Insurance. The Company shall however, remain liable for any claim, which arose prior to the date of cancellation. The Insured may at any time cancel this Policy and in such event the Company shall allow refund of premium at Company's short period scale of rate only (table given below) provided no claim has occurred up to the date of cancellation.

Period On Risk	Rate of Premium To be Charged
Up to one-month	1/4th of the annual rate
Up to three months	� of the annual rate
Up to six months	3/4th of the annual rate
Exceeding six months	Full annual rate

8. Free Look Period: The insured additionally to have 10 days free look period to cancel the policy and premium is returned without interest.

9. Disclaimer of Claim: If the TPA/Company shall disclaim liability to the Insured for any claim hereunder and if the insured shall not, within 12 calendar months from the date or receipt of the notice of such disclaimer, notify the TPA/Company in writing that he does not accept such disclaimer and intends to recover his claim from the Company, then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.


10. All medical/surgical treatment under this policy shall have to be taken in India.

11. Cumulative Bonus: The cumulative bonus is allowed when a policy is renewed after a claim free year at the rate of 5% of the expiring sum insured. Cumulative Bonus will be limited to a maximum of 30%. Renewals from other companies will not be eligible for Cumulative Bonus and will be treated as fresh insurance.

In the event of a claim, entire Cumulative Bonus will be withdrawn at the time of renewal, irrespective of the claim amount.

Note: Please refer to the policy documents for the complete Insurance Policy subject to the insurance Company.

Reference

Disclaimer: This information is extracted from the company�s official website to provide information to the general public. The information is likely to change based on the concerned insurance companies� discretion. Alterations, deletions and/or additions to the existing policy products, coverage and their premiums may be enhanced or reduced. These figures are only guidelines. We recommend the individual to visit the official website of the insurance company for more details and updated matters.

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