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New India Atmanirbhar Health Policy

Atmanirbhar Health Policy, New India Assurance Co Ltd is specially designed for persons with disabilities, mental illness, and persons with HIV/AIDS to cover hospitalisation expenses. This policy is specially designed for this certain type of people so that they can receive the treatments without any financial hazards. To know more about this policy, have a look at the following mentions.

Eligibility Criteria

Age at entry

Minimum – 18 years

Maximum – 65 years

For dependent children:

Minimum – New-born

Maximum – 17 years

Who is eligible?The insured must have a certificate of 40% or more disability as certified by the competent authority.
Sum insured optionsRs. 4 lakhs and Rs. 5 lakhs
Policy basisIndividual type
Grace period15 days
Coverage availableOnly in India
Policy period1 year

Coverage Details

The following table gives a brief idea about the policy and its sub-limits.

Pre-hospitalization expenses30 days
Post-hospitalization expenses60 days
ICU, ICCU chargesUp to 2% of the sum insured
Each eye in one policy yearRs. 40000
Modern treatmentUp to 50% of the sum insured
AYUSH expensesUp to 50% of the sum insured

What are the benefits of the New India Atmanirbhar Health Policy?

This policy has come up with a sack full of benefits and facilities. The important mentions are as follows.

Covered Expenses:

The following expenses are covered

  • Expenses incurred on the treatment of cataracts are subject to sub-limits.
  • Dental treatment is necessitated due to disease or injury (for inpatient care only).
  • Plastic surgery is necessitated due to disease or injury.
  • All daycare treatments

Cataract Treatment:

The company shall indemnify medical expenses incurred for treatment of Cataracts, subject to sub-limit.

Emergency Road Ambulance:

The Company will reimburse Reasonable and Customary Charges for expenses incurred towards ambulance charges for transportation of an Insured person, per hospitalization up to Rs. 2000 as per the terms and conditions mentioned in the Policy Clause.

Room Rent:

Room Rent, Boarding, and Nursing Expenses as provided by the Hospital, Nursing Home are covered up to a maximum of 1% of the Sum Insured per day.

Treatment Under AYUSH:

The Company shall indemnify medical expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy systems of medicines during each Policy Year up to 50% of the sum insured as specified in the policy schedule in any AYUSH Hospital.

Tax Benefit:

Payments made for health insurance in any mode other than cash are eligible for deduction from taxable income as per Section 80 D of the Income Tax Act, 1961.

Continuity Benefit:

There are certain treatments that are payable only after the Insured Person is continuously covered for a specified period.

General Exclusions of New India Atmanirbhar Health Policy

The claims arising out of the following conditions are not covered under this policy.
  • Expenses related to any admission are primarily for diagnostics and evaluation purposes.
  • Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment.
  • Expenses related to any admission primarily for enforced bed rest and not for receiving treatment.
  • Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex.
  • Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident, Burns, or Cancer or as part of the medically necessary treatment to remove a direct and immediate health risk to the insured. For this to be considered a medical necessity, it must be certified by the attending Medical Practitioner.
  • Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports.
  • Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
  • Treatment for, Alcoholism, drug or substance abuse, or any addictive condition and consequences thereof.
  • Treatments received in health hydros, nature cure clinics, spas, or similar establishments or private beds registered as a nursing home attached to such establishments or where admission is arranged wholly or partly for domestic reasons.
  • Dietary supplements and substances that can be purchased without a prescription, including but not limited to Vitamins, minerals, and organic substances unless prescribed by a medical practitioner as part of hospitalization claim or day care procedure.
  • Expenses related to the treatment for correction of eyesight due to refractive error less than 7.5 dioptres.
  • Medical treatment expenses traceable to childbirth (including complicated deliveries and cesarean sections incurred during hospitalization) except ectopic pregnancy.
  • Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.
  • Expenses related to any unproven treatment, services, and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures, or supplies that lack significant medical documentation to support their effectiveness.

Buying Process of New India Atmanirbhar Health Policy

One can easily buy this policy by following the below easy steps carefully.

  • Search for the ‘Products’ tab at the top of this page. Click on that, and select the ‘Health Insurance’ option.
  • After that, one has to select the gender and input his/her “pin code” in the section on the right-hand side of the page. Click “Continue” from the menu.
  • Then, choose the individual you wish to insure next.
  • After completing that, one must need to choose the “deductible amount” and enter his/her age before continuing. (Select whether you have experienced ailments by selecting yes or no). Click “Get Plan” after that.
  • Go through the list of plans and find New India Atmanirbhar Health Policy.
  • Enter the other required details and pay the premium to buy the plan.
  • After buying, download the policy for better convenience.

What is the claim process of the New India Atmanirbhar Health Policy?

This company has come up with both cashless and reimbursement claims. Both procedures are given below.

Cashless Claim Procedure:

  • Treatment may be taken in a network provider and is subject to pre-authorization by the company or its authorized TPA.
  • A cashless request form is available with the network provider and TPA shall be completed and sent to the company/TPA for authorization.
  • The company/TPA, upon getting the cashless request form and related medical information from the insured person/network provider, will issue a pre-authorization letter to the hospital after verification.
  • At the time of discharge, the insured person has to verify and sign the discharge papers and pay for non-medical and in-admissible expenses.
  • Company/TPA reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant medical details.
  • In case of denial of cashless access, the insured person may obtain the treatment as per the treating doctor’s advice and submit the claim documents to the company/TPA for reimbursement.

Reimbursement Claim Procedure:

  • Under this type of claim, one can receive treatment from a non-network hospital.
  • Receive the treatments and get the discharge certificate from the hospital.
  • Submit all the relevant documents to the insurer.
  • The claim will be assessed.
  • If no discrepancy is found, the claim amount will be settled within the stipulated time.

Required Documents:

  • Duly completed claim form.
  • Photo identity proof of the patient.
  • Medical practitioner’s prescription advising admission.
  • Original bills with the itemized break-up
  • Payment receipt
  • Discharge summary, including complete medical history of the patient along with other details.
  • Investigation/diagnostic test reports, etc., supported by the prescription from the attending medical practitioner.
  • OT note, or surgeon’s certificate giving details of the operation performed.
  • Sticker/invoices of the implants, wherever applicable.
  • MLR if carried out and FIR if registered wherever applicable.
  • NEFT details and canceled cheque.
  • KYC of the proposer, where claim liability is above Rs. 1 lakh as per AML guidelines.
  • Legal heir/succession certificate, wherever applicable.
  • Any other relevant document required by the company/TPA for assessment of the claim.

Frequently Asked Questions

The following time limits have to be followed.

Type of claimPrescribed time limit
Reimbursement of hospitalization, daycare, and pre-hospitalization expensesWithin 30 days of the date of discharge from the hospital
Reimbursement of post-hospitalization expensesWithin 15 days from the completion of post-hospitalization treatment.

Each and every claim under this policy shall be subject to a co-payment of 20% applicable to the claim amount admissible, and payable as per the terms and conditions of the policy. The amount payable will be after the deduction of the co-payment. This co-payment can be waived by paying an additional premium (optional).

No, it is not required. However, for persons suffering from HIV/AIDS, a recent certificate of the current CD4 count (within the past 30 days) needs to be submitted.

The initial waiting period of the policy is 30 days.

The following modern treatments are covered.

  • Uterine Artery Embolization and HIFU (High intensity-focused ultrasound) 
  • Balloon Sinuplasty 
  • Deep Brain stimulation 
  • Oral chemotherapy 
  • Immunotherapy- Monoclonal Antibody to be given as an injection. 
  • Intra Vitreal injections 
  • Robotic surgeries 
  • Stereotactic radio Surgeries 
  • Bronchial Thermoplasty 
  • The vaporization of the prostrate (Green laser treatment or holmium laser treatment) 
  • IONM- (Intra Operative Neuro Monitoring) 
  • Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered.

Yes. You may seek enhancement of the Sum Insured in writing before payment of the premium for renewal, which may be granted as per the company’s Underwriting guidelines.

Yes, it is possible to shift to another hospital for reasons of the requirement of better medical procedures. However, this will be evaluated by the TPA on the merits of the case and as per policy terms and conditions.

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