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New India Universal Health Insurance Scheme (APL)

New India Assurance Universal Health Insurance APL to mitigate the economic woes and ensure quality healthcare to the APL (Above Poverty Line) sections of society to individuals, families, and groups. The New India Assurance Universal Health Insurance APL Policy pays for hospitalisation costs associated with an accident or illness.

This health insurance policy is designed for both groups and individuals (Below-the-poverty-line). The primary breadwinner of the family’s name, together with the information for the other insured family members, must appear on the individual health insurance policy.

Read on to know more about the New India Universal Health Scheme (APL) in detail!

Eligibility Criteria

Here are the eligibility criteria for the New India Universal Health Insurance Scheme (APL).

ParametersDetails
AgePersons / Families between the age of 3 months and 65 years
Members CoveredSpouse, Dependent Children (maximum three), Dependent Parents
Installment Facility offeredNo

Coverage Details

Here are the coverage details for the New India Universal Health Insurance Scheme (APL).

ParametersDetails
  • Room, Boarding expenses as provided by the Hospital/Nursing Home
  •  If admitted to IC Unit
  • Up to 0.5% of the Sum Insured per day
  • Up to 1% of Sum Insured per day
Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing ExpensesUp to Rs.15% of Sum Insured per Illness/ Injury
Anesthesia, Blood, Oxygen, OT charges, Surgical appliances, Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, and artificial limbs.Up to 15% of the Sum Insured per Illness/Injury
Total expenses incurred for Any one Illness isRs.15,000/-.
Coverage for Earning Head of the familyRs. 25, 000
Disability Compensation for Earning Head of the FamilyDisability compensation at the rate of Rs. 50/- per day up to a maximum period of 15 days in a policy year
Payment of premium

Individual Person Rs.383/- per annum.

Family (not exceeding five members) consisting of Insured, Spouse, and first 3 dependent children Rs.575/- per annum.

Family not exceeding 7 members consisting of Insured, Spouse, first 3 dependent children and dependent parents Rs.767/- per annum.

Features and Benefits of Choosing the New India Universal Health Insurance Scheme

Here are the key features and benefits of choosing the New India Universal Health Insurance (APL) Scheme.

Free Look Period:

The free look time shall begin when the policy is first issued. The policyholder will have 15 days after receiving the policy to evaluate the terms and conditions and return the policy if they are not satisfactory.

Migration:

As per IRDAI guidelines on migration, you will have the choice to migrate the policy to other health insurance products or plans provided by the company by applying for the migration of the policy at least 30 days before the policy renewal date.

Portability:

According to IRDAI portability guidelines, you will have the choice to port the policy to other insurers by applying to such insurer to port the complete policy, together with all of the family members, if any, at least 45 days before, but not sooner than 60 days after the policy renewal date.

Maternity Cover:

After a one-year waiting period, maternity insurance is given (only one delivery or child is covered). The limit is fixed at Rs. 2500 for normal delivery and at Rs. 5000 for a caesarean. Maximum maternity benefits during the policy period are restricted to Rs.30,000 per family or person.

Behavioural and Neurodevelopmental Disorders:

Adult personality disorders and speech and language disorders, such as dyslexia and stuttering, are covered as inpatient procedures after 24 months of uninterrupted coverage.

Not Covered Under the New India Universal Health Insurance Scheme

The following are the things not covered under the New India Universal Health Insurance Scheme (APL).

  • Change-Of-Gender Treatments

Expenses associated with any form of treatment, including surgical intervention, to transform a person’s physical traits to those of the other sex.

  • Cosmetic Or Plastic Surgery 

Costs associated with cosmetic or plastic surgery, or any other procedure to alter the appearance, unless necessary for reconstruction following an accident, burn(s), or cancer, or if done as part of medically required therapy to eliminate a direct and immediate risk to the insured’s health.

  • Hazardous Or Adventure Sports

The cost of any medical care required as a result of a professional athlete’s participation in risky or adventure sports, such as skydiving, deep-sea diving, hand gliding, motor racing, mountaineering, rafting, parachuting, rock climbing, and others.

  • Breach of Law

Treatment costs that are directly related to or resulting from any insured person breaking the law with criminal intent or attempting to do so.

  • War (whether declared or not), invasions, conflicts, civil war, uprisings, revolutions, insurrections, mutinies, military or usurped authority, as well as all types of seizure, capture, arrest, restriction, and detention.
  • Costs associated with any admission, mostly for testing and evaluation.
  • Any diagnostic costs that are not incidental to the current diagnosis or treatment or that are unrelated to it.
  • Treatment costs for cataracts, benign prostatic hyperplasia, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, congenital internal disease, fistula in anus, piles, sinusitis, and related disorders are not covered until 12 months have passed since the first policy with the insurer began.
  • Personal care services such as assistance with activities of daily living like washing, dressing, and moving around are provided under custodial care either at home or in a nursing facility by trained nurses, assistants, or unskilled individuals.
  • Any services that meet the physical, social, emotional, and spiritual needs of those who are terminally ill.

How To Buy the New India Universal Health Insurance Scheme?

Although purchasing the New India Universal health insurance plan can provide policyholders with a wide range of health benefits, sadly, it is not accessible through the New India Insurance company’s official website. There is no need to worry, though. This is where the importance of Probus Insurance comes into play.

Probus Insurance Broker Private Limited, a specialised insurance broker, operates all over India and offers a variety of insurance plans (including life and non-life) to meet the rising demands of the populace.

Let’s talk about how to purchase the New India Universal health insurance scheme.

  • The “Product” section can be found at the top of the main page. The phrase “Health Insurance” will appear when you hover over it. Just click it.
  • The next step is to choose your gender and input your “pin code” in the section on the right-hand side of the page. Select “Continue” from the menu.
  • Choose the individual you wish to insure next. You must then choose your “deductible amount” and enter your age before continuing. (Select whether you have experienced ailments by selecting yes or no). Click “Get Plan” after that.
  • You will see a list of plans and the required premium amount as soon as you click on it. Find your “New India Universal health insurance scheme” after that, and buy it now.

If you are still facing difficulties in purchasing the plan, then all you need to do is contact a customer service representative to obtain the New India Universal health insurance plan at Probus Insurance right away. The contact information is provided below.

  • Call: +91 7304332968
  • WhatsApp: Say “Hi” to 7304332968
  • Mail: care@probusinsurance.com

How to File a Claim for the New India Universal Health Insurance Scheme?

If the Insured intends to make any claim under this Policy, listed below are the steps to consider while filing a claim.

  • Inform TPA in writing as soon as you become aware of any illness or injury, no later than 48 hours before hospitalisation.
  • In case of hospitalisation due to a medical emergency, notify within twenty-four hours of the time of admission.
  • Within seven days of the date of discharge from the hospital, send the following supporting documentation to TPA about the claim:
  • Bill, receipt, and hospital discharge card or certificate.
  • Cash Memos from Hospitals/Chemists, accompanied by valid prescriptions.
  • The receipt and pathological test results from the pathologist, backed up by a note from the attending physician or surgeon urging such pathological studies.
  • Surgeon’s certificate outlining the procedure’s nature as well as the surgeon’s invoice and receipt.
  • The bill and receipt from the attending physician, the consultant, the specialist, the anaesthetist, and the certificate of diagnosis.
  • You must submit all claim documentation within seven days of the end of any post-hospitalization care (limited to sixty days).
  • Give TPA permission to acquire medical records and other documents from any hospital, laboratory, or other organisation.
  • The insured individual must provide all original invoices, receipts, and other supporting documentation to the TPA along with any other information and support that the TPA or the company may need.
  • Any physician permitted by the TPA or company may examine the insured person at the company’s expense if the company determines that doing so is medically necessary in connection with any claim.

Renewal Process of the New India Universal Health Insurance Scheme

The majority of health insurance contracts are yearly agreements that must be renewed each year to maintain coverage. Due to this, it is equally crucial to renew your coverage on time. By doing this, you can keep taking advantage of the policy’s advantages, including no-claim bonuses and the ability to skip waiting periods. Regular insurance renewals guarantee that the coverage doesn’t expire and that its benefits are still available. If you want to renew your New India Universal Health insurance scheme, listed below are the steps to follow.

  • Visit the New India Insurance official website.
  • The “Quick Help” button is located at the top. Simply click it. Then, the words “Quick Renewal” will show up. Simply click it.
  • On a subsequent page, you will be asked for your customer ID and policy number. Make sure you enter the correct data while typing. After that, click the “Proceed” button.
  • After that, the insurance renewal premium must be paid. You can then renew your insurance with a credit or debit card.
  •  When you make the payment, a message containing information about your insurance will be sent to your registered phone number and email address.

Frequently Asked Questions

Under Section 80D of the Income Tax Act of 1961, the premium for the New India Assurance Universal Health Insurance APL Policy is exempt from taxes.

After giving the insured a 30-day warning, the insurer has the right to revoke the New India Assurance Universal APL Health Insurance policy. In the same vein, the insured has the right to revoke the insurance at any moment throughout the policy term for any reason.

Within thirty days of receiving the final required document, the insurer is required to resolve the claim, including any rejections.

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