New India Assurance Sets Tight Terms For Mediclaim

New Delhi: Insurer divides country into three zones with varying premiums. New India Assurance, the country''s largest general insurance company, has come out with differential pricing and tougher conditions in mediclaim policies from August 16 to check losses in health portfolio. Based on the region-wise claim experience, the company has divided the country into three zones with changing premium rates and claim amounts with effect from August 16. If one pays premium in Zone III but is hospitalised in Zone I, one has to bear 20 per cent of the claim amount, or in other words only 80 per cent of the claim will be paid. Mumbai comes under zone I, Delhi and Bangalore fall under zone II and the rest of India falls under zone III. Since there have been many claims for the age group 3 months to 5 years, a new category has been created for this age band and for a sum assured of Rs 3 lakh, the premium is Rs 3,615 for Zone III, Rs 3,705 for Zone II and Rs 3,800 for Zone I.

Compare this with rates for the age group 6 years to 35, where the rate is lower for the same sum assured Rs 3,445 for Zone III, Rs 3,530 for Zone II and Rs 3,620 for Zone I. Similarly, persons, aged above 45 buying a policy for the first time, will now have to undergo a prescribed medical test at own cost, no enhancement in sum insured will be allowed to persons above 60 years, cumulative bonus has been revised with a maximum limit of 30 per cent instead of 50 per cent and the entire cumulative bonus will be withdrawn at time of renewal if there is any claim. Compulsory coverage for pre-existing condition and existing conditions of diabetes and hypertension have to be covered compulsorily by payment of additional premium at rate of 20 per cent of basic premium per each pre-existing condition. Claim ratio in respect of mediclaim policies has increased from 102 per cent in 2004-05 to 128 per cent in 2005-06 for New India.

Source : www.indian-commodity.com