Policy explained · New India
New India Mediclaim 2012: what your policy covers
New India Mediclaim 2012 caps room rent at 1% of the sum insured a day on a ₹5 lakh cover. It has a 20% co-pay if you are treated in a higher zone than the one your policy covers. For our example person, a typical ₹4,50,000 bill (estimate) is not covered yet: 36-month waiting period.
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At a glance
- 🛏️1% of SI a dayRoom rent1% of the sum insured a dayPolicy wordings, page 9, read 27 Sep 2026
- 🧾20%Co-payIf you are treated in a higher zone than the one your policy coversNot in the worked examplePolicy wordings, page 35, read 27 Sep 2026
- ⏳36 monthsKnee & hip replacement waitNot over at month 30Conditions apply, see the termsPolicy wordings, page 21, read 27 Sep 2026
- ⏳36 monthsPre-existing conditions waitNot over at month 30Policy wordings, page 19, read 27 Sep 2026
- 🩹Not coveredConsumablesThese are yours to payPolicy wordings, page 34, read 27 Sep 2026
Waiting periods, month by month
- Pre-existing conditions36 monthsNot over at month 30
- Knee & hip replacement36 monthsNot over at month 30Conditions apply, see the terms
- Elective cardiac surgery3 monthsOver by month 30Conditions apply, see the terms
- Spine surgery24 monthsOver by month 30
- Prostate surgery24 monthsOver by month 30
- Hysterectomy24 monthsOver by month 30
Worked example: a knee & hip replacement bill
The example person joined the policy before age 61, is treated at a network hospital in the zone their policy covers, has no add-ons, and has a ₹5,00,000 sum insured on a policy running 30 months.
Room rent ₹9,000 a day for 4 days (example), a semi-private room, on a typical NCR knee & hip replacement bill of ₹4,50,000 (estimate).
Not in these numbers: a 20% co-pay applies if you chose an optional co-pay or add-on. A 20% co-pay applies if you are treated in a higher zone than the one your policy covers. A limit of ₹2,50,000 applies if you have robotic surgery (policy wordings).
Not covered yet: 36-month waiting period. The insurer pays ₹0 and you pay ₹4,50,000 (estimate).
The terms, with the policy text
14 terms read from the New India Mediclaim 2012 documents (UIN NIAHLIP25040V102425). Open a source to read the policy text, its conditions and the page.
| Term | What it means | Policy text and source |
|---|---|---|
| Room rent limit | 1% of the sum insured a dayLimit applies | Policy wordings, page 9Plan Name Sum Insured Room Rent Limit BASIC Plan Up to Rs. 15L 1% of the Sum Insured per day maximum up to Rs. 15,000 per day |
| ICU limit | 2% of the sum insured a dayLimit applies | Policy wordings, page 9BASIC Plan Up to Rs. 15L 2% of the Sum Insured per day maximum up to Rs 25,000 per day |
| Co-pay | 20% of the claim is yours if you are treated in a higher zone than the one your policy coversOnly in some cases | Policy wordings, page 355.29 CO-PAYMENT: Where the Insured Person is treated in a Hospital situated outside the Area of Coverage (lower Zone to higher Zone) as stated in the Schedule, our liability will be: a) 80% of the admissible claim amount, (or) b) Sum Insured. Whichever is less: Note: Co-payment of 20% will be applicable only, if the insured opts the lower zone and gets treated in the higher zone. |
| Proportionate deduction | Applies: if your room costs more than the limit, the insurer cuts the charges linked to the room in the same ratioCan cut your bill | Policy wordings, page 10Condition: Applies to the charges linked to the room only, and not at hospitals that charge the same for every room. Proportionate Deduction is applicable on the Associate Medical Expenses, if the Insured Person opts for a higher Room than his eligibl e category. |
| Consumables (gloves, masks and other non-medical items) | Not covered: these are yours to payNot covered | Policy wordings, page 345.27 The expenses that are not covered in this policy are placed under List-I of Annexure-II. |
| Costs before and after the hospital stay | 30 days before admission, 60 days after dischargeCovered | Policy wordings, page 103.1(e) Pre-Hospitalization Medical expenses for up to 30 days 3.1(f) Post-Hospitalization Medical expenses for up to 60 days |
| Waiting period for pre-existing conditions | 36 months of continuous coverNot over at month 30 | Policy wordings, page 19Expenses related to the treatment of a pre -existing Disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after commencement of the policy. |
| Waiting period for knee & hip replacement | 36 months of continuous coverNot over at month 30 | Policy wordings, page 21Condition: Not applicable to claims arising from an accident. (iii) 36 Months waiting period 1. Congenital External Disease 2. Joint Replacement due to Degenerative Condition |
| Waiting period for elective cardiac surgery | 90 days of continuous coverOver by month 30 | Policy wordings, page 20Condition: For hypertension, diabetes and cardiac conditions. (i) 90 Days Waiting Period 1. Diabetes Mellitus 2. Hypertension 3. Cardiac Conditions |
| Waiting period for spine surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 2012. Prolapse inter Vertebral Disc and Spinal Diseases unless arising from accident |
| Waiting period for prostate surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 203. Benign prostate hypertrophy |
| Waiting period for hysterectomy | 24 months of continuous coverOver by month 30 | Policy wordings, page 2116. Treatment for Menorrhagia / Fibromyoma, Myoma and Prolapsed uterus |
| Exclusion rule for bariatric surgery | Covered when the policy's conditions are metConditions apply | Policy wordings, page 224.4.3 OBESITY/ WEIGHT CONTROL (Code-Excl06) Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions: |
| Robotic surgery sub-limit | 50% of the sum insured, up to ₹5 lakhLimit applies | Policy wordings, page 18Condition: For a sum insured up to ₹15 lakh (BASIC plan). 3.17.7 Robotic surgeries. Up to 50% of Sum Insured subject to Maximum of Rs. 5 Lakhs. |
Questions
Does New India Mediclaim 2012 have a room rent limit?
At a ₹5 lakh sum insured: 1% of the sum insured a day. BASIC plan (sum insured up to ₹15 lakh): up to 1% of the sum insured a day, at most ₹15,000 a day. Source: Policy wordings, page 9, read 27 Sep 2026.
How is proportionate deduction calculated on New India Mediclaim 2012?
If your room costs more than the room rent limit, the insurer divides the limit by your room's daily rent and pays that share of the charges linked to the room. Applies to the charges linked to the room only, and not at hospitals that charge the same for every room. Source: Policy wordings, page 10, read 27 Sep 2026.
Check your own policy
Send your policy on WhatsApp. A person reads it and works out what your stay would cost you before you are admitted.
A person replies, not a bot. Free for you.
Sources
- New India Mediclaim 2012: policy wordings (accessed 27 Sep 2026)
- New India Mediclaim 2012: customer information sheet (cis) (accessed 27 Sep 2026)