The New India Assurance Co. Ltd.
Head Office : 87, M.G. Road, Mumbai - 400 001
TERTIARY CARE INSURANCE
(MAJOR AILMENTS HOSPITALISATION/ DOMICILIARY HOSPITALISATION EXPENSES
REIMBURSEMENT INSURANCE POLICY)
UNDERWRITING INSTRUCTIONS
After scrutiny of Questionnaire, Underwriting Officer should ask additional tests as per following
Guidelines.
For High Blood Pressure & Diabetes

Physician’s certificate that he is under treatment and the condition is under control.

Patient to give an undertaking that he will continue to keep it under control.

Physician’s certificate again at the time of renewal.
Family History

If positive, and if patient does not have any of the mentioned condition, a Physician’s
certificate that he is not having any of the above condition.

To be obtained at the time of entry and at every interval.
SECTION I
If any Positive answer for Breathlessness
X-RAY OF CHEST,
E.C.G,
CBC,
PERUM CHOLESTROL,
TRIGLYCERIDES WITH HDL/ LDL
If Chest pain positive, Add
STRESS TEST
If Breathlessness excessive,
PULMONARY FUNCTION TEST.
SECTION II
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Acidity -
BARIUM MEAL UPPER GI TRACT /
GASTRODUODENOSCOPY
Urinary Symptoms -
X-RAY KUB, URINE ROUTINE & CULTURE SERUM
CREATININE / BLOOD UREA.
Bowel Symptoms -
STOOL ROUTINE & FOR OCCULT BLOOD
If Vague Symptoms -
SONOGRAPHY OF ABDOMEN
SECTION III
If Pinpricks / weakness in arms - CERVICAL SPINE X-RAYS WITH REPORT
If Pinpricks / weakness in legs -
LUMBAR SPINE X-RAYS WITH REPORT
If Joint Pains -
X-RAY OF THE JOINT WITH REPORT
SECTION IV
CBC, ESR,
If Alcohol intake excessive -
LIVER PROFILE BLOOD REPORTS
If Tobacco/ Pan Parag chewer - ORAL SURGEON / ENT CONSULTANT CERTIFICATE.
SECTION V
If Positive -
CT SCAN OF BRAIN
SECTION VI
If Positive -
ULTRASONOGRAPHY OF PELVIS
If Breast Complaints -
MAMMOGRAPHY
Re : All Medical Reports
Copies to be submitted.
Original Reports / X-Rays to be submitted on demand.
CHART OF NORMAL REPORTS
NORMAL VALUES
CBC
INVESTIGATION
FINDINGS
ADULT AND
BELOW 6 YRS.
BELOW
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Erythrocytes per c mm
(in Millions)
:
/
/
ABOVE 6 YRS.
M - 4.5 - 6.0
F - 4.0 - 5.5
1 YRS.
4.1 - 5.5
3.2 - 4.8
M - 14 -18G
F - 12 - 16G
12 -14G
9.5 - 13.5G
5,000 - 15,000
3-8
20 - 45
3-8
0-1
45 - 65
4 - 10
6,000 - 18,000
0 - 10
0 - 10
0 - 10
0-4
0 - 10
0-4
/
Haemoglobin per 100 ml
:
/ G%
/
/
Leukocycles per cmm
:
/
Differential count (%)
:
/
Neutrophils
:
/
Eosinophils
:
/
Basophils
:
/
Lymphocytes
: /
Monocytes
: /
Erythrocytes Sedimentation Rate :
By Westergren
: /mm/hr
/
By Wintroba
: / mm/hr
/
By Landau’s( Micro )
:/ mm/hr
5,000 - 10,000
50 - 70
0-7
0-1
20 - 40
0-8
M - 0 - 10
F - 0 - 15
M - 0 - 10
F - 0 - 15
0-4
20 - 45
3-8
0-1
45 - 65
4 - 10
SERUM
Cholestrol
- mgm%
150- 250 mgms%
L.D.L. Cholesterol
- mgms%
Up to 150 mgms%
Triglycerous
- mgm%
40 - 140 mgms%
T. Chol/HDLC
-
up to 5.0
HDL
Cholesterol
-mgm%
35 95 mgms%
LDLC/HDLC
-
up to 3.5
LIVER PROFILE :
BILIRUBIN:
S. PROTEINS
Total
- mgms%
0.2 - 1.0 mgms%
Total Proteins
- Gms%
8 - 8 Gms%
Direct
- mgms%
0.1 - 0.6 mgms%
Albumin
- Gms%
3.5 - 5.5 Gms%
Indirect
-
0.1 - 0.4 mgms%
Globulin
- Gms%
2 - 4.5 Gms%
A/G Ratio
ALK. Phosphatase
IU/L
gms%
S.G.P.T.
IU/L
5 - 35 IU/L
S.G.O.T.
IU/L
5 - 35 IU/L
Australia
Hbs Aq.
Antigen. -
0.9 - 2.0
40 - 250 IU
Absent
G.G.T.P.
IU/L
5 - 40 IU
STOOL REPORT :- NO OVA, NO CYST, NO VEG.FORM OF EH, NO BLOOD.
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