National Health Insurance

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About National Insurance

National Insurance Company Limited (NICL) is one of the oldest insurance companies and fully owned by the Government of India. The company was founded in 1906 and headquartered in Kolkata.

National Health Insurance plans offer a wide range of customizations for various needs of individuals, families, senior citizens, etc. It covers the necessities such as in-patient hospitalisation, daycare treatment, and offers maximum financial comfort to the insured at the time of treatment.

Highlights:

Customer Assistance

24*7

Number of Offices

1730

Number of Employees

13000+

**Last Updated on 04-01-2021

National Health Insurance Highlights

What Are the Types of National Health Insurance Plans?

1. National Mediclaim Policy

National Mediclaim Policy covers the hospitalization expenses for the treatment of illness/disease or injury sustained by the insured person during the policy period. One can cover self, spouse, dependent children, parents, parents-in-law, brother (up to 25 years), sister (if not employed till marriage), and new born from 3 months age.

Features:

  • AYUSH treatments are covered (up to 100% of the sum insured).
  • It provides coverage for 140+ day care procedures.
  • The policyholder is also eligible for a 5% cumulative bonus of the sum insured for each claim-free policy year, provided the policy is renewed without break.
  • 12 modern treatments like immunotherapies, oral chemotherapies, etc. are covered under the plan.

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

1-10 lakhs

**Last Updated on 04-01-2021

2. National Parivar Mediclaim Policy

National Parivar Mediclaim is a family floater health insurance plan that covers the medical expenses of the entire family (at least two family members like self, spouse, parents, and dependent children) in a single sum insured.

Features:

  • It offers coverage only for Allopathic, Ayurvedic, and Homeopathic treatments.
  • The policy covers pre-hospitalisation expenses (up to 30 days) and post-hospitalization expenses (up to 60 days).
  • Enjoy tax exemptions under Section 80D of the Income Tax Act, 1961 for the premiums paid.
  • The plan reimburses the medical expenses incurred under domiciliary hospitalization.

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

1-10 lakhs

**Last Updated on 04-01-2021

3. National Mediclaim Plus Policy

National Mediclaim Plus Policy is an individual plan that ensures protection against your medical expenses by offering comprehensive cover that goes beyond the traditional health plans.

Features:

  • It covers (up to sub-limits mentioned in the policy) the ambulance charges (including air ambulance) and organ donor's expenses.
  • It offers coverage (payable as per limits of the plan) against the expenses incurred due to doctor's home visit and nursing care after hospitalization.
  • Hospital cash facility (up to a maximum of 5 days) is provided to the insured as per the clauses of the policy.
  • Vaccination for children up to 12 years is covered under the plan.

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

2-50 lakhs

**Last Updated on 04-01-2021

4. National Parivar Mediclaim Plus

National Parivar Mediclaim Plus is a comprehensive health insurance policy that offers coverage to self, dependent children, spouse, and parents/parents-in-law under one sum insured.

National Parivar Mediclaim Plus policy offers the following 3 variants:

  1. Plan A: 5 slabs, 6L to 10L in multiple of 1L
  2. Plan B: 3 slabs, 15L/ 20L/ 25L
  3. Plan C: 3 slabs, 30L/ 40L/ 50L

Features:

  • The policy offers AYUSH benefit under which Allopathic, Ayurvedic, and Homoeopathic treatments are covered up to the full sum insured.
  • It offers pre-hospitalisation cover for up to 30 days and post-hospitalisation cover for up to 60 days.
  • On payment of an additional premium, you can cover pre-existing diabetes and hypertension.

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

6-50 lakhs

**Last Updated on 04-01-2021

5. Overseas Mediclaim Business and Holiday

Overseas Mediclaim Business and Holiday policy is designed to cover overseas medical emergencies when one is travelling for work or pleasure. The plan is available for 3 categories of travellers:

  1. Business & Holiday
  2. Employment and Study
  3. Corporate Frequent Traveller

Features:

  • Under the plan, the first US $100 of all claims is to be paid by the traveller.
  • It covers the loss and delay of checked-in luggage.
  • For any traveller who is over 70 years of age and travelling above 60 days of the journey, (s)he has to submit the following medical reports (from an MD Cardiologist) and the proposal form:
  1. ECG
  2. Fasting Blood Sugar or Urine Strip test

6. Overseas Mediclaim Employment and Studies Plan

Overseas Mediclaim Employment and Studies is a package plan that reimburses the expenses for travel emergencies while travelling abroad. It is available for 3 categories of travellers:

  1. Business & Holiday
  2. Employment and Study
  3. Corporate Frequent Traveller

Features:

  • The policy covers the loss and delay of checked-in baggage.
  • Medical accidents and disablement are also covered under the policy.

7. National Critical Illness Policy

National Critical Illness Policy looks after the cost of treatment and the expensive recovery process associated with these illnesses. This policy is one of its kind and provides unique cover if the insured person is affected by any of the listed critical illnesses.

The policy offers 2 types of variants for the critical illness cover-

  • Plan A – Under this 11 Critical Illnesses are covered.
  • Plan B – Under this 37 Critical Illnesses (including Plan A covered illness) are covered.

Features:

  • Policyholders can avail of a 10% discount on premiums for eligible family members if the policy is purchased for the family.
  • If you are a National Insurance company's employee, this policy allows a discount of 15% on premiums for covering self and family.

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

1-75 lakhs

**Last Updated on 04-01-2021

8. National Senior Citizen Mediclaim Policy 

The plan is specially made for senior citizens (60-80 years) and covers the expenses of inpatient treatment (allopathy, ayurveda, and homeopathy), domiciliary hospitalization, or treatment for a disease/injury during the policy tenure.

Features:

  • The plan offers two variants:
  • Plan A – 10 slabs, Rs. 1,00,000 to Rs. 10,00,000
  • Plan B – 10 slabs, Rs. 1,00,000 to Rs. 10,00,000, with some additional features
  • The plan offers coverage for allopathic, ayurvedic, and homeopathic treatments.
  • The plan also reimburses (up to 20% of the SI) the medical expenses incurred under domiciliary hospitalization.

9. National Super Top Up Mediclaim Policy

National Super Top Up Mediclaim is a high threshold health insurance policy that covers all the members of a family under a single sum insured. The policy comes with a wide coverage at a reasonable cost.

Features:

  • Treatment expenses of morbid obesity are covered after the listed waiting period.
  • The plan offers coverage (up to the sum insured) for pre & post hospitalisation expenses (up to 30 and 60 days), organ donor's medical expenses, and inpatient treatment.
  • 12 modern treatments are also covered under the policy.

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

3-20 lakhs

**Last Updated on 04-01-2021

10. Arogya Sanjeevani Policy

Arogya Sanjeevani is a standard individual health insurance product that covers hospitalisation expenses for any illness/injury sustained during the policy period.

Features:

  • For cataract treatment of one eye, the plan will offer decent coverage (Rs.40,000 or 25% of SI, whichever is lower).
  • A policyholder will get coverage for AYUSH treatments.
  • The plan offers pre and post hospitalization coverage (up to 30 days and 60 days respectively).

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

1-5 lakhs

**Last Updated on 04-01-2021

11. Vidyarthi Mediclaim Policy for Students

Vidyarthi Mediclaim policy is designed to provide health and personal accident cover to the students. If the guardian dies or becomes permanently disabled, the plan provides for the continuation of the insured student's education.

Features:

  • The plan offers three sections-
  • Section I, covers hospitalization expenses of students with a sum insured that ranges from Rs. 50,000 to Rs.2,00,000.
  • Section II, covers the personal accident of parents, where the sum insured will be two times the S.I. under Section I.
  • Section III, covers personal accident of insured students with a sum insured of Rs.50, 000.
  • The plan offers an increase in sum insured by 5% for each claim-free year.

12. Corona Kavach Policy

Corona Kavach Policy has been introduced to offer coverage against the treatment cost of COVID-19.

Features:

  • No pre-policy health check-up is required.
  • The policy covers pre and post hospitalization expenses (up to 15 days and 30 days respectively).
  • Ambulance charges are also covered by the plan.

Eligibility:

Entry Age

18-65 years

Sum Insured (Rs.)

50,000-5,00,000

**Last Updated on 04-01-2021

How to purchase National Health Insurance Plans?

One can now easily purchase health insurance from National Insurance's website. Here is the process for the same.

  • Visit the official website of National Insurance and click on 'Products'.
  • Choose 'Health' and click on 'Get Quote/Buy Policy'.
  • Select your desired plan and click on it.
  • Fill in the required information and make the online premium payment.
  • Once done, you will get the soft copy of the policy on your registered email id.

You can also visit the nearest National Insurance company's branch to buy health plans.

What Is the Claim Procedure of National Health Insurance Plans?

For Cashless Claims:

The cashless facility is only for policies that are purchased via the Third Party Administrator (TPA).

  • One has to check whether the selected hospital falls under the list of network hospitals as the cashless claim facility is available at the network hospital only.
  • In planned hospitalisation, the insured has to inform TPA/company in advance (72 hours prior) about the case.
  • In emergency hospitalisation of the insured, (s)he must inform the TPA/company within 24 hours of hospitalization.
  • On getting admitted, a pre-authorisation request will be shared with the TPA by the hospital along with the duly signed papers.
  • The TPA will settle all the bills with the hospital.

Note- Submit all the required documents to the TPA within 15 days.

For Reimbursement Claims:

  • One has to submit a written intimation (through the mail/fax) about the hospitalisation to the Third Party Administrator (TPA)/company within 72 hours of emergency/planned hospitalisation.
  • Don't forget to collect the discharge summary, investigation report, and required documents from the hospital.
  • All original documents should be submitted to TPA/company within 15 days from the date of discharge.
  • The company will verify all the documents. On approval, the claim amount will be released.

How To Contact National Insurance Company?

Contact Address:

National Insurance Company Ltd., 3, Middleton Street, Prafulla Chandra Sen Sarani, Kolkata, West Bengal, 700071.

Head Office Telephone: 22831705

Fax: 22831740

FAQ's

1. What documents are required for filing a National health insurance claim?

  • Duly completed claim form
  • Photo Identity proof of the patient
  • Medical practitioner's prescription advising admission.
  • Original bills with the itemized break-up
  • Payment receipts
  • Discharge summary including a complete medical history of the patient along with other details.
  • Investigation/Diagnostic test reports etc. supported by the prescription from attending medical practitioner
  • OT notes or surgeon's certificate giving details of the operation performed (for surgical cases).
  • Sticker/Invoice of the Implants, wherever applicable.
  • MLR (Medico Legal Report copy if carried out an FIR (First information report) if registered, where ever applicable.
  • NEFT Details (to enable direct credit of claim amount in a bank account) and cancelled cheque
  • KYC (Identity proof with Address) 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 Company/TPA for assessment of the claim.

2. How can I renew my National Health Insurance Plan?

Renewing your National Health policy online is an easy and convenient process. Follow the below steps for the same-

  • Visit the official website of National Insurance Company and click on the 'Quick Renewal' tab given at the top of the page.
  • Enter your 'Policy Number' and 'Captcha' to continue.
  • Fill in the required details and make the payment.
  • You will receive the renewal confirmation on your registered email id.

3. Does the National Parivar Mediclaim policy cover infertility cases?

Yes, the National Parivar Mediclaim policy covers infertility cases after 45 years of age at a discount of 3% on the individual premium (for both self and spouse).

4. How can I check the policy status for my National Health plan?

Log in to the company's website with valid credentials and enter the policy number.

5. What is not covered In National Health Insurance Plans?

Some of the exclusions include-

  • Any type of psychiatric and psychosomatic disorders, disease/illness/accidental injury that arises out of drug/alcohol abuse by the policyholder.
  • If the policyholder is travelling against medical advice or for medical treatment including routine check-up, (s)he is not provided with any cover.
  • Claims arising out of participation in military, naval, or air force operations.
  • Any injury or illness that is directly or indirectly caused by attribution to war, invasion, any terrorist act, or riot.
  • Any type of spinal cord injury treatment.
  • Any expense incurred with the treatment of any sexually transmitted disease, HIV, or AIDS.

Page updated on 04-01-2021