National Health Insurance

National Health Insurance
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About National Health 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. It started its operations with 14902 skilled employees and 1998 offices situated across India.

National Health Insurance plans offer a wide range of customizations for various needs of individuals, families, senior citizens, etc. It covers the basic necessities such as in-patient hospitalisation, day care treatment and offers a plethora of other medical expenses to the insured.

Highlights of National Insurance Company

Number of Network Hospitals10,000+
Incurred Claims Ratio115.55%
RenewabilityLifelong
Pre-existing diseases4 years
Grievances Solved97.07%

Table Data updated on 21-09-2020

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 treatment of illness/disease or injury sustained by the insured person during the policy period.

Features & Benefits

  • The policy reimburses the expenses that occur during hospitalisation such as room, boarding and nursing up to 1% of the sum insured per day and 2% of sum insured per day for ICU. This reimbursement is subject to an overall limit of 25% of the sum insured.
  • Expenses incurred on account of anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, diagnostic materials, X-ray, dialysis medicines and drugs, chemotherapy, radiotherapy, cost of the pacemaker, etc. are also covered under the policy up to 50 % of the sum insured.
  • It offers AYUSH benefit under which covers for Ayurvedic and Homeopathy treatment are admissible up to 20% of the sum insured for any one illness.
  • It provides coverage for 140+ day care procedures which require hospitalization for less than 24 hrs.
  • The policyholder is also eligible for a 5% cumulative bonus of sum insured for each claim-free policy year provided the policy is renewed without break.

2. Parivar Mediclaim Policy

Parivar Mediclaim is a family floater health insurance plan that covers the whole family in a single sum insured with an additional benefit of in-patient treatment expenses.

Features & Benefits

  • It offers coverage only for Allopathic treatment of a disease.
  • It protects the whole family including self, spouse and 2 dependent children for a single floater sum assured.
  • Provision to cover pre-existing diabetes and hypertension on payment of additional premium of the policyholder.
  • The policy covers pre-hospitalisation for 15 days and post-hospitalization up to 30 days.
  • Enjoy tax exemptions under Section 80D of the Income Tax Act, 1961 for the premiums paid by the insured.

3. National Mediclaim Plus Policy

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

National Mediclaim Plus Policy has 3 variants as follows:

  • Plan A- Sum assured is offered in 9 slabs, 2L to 10L (in multiples of 1L).
  • Plan B- Sum assured is offered in 3 slabs, 15L/ 20L/ 25L.
  • Plan C- Sum assured is offered in 3 slabs, 30L/ 40L/ 50L.

Features & Benefits

  • It covers the ambulance charges (including air ambulance) and organ donor's expenses up to sub-limits mentioned in the policy.
  • It offers the cover of expenses due to doctor's home visit and nursing care after hospitalization payable as per limits of each plan.
  • It provides add-on covers such as critical illness and out-patient treatment at minimal extra premium rates.
  • Hospital cash facility up to a maximum of 5 days is also provided to the insured as per the clauses of the policy.
  • Vaccination for children up to 12 years will be covered for a maximum of Rs. 1000 for all the policy variants available under the plan.

4. National Critical Illness Policy

National Critical Illness Policy covers the cost of treatment as well as the expensive recovery process associated with these critical illnesses. This policy is one of its kind and provides unique cover in the event the insured person is affected with any of the listed critical illnesses like cancer of specified severity, myocardial infarction (first heart attack of specified severity), open-chest Coronary Artery Bypass Graft Surgery (CABG), open heart replacement or repair of heart valves, coma of specified severity, kidney failure requiring regular dialysis, etc.

National Critical Illness Policy offers 2 types of plans for the critical illness cover, viz.,

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

Features & Benefits

  • The National Critical Illness Policy pays the full sum insured as a maturity benefit to the policyholder for surviving until the maturity date.
  • Under Plan A and Plan B, the policyholder can avail the benefit of the sum insured from Rs. 1 lakh to 75 lakhs.
  • Policyholders can avail 10% discount for premiums paid for eligible family members if the policy has been purchased for the family.
  • If the insured person has entered the policy before the age of 42 (completed age) and renewed the policy for a continuous period of 3 years, Early Entry Discount (EED) of 5% on the individual premium will be applicable starting from the 4th policy period and continue in subsequent renewals during the lifetime of the policy.

5. Overseas Mediclaim Employment and Studies Plan

Overseas Mediclaim Employment and studies is a package plan that reimburses 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.

Plan Variants

Plan C & D- Employment & Studies (figures are mentioned in US dollars)

VisitWorldwide Excl.
USA/Canada
Worldwide Incl.
USA/Canada
Worldwide Incl.
USA/Canada
PlanCDD1
Section – 1A
illness
1,50,0001,50,0001,50,000
Section – 1B
Medical evacuation
10,00010,00010,000
Section – 1C
Repatriation
10,00010,00010,000
Section – 1D
Medical Emergency reunion
5,0005,0005,000
Section – II
Contingency Insurance (applicable for sponsored students only)
USD 750
for each month of study completed
USD 750
for each month of study completed
USD 750
for each month of study completed
**Plan D1 offers additionally:
(i) Loss of checked-in luggage- US $ 1000
(ii) Delay of checked-in luggage- US $ 100

Table Data updated on 21-09-2020

Features & Benefits

  • The premium of the policy can be paid in Indian Rupees (except in the case of employment).
  • Overseas Mediclaim Employment and Studies Policy provides claim assistance even from an international service provider.
  • The policy covers loss and delay of checked-in baggage and loss of passport can also be covered under this plan.
  • Personal accident and disablement are also covered under the policy.
  • Claims for the policy are payable in foreign currency to doctors/hospitals abroad, directly by the service provider in most cases. If the cashless service is not available, the insured can ask for a reimbursement claim.

6. National Parivar Mediclaim Plus

National Parivar Mediclaim Plus Policy is a comprehensive health insurance policy that offers coverage to self, children, spouse, and parents/parents-in-law under one sum insured. The National Parivar Mediclaim Plus policy can be renewed during the lifetime.

Features & Benefits

  • The policy offers the benefit of the AYUSH treatment under which Allopathic, Ayurvedic, Yoga, Naturopathy, Unani, Siddha, and Homoeopathy are covered up to the full sum insured.
  • It offers the pre-hospitalisation cover for 30 days and post-hospitalisation cover for 60 days.
  • National Parivar Mediclaim plus is a unique policy that offers a higher sum assured, up to a maximum of Rs. 50 lakhs.
  • 140+ day care treatments in which the insured does not require hospitalisation for more than 24 hours is also covered under the policy.
  • The policyholder can avail an online discount of 5% while enrolling for new policies and 2.5% if you are renewing your health insurance policy.

National Parivar Mediclaim Plus policy offers the following 3 variants:

  1. Plan A
  2. Plan B
  3. Plan C
BenefitsPLAN APLAN BPLAN C
Sum Insured/Coverage optionRs. 6/7/8/9/10 lakhsRs. 15/20/25 lakhsRs. 30/40/50 lakhs
Hospital cash benefit (per insured person, per day )Rs.500, max. of 5 daysRs.1,000, max. of 5 daysRs.2,000, max. of 5 days
Domiciliary treatmentUp to Rs. 1,00,000Up to Rs. 2,00,000Up to Rs. 2,00,000
Maternity, Newborn baby coverUp to Rs. 30,000 for normal delivery and Rs. 50,000 for caesarean sectionActualActual
Infertility treatment CoverUp to Rs. 50,000Up to Rs. 1,00,000Up to Rs. 1,00,000
Ambulance expenses (per insured person, in a policy year)Up to Rs. 2,500Up to Rs. 4,000Up to Rs. 5,000
Air Ambulance expensesNot coveredUp to 5% of the Sum InsuredUp to 5% of the Sum Insured
Policy TenureMinimum – 1 year and Maximum – 3 yearsMinimum – 1 year and Maximum – 3 yearsMinimum – 1 year and Maximum – 3 years

Table Data updated on 21-09-2020

7. National Parivar Mediclaim

National Parivar Mediclaim Policy is an effective family floater health insurance policy that offers coverage to the self, dependent children, spouse as well as parents under one sum insured, unlike Parivar Mediclaim policy which does not provide protection to parents.

Features & Benefits

  • National Parivar Mediclaim policy covers the hospitalisation expenses of the policyholder.
  • Domiciliary treatments, as suggested by the doctor or due to unavailability of bed in hospital but should be done at the hospital are also covered and offer an amount of up to 20% of the sum assured. The benefit is subject to a maximum of Rs. 50,000.
  • Organ donor expenses are also covered in case of organ transplantation.
  • Insured can also enjoy the no-claim benefit; 5% discount on the base premium for each claim-free year.
  • This plan covers expenses incurred (up to Rs. 1,000 per illness with discounts applicable to selected zones) during the transfer of a patient to the hospital in an emergency situation.
  • It also offers coverage for handling maternity and newborn expenditure up to 10% of sum insured subject to Rs. 30,000 in case of normal delivery and Rs. 50,000 in case of a caesarean.

8. Overseas Mediclaim Business and Holiday

Overseas Mediclaim Business and Holiday Policy is designed for overseas medical emergencies, while one is travelling or out for work. The policy covers illness, repatriation, medical evacuation and it starts from 50,000 USD to 5 lakhs USD to the policyholders dwelling abroad.

National Overseas Mediclaim Business and Holiday Policy are available for 3 categories of travellers:

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

Features & Benefits

  • Claims under the plan are payable directly by the service providers in foreign currency to doctors and hospitals abroad. In case, cashless service is not available, the policyholder can request for a reimbursement claim.
  • The policy can be only purchased by citizens of India, Nepal or Bhutan who are going abroad for business or holiday purposes or any foreign nationals working in India for Indian employers of multinational organizations getting salary in Indian rupees.
  • Under the Overseas Mediclaim Business and Holiday Policy, the first US 100 dollars of all claims is to be borne by the traveller.
  • The premium of the policy can be paid in Indian Rupees (except in the case of employment).
  • International service providers can also assist during claims.
  • It covers the loss and delay of checked-in luggage in addition to passport loss.

**Note: If any traveller who is over 70 years of age and travelling above 60 days of the journey, he/she have to submit the following Medical reports (from an MD Cardiologist) along with the proposal form:

  1. ECG
  2. Fasting Blood Sugar or Urine Strip test

If the travellers are unable to submit the above Medical reports, its cover stands restricted to USD 10,000.

Plan Variants

Plan A & B- Business and Holiday Travel (figures are mentioned in US dollars)

VisitWorldwide Excl.
USA/Canada
Worldwide Incl.
USA/Canada
PlanA1A2B1B2
Section – A Illness, medical evacuation, repatriation50,0002,50,0001,00,0005,00,000
Section – B
Personal Accident & disablement
10,00025,00025,00025,000
Section – C
Loss of Checked Baggage
1,0001,0001,0001,000
Section – D
Delay of Checked Baggage
100100100100
Section – E
Loss of Passport
150250250250
Section – F
Third-Party Bodily Injury & Property damage
2,00,0002,00,0002,00,0002,00,000

Table Data updated on 21-09-2020

How To Purchase National Health Insurance Plans?

Offline Method:

  • Visit any branch of National Insurance Company after selecting health insurance of your choice.
  • The person sitting at the helpdesk will provide you with an application form. Fill the form and submit.
  • The form will be processed further and you will be communicated for the verification process from the concerned department.
  • You will be notified after the successful completion.
  • The policy documents will be sent on your registered email id.
  • You are free to contact the insurance company anytime you need assistance regarding the policy.

Online Method:

  • Open the website of National Insurance Company and you will see the 'Customer Login' tab. Click on it.
  • Log in with your credentials (you need to first register yourself if you are a new customer).
  • Choose the 'health' category and select a plan as per your requirements.
  • Provide the details asked and tap the 'Buy Policy Online' button.
  • After this, you need to make the payment.
  • You will get the soft copy of the policy on your registered email id.

What Is the Renewal Process of National Health Insurance Plans?

  • Visit the official website of National Insurance Company and click on the 'Quick Renewal' tab given at the top of the page.
  • Enter the policy number and captcha to continue.
  • Fill in the required details and make the payment. You can choose from various payment modes (Internet Banking/Debit/Credit Card) as per your convenience.
  • Once you finish this, you will receive the renewal confirmation on your registered email id.

What Is the Claim Procedure of National Health Insurance Plans?

For Cashless Claims:

The cashless facility of the National Health Insurance plans is only for policies that are purchased via 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 in the network hospital only.
  • In case of planned hospitalisation, the insured has to inform TPA/company in advance (72 hours prior) about the case with basic details.
  • In case of emergency hospitalisation of the insured, he/she must inform the TPA/Company within 24 hours of hospitalization.
  • On getting admitted, a pre-authorisation request associated with the cashless service will be shared with the TPA by the hospital along with the duly signed papers.
  • The claim settlement team has the authority to question and result in the cashless claim.
  • Pre and post-hospitalisation expenses can be claimed separately after treatment.
  • All original documents should be submitted within 15 days to TPA, after post-hospitalisation treatment.

For Reimbursement Claims:

  • One has to submit a written intimation that can be done through the mail/fax about the hospitalisation of the insured to Third Party Administrator (TPA)/Company within 72 hours of hospitalisation in the case of emergency hospitalisation. And in case of planned, the intimation should be done 72 hours prior.
  • Don't forget to collect discharge summary, investigation report and required documents from the hospital.
  • All original documents should be submitted to TPA/office within 15 days from the date of discharge.
  • You can claim for pre and post-hospitalisation separately as well.
  • Submit original copies of all required documents within 15 days after completion of post-hospitalisation treatment.

What Is Not Covered In National Health Insurance Plans?

  • 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, then he/she is not provided with any cover.
  • Claims arising out of participation in military, naval or air force operations.
  • Expenses incurred towards the treatment of Illness or Injury arising out of alcohol or any in the toxic drug.
  • 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.

How To Contact National Insurance Company?

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

Customer Care Service: 1800-345-0330, 1800-123-230-230

Head Office Telephone: 22831705

Fax: 22831740

Email: customer.relations@nic.co.in (for unresolved grievances)
website.administrator@nic.co.in (for queries)

National Health Insurance: FAQs

1. What are the documents required to settle the claim of National Health Insurance plans?

Following original documents are required to settle the claim of National Health Insurance plans-

  • Duly signed claim form discharge documents.
  • Doctor's certificates and prescriptions.
  • Hospital bills and receipts.
  • Pharmacy bills and receipts.
  • Laboratory and other investigation reports/plates/films and bills.

2. Who has to go for the pre-policy medical check-up to purchase National Health Insurance plans?

Pre-policy medical check-up to purchase National Health Insurance plans is required in cases where the proposer is

  • 40 years and above or
  • He/She has opted for Sum Insured Rs. 6 lakhs and above (irrespective of age)
  • He/She has opted for Critical Illness optional cover, between the age of 18 years and 65 years.

3. What is the age limit for renewal of National Parivar Mediclaim Policy?

The age limit for National Parivar Mediclaim Policy is up to 65 years.

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

In order to check the status of your National Health Insurance policy, log in to the company website with valid credentials and enter the policy number.

5. Will the National Insurance company transfer all the credits gained for my current health insurance policy to the new national health insurance policy?

Yes, the company will transfer all the credits gained from your current policy to the new national health insurance policy in the case of portability.

6. If I opt for the National Critical Illness Policy, will I get any add-on benefits?

Yes, you will get an option to add two more critical illnesses on opting for National Critical Illness Policy:

  • 1. Permanent Paralysis of Limbs
  • Total and Permanent Blindness.

7. Does the National Parivar Mediclaim policy cover for infertility cases?

Yes, the National Parivar Mediclaim policy covers infertility cases after 45 years of age at 3% base premium for both self and spouse.

Page updated on 21-09-2020