Buying individual health insurance may seem hectic for some of us, as the monthly premiums might be a pain for our pockets. Here comes the contribution of a group mediclaim policy that offers you all-inclusive health support benefits. The National Insurance Group Mediclaim Policy is an indemnity insurance product that significantly provides coverage for a group of policyholders. The plan caters to the basic health care needs of an employer-employee and a non-employer-employee. Anyone is entitled to get issued with this policy on an individual basis under a group. Given that the separate sum insured of the plan applies to each of the individuals who are insured under the group policy, the above condition applies to a family group or an employee-employer group.
This plan has a wide sum insured ranging from INR 50,000 to INR 10 Lakhs in 15 slabs (in the multiples of x value in ascending order). The value of the sum insured is attended in two ways:
Sum insured- INR 50,000 - 5 Lakhs (comes in a multiple of INR 50,000)
Sum insured- INR 6 - 10 Lakhs (comes in a multiple of INR 1 Lakh)
Apart from this, if you are worried about getting coverage for daycare treatment or hospitalisation, worry not. National Insurance Group policy covers 140+ daycare procedures, along with in-patient hospitalisation (for allopathic, homoeopathic, and Ayurvedic treatment), pre-hospitalisation (30 days prior hospitalisation), post-hospitalisation (60 days from the date of hospital discharge), and an illness constrained during the policy tenure.
Similarly, the plan has extended coverage facilitating 12 kinds of modern treatment, the inclusion of advanced treatment like HIV/AIDS, mental illness, morbid obesity, refractive error correction, organ donor's expenses, ambulance service benefits, etc. Additionally, this plan has a clause of sub-limits which is subject to be applied over the mentioned expenses from the policy schedule. For example, room rent charges, medical practitioner/doctor's visit fees, procedures such as hemodialysis, radiotherapy, and chemotherapy (subject to over-sub-limit expenses), pre & post-hospitalisation, etc are advised under or over the sub-limit (as per the schedule).
This page consists of the benefits and specifications of the National Insurance Company Group Policy. Read further to know more.
Eligibility Criteria for the National Insurance Group Mediclaim Policy
These are a few factors that decide the eligibility criteria for the National Insurance Group Mediclaim Policy:
Child Entry Age
3 Months - 18 Months (dependant)
Adult Entry Age
18 Years - No Maximum Limit
Plan Type
Group indemnity policy (on an individual basis)
Policy Tenure
1 Year
Initial Waiting Period
30 Days
Sum Insured
INR 50,000 - 10 Lakhs
*The Initial Waiting Period is the period between the issuance of the policy and the time it starts actively. During this period, a policyholder has to wait to avail of the benefits offered under a health insurance plan.
To know more about the plan, read the prospectus provided below:
Benefits of National Group Mediclaim Policy
Read below to know in detail about the benefits of a group mediclaim policy by the National Insurance Company:
Hospitalisation benefits with sub-limit
The policyholder can avail of the hospitalisation benefits, specifications of which are mentioned here: The plan covers expenses for the ICU, room charges, doctor's/consultation fees, modern treatment, etc on an applicable rate of the sub-limit. Apart from this, hospitalisation charges for hemodialysis, chemotherapy, and radiotherapy are also applicable on a sub-limit.
Pre-existing disease cover
Pre-existing diseases that are mentioned under the schedule of your policy, are covered after a waiting period of 4 years.
Co-payment discounts
If the policyholder opts for a copayment at the rate of 5%, they can avail of a 4% discount on the payable premiums. And on choosing a copayment of 10%, you are entitled to avail of an 8% discount on your policy's premium.
Modern treatment cover
You can avail of the coverage benefit against 12 listed modern treatments under this plan. For hospitalisation of the same, a maximum of 25% of the sum insured will be applicable.
Optional covers available
There are two optional covers under the plan:
For modern treatment: The plan facilitates and enhances up to 12 kinds of modern treatment procedures which are all subject to 50% of the sum insured for each treatment.
For maternity benefits: You can avail of INR 50,000/- the maximum for each delivery or a medically necessary termination of pregnancy in a policy year.
Tax Benefits
All the premiums paid towards the National Group Mediclaim Policy are eligible for tax benefits under Section 80D of the Income Tax Act, 1961.
Specifications of National Insurance Group Mediclaim Policy
The National Insurance Group Mediclaim Policy has different features based on the criteria mentioned in the company's policy schedule. See below the plan specifications:
In-patient & Out-patient coverage
Room Rent
Available
ICU Charges
Available
Pre-Hospitalization
Available
Post-Hospitalization
Available
Domiciliary Hospitalization
Not Covered
Daycare Treatment
Covered
OPD Charges
Not Covered
Coverage Terms
COVID-19 Treatment
Not Covered
Cataract
Covered
No Claim Bonus
Not Applicable
Automatic Restoration
Not Covered
Daily Hospital Cash
Not Covered
Organ Donor
Covered
Maternity Cover
Covered
New Born Baby Cover
Covered
Alternative Treatments
AYUSH Treatment
Covered
IVF Treatment
Not Applicable
Modern Treatment
Covered
Emergency Coverage
Ambulance
Covered
Air Ambulance
Not Covered
Compassionate Travel
Not Available
Global Coverage
Not Available
Wellness Programmes
E-Consultation
Not Covered
Health Check-Up
Not Covered
Second Medical Opinion
Not Covered
Vaccination
Not Covered
Limitations
Co-payment
Applicable
Sub-limits
Applicable
What is Room Rent?
The room rent limit is the maximum amount of bed charge that you can claim if you are hospitalized.
Common room categories covered under room rent are:
Private Single AC Room
Twin Sharing
General Ward
Coverage status under the National Insurance Group Mediclaim Policy?
Room rent per day shall be payable up to 1% of the Sum Insured subject to a maximum of INR 10,000 per day. The maximum amount admissible under room charges for any one illness shall be 25% of the SI.
What are ICU Charges?
It is a special department in the hospitals where patients with serious medical conditions are treated.
Coverage status under the National Insurance Group Mediclaim Policy?
ICU Charges per day shall be payable up to 2% of Sum Insured subject to a maximum of INR 20,000 per day (sub-limits are applicable)
What is Pre Hospitalization?
Medical expenses incurred before the hospitalization of the policyholder.
Coverage status under the National Insurance Group Mediclaim Policy?
Covered for up to 30 days before hospitalisation.
What is Post Hospitalization?
Medical expenses incurred after the discharge of the policyholder from the hospital.
Coverage status under the National Insurance Group Mediclaim Policy?
Covered for up to 60 days after hospitalisation.
What is Domiciliary Hospitalization?
Home hospitalization arrangement for the insured person due to unavailability of medical amenities in hospitals. The treatment should last equal to or more than 72 hrs to get financial coverage.
Coverage status under the National Insurance Group Mediclaim Policy?
Not Available
What is Daycare Treatment?
Treatments that can be treated in less than 24 hours of hospitalization like blood dialysis, cataract, etc.
Coverage status under the National Insurance Group Mediclaim Policy?
140+ listed daycare treatments covered up to SI.
What are OPD charges?
Covers the cost of doctor consultation and prescribed medical tests that may not require hospitalization.
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered.
What is COVID-19 Treatment?
COVID-19 treatment includes the cost of treatment for COVID-19 with a confirmative diagnosis from Govt. an approved center.
Coverage status under the National Insurance Group Mediclaim Policy?
Not Available
What is Cataract Treatment?
A common eye condition in which your vision gets blurred.
Coverage status under the National Insurance Group Mediclaim Policy?
Covered. Subject to 25% of the Sum Insured or INR 40,000 per eye, whichever is lower in a policy period for each insured person with a waiting period of 2 years.
What is a No-Claim Bonus?
For every claim-free year, insurance companies reward policyholders with an increase in the Sum Insured amount as a no-claim bonus on policy renewal. However, in the case of a claim, this bonus amount either lapses or is reduced by a certain percentage that varies from plan to plan.
Coverage status under the National Insurance Group Mediclaim Policy?
Not Applicable.
What is Automatic Restoration?
Automatic restoration is a benefit in which an insurance company restores the sum insured amount completely or up to a certain percentage after it gets fully exhausted in treatments. This restoration amount may vary from plan to plan.
Coverage status under the National Insurance Group Mediclaim Policy?
Not applicable.
What is Daily Hospital Cash?
It is a cash amount that you receive each day during the time of hospitalization.
Coverage status under the National Insurance Group Mediclaim Policy?
Not available
What is an Organ Donor Cover?
It is a cover that includes the cost of the procedure for removing the damaged or malfunctioning organs from the body.
Coverage status under the National Insurance Group Mediclaim Policy?
The expenses of the organ donor are covered.
What is a Maternity Cover?
It refers to the cover that includes expenses for normal and c-section procedures deliveries.
Coverage status under the National Insurance Group Mediclaim Policy?
Covered only under the optional covers. Ranges up to INR 50,000 for up to the first two deliveries or terminations of pregnancy of the insured.
What is a New Born Baby Cover?
It takes care of the medical expenses that arise due to the hospitalization of the newborn baby in case of unforeseen circumstances. Some of the common treatments that are covered under the newborn cover are listed below and these common treatments can vary from plan to plan:
Congenital anomaly (conditions since birth)
Acute condition
Chronic condition
Premature delivery
Birth asphyxia
Day care treatment
Coverage status under the National Insurance Group Mediclaim Policy?
Pre-natal and post-natal hospitalisation expenses per delivery are covered under maternity cover (applicable under optional covers only)
What is AYUSH Treatment?
Refers to the cost of medicines and procedures used under AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy) treatment.
Coverage status under the National Insurance Group Mediclaim Policy?
Only Ayurveda and Homeopathy treatment and hospitalisation under these two are applicable.
What is IVF Treatment?
In Vitro Fertilization (IVF) is a method of assisted reproductive technology. The common expenses incurred under IVF and infertility treatments are for:
Full infertility
No fertility
Infertility diagnosis
Infertility diagnosis and limited fertility treatment
Medication (which may or may not include fertility drug prescriptions)
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered
What is a Modern Treatment?
Medical treatments that demand modern technology such as robotic surgeries, stem cell therapy, etc.
Coverage status under the National Insurance Group Mediclaim Policy?
12 kinds of modern treatment are covered. The maximum amount admissible for any one modern treatment shall be 25% of the Sum Insured and this limit may be increased to 50% of the Sum Insured, by opting for optional cover.
What is an Ambulance Cover?
An ambulance is used to move the patient from home to hospital, transfer to another hospital, and take them for different tests outside the hospitals.
Coverage status under the National Insurance Group Mediclaim Policy?
Covered up to 1% of the Sum Insured subject to a maximum of INR 1,000 in a policy year for each insured person, for transportation to the hospital or from the hospital to another hospital or from the hospital to the diagnostic centre and return during the same hospitalisation.
What is an Air Ambulance?
Air ambulances are specially prepared planes that transfer the patient from one place to another in case of a health emergency.
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered.
What is Compassionate Travel?
Refers to the traveling expenses of a family member of the insured person in case the policyholders get admitted to a hospital outside his/her residential city.
Coverage status under the National Insurance Group Mediclaim Policy?
Not Applicable
What is Global Coverage?
Any kind of medical/health emergency when you are outside of India.
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered.
What is E-Consultation?
If a policy offers E-consultation it allows policyholders to connect with a doctor for medical consultation through video chat, audio call, or chatbot.
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered.
What is a Health Checkup?
A facility where the policyholder can avail free health check-ups after fulfilling the company's policies.
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered.
What is a Second Medical Opinion?
If the policyholder wants, they may opt for a second medical opinion wherein the policyholder can consult another doctor within the company's network of medical practitioners.
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered.
What is Vaccination cover?
Coverage against the expenses incurred on vaccinations is provided by the insurance companies.
Coverage status under the National Insurance Group Mediclaim Policy?
Not covered.
What is Co-payment?
In the co-payment clause, policyholders have to pay a portion of the hospitalization expense on their own and the insurer will pay the rest of the amount.
Status under National Mediclaim Policy?
Applicable.
What is the Sub limit?
Sub limit is a condition in which the insurer will have to pay the medical expense up to a certain percentage and the remaining amount will have to be paid by the policyholder.
Status under National Mediclaim Policy?
Available.
What is not covered (Exclusions) under the National Group Mediclaim Policy?
Here is a list of standard exclusions under the National Group Mediclaim Policy:
Investigation and evaluation
Rest cure, rehabilitation and respite care
Obesity/ weight control treatment
Change-of-gender treatments, cosmetic or plastic surgery, and unproven treatments
Birth control, sterility and infertility
Hazardous or adventure sports
Breach of law, drug/alcohol abuse, self-inflicted injury, suicidal act, and non-prescription drug
Hormone replacement therapy, general debility, congenital external anomaly, and dental treatment
Domiciliary hospitalisation & out-patient department (OPD) treatment
Massages, steam baths, alternative treatment (Other than Ayurveda and Homeopathy)
Treatment taken outside the geographical limits of India
Permanently excluded diseases, etc.
How to claim the National Insurance Group Mediclaim Policy?
To avail of claim settlement services, the insured individual must follow the process below:
For cashless
Cashless claims are subject to be facilitated in networking hospitals by a TPA only
Inform your TPA/insurer about getting hospitalised in a non-networking hospital 72 hours before a planned hospitalisation.
In case of an emergency/ unplanned admission, intimidate your TPA within 24 hours of your hospitalisation
The hospital will send the TPA, the filled, pre-authorization form of the insured individual, the proposed treatment bills, and all the expenses of treatment estimated by the hospital authorities.
The policyholders can intimate their TPA for the pre and post-hospitalisation separately
Once the treatment is received, you must submit all the original copies of the requested documents within 15 days.
For Reimbursement
Inform your TPA/insurer about getting hospitalised in a non-networking hospital (72 hours prior in case of planned hospitalisation and within 72 hours in case of unplanned hospitalisation/emergency)
Submit the claim form (parts A & B), hospital discharge summary, medical receipts, investigation records, etc
Submit all the asked documents at your TPA's office within 15 days from your date of discharge from the hospital
The policyholder is allowed to claim on separate grounds for pre-hospitalisation claims and post-hospitalisation claims against the treatment received
On examination and evaluation of the claim, the insured would receive the reimbursed amount
Documents required to be submitted:
Completely and sincerely filled claim form (parts A & B) issued by your insurance company
Original copies of certification of admission at the hospital, medical bills, hospital discharge summary, a recorded medical history document, etc
Diagnosis receipt, prescriptions from the pharmacist, chemist, or a medical practitioner
Other documents requested/asked by your policy's TPA or insurance company
Individuals can call the toll-free number 1800 345 0330 or email nic.health@nic.co.in to know about their policy's claim settlement procedure.
Explore other National Health Plans
National Health offers a wide range of health insurance plans to fulfill the medical needs of individuals, families, and senior citizens.
This plan suits you best if you are a newly married individual or have dependents like kids or elderly parents as this health plan covers all of them along with you.
If you are looking for a healthcare policy providing a high sum assured and covers your family members under one cover this is the right policy for you.
Unique Features
Cover up to 50 Lakhs
5% No claim discount
Critical Illness Benefit
Parivar Mediclaim Plus Policy (Pros)
High SI
Zone Wise Premiums
Multiple Discounts
Optional Covers Available
OPD Cover
Parivar Mediclaim Plus Policy (Cons)
Treatment outside India
PED
Injury Due To Illegal Activity
Injury Due To Hazardous Activities
Adventure Sport Injuries
Parivar Mediclaim Plus Policy (Other Benefits)
Affordable Premiums
Tax Benefit
AYUSH Cover
Anti Rabies Vaccination
Air Ambulance
Parivar Mediclaim Plus Policy (Eligibility Criteria)
This policy is designed to cater to high-risk professionals categorized as the normal, medium, and heavy occupational risk of the person.
Unique Features
100% accidental death payout
PTD, PPD, TTD benefit
Dead body portability
Personal Accident Policy (Pros)
Temporary disability treatment
Death coverage benefits to the family
Loss of organ cover
Educational fund
Permanent Partial Disability cover
Personal Accident Policy (Cons)
PEDs not covered
Adventure sports not covered
Vaccination not covered
Maternity not covered
Personal Accident Policy (Other Benefits)
Family discounts available
Accidental treatment benefits up to SI
Cashless claim settlement
Deady body portability
Personal Accident Policy (Eligibility Criteria)
Entry age - 5 - 70 Years
SI - Upto INR 10 Lakhs
Policy tenure - 1 Year
Waiting period - None
Wrapping it up
National Insurance Group Mediclaim policy is a wholesome indemnity insurance that provides overall coverage to the policyholder. The coverage benefits include pre and post-hospitalisation, in-patient care (for Allopathy, Ayurveda, and Homoeopathy) modern treatment, daycare procedures, mental illness coverage, and much more.
There's no better way of safeguarding yourself as the entitled insured of a group and your family with a group plan than the National Insurance mediclaim policy. So, why the wait? Waste no time to buy a health policy now!
Want to know more? Contact our customer care executives at 18003450330 or visit the official website of PolicyX.com.
National Group mediclaim policy: FAQ's
1. What are the coverages under the National Insurance Group mediclaim policy?
In-patient care (Allopathic, Ayurveda and Homoeopathy), day care treatment, pre-hospitalisation (30 days) and post-hospitalisation (60 days) expenses, 140+ day care procedures, mental illness treatment, HIV/ AIDS treatment, organ donor's medical expenses, ambulance charges & Morbid Obesity Treatment,
2. Are daycare procedures covered under the plan?
Yes, more than 140 daycare procedures are covered under the National Insurance group mediclaim policy.
3. What is the maximum sum insured for this plan?
The maximum sum insured of this plan goes up to INR 10 Lakhs of which SI ranging from INR 50,000 - 5 Lakhs comes in a multiple of INR 50,000. Whereas, SI of INR 6-10 Lakhs is available in the multiples of INR 1 Lakh.
4. Can I get a modern treatment cover with the National Insurance Group Mediclaim policy?
Yes, 12 kinds of modern treatment within the sub-limit are available under the plan.
5. Who should buy this plan?
The National Insurance group mediclaim policy is curated to provide basic health care support for a group of people either as an employer-employee or a non-employer-employee.
My father in law lives alone in jalandhar and we wanted an insurance company that take cares of him in our absence. They are very good with their commitment and service.
Urmil Thakur
Kochi
September 1, 2021
I bought my health plan from National a while back. Recently had to make a claim for hospitalization. I was a little worried but the response time was at best amazing! Thanks guys
Akshay Malhotra
Gurgaon
August 18, 2021
I have bought health insurance from National Health Insurance and I am very impressed by their services and attention towards customers.
Pooja Singh
Delhi
May 10, 2021
I will recommend everyone to buy health insurance plan from this company because I am very happy with the plan I purchased from the company. I am using my insurance from two years and till now ...
Bipinchandra Somabhai Patel
Vadodara
October 26, 2020
I want to portability of United India insurance company individual health mediclaim policy taken since December 2005 and falling due for renewal on 06-12-2020
Shilpa
Thane
May 6, 2018
I hold a National Parivar Mediclaim insurance plan with National Insurance from last 3 years, i am happy with the coverage value of this policy.
alok kumar de
Kolkata
October 16, 2017
my varistha mediclaim policy number of which is-150100501610012195 renewed this year but when i want to know my claim claim status online it says wrong policy number then what is the corect num...
Sabhadiya nareshbhai govindbhai
Surat
September 30, 2017
My father has been admitted in hospital but ypur company not receive my call
I inform you for admitted my father date 30/09/2017
Simran has an experience of 3 years in insurance content writing. She transitioned from hospitality to the insurance industry after her emerging interest in how vast insurance is. With her ability to write complex insurance concepts in a simple, relatable manner she keeps her audience hooked and solves their doubts smoothly.
