National Mediclaim Plus Policy

National Mediclaim Plus Policy is a comprehensive health insurance plan by the National insurance company in India that goes beyond the traditional plan to protect the healthcare needs of the customers. The plan is carefully designed to provide policyholders with the required protection against rising health care costs and make healthcare-associated services easy and accessible for them. This plan offers coverage against hospitalisation expenses, pre & post hospitalization costs, daycare treatment, maternity expenses, newborn and vaccination cost, etc.

By offering a long list of features at affordable prices, National Mediclaim Plus Policy has become the first choice of customers. With the trust of the National Insurance Company, this plan has made a lot of things easier for the customer. It allows you to grab several discounts on insuring your family under the same. National Mediclaim Plus policy is an effective and pocket-friendly health insurance plan that you should add to your investment portfolio.

Let's read more about the plan's features, benefits, and eligibility criteria.

Key Features of National Mediclaim Plus Policy

National Mediclaim Plus Policy is a suitable health insurance plan, allowing the insured to get quality treatment in the hour of need. Given below is a list of this plan's key features that will help you understand the plan better.

1. Comprehensive Cover

   The plan offers a wide range of coverage to people of age groups between 18 to 65 years. It provides an optional cover for critical illness and outpatient treatment.

2. Sum Insured Range

   The National Mediclaim Plus Policy plan is available within three sum insured payment plan options ranging from Rs. 2,00,000 to Rs. 50,00,000. These plans are:

   • Plan A - 9 slabs, 2L to 10L in multiple of 1L
   • Plan B - 3 slabs, 15L/ 20L/ 25L
   • Plan C - 3 slabs, 30L/ 40L/ 50L

3. Inpatient Treatment

   Expenses such as room rent, ICU charges, nursing care charges, anaesthesia, oxygen, blood, diagnostics, medical practitioner, OT charges, prosthetic charges and other devices (if implanted internally in case of a surgical procedure) are taken care of by this plan.

4. Pre & Post Hospitalization

   The plan provides pre-hospitalization cover (up to 30 days) and post-hospitalization cover (up to 60 days) respectively for the same disease/illness/injury for which hospitalization occurred.

5. Cashless Facility

   The plan allows you to grab the cashless facility at any network hospital. Under the same, you don't have to pay a single penny from your pocket to get the treatment done.

6. Modern Treatments

   The plan offers coverage against 12 Modern treatments including Robotic surgery, oral chemotherapies, immunotherapies and many more. The maximum cover provided for availing any one modern treatment is equal to 25% of the sum insured amount.

7. Annual Increase in Sum Insured

   The plan provides an additional benefit where the sum insured amount increases annually by 5% for each claim-free year. The maximum increase in this amount can be up to 50% of the opted sum insured amount.

8. Health Checkup

   It reimburses the cost of the health check-up once at the end of a block of every 3 claim-free years.

9. Discounts and Rebates

   With this plan, customers can avail of various discounts including discounts on online purchase of policy, family and youth discount of 10%.

10. Daycare Procedures

    National Mediclaim Plus Policy offers coverage against 140+ day care procedures that require less than 24 hours of hospitalization.

11. Medical Second Opinion

    If you are diagnosed with a serious disease, a medical second opinion from the World Leading Medical Centre will be arranged. It will cover up to 160+ diseases.

12. Optional Covers

    The plan comes out with multiple optional covers that help you enhance the basic cover at a nominal cost such as critical illness, good health incentives and outpatient treatment among others.

13. Lifetime Renewability

    To assist you for a long tenure, the plan offers the lifelong renewability option to all policyholders.

14. Multiple Treatment Cover

    The plan covers expenses of multiple treatments that include ayurvedic, allopathic, and homoeopathic.

15. Tax Benefits

    The premium that you paid towards your health insurance policy is liable to get the helpful tax benefits under section 80D of the Income Tax Act, 1961.

Eligibility Criteria of National Mediclaim Plus Policy

Customers are required to fulfill a certain set of conditions to buy the National Mediclaim Plus Policy. Given below are the details of the eligibility criteria of this plan. Let's have a look.

Sample Premium Illustration of National Mediclaim Plus Policy

For your convenience, we've created here a sample illustration chart that shows the premium rates of the plan as per the different sum insured amounts opted by the insured person. Note that the data in this chart is calculated for a 30-year male person selecting the Plan A category of the sum insured.

Sample Premium Illustration of National Mediclaim Plus Policy

Exclusions of National Mediclaim Plus Policy

There are certain exclusions applicable within this plan under which the company does not pay any coverage benefits. It is important that you as a customer should have a clear understanding of these exclusions before buying this plan to avoid any confusion at the time of settling the claim. The plan has the following exclusions:

• Treatment associated with HIV, AIDS, STD, etc.
• Run-down condition, general debility, sterility, convalescence, etc.
• Treatment-related to obesity
• Genetic disorders treatment
• Plastic surgery, cosmetic treatment, hormone replacement and change of sex
• Experimental treatment and naturopathy
• Drug/alcohol abuse
• Contact lens, spectacles, hearing aid and cochlear implants

Claim Process of National Mediclaim Plus Policy

While applying a claim, policyholders appreciate a simple and hassle-free process. National Insurance Company understands the concern and provides an easy claim process to its customers. There are two options from which people can choose- cashless and reimbursement. Let's explore in detail.

Cashless Claim Procedure

The cashless claim process allows the insured to get the required cover without paying a single penny from his/her pocket. It is one of the most preferred options when it comes to claiming National Mediclaim Plus Policy.

• To file a cashless claim, you need to inform the insurer about the same as soon as possible or connect with the TPA along with required documents.
• In case of an emergency, you should inform them within 24 to 48 hours and in case of a planned hospitalization at least 3 to 4 days before.
• The insurer or the TPA will take care of the rest of the procedure, allowing you to focus on your treatment rather than expenses.

Reimbursement Claim Procedure

Under this process, you have to pay all your medical bills in the first place and then you can file for the reimbursement. For the same, you need to immediately inform the insurer.

• You need to submit a claim form with all the required documents that include all medical bills, prescriptions, discharge cards, medical investigations reports and other documents related to the treatment.
• The insurance company or accessor can ask for additional documents if required. He/she will analyze all the reports and will share results with you.
• If it gets approved, the company will transfer the claim amount directly to your account or in case of rejection, you will receive a reason for the same.

Documents Required While Filing a Claim

While filing for a claim, the policyholder is required to support his claim form along with the following list of documents:

• Completed claim form
• Bills, payment receipts, discharge certificate
• Cash-memo from the hospital
• Payment receipt, investigation test reports
• Attending medical practitioner's certificate regarding diagnosis along with the date of diagnosis
• Surgeon's original certificate stating diagnosis and nature of operation performed
• Any other document required by company/TPA