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The National Insurance Company, in an objective to provide unlimited health benefits to the family of Indian nationals, introduced National Parivar Mediclaim Plus Policy. The policy will give coverage for all sort of hospitalization expenses for various illnesses and other benefits in the shape of health incentives, income tax deductions.
National Parivar Mediclaim Plus Policy will cover your spouse, children, parents, and parents-in-law under a single sum insured common to all members.
|Name of the product||National Parivar Mediclaim Plus|
|Minimum age of entry||3 months for children and 18 years for adults|
|Maximum age of entry||65 years|
|National Parivar Mediclaim Plus Plans||Plan A||Plan B||Plan C|
|Sum Insured||Rs 6/7/ 8/ 9/ 10 lakhs||Rs 15/20/25 lakhs||30/40/50 lakhs|
|Duration of the Policy||1 year, 2 years, 3 years|
|Claim Settlement||Cashless and Reimbursement method|
|Family Members Can be Covered||Self, Spouse, Children, Parents or Parents in Law|
|Riders||Out-patient treatment, pre-existing Diabetes/hypertension, Critical illness.|
|Tax Benefit||Available under Section 80D of Income Tax Act|
|Coverage Provided||Plan A||Plan B||Plan C|
|Pre-Hospitalization||Up to 30 days||Up to 30 days||Up to 30 days|
|Post-Hospitalization||Up to 60 days||Up to 60 days||Up to 60 days|
|Domiciliary Hospitalisation||Up to Rs 1 lakh||Up to Rs 2 lakh||Up to Rs 2 lakh|
|Day Care Procedure||140+ daycare treatments|
|Ayurveda and Homeopathy||Covered under all the pans|
|Air Ambulance||Not Covered||Up to 5% of the sum insured||Up to 5% of the sum insured|
|Hospital Cash||Rs 500 for 5 days maximum||Rs 1000 for 5 days maximum||Rs 2000 for 5 days maximum|
|Medical Emergency Reunion||No Coverage||No sub-limit||No sub-limit|
|Post Hospitalisation expenses like Doctor’s Home Visit and Nursing Care||No Coverage||Rs 1000 for 10 days maximum||Rs 2000 for 10 days maximum|
|Infertility||Up to Rs 50k||Up to Rs 1 lakh||Up to Rs 1 lakh|
|Vaccination for Children (male child up to 12 years and female child up to 14 years)||Up to Rs 1000||Up to the actual amount incurred||Up to the actual amount incurred|
|Room Charges and the Intensive Care Unit (ICU) Charges||Room: up to 1% of the actual amount or sum insured ICU: up to 2% of the actual amount or sum insured||No sub-limit||No sub-limit|
|Maternity and New Born Baby (2 years of waiting period)||Up to Rs 30,000 for normal delivery and Rs 50,000 for C-section delivery||Covered up to the actual cost of delivery||Covered up to the actual cost of delivery|
|Organ Donor expenses||In-Patient treatment, Pre and Post-hospitalization||In-Patient treatment, Pre and Post-hospitalization||In-Patient treatment, Pre and Post-hospitalization|
|Anti Rabies Vaccination Cover||Up to Rs 5,000||Up to Rs 5,000||Up to Rs 5,000|
|Pre-existing Disease||After 36 months of the policy||After 36 months of the policy||After 36 months of the policy|
|Medical Second Opinion (MSO)||Two MSO per family member for listed illness in a policy year||Two MSO per family member for listed illness in a policy year||Two MSO per family member for listed illness in a policy year|
|Re-installment of sum insured due to road traffic accident||covered||covered||covered|
No Claim Discount: The policyholder will receive a benefit of a 5% bonus on every claim free year with regular and timely renewals. This 5% discount will be given over base premium after completion of claim free year.
Medical Second Opinion: This gives the facility of having a second suggestion from an insurer’s panel of world-leading Medical centers (WLMC) for 160 major ailments as listed in the policy wordings.
Health Check-Ups: The health check-up taken can be reimbursed after the termination of two continuous years of policy with timely renewal without any delay.
Discounts: The policyholder gets a discount on choosing two or three policy over one-year policy and on the number of members included in the family.
No Sub Limits: When you buy plan A and Plan C, there are no limits in minimum or maximum amount payable on room charges, ICU, vaccinations, maternity, newborn baby expenses, Medical Emergency reunion.
Lifelong Renewability: The policy can be renewed after every one or two years based on the term of the policy taken.
1. What are the various plans available under National Parivar Mediclaim Plus Plans?
There are three plans that cover family member under a single sum-insured-
Each plan offers different sum insured values at different premiums.
2. Do we need to undergo pre-policy checkup?
No, there is no requirement to go pre-policy check-up, if you are less than 40 years of age. In case you are selecting an optional coverage of Critical illness on extra payment of premium, then the check-up is mandatory for the individual between 18-65 years. Also, if you are buying a coverage of
3. Do the insurance provider pay for the pre-policy check-up?
The insurance provider will be responsible for a 50% amount of the expenses happened due to pre-policy check-up.
4. What do you mean by TPA?
TPA stands for Third-party administration which is licensed under the regulation of IRDA. The TPA receives a fee from the insurance company in providing necessary health services.
5. What kind of diseases comes under two years of waiting period?
Every health insurance policy has waiting periods for some specific diseases. This policy also has a list of illnesses that are covered after a waiting period of two-years.
6. What is the free-look period of the policy?
The free-look period is the time given to insured after buying the policy to analyze all the terms and conditions and can cancel the policy if they are not satisfied. The premium paid will be returned with some deduction of stamp duty charges and medical tests expense if incurred by the insurance company.
7. What is the Medical Emergency Reunion?
This feature assists the insured to get the support of a family member in the event of hospitalization far away from the place of residency more than five perpetual days in ICU. Under this, the insurance provider gives permission to the family member only on the confirmation from the attending doctor. The insurer will cover expenses related to round trip economy class air tickets and family member can be spouse, children or parents of the insured.
8. What kinds of discounts are available under the policy?
9. What is the procedure for Cashless claim?
For cashless settlement, the process is simple -
10. What is the procedure for reimbursement of claim?
In case of planned/domiciliary hospitalization
In case of Emergency hospitalization
After giving information, you have to submit the necessary evidence that will support your reimbursement claim. Documents can be bills, discharge certificate, prescriptions, reports etc. The company will probe into your documents and will take thirty days of time for claim settlement.
The insured will receive an offer of settlement which will assure the payment of the claim within 7 days and in a situation of delay the insurer will pay a 2% interest rate.
11. What documents are required for submitting a reimbursement claim?
The major illnesses have been categorized into forms-
12. What is the time limit to submit the documents to the insurer for reimbursement?
The major illnesses have been categorized into forms-
|Type of Reimbursement||Time limit for submission of the documents|
|In-patient and pre-hospitalization, Medical Emergency Reunion, air ambulance,||Within a period of 15 days from the date of discharge from the hospital|
|Post-hospitalization, Doctor home visit, and nursing at the time of post-hospitalization||Within a period of 15 days from the date of fulfillment of post-hospitalization|
|Domiciliary hospitalization||Within a period of 15 days from the issuance of wellness certificate|
|Anti-rabies vaccination, newborn baby vaccination and vaccination of children||Within a period of 15 days from the date of vaccination|
|Infertility Treatment expenses||Within a period of 15 days from the date of completion of treatment or expiry of policy tenure whichever happens before|
|Health check-up expenses||Within a period of 6 months of the third policy year|
13. What is Air Ambulance?
It facilitates the insured in obtaining medical transportation from one hospital to another o from home to the nearest hospital available with regard to prior intimation to the prior intimation to the company or TPA. The company shall reimburse the transportation expenses no claim basis.
14. What are the sub-limits for the Pre-existing Diabetes/hypertension add-on cover?
The insured while choosing the optional cover of Pre-existing Diabetes/hypertension will receive the decided amount of sum insured on making a claim.
|Policy years||Claim Amount|
|First Year||Up to 25% of SI|
|Second Year||Up to 50% of SI|
|Third Year||Up to 75% of SI|