National Parivar Mediclaim Plus

National Parivar Mediclaim Plus

  • High Coverage up to 50 lacs
  • Vaccinations for children
  • Medical second opinion on critical illness
  • Covers critical illness & out-patient treatment
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National Parivar Mediclaim Plus Plan

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.

Eligibility Criteria

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

Features of the Plan

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

Coverage Provided Plan A Plan B Plan C
In-Patient Treatment Covered Covered Covered
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

Benefits

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.

Optional Covers

  • Critical Illness: If the insured is detected with a critical illness during the policy tenure, then this cover will provide a maximum of 50% amount of the sum insured for the treatment. The amount available per individual between 18-65 are 2L/ 3L/ 5L/10L 15L/20L/25L in complementary to the sum insured amount.
  • Out-Patient Treatment: The additional amount for the Out-Patient treatment of any illness are Rs 2K, 3K, 4K, 5K, 10K, 15K, 20K, 25K along with the sum insured opted. The company will pay for the diagnostic tests, medicines, consultation fee, dental treatment occurred on an out-patient basis.
  • Pre-existing Diabetes/Hypertension: The company will pay for the pre-existing Diabetes/Hypertension expenses on the payment of additional premium by the insured. The expense limit is up to the sum insured value.

Exclusions

  • HIV/AIDS which are sexually transmitted and genetic disorders
  • Dental treatments, obesity, cosmetic surgery, weight maintenance programs.
  • Pregnancy and childbirth-related complication
  • Hearing aid, spectacles and contact lenses expenses
  • Injuries due to war, radioactivities, or nuclear bombs explosions

FAQs

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-

  • Plan A
  • Plan B
  • Plan C

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.

  1. Cataract
  2. Hernia
  3. Hydrocele
  4. Piles
  5. Non-infective Arthritis
  6. Fissure/Fistula in Anus
  7. Pilonidal Sinus
  8. Gout and rheumatism
  9. Surgeries of the gall bladder, urinary system, varicose vein, intervertebral disc.
  10. Hysterectomy and calculus diseases

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?

  • Online discount: 5% on purchasing a policy online
  • Renewal Discount: 4% discount on the premium payable on every renewal.
  • Long-term Discount: On buying a policy for two or three years, a 4% discount will be given on 2 years and 7.5% for the 3-year tenure of the policy.
  • Zonal Discount: If living in Zone II, 4.4% discount which includes the areas of Delhi NCR, Chandigarh, Pune.
  • If living in Zone III, a discount 11.11% which involves the cities Chennai, Hyderabad, Banglore, Kolkata.
  • A discount of 20% on living in the Zone IV that consist rest of the parts of India.

9. What is the procedure for Cashless claim?

For cashless settlement, the process is simple -

  1. You have to take TPA service to avail cashless facility at a network hospital.
  2. Then you have to submit a cashless request form to the TPA filled with complete details for further authorization. The form is available with a network hospital or a TPA.
  3. After inspecting the documents, the TPA will issue a pre-authorization letter to the network hospital.

10. What is the procedure for reimbursement of claim?

In case of planned/domiciliary hospitalization

  • First, intimate the insurance provider at least seventy two hours before admitting the insured for treatment.

In case of Emergency hospitalization

  • Inform the insurer within 24 hours after the reception of the insured to the network hospital.

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-

  1. Fully completed claim form
  2. Hospital Bills, medical history of the patient, discharge letter, cash memo from chemist/hospital.
  3. Receipt of payment, medical test reports along with a prescription from the attending doctor.
  4. Attending doctor’s certificate of diagnosis carried out with date and bill receipts
  5. Medical certificate stating the need for treatment (in case of domiciliary) and fitness certificate.
  6. In case of Emergency Reunion, a confirmation from the doctor for the need of a family member in supplementary to above-stated documents.
  7. In the case of Re-installment of sum insured due to the road traffic accident, a police investigation report that justifies the road accident.

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

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*Information provided on this webpage/website is only for the purpose of general information & understanding of the topic. PolicyX or any of its subsidiaries does not endorse any of the information provided herewith and are committed in providing correct and unbiased information to its customers helping them make an informed decision.