National Parivar Mediclaim

National Parivar Mediclaim

  • Tax rebates on premium paid
  • Multiple Discounts on premiums
  • Financial aid during Infertility
  • Special coverage for Diabetes/ Hypertension
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Cover For
DOB
(eldest member)

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National Parivar Mediclaim Policy

National Parivar Mediclaim Plan is introduced with an objective to encourage the protection of the whole family on a single sum insured. The coverage provided for various illnesses or accidents under National Parivar Mediclaim can be availed by any of the family member covered in the plan.

To become eligible to enter into the policy family members need to fulfill the eligibility requirement as mentioned below.

Features of the Policy

Sum Insured 1 Lakh to 10 lakhs
Period of the Policy One, two, or three years
Maximum entry age limit 65 years
Minimum Entry Age Limit 91 days - 18 years for children,
Family Members Self, Spouse, Dependent children, Parents
Tax Rebate Benefits under section 80D of Income Tax Act
Pre-policy Check-up Required for insured above 50 years, or if taking critical illness cover or
Renewal Lifetime

Coverage Provided

Inpatient Hospitalization - This will consist of all the charges associated with room charges, pharmaceuticals, operation theatre expenses, diagnostic procedures, ICU, surgeries etc.

Pre and Post Hospitalization - The pre-hospitalization expenses will cover on a reimbursement basis for 30 days prior to in-patient hospitalization.

Whereas the post-hospitalization charges will get coverage for 60 days immediately after the discharge letter has been allocated to the insured.

Domiciliary Hospitalization - The treatment of illness mentioned in the policy that took place at home on the advice of medical practitioner is called Domiciliary Hospitalization. The treatment should last for more than three days.

Daycare Procedure - The policy listed 140+ daycare procedures which can be cured within a day or 24 hours due to the advancement in medical technology.

Ayurveda and Homeopathy - The insured can make the claim for in-patient, pre and post-hospitalization expenses incurred on Ayurveda and Homeopathy treatment which is up to the sum insured.

Organ Donor Expenses - This will cover the expenses of organ transplantation advised by a medical expert to the insured. All the in-patient, pre and post-hospitalization expenses of the donor will get reimbursed.

Hospital Cash - The insured will get a daily allowance of cash on the hospitalization of more than 3 days. The amount payable on a daily basis is Rs 300 for a maximum of five days. For example, if the hospitalization is for 10 days, the cash payable will be from 4th to 8th day i.e only for five days.

Ambulance - The insured can avail ambulance cover up to Rs 1000 per illness/ailment in a policy year and Rs 2,500.

Maternity and Baby Expenses - All the in-patient expenses of the delivery or termination of pregnancy will get covered for two times maximum during the life of the policy.

Anti-Rabies Vaccination - A coverage of Rs 5000 will be supplied towards the vaccination expenses incurred.

Infertility - A coverage os Rs 50,000 maximum will be provided to the spouse of the insured for the in-patient expenses occurred due to the treatment of infertility.

Discounts Available

Long Term Discount: Buying the policy of more than one year like two or three years will permit a discount of 4% on two years and 7.5% on a three year policy period.

Online Purchase Discount: Anything did online regarding the insurance policy, like a purchase and renewal will gain a discount of 5% and 2.5%, respectively.

Discount for Infertility for Insured Above 40 Years: If the insured and his spouse suffers any infertility, they will avail a discount of 3% on the premium paid annually. The couple must be more than 40 years.

Zonal Discount: The policy has 4 zones in total which get a specified percentage of discount on premium paid.

  • Zone I- No discount available
  • Zone II will get 4.4%,
  • Zone III will get 11.11%
  • Zone IV will get 20%

Benefits

  • Health Check-ups - The expenses happened during health check-ups are paid by the insurer after four continuous years of the policy and up to Rs 5,000.
  • No Claims Discount - Insured will gain a discount of 5% on the base premium of not making claim in a year along with the timely renewal of the policy.
  • Medical Second Opinion - In the case of major illness which can be cancerous/non-cancerous are given the facility of one medical second opinion per year for 88 major ailments listed in the policy.

Optional Coverage

Pre-Existing Diabetes/Hypertension

Though pre-existing ailments are covered after a waiting period but with this add-on cover insured can get coverage on the inception of the policy. The insured is liable to pay some percentage of the claim as a co-payment.

If opting either for one Pre-Existing Diabetes or Pre-Existing Hypertension cover, then you will pay 10% of co-payment

If opting for both Pre-Existing Diabetes and Hypertension cover, then you have to pay 25% of co-payment.

Outpatient Treatment

The expenses carried upon oneself on out-patient treatment like consultation fee, pharmaceuticals, medical tests, and out-patient dental treatment can get reimbursed with this add-on. The additional coverage amount offered by the company are Rs 2,000; 3,000; 4,000; 5,000; 10,000 along with the sum insured.

Critical Illness

With the payment of additional premium, insured can easily get cover in the event of critical illness detection. The additional amounts that insured can utilize towards the treatment of illness are Rs 2/ 3/ 4/ 5/ 10 lakhs along with the sum insured.

Exclusion of the Policy

  • Sexually transmitted HIV/AIDS
  • Genetic Disorders, Dental treatment, miscarriage, abortion, surrogacy
  • Vaccinations except for anti-rabies
  • Cosmetic or aesthetic treatment, hormone replacement therapy
  • Massages, spa, naturopathy
  • Obesity, self-inflicted injuries, suicides, psychiatric disorder
  • Hearing aid, contact lens, spectacles

FAQs

1. Will, the company pays for the pre-policy expenses?

Yes, the company is liable to pay 50% of the expenses that arise out of pre-policy check-up.

2. What kind of check-ups are done in pre-policy check-up?

The policyholders, if required had to undergo following check-ups -

  • Physical examination
  • Blood sugar and lipid profile
  • Urine and microscopic examination
  • ECG
  • Eye check-up
  • Serum creatinine
  • There may be a possibility of additional examination as demanded by the company.

3. What are the waiting periods in the policy?

There are certain diseases in the policy that go through waiting periods-

  • 4 years of waiting- Pre-existing diseases like diabetes, hypertension, joint replacement (not by accident) are covered after the 48 months from the starting date of the policy.
  • 2 years of waiting- Ailments such as cataract, hysterectomy, non-infective arthritis, piles, hernia, Sinusitis, calculus, diabetes, hypertension, surgeries of the gall bladder and genito-urinary etc are covered after passing of 24 months.
  • 30 days waiting- If insured suffered any illness or injuries in the first thirty days of the policy, then he will not get any reimbursement for the expenses incurred.

4. What is the time limit to inform the TPA for a cashless claim?

In the case of planned hospitalization, the insured is given a time limit of 72 hours to inform before the reception of the patient into the network hospital.

In the case of emergency hospitalization, the insured have to notify the insurer within 24 hours immediately after the reception of the patient into the network hospital.

5. What is the notification period for reimbursement of claim?

For planned and domiciliary hospitalization, the insurance provider has to be notified at least 72 hours before the admission process of the patient took place.

For emergency and domiciliary hospitalization, a time limit of 24 hours is given to update insurer after the admission to the network provider.

For Anti-Rabies Vaccination, the insurer must be notified at least 24 hours before the vaccination takes place.

6. What is co-payment?

When Insured is bound to pay some percentage of the claim as determined during the purchase of the policy, is called co-payment.

7. Are there any copayments in the optional cover of Pre-existing Diabetes/Hypertension?

Yes, the insured person has to present for the co-payments while buying this optional cover.

Cover Copayment
Pre-existing Diabetes 10% of the claim amount admitted by the insurer for diabetes alone.
Pre-existing Hypertension 10% of the claim amount admitted by the insurer for Hypertension alone.
Pre-existing Diabetes and Hypertension 25% of the claim amount admitted by the insurer for both Diabetes and Hypertension

8. What are the different zones in the policy?

The premium paid by the insured is according to the Zone selected. There are 4 Zones in total.

  • Zone I- Includes Metropolitan area of Mumbai and whole Gujarat
  • Zone II- Delhi NCR, Chandigarh, Pune
  • Zone III - Chennai, Hyderabad, Kolkata
  • Zone IV- Remaining parts of India

9. What copayment is involved in availing treatment outside of the selected Zone?

  1. If Zone I is selected, the treatment is taken in zone II, Zone III, Zone IV is free of any copayment.
  2. If zone II is selected, then the treatment carried out in zone II, Zone III, Zone IV is free of copayment. While the treatment in Zone I will subject to a copayment of 5% of the claim.
  3. If zone III is selected, then the treatment carried out in Zone III, Zone IV is free of copayment.
  4. Whereas treatment availed in zone II and Zone I will subject to a copayment of 7.5% and 12.5%, respectively.
  5. If zone IV is selected, then the treatment carried out in Zone IV is free of copayment. On the other side, if the treatment is availed in Zone III/ Zone II/ Zone I, then copayment percentages will be 10%/ 17.5%/ 22.5%, respectively.

10. How much premium is charged in case we cancel the policy?

If you cancel your policy, the insurance company will charge a cancellation cost on the premium submitted for a year. The rate will be determined on the period of risk.

Period of risk Premium charged
Up to 1 month ¼ of the yearly amount of premium
Up to 3 month ½ of the yearly amount of premium
Up to 6 month ¾ of the yearly amount of premium
Exceeding 6 months Whole amount of premium paid in a year

11. What are some major illnesses for which the second opinion can be availed?

The major illnesses have been categorized into forms-

  1. Non-Cancerous- AIDS/HIV, coronary artery, Elephantiasis, liver and lung diseases, kidney and liver failure, paralysis, heart disease, stroke, cirrhosis, brain tumor etc.
  2. Cancerous- Cancer-related to breast, eye, thyroid, bladder, cervical, lung, kidney, skin, uterine, stomach, pancreas, ovary etc.

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