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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.
|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|
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.
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.
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.
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.
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.
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 -
3. What are the waiting periods in the policy?
There are certain diseases in the policy that go through waiting periods-
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.
|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.
9. What copayment is involved in availing treatment outside of the selected Zone?
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-