National Insurance Varistha Mediclaim Policy
National Insurance Company has been providing us with excellent insurance products for a long time. It has been a trusted insurance provider since 1906. The National Insurance Company cares for you in the phase of old age, so it is serving a health insurance plan named Varistha Mediclaim for Senior Citizens.
The National Insurance Varistha Mediclaim Policy provides the flexibility to choose among the plan options. There are two excellent and affordable plan options under this policy:
1. Coverage for hospitalization and domiciliary hospitalization expenses.
2. Critical Illness (Optional Cover).
Are you pondering whether you will be able to buy the policy or not? Then let me clarify the eligibility criteria of the plan:
Eligibility
| Criteria | Details |
| Minimum | Maximum |
| Entry Age | 60 Years | 80 Years |
| Sum Insured | 1. Hospitalization and domiciliary hospitalization expenses cover - Rs.1 lakh. Critical Illness (Optional Cover) - Rs.2 lakhs |
| Policy Term | 1 year |
Let us have a look at the features of the Varistha Mediclaim for Senior Citizens plan along with the benefits and coverage offered to the policyholders in detail.
Varistha Mediclaim Policy Features
The salient features of the plan have been detailed below:
- Sub-limit: The National Insurance company applies sub-limits concerning certain treatments under Varistha Mediclaim for Senior Citizens policy. Here are all of them mentioned in details:
- A sub-limit of Rs.10,000 is applied in case of treatment relating to cataract.
- A sub-limit of Rs.20,000 is applied to Benign prostatic hyperplasia treatment.
- In the case of plan option 1 cover, a sub-limit of maximum 20% of the sum insured is applicable under domiciliary hospitalization.
- Copayment: Copayments apply to the medical treatment bills under Varistha Mediclaim for Senior Citizens policy for selective treatment. The copayments applied are as follows:
- 10% copayment is applied to all treatments other than cataract and Benign prostatic hyperplasia treatment.
- 20% co-payment shall be considered wherever the insured person has opted treatment for cataract and Benign prostatic hyperplasia treatment.
- 10% co-payment is applicable for all pre-existing disease treatment opted by the insured and for which additional premiums have been paid.
- Pre-Policy Medical Screening: Pre-insurance medical screening is not required for all who are insured under one of the health insurance policies of the National Insurance Company.
- Others have to get their medical checkup done at their own cost.
- 50% of the medical expense incurred in the pre-insurance medical checkup gets reimbursed if the insurance company accepts the proposal.
- The medical reports date should not be within 30 days from the date of the policy proposal.
- Policy Renewal: The policy can be renewed annually. Policyholders can renew the policy by paying the renewal premium on time. The renewal premium should be paid within 30 days before the date of policy expiry.
- Waiting Period: The insured has to serve the waiting period of 1 year for specific diseases under Varistha Mediclaim for Senior Citizens plan. The details of diseases can be found in the policy document.
- Initial Waiting Period: The Varishtha Mediclaim Senior Citizens policy implies an initial waiting period of 30 days.
- Loading: Loading is applied to the premium amount on the following basis:
- 10% loading on the premiums up to 85 years of age.
- 20% loading on premium for age above 85 years.
- Free Look Period: A 15 days free look period is provided to the insured in which the insured can cancel the policy on the grounds of dissatisfaction form the coverage/ terms/ conditions of the policy.
- Policy Withdrawal: The withdrawal of the policy can be done from the insurance company’s side. The National Insurance company informs its policyholder before withdrawing any of the health insurance plans. Moreover, the policyholder gets an opportunity to switch to any other similar health insurance plan provided under the National Insurance company.
- Critical Illness Survival Period: 30 days of critical illness survival period is provided under the plan. According to this, the policyholder needs to survive for 30 days after diagnosis of critical illness to claim the Varistha Mediclaim for Senior Citizens policy.
- Number of Claims in a Policy Period (Critical Illness Option): In the case of critical illness, the National Insurance Company provides coverage only once a policy year.
- Restricted Cover: The policyholder under Varistha Mediclaim for Senior Citizens plan gets coverage for open-chest CABG treatment. But as per restricted cover, the amount payable is limited to 20% of the sum insured.
Benefits of National Insurance Varistha Mediclaim Policy
- Health Check-up: For each block of 3 years policy period, a free health checkup is provided to the insured under the plan. There are few conditions applied to this. The conditions are:
- No claims have been made during the block of 3 years policy term.
- The policy is renewed continuously without any break.
On fulfilling these conditions, the health checkup expenses payable is a maximum of 2% of the average sum insured. The insured should claim for health checkup benefits in the fourth year itself. Lastly, the insured can claim at least 45 days before the expiry of the fourth policy year and not after that. - Fixed Sum Insured: The Varistha Mediclaim plan has fixed insured sum for both the plan options.
- The Mediclaim plan option has a sum insured of Rs.1 lakh.
- The Critical Illness plan option has a sum insured of Rs.2 lakhs.
- Cashless Facility: The plan provides its policyholders with cashless medical facilities. It has proved very beneficial to the policyholder taking treatment outside India.
- Grace Period: A grace period of 30 days is provided under the Varistha Mediclaim policy. The policyholders can pay the policy premium within the grace period if s/he misses out the premium payment date.
Coverage Under Varistha Mediclaim Policy
Here are mentioned all the coverage provided under the Varistha Mediclaim Senior Citizen Policy:
- Domiciliary Hospitalization: If the insured is not in a condition to relocate/move to the hospital or there is the unavailability of bed in the hospital, the policyholder can get treatment back at home. Domiciliary hospitalization is done in certain cases on special recommendation of the doctor. Domiciliary treatment does not cover the following things:
- Any treatment for less than three days.
- Pre-hospitalization and post-hospitalization medical expenses incurred.
- Medical expenses incurred for any of the below-mentioned diseases:
- Asthma
- Bronchitis
- Chronic Nephritis and Nephritic Syndrome
- Diarrhoea and all types of dysenteries including Gastroenteritis
- Diabetes Mellitus and Insipidus
- Epilepsy
- Hypertension
- Influenza, Cough and Cold
- All Psychiatric or Psychosomatic Disorders
- Pyrexia of unknown origin for less than 10 days
- Tonsillitis and Upper Respiratory tract Infection including Laryngitis and Pharyngitis
- Arthritis, Gout and Rheumatism
- Inpatient Hospitalization : The insured gets in-patient hospitalization facilities only when the hospitalization has been done for 24 continuous hours or more.
- Pre-Hospitalization Cover: All the medical expenses incurred during 30 days before the date of hospitalization is covered under pre-hospitalization cover.
- Post-Hospitalization Cover: All the medical expenses incurred within 60 days after the date of discharge from the hospital is covered under post-hospitalization cover.
- Pre-existing Diseases Cover: A waiting period of 4 years applies to any pre-existing disease treatment expense cover.
Extra Cover Provided
Life-Terminating illnesses are covered under the critical illness plan option of Varistha Mediclaim Policy. The plan provides coverage for illnesses like:
Varistha Mediclaim Policy: Premium Table
Here is presented a table mentioning all the affordable premiums under the plan age-wise.
| Plan Type | Sum Insured | Premium |
| 60 Years-65 Years | 66 Years-70 Years | 71 Years-75 Years | 76 Years-80 Years |
| Mediclaim | Rs.1 lakh | Rs.4,180 | Rs.5,196 | Rs.5,568 | Rs.6,890 |
| Critical Illness | Rs.2 lakh | Rs.2,007 | Rs.2,130 | Rs.2,200 | Rs.2,288 |
| Total | Rs.6,187 | Rs.7,326 | Rs.7,768 | Rs.9,178 |
Exclusions
- Any self-inflicted injury.
- Sterility treatment.
- Venereal disease treatment.
- Any treatment related to maternity, traceable pregnancy & delivery including caesarean section.
- Cases of drug abuse and intoxicating substance abuse.
- Suicide and attempt to suicide.
- Congenital external disease or defects or anomalies.
- Inoculation or vaccination expenses cover.
- Any type of dental treatment.
- Expenses of tonics and vitamins unless prescribed by the doctor under hospitalization for more than 24 continuous hours.
- Spectacles/ contact lenses and hearing aids expense.
- Cosmetic surgeries and plastic surgeries.
- Hair implantation treatment.
- Injury caused by nuclear weapons/ materials.
- Injury due to involvement in war activity.
- Injury during any illegal activity.
