National Insurance Mediclaim Policy

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National Insurance Mediclaim Policy

	Objective			The objective of this policy is to provide for financial support in case the insured member is hospitalised for an illness, disease or accident.
Suited for			his policy can be bought by an individual for self or for family on an individual sum insured basis or as a floater cover.
What does it do?			The policy covers hospitalisation expenses and day care procedures which that do not require an overnight stay in the hospital due to technological advancements. Ambulance charges and hospitalisation expenses of organ donor in case of major organ transplant are also covered. It is up to the policyholder to avail cashless facility. If policyholder doesn't avail cashless treatment, he will be entitled to 6 per cent discount on premium.
Pros			This policy can be bought online. The policy offers a premium discount if policyholder does not require cashless facility. It offers an extended renewal period till 90 years of age, if the insured has taken this Mediclaim policy regularly for at least five years prior to attaining 80 years of age. Premium paid towards the policy is exempt from Income Tax under section 80D of Income Tax Act.
Cons			There are sub-limits on the policy benefits. The policy can be renewed only up to 80 years of age for those who do not subscribe to it for five consecutive years until 80.
Our View			This basic health insurance policy is good enough as far as its coverage is concerned. The only drawback is the sub-limit imposed on various expenses incurred during hospitalisation.
Eligibility
Entry Age (years)
Minimum		18
Maximum		59
Maximum Policy Renewal Age (years)		80 or upto 90 if policy continued for atleast 5 years prior to attaining age of 80 years with special approval
Coverage Type		Individual/ family on an individual basis/ family floater
Policy Term (years)		1
Sum Insured (Rs)
Maximum		5 lakh
Minimum		50000
No Claim Bonus		5% for each claim free year till it reaches 50%
Pre Policy Medical Check Up		Mandatory for age of 50 years and above. Cost shall be borne by insured.
Policy Termination		Insurance company may cancel the policy by giving a 30days notice. Insurer may also cancel the policy at anytime. In such an event, insurance company shall refund the proportionate premium as agreed in the policy document
Customer Service
Address		Head Office: National Insurance Company Limited 3 Middleton Street Kolkata West Bengal Pincode : 700071
Mail to		website.administrator@nic.co.in
Call to		1800 419 4033

 

	Scope Of Cover
Cashless facility		available if treatment availed in a network hospital
Reimbursement facility		available if treatment availed in a non-network hospital
Pre and post hospitalisation		medical expenses incurred during 30 days prior to hospitalisation and 60 days after discharge from hospital will be covered
Room, Boarding and nursing expenses*		pays 1% of Sum Insured per day subject to maximum of Rs 5000
I.C.U expenses*		pays 2% of sum insured per day subject to maximum of Rs 10000
Surgeon, Anesthetist, Medical Practitioner, Consultants Specialist fees		covered upto maximum of 25% of sum insured per illness
Anesthesia, Blood, Oxygen, OT charges, Surgical appliance, Medicines, drugs, Diagnostic Material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs and cost of stent and implant		covered upto maximum of 50% of Sum Insured
Ambulance charges		pays 1% of the sum insured subject to maximum of Rs 1000
Organ donor expenses		covers hospitalisation expenses of organ donor
Day care procedures such as dialysis, chemotherapy etc.		covers certain treatments which does not require overnight hospitalisation due to advancement of technology
Health check up		allowed once at the end of four continuous claim free years
*Overall limit for these benefits is 25% of sum insured per illness

 

	Exclusions and Waiting period
Pre-existing illnesses		covered after 4 continuous claim free policy years
Waiting period		Certain disorders and surgeries will be covered after first policy yearCertain illnesses such as cataract, hernia, diabetes, hypertension etc. will be covered after completion of first two policy yearsAIDS/ HIV or related diseases

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