National Insurance Company Limited - Mediclaim Policies

Purchase mode: Offline

Options available: Individual and Family Floater

Recommendation about Mediclaim: No

Premium : Premium is cheaper as compare to individual policy

Product Features:

Parameter

Value

Entry age

18 to 59 years

Renewal

Upto 80 Years

Policy tenure

Yearly

Pre existing illness cover

Pre-existing diseases shall be covered after 4 continuous claims free Policy years

Cashless Facility

To Network Hospital

Sum Insured

Rs. 50,000 to Rs. 5,00,000

Family Combination

A) Self (Primary Insured).

B) Spouse.

C) Dependent Children (i.e. legitimate or legally adopted children).  Children above 18 years, if Employed, cannot be covered. Male children, if not employed, but a bonafide student can be covered upto age of 25 years. Female children, if not employed, can be covered until the time she is married.

D) Dependent parents.

Hospitalization cover

Covered

Pre & post hospitalization medical expenses

Covered

Domiciliary treatment

Not Covered

Sub limits

No sub limits


What does this policy Cover

  • Room, boarding expenses as provided by the hospital/nursing home.
  • Nursing expenses.
  • Fees of surgeon, anaesthetist, medical practitioner, consultant and specialist.
  • Expenses on account of anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic material, X-ray, dialysis, chemotherapy,radiotherapy, cost of pacemaker, artificial limbs and cost of organs and similar expenses.

Exclusions

The most important exclusion relates to pre-existing illness. If the insuring person had a health condition, existing prior to taking the policy, which required medical treatment, the same gets automatically excluded in the policy. To ensure that in subsequent renewals medical conditions intercepting since the policy was taken do not get excluded, the insuring person must renew the policy without break. The other exclusions for illustrative purposes are:-

Exclusion of certain named diseases in the first year of the policy.

  • Congenital external disease, sterility, venereal disease, intentional self-injury, use of drugs, alcohol, rest cure etc.
  • AIDS
  • Charges primarily for diagnostic, laboratory examinations, and not related to any treatment in hospital. So also for vitamins and tonics unless prescribed for treatment.
  • Dental treatment not requiring hospitaiisation.
  • Treatment arising from or traceable to pregnancy, childbirth, including caesarean.
  • Naturopathy treatment.

Special features of the policy   

  • Room, Board and Nursing Expenses as provided by the Hospital /Nursing Home- Room Rent limit  : 1 % of the Sum Insured per day  subject to maximum of Rs.5000./-. I.C. Unit expenses :  2 % of  Sum Insured per day subject to maximum  of  Rs. 10,000/-. Over all limits under this head  : 25% of S.I. per illness.
  • Surgeon, Anesthetist, Medical Practitioner,Consultants Special fees – maximum limits per illness – 25% of S.I.
  • 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.  Maximum limit per illness – 50% of Sum Insured.
  • Ambulance services - 1% of the sum insured subject to maximum of Rs 1000/- provided registered ambulance is used for shifting patient from residence to hospital if admitted to ICU or emergency ward  OR  from one hospital to another subject to sub-limits under ‘c’ above.
  • Hospitalization expenses of person donating an organ during the course of organ transplant will also be payable subject to the sub-limits  under ‘c’ above.

Illustration showing premium:

No. Of Members (Individual)

Age Group

Premium Suminsured Rs.3 lacs

1  Adult

36-45

Rs. 5467

2 Adult + 2 Children

66-70

Rs. 12919

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