National Parivar Mediclaim Plus Policy
National Parivar Mediclaim Plus Plan is a health insurance policy designed to protect against financial crunches that may arise due to an emergency hospitalization. It covers health emergencies for the whole family. The family floater policy provides coverage in a single plan, which is economical when compared to single health insurance plans. The sum insured is used by any member in the policy against hospitalization due to injuries and diseases. According to policy terms, one can include self, spouse, parents, and 2 dependent children. The main aim of the plan is to reduce the financial burden on the policyholder's family due to any medical treatment of a person insured.
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What is the National Parivar Mediclaim Plus Policy?
National Parivar Mediclaim Policy Plus is a family floater or individual basis health insurance plan that covers various health care needs of the policyholder and the family. The family floater policy includes the person insured, the spouse, and dependent children for which the person insured will have to pay a single premium. Sum insured options in this plan range from Rs 6 lakh to Rs 30 lakh. The policy tenure has 3 main options available for the age i.e. 1 year, 2 years, and 3 years.
The policy provides coverage against pre-hospitalization, organ donor expenses, post-hospitalization, domiciliary treatments, daycare treatments, and others. The policy has a lifelong renewability option. It has various other benefits of critical illness cover, pre-existing hypertension, outpatient treatment, and diabetes cover.
Features of the National Parivar Mediclaim Plus Policy
The key features of the National Parivar Mediclaim Plus Policy are as follows:
- Coverage - The sum insured in the plan ranges between Rs 6 lakh and Rs 50 lakh.
- Cashless Treatment and Reimbursement - The plan not only offers cashless treatment claim facilities at the network hospitals but also provides reimbursement claim facilities to pay for the expenses on the admission of the policyholder at a non-network hospital according to the conditions and terms of the plan.
- Renewal - The policy tenure lies between 1 year and 3 years. After completion of the policy term, the person insured should renew the policy.
- Pre and Post-hospitalization Charges - Pre-hospitalization and post-hospitalization charges are covered in the plan for 30 days and 60 days respectively.
- Ambulance Charges - Ambulance charges are given to policyholders per hospitalization and per person insured. It varies according to the plan type chosen.
- No Claim Bonus - The bonus is given if, in a particular policy year, no claim is made, i.e., for a claim-free year. On continuous renewal of the policy, the policyholder is given a 5% rebate.
- Medical Check-up - The plan has free medical check-ups for policyholders who have the policy for 4 continuous years.
- Benefits on Tax - Premiums paid for the health insurance plan are eligible for various tax benefits according to the provisions mentioned under Section 80D of the Indian Income Tax Act, 1961.
- Co-Payment - If the person insured chooses coverage against pre-existing illnesses like hypertension and diabetes, they must pay a co-payment of 10%, which needs to be paid for the treatment of these diseases.
- Waiting Period for Pre-existing Diseases - All pre-existing illnesses are covered in the policy after a waiting period of 36 months of continuous policy years.
National Parivar Mediclaim Plus Policy: Benefits
Benefits of the National Parivar Mediclaim Plus Policy are:
- Hospital Room Rent - Daily hospital room rent is covered under this plan up to a maximum 1% of the sum insured per day.
- ICU Charges - is covered up to a maximum 2% of the sum insured cover daily.
- Hospital cover - The plan covers various charges that are paid to anesthetists, surgeons, consultants, and medical practitioners.
- Medical Expenses - The plan covers charges of anesthesia, artificial limbs, blood, cost of pacemaker, chemotherapy, drugs, medicines, oxygen, operation theatre charges, surgical appliances, x-rays, and essential charges.
- Organ Donor Charges or Expenses - The plan covers surgery costs if the policyholder is donating his/her organ to another person.
- Cap on Expenses - Total expenditure for a particular disease is limited up to a maximum of 50% of the sum insured.
- Flexibility - The plan covers everyone from 18 years to 65 years. It also has the flexibility to add dependent children from 3 months to 18 years if both the parents are a part of the cover.
- Sum Insured - The plan has a wide range of the sum insured from Rs 6 lakh to Rs 50 lakh depending on the type of coverage required by the customers.
- Coverage - It has comprehensive coverage on the hospitalization of the person insured due to accidental injuries or diseases. Pre-existing illnesses are also covered in the plan.
- Premium Charges - Premium charge of the plan is based on the eldest member of the family in case of a family floater plan.
- Daycare Procedures Covered - The plan covers up to 140+ daycare services up to a limit of the sum insured amount.
- Organ Donor Benefits - It covers the organ donor's expenses - if a person is donating their organ to the policyholder.
- AYUSH Benefits - The plan covers non-allopathic treatments like ayurveda and homeopathy treatment up to the sum insured limit.
- Waiting Period - The plan has a waiting period of 30 days.
Inclusions of National Parivar Mediclaim Plus Policy
This National health insurance plan reimburses hospitalization expenses incurred, under the following:
- Boarding, room costs, and nursing expenditures provided by a hospital or a nursing home can be availed up to
- a maximum of 1% of sum insured per day for normal room
- a maximum of 2% of the sum insured p/d for ICU room.
- Fees for Anaesthetist, Consultant, Medical Practitioner, Nursing, Surgeon, and Specialist’s fees are covered under the policy.
- Charges incurred on anesthesia, artificial limbs, blood, cost of pacemaker, chemotherapy, drugs, medicines, oxygen, operation theatre charges, surgical appliances, x-rays, and essential charges are covered.
- The plan covers diabetes and hypertension from the commencement through a rider.
- Pre and post-hospitalization charges are covered for 30 and 60 days respectively.
- Cashless facilities are available for network hospitals.
National Parivar Mediclaim Plus Policy: Exclusions
Exclusions of National Parivar Mediclaim Plus policy are:
- Pre-existing illnesses are covered after 36 months of continuous policy coverage under the plan.
- Various diseases and injuries related to which pre-existing illness from the commencement of the plan, are covered only after 36 continuous no claim policy years.
- No claim except accidental injuries is paid by the insurance provider within the first 30 days from the plan's commencement.
- Hospitalization due to congenital diseases, venereal disease, sterility, intentional self-injury, alcohol, use of drugs, rest cure, and others are not covered in the policy.
- AIDS and HIV are not covered.
- Expenses incurred for laboratory examinations, diagnostic which are not related to any disease to or for such diagnosis for which policyholder's hospitalization is not required.
- Dental treatment except for due to accidental injury, which requires hospitalization is not covered.
- Treatment due to invasion, war, and nuclear weapons.
*This list is only indicative and not exhaustive. For the complete list one can refer to the policy document.
Eligibility of National Parivar Mediclaim Plus Policy
The minimum eligibility to buy this policy from National Insurance company are:
- Minimum entry age of the policyholder - 18 years
- Maximum entry age of the policyholder - 65 years
- Minimum entry age of the child - 3 months
- Maximum entry age of the child - 18 years
- Policy tenure - 1 to 3 years
- Minimum sum insured:
- For Plan A - 6 lakh to 10 lakh
- For Plan B - 15 lakh, 20 lakh, 25 lakh
- For Plan C - 30 lakh, 40 lakh, 50 lakh
- Pre-existing illness - After 36 months of coverage.
*The above information is subject to change as per the norms of the insurance provider.
Claim Process of National Parivar Mediclaim Plus Policy
For the claim process of National Parivar Mediclaim Plus Policy, the steps are as follows:
For Cashless Treatment
- Step 1: For pre-planned cashless treatment, inform the policy provider before hospitalization in a network hospital. For emergency treatment, the insurance provider must be notified within 24 hours of hospitalization.
- Step 2: If filing online through the website, then go to the claim section, enter the policy number, and the policyholder's date of birth.
- Step 3: Fill the claim form by providing necessary details like the reason for hospitalization, the hospital's name, etc. The claim form asks for policy details and contact numbers. Submit the form after attaching the necessary documents.
- Step 4: At the hospital desk, show policy documents and the ID card of the policyholder.
- Step 5: After verification, the company will notify about the claim acceptance or rejection.
- Step 6: If the claim is approved, the company will pay the hospital directly.
For Reimbursement Claim
Step 1: If the treatment is done at a non-network hospital, inform the policy provider at least the day ahead in case of planned hospitalization. For an unplanned one, inform within 24 hours.
Step 2: After completion of the treatment, pay the total hospital bill.
Step 3: Fill up a claim stating the reason for the hospitalization and other details as asked. Attach all the necessary documents like bills, receipts of the plan.
Step 4: The policy company will verify the details asked, and after cross-checking, it will inform about claim rejection or approval.
Step 5: If the claim is approved, then the policy provider company will pay the amount through NEFT.
Documents Required for Claim Settlement of National Parivar Mediclaim Plus Policy
The necessary documents required for claim settlement are:
- Completed claim form
- Prescriptions and copies of treatment undertaken by the policyholder
- A second copy of the consultation letter
- Diagnostic reports
- All bills, receipts for payment
- FIR in case of accidental hospitalization
After a thorough verification process, the company will process the claim.
How to Buy National Parivar Mediclaim Plus Policy?
For buying a policy, one must follow the below steps:
- Step 1: Go to the official website of paisawiki.com. Visit the buy policy section. Enter information such as phone number, date of birth, email address, medical health, and type of policy required.
- Step 2: According to one's choice, the website will generate a list of different insurance policies. One can compare the various health policies online or read the policy's features and benefits.
- Step 3: One can also mark their favorite policies and compare a plan with similar policies. After an in-depth comparison of insurance policies, select the required policy.
- Step 4: After selecting, the website will ask for personal details like the name of the person to be insured, their address, ID proof, health condition, and other details for all the members added to the policy. Then enter policy-specific details like policy tenure, the sum assured, no of members to be assured, their age and additional covers or riders.
- Step 5: After filling the above details, the website will show all the riders that can be available along with the policy and their benefits.
- Step 6: Click to add riders. After adding all the necessary details, the website's premium calculator will generate the premium amount automatically.
- Step 7: Upload all necessary documents asked with clear photographs. Once done, click on the submit button.
- Step 8: The buyer will be notified that the proposal is mailed to the policyholder, and they can choose to save the policy and buy later or buy the policy now.
- Step 9: For buying the policy, enter bank details and other necessary details asked to pay the premium through Debit Card, Credit Card, Mobile banking, Internet Banking, or through Wallet. Once the premium is paid, the policy documents will be mailed.
Documents Required for National Parivar Mediclaim Plus Policy
There are various documents required to buy a policy. Here is a general list of documents required to purchase the National Parivar Mediclaim Plus Plan are:
- Coloured photograph
- Age proof:
- Aadhar Card, Driving License, Birth Certificate, PAN card, Passport, Voter Card or School Leaving Certificate
- Address proof (any one)
- Electricity Bill, Passport, Postpaid Bill, Bank A/C statement, Telephone Bill, Utility Bill or Ration Card
- Photo ID proof (any one)
- Driving License, Voter ID, PAN card, Passport, and Aadhar Card
Renewal Process of National Parivar Mediclaim Plus Policy
For the renewal of National Parivar Mediclaim Plus, follow the below steps:
- Step 1: Go to the paisawiki.com renewal section. Enter policy number and date of birth or registered mobile number.
- Step 2: The website will search and generate policy details of the person insured. One can choose to add riders or members or remove them according to their choice.
- Step 3: After the following selection, a new premium amount will be generated automatically by the calculator.
- Step 4: Click on renew now and pay the premium amount through online transactions.
After the policy is renewed, new policy details will be sent.
Ans: No, a pre-policy check-up is only necessary if the person to be insured is above 40 years of age.
Ans: Yes, maternity expenses are included.
Ans: Yes, the company will pay for pre-policy expenses.
Ans: The policy has a GST of 18%.
Ans: Yes, co-payment is required for pre-existing illness.
Written By: Paisawiki - Updated: 12 February 2021