National Mediclaim Policy
National health insurance is among the most sought-after products in India. The insurance company provides different health insurance policies that aid the policyholder during medical emergencies or hospitalisation of the person insured. The insurer knows that medical expenses incurred during treatment is very high, so investing in a health insurance plan has become a basic necessity. The National Mediclaim policy covers day care treatment, in-patient hospitalisation, and has incorporated a plethora of other medical expenses.
What is the National Mediclaim Policy?
National Mediclaim Policy is a health mediclaim policy which covers the cost of hospitalisation in case of any disease, illness, or emergency hospitalisation due to an accident. The National Insurance Company is founded by the Government of India. The plan is customised according to the needs of family members or individuals, senior citizens, and others.
In the National Mediclaim policy, there are various riders which can be added to increase the coverage of the policy like Accidental Death Benefit, Critical Illness Rider, etc. Policyholders have the choice to take an individual cover for family cover according to their needs. To enhance the effectiveness of the plan, there are various benefits available.
Features and Benefits of the National Mediclaim Policy
The National Mediclaim policy under National health insurance comes with multiple features and benefits. Let’s start with the features now:
- Pre-hospitalisation - The plan covers pre-hospitalisation charges of the person insured for up to a maximum of 30 days before getting admitted to the hospital.
- In-patient hospitalisation - It includes expenses incurred due to in-patient hospitalisation of the policyholder for every 24 hours.
- Post-hospitalisation - For up to 60 days from date of discharge from the hospital, the plan covers all the expenses of post-hospitalisation.
- Cumulative Bonus (CB) - The sum insured of the policy gets increased by 5% for every claim-free policy year, i.e. no claims get reported in a particular year. But one must continuously renew the policy without any break for getting a maximum of 50% cumulative bonus on the sum insured.
- Other Medical Expenses - The plan covers all types of medical expenses incurred during the treatment of the person insured on the advice of qualified medical practitioners. The hospitalisation must be more than 24 continuous hours.
- Cashless Claim Facility - The plan provides cashless facilities in a network of 6000 hospitals and reimbursement facilities in treatment in a non-network hospital.
- Pre-policy Check-up – The policyholder can have medical check-ups before buying the National Mediclaim Policy from National Health Insurance. Still, the tests are not mandatory with an exception in particular conditions, if the policyholder is above 40 years of age or is opting for a sum insured greater than Rs 6 lakh or adds Critical Illness rider. On acceptance of the proposal, the insurance company will reimburse 50% of the expenses to the person insured who have bought the National Mediclaim Policy.
- Customer Care – The policy provider's company has a dedicated team for claim settlement. It is equipped with a skilled team of professional customer service personnel who are willing to assist and guide policyholders with all related health insurance questions and services through online chat, email, and toll-free number.
- Online Availability - National Mediclaim Policy offers all the policyholders, customised for plans for groups and families which can be bought online.
- Online Renewal – The insurance company offers the flexibility and convenience of online renewal of insurance plans, ensuring that the processes are fast and hassle-free.
- Tax Benefits - There are tax exemptions on the premium paid by the policyholder according to Section 80D of the Income Tax Act, 1961.
- Incurred Claim Settlement Ratio - The claim settlement ratio of National Mediclaim Insurance for the F.Y. 2018 - 19 is 107.64%.
Various benefits of the National Mediclaim Policy are discussed below:
- The policy provides coverage against hospital cash in hospitalisation for greater than 3 days, which depends on the type of policy taken.
- The policy has a free look period during which a policyholder can return the policy within 15 days from the date of the receipt of the policy, and all premiums paid are returned.
- The policy provides coverage against non-allopathic treatment, i.e. homoeopathic and ayurvedic treatments.
- The plan offers a grace period of about 30 days from the due date of premium payment.
- The plan offers portability options in which, one can switch to a different insurance company. Still, the probability process has to be completed at least 45 days before the date of expiry of the National Health Insurance policy.
- There are various add-on riders like for pre-existing diabetes, out-patient treatment, pre-existing hypertension, and other critical diseases.
- The plan also provides more riders in comparison to traditional insurance plans.
Inclusions of the National Mediclaim Policy
The National Mediclaim Policy covers the following treatment expenses in its list of inclusion:
- All charges incurred due to hospitalisation and treatment like surgeon's fees, doctor consultation fees, specialist doctors, and charges for anaesthetist for up to a maximum of 25% of sum insured is given.
- The plan covers hospital room rent of up to 1% of the fixed sum insured, up to a maximum of Rs 5,000 per day.
- The reimbursement for ICU room rent of up to a maximum of 2% of sum insured, i.e. Rs 10,000 per day
- The plan pays for the expenditures towards operation, medicines, operation theatre expenses, nursing, oxygen, blood, etc. paid as per the terms of the policy.
- The plan has specialised medical treatments like chemotherapy, radiotherapy, organ transplant, etc. which can be paid up to a particular amount of sum insured.
- The plan has affordable premiums available as compared to other health plans.
*The above information is subject to change as per the norms of the insurance provider.
Exclusions of the National Mediclaim Policy
Under the following conditions, the policy becomes null and void when it comes to claiming it:
- The plan doesn't cover for hospitalization charges only for diagnostic purposes.
- In this plan, no pre-existing diseases are covered, even after the person insured has renewed the policy several times.
- The plan doesn't cover any medical and hospitalisation caused due to overuse of drugs or alcohol, intentional self-injury, congenital external disease, sterility, venereal diseases etc.
- Diseases like HIV AIDS, dental treatments, maternity-related needs and childbirth treatments are not covered.
*This list is only indicative and not exhaustive. Kindly refer to the policy document for the complete list of exclusions
Eligibility of National Mediclaim Policy
The eligibility criteria of National Mediclaim Policy are:
- Minimum entry age of the policyholder in the plan- 18 years
- Maximum entry age of the policyholder in the plan - 65 years
- Minimum entry age of the child in the plan - 91 days
- Maximum entry age of the child in the plan - 21 years
- Sum assured - Rs1 lakh to Rs 10 lakh
- Critical Illness benefit amount: Rs 2 lakh, 3 lakh, 5 lakh and 10 lakh.
- Renewability - lifelong renewability
- Policy Tenure - 1 year, 2 years or 3 years.
- Free health check-ups available.
- After every 4 claim-free years the sum insured increases up to Rs 5,000
- There is no capping on any one illness.
Claim process for National Mediclaim Policy
National health insurance policy can be claimed for availing cashless and reimbursement benefits
For cashless claim process, the steps to be followed are:
- For cashless claim process, visit the claim section. It is essential to inform the National Insurance Company, 7 days before getting any kind of hospitalization for any treatment if planned earlier. In the case of hospitalization, due to an accident or emergency, the person insured should inform the insurer within 24 hours of hospitalization.
- On getting admitted to a network hospital, the person insured needs to provide all the essential documents at the hospital's helpdesk - health card provided by the insurance company, policyholder's ID proof and plan document.
- The policyholder can fill up a claim form stating the reason for hospitalization. After filling up the details on the claim form & attaching all the documents, the policyholder needs to wait for the insurance provider to notify its decision on claim approval.
- All health insurance companies must notify the person insured within 5-9 hours about claim rejection or approval. Although the time required varies from insurer to insurer.
- On getting discharged from the hospital, the policyholder needs to keep all the documents like bills & receipts at the hospital desk. Policyholders must ensure to pay the hospital bill amount, which is not included by the insurer or co-payment.
On completion of the above procedures, the insurer will pay the outstanding bill to the hospital.
Reimbursement claim process comes with the following claim steps:
- Reimbursement process is necessary for the treatment of the person insured who isn't admitted at the network hospitals. In this process, the person insured admits themselves to any hospital for the insured treatment and notify the insurance provider. For emergency or accidental hospitalization, inform the insurance provider in 24 hours of hospitalisation.
- After the treatment is over and the policyholder gets discharged, one must ensure to collect all the original documents and pay the charges.
- Enter the details in the claim form from the official website and notify the insurer about the claim.
- The insurance company will check and verify the documents received. Then the company will approve the claim.
- The insurer will notify the policyholder about the claim.
After accepting the claim, the insurer will process the claim through NEFT.
The documents required to submit for the claim are:
- A medical report stating no pre-existing disease
- The second copy of the first consultation letter
- An FIR copy of the accident.
- Claim form
- Indoor case paper
- Hospital bill
- Various medical certificates
After submission of necessary documents by the policyholder, the insurance provider informs about claim approval.
How to Buy the National Mediclaim Plan?
The policyholder may buy National Mediclaim Policy online through paisawiki.com. The buying steps are as mentioned below:
- To buy the policy, visit Paisawiki.com to check all the policy details.
- Select the plan for buying it. Click the Get Free Quotes” option.
- Enter the details and click the 'continue' button.
- On entering details, the policyholder is required to compare online with another health insurance plan or choose the 'continue' button.
- One must enter the necessary plan related details. Enter sum insured, policy tenure, etc. from the drop down menu. For the calculation of premiums, PolicyBazaar.com has a dedicated health premium calculator.
- The policyholder is required to add riders for extra coverage. Choose the 'proceed' button.
- Add requested details.
- Add the requested KYC documents asked by the policy provider company.
- Agree to the conditions of the policy.
- One must enter bank details to pay online transactions, pay the premium. After payment, the policy document is to be mailed
If not, one can buy the policy offline as well by visiting a nearest branch of the National Insurance Company.
Documents Required to Buy the National Mediclaim Policy
To buy National Mediclaim Plan, the documents required are:
- Passport size photo
- Age proof: Voter Card, Birth Certificate, PAN card, Passport, Driving Licence, Aadhar Card and School Leaving Certificate
- Address proof: Passport, Electricity Bill, Bank A/C statement, Ration Card, Telephone Bill, Utility Bill, and Postpaid Bill.
- Photo ID Proof: Driving License, Voter ID, Aadhar Card, PAN card or Passport.
Renewal Process of the National Mediclaim Plan
The renewal process of the plan is as follows:
- Visit Paisawiki.com
- Choose the plan renewal option. Input plan number & click on continue option.
- Enter the requested policy details like policy tenure, email id, etc.
- Choose the renewed plan.
- The person insured needs to add family members and riders.
- In this step, it is requested to add the mandatory details & add documents.
- On adding new members or riders, calculate the premium amount using a premium calculator.
- Choose the next option.
- One must agree to the new plan conditions. Pay the renewal premium by entering the bank details asked.
After renewal premium payment, the policy details are mailed to the person insured.
Ans: Yes, the infertility treatment is covered, the plan covers up to Rs 50,000.
Ans: The maximum amount given is Rs 300 per day for a maximum of 5 days.
Ans: Yes, ambulance expenses up to Rs 1,000 per insured person are given per hospitalisation.
Ans: No, there are no charges for online payment of premium. Online payment is free of cost.
Ans: A GST of 18% is applicable to health insurance policies.
Written By: Paisawiki - Updated: 22 October 2020