National Parivar Mediclaim Policy
National Parivar Mediclaim Policy is an umbrella medical insurance policy for the entire family from the National Insurance Company. The policyholder needs to pay a single premium for the entire term of the National Parivar Mediclaim policy.
This policy's objective is to encourage individuals to protect the financial well-being of their families in the event of a diagnosis of any critical illness or accidental injuries.
What is National Parivar Mediclaim Plan?
Under the National Parivar Mediclaim plan, coverage for the entire family of the proposer can be obtained under a single policy and single premium. The sum insured is shared by all family members who are a part of the plan. The sum insured options offered range between 2 lakh to 10 lakh. The term options are wide under this policy in the range of 1, 2, or 3 years. By going for a long-term National Parivar Mediclaim policy, policyholders can enjoy extended benefits and avoid hassles of frequent renewals of National health insurance. The National Parivar Mediclaim from National Insurance also offers several savings on premiums for its loyal members.
Features of the National Parivar Mediclaim plan
Given below are the main features of the National Parivar Mediclaim plan:
- A single policy can be taken for all the family members of the applicant through a lump-sum premium payment.
- The policy can be taken for 1, 2, or 3 years.
- The family members that can be included in the policy can be the individual, spouse, parents, and dependent children.
- The policy can be renewed for the entire lifetime of the policyholder.
- Pre-hospitalization expenses for up to 15 days and post-hospitalization expenses for up to 30 days are covered under this policy.
- Expenses covered for a specific disease is capped on 50% of the sum insured.
- Room charges are reimbursed up to 1% of the sum insured, and ICU charges are limited to 2% of the sum insured.
- Operation theatre expenses are reimbursed up to 10% of the sum insured.
- In case the policyholder is suffering from diabetes or hypertension, a co-payment of 10% to 25% is admissible.
- The policy has a waiting period of 30 days for all kinds of diseases.
Benefits of the National Parivar Mediclaim
The main benefits of the National Parivar Mediclaim plan are:
- Tax deduction is allowed on the premium paid in this policy under section 80Dof the Income Tax Act.
- A cashless facility for claims can be availed under this policy within network hospitals.
- Purchasing the policy for more than one year can fetch savings of 4% on premiums for 2-years and 7.5% for a 3-years period.
- Online purchase or renewal of the policy will fetch savings of 5% and 2.5%, for 2-yers and 3-years policy respectively.
- If a couple is over 40 years, they are eligible to receive a 3% savings on the annual premium for infertility treatment.
- The policy also offers different savings rates for various zones.
- Expenses for health checkups are paid by the insurance company up to Rs 5000 after 4 continuous years of the policy.
- The policyholder will get a no claims bonus of 5% on base premium if he/she doesn’t make a claim for a whole year with proper renewal.
- A medical second opinion is covered under this policy for any of the 88 major illnesses listed in the policy document.
- Pre-existing diseases are covered after 48 months of continuous policy coverage.
Inclusion of the National Parivar Mediclaim plan
The following medical expenses are covered under the National Parivar Mediclaim policy:
This policy will compensate all medical expenses incurred for:
- In-patient treatment including
- Room charges
- Medical Practitioner fees
- Anaesthesia, blood, oxygen, surgery
- Medicine and drugs
- Diagnostic procedures
- Dental treatment due to an injury
- Plastic surgery if needed due to an injury
- Room rent and ICU charges up to permissible limits
- Cataract surgery expenses up to a permissible limit
- Pre-hospitalization expenses are covered up to 15 days immediately after the insured person is hospitalized.
- Post-hospitalization expenses are covered up to 30 days immediately after the insured person is discharged from the hospital.
- Domiciliary hospitalization expenses will be reimbursed up to the specified limit in the policy.
- Daycare procedure expenses if undergone in a hospital.
- Organ donor medical expenses are covered during organ transplants.
- Hospital cash benefit for 5 days is paid to the insured by the insurance company provided the hospitalization exceeds 3 days.
- Ambulance charges for transportation to and from the hospital are covered up to the specified amount.
Exclusions of the National Parivar Mediclaim Policy
The following expenses are excluded from the coverage of the National Parivar Mediclaim policy.
- Treatment for sexually transmitted diseases such as AIDS or HIV
- Genetic disorders, pregnancy-related complications, and dental surgeries (if not related to hospitalization) are excluded.
- Cost of vaccinations (except rabies) are excluded.
- Any massage, or spa treatment costs are not covered.
- Naturopathy treatment expenses are not covered.
- Treatment for obesity, weight etc. are excluded.
- Treatment for self-inflicted injuries and psychiatric disorders is not covered in this policy.
- Expenses for obtaining hearing aid, spectacles or contact lenses are not covered.
- Certain listed diseases are excluded from the policy coverage for 2 years of the policy.
- Diagnostic or laboratory tests that are not related to the reason for which the insured is hospitalized.
- Injury caused due to war or nuclear weapon attack is not covered.
- Treatment due to drugs or alcohol abuse is not covered.
Eligibility Criteria to Buy the National Parivar Mediclaim plan
The eligibility requirements to buy the National Parivar Mediclaim policy is given below:
- The policy must cover at least 2 family members
- The policy proposer must be between 18-65 years of age,
- The maximum age of entry of any family member must be 65 years.
- Children between 3 months to 25 years may be covered if the parents are covered under the same policy.
- The family members to be covered include spouse, dependent children, and parents.
- The maximum age of the dependent child must be 18 years.
Claim Process of the National Parivar Mediclaim Plan
In the event of hospitalization, the insured or his family member must inform the TPA (Third Party Administrator). The notification must be sent through email, letter, or fax along with the policy and treatment information.
Procedure for Cashless Claims
Cashless claims can be registered for availing treatment at a network hospital. The following steps are to be followed for the same.
- To avail of a cashless facility from the hospital, TPA needs to be informed first through a cashless request form.
- The TPA will check the request form and then issue a pre-authorization letter to the hospital, seeking approval for cashless treatment.
- After treatment, the policyholder must verify and sign discharge papers and make payments for non-medical expenses that are excluded. The rest of the bill amount is paid by the insurer directly.
- In case the cashless claim is rejected by the TPA, the insured can still get access to the required treatment under reimbursement clause and submit the claim papers later.
Procedure for Reimbursement of Claims
For reimbursement of claims for regular or domiciliary hospitalization, the insured must submit the necessary documents to the TPA within the prescribed time limit.
- Once the claim request is received, and the documents are in order, the insurance company will process the request within 30 days.
- In the case of claim rejection, the same will be communicated to the insured within 30 days.
- Upon accepting the claim request, the payment of the claim amount will be made within 7 days of acceptance of the request.
Documents Required to File a Claim
The insured needs to submit the following documents for claim settlement:
- Duly filled Claim Form
- Original bills, discharge certificate, payment receipts, medical history of the patient
- Prescriptions of the physician
- Medical bills from the pharmacist
- Certificate of diagnosis from the medical practitioner
Documents Required to Buy the National Parivar Mediclaim Plan
The documents needed to apply for the National Parivar Mediclaim Policy are:
- Document showing proof of age such as Birth Certificate, School mark sheets, Passport, Aadhar Card, Voting ID, Drivers' license, etc.
- Document showing identity proof such as Aadhar Card, Passport, Voter ID, Driver license, PAN card, etc.
- Document showing address proof such as Aadhar card, Utility bills, ration card, Passport, Driver License, etc.
- Passport size photos
- Medical Test results if taken
How to Buy the National Parivar Mediclaim plan?
Buying National health insurance is very easy. One can either buy it from the official website or can compare several plans at the aggregator websites such as Paisawiki.com, compare the premiums and choose the National Parivar Mediclaim policy. The policy can also be bought from the nearest National Insurance Company branch office either directly or through an agent through the steps given below:
- The applicant must collect and duly fill the proposal form.
- The form must be submitted to the office directly or through an agent.
- Premium estimates of the various plans will be given to the proposer from the offices.
- Once the premium is paid, the policy will be issued directly or through a registered
Buying through Paisawiki
Alternatively, he/she can visit paisawiki.com to buy the National Parivar Mediclaim Plan in just a few clicks. First, one must enter basic details, and the portal will show all the insurance options that match. Click on the National Health Insurance tab to compare plans, choose the National Parivar Mediclaim plan, and follow the instructions to complete the buying process. The last step is to pay the premiums online and get the policy document mailed.
Renewal Process of the National Parivar Mediclaim plan
Given below are the steps to renew the National Parivar Mediclaim plan at pasiwiki.com:
- Visit the official website of paisawiki.com
- Next go to the ‘Renewal’ option and choose National Parivar Mediclaim Plan renewal from the policy options.
- Next is to fill the policy details such as the policy number, email ID, date of birth, and registered phone number to proceed.
- Next, view the premium amount. The required premium amount shown can be paid through net banking, credit, or debit card.
- The insured must click on the Purchase Policy button to confirm renewal and to get a confirmation message to the email Id and phone number.
Ans: The insurance company is liable to pay 50% of the pre-policy expenses that arise out of pre-policy checkup.
Ans: The waiting periods for various ailments under this policy are:
- 4 year waiting period for diseases such as diabetes, hypertension, and joint replacement.
- 2 years waiting period for treatments for cataract, hysterectomy, arthritis, hernia, piles, sinusitis, and so on.
- 30 days waiting period for any injury or illness suffered within 30 days of policy purchase. After which the insured will not get any reimbursement.
Ans: For planned hospitalization, the policyholder will have to inform the TPA within 72 hours before the patient is admitted into the hospital.
For emergency hospitalization, the policyholder must inform the TPA or insurance company within 24 hours after admission into the hospital.
Ans: Co-payment is the percentage of the claim amount that insured needs to pay that is determined during purchase of the policy.
Ans: The various zones under this policy are:
- Zone I that includes the whole Metropolitan area of Mumbai and Gujarat
- Zone II that includes Delhi, NCR, Chandigarh, and Gujarat.
- Zone III that includes Chennai, Hyderabad, and Kolkata
- Zone IV that covers the rest of India
- Ans: If Zone I is allotted, treatment taken in all other zones is free of co-payment.
- If Zone II is allotted, the treatment is taken in Zone III, and IV is free of co-payment while zone I is subject to 5% of the claim amount.
- If Zone III is selected, treatment taken in Zone IV is free of co-payment while Zone I and II are subject to 12.5% and 7.5% of the claim amount respectively.
- If Zone IV is selected, treatment in Zone I, Zone II, and Zone III have co-payment percentages of 22.5%, 17.5%, and 10% respectively.
Written By: Paisawiki - Updated: 18 November 2020