National Mediclaim Plus Policy

Coverage

Section I: Hospitalisation Expenses as an inpatient. Treatment for Allopathy, Homeopathy & Ayurveda and 140+ day care, Pre and Post Hospitalisation are covered, The Policy comes in three plans A, B and C. Plans B and C are enhanced covers having facilities like Air Ambulance, Medical emergency reunion, Doctors home visit and nursing care during post hospitalisation.

Optional covers are - Outpatient Treatment & Critical Illness.

General Exclusions & Deductible: As per policy.

Medical Second Opinion: - There are 160 major diseases for which insured can take Medical Opinion (one per illness) from the overseas doctors (World Leading Medical Centre- WLMC) through the TPA named in the policy.

Out Patient Expenses: SI to be chosen separately

Cumulative Bonus 5% each claim free year max 50%

No CB on Critical Illness cover or OPD

Extension

Section-II: Critical Illness:

Cover is available for Sum Insured Rs. 2/3/5/ 10/15/20 & 25 lacs. The SI for Critical Illness should not be more than Mediclaim section Sum Insured.

Diseases/illnesses covered–

Critical illness means Stroke resulting in permanent symptoms, cancer of specified severity, kidney failure requiring dialysis, major organ/bone marrow transplant, multiple sclerosis with persisting symptoms and open chest CABG (Coronary Bypass Graft), Permanent Paralysis of limbs and blindness. The exact definition for each illness is specified in the policy

If the insured person is diagnosed with a specified critical illness, symptoms which were not present prior to taking the policy, and he survives the disease for 30 days, he/she is eligible for a claim. No claim is admissible under this section up to 90 days from inception of cover.

Eligibility

Policy can be taken by the insured between 18 and 65. Spouse, dependent children and parents (as per NMP) can be covered. Medical Reports are required for persons above 40 years for persons opting for SI above 6 lacs and all persons opting for critical illness cover, irrespective of age. 50% report costs reimbursed if proposal accepted & premium paid. The Reports are valid for a period of 30 days. Tests required are as follows

• Physical examination (signed by MD)

• Blood Sugar Fasting & PP

• Lipid Profile

• Serum creatinine

• Urine routine and Microscopic Examination

• ECG

• Eye check-up including retinoscopy

• Any other investigation required (proposal assessment)

Premium:

SI

3m -
5yrs

6-17

18-25

26-35

36-45

46-55

56-59

60-65

66-70

71-75

76-80

81-85

86+

2,00,000

5050

5101

5668

5781

5897

8127

11756

15299

22194

25812

27225

28412

29532

3,00,000

6589

6589

7321

7468

7468

10804

15755

20309

29863

34114

37111

39040

40494

4,00,000

7982

7983

8870

9047

9047

13250

19421

24853

36888

41601

46260

48940

50684

5,00,000

9279

9279

10310

10516

10517

15537

22857

29082

43471

48537

54898

58334

60271

6,00,000

10335

10335

11483

11713

11714

17707

26122

33076

49722

55064

62596

66768

69561

7,00,000

11334

11335

12594

12846

12847

19615

29082

36729

55554

61113

70166

75146

78343

8,00,000

12288

12289

13655

13928

13928

21446

31931

40230

61171

66900

77473

83145

86831

9,00,000

13205

13205

14673

14966

15586

23214

34686

43604

66606

72468

84438

90901

95067

10,00,000

14088

14089

15654

15967

17334

24927

37361

46869

71883

77847

91192

98445

103083

15,00,000

19002

19003

28070

31501

31816

34917

49962

58719

76711

82983

102105

119966

126272

20,00,000

22672

22673

30291

44606

45052

45502

60568

68885

83460

86190

113693

139731

147876

25,00,000

26055

26056

32680

46682

47149

50974

70221

77027

86328

89518

120707

154911

164683

30,00,000

29730

29732

35729

49351

50627

59199

79260

83996

86938

93430

124801

166901

177731

40,00,000

35609

35611

41473

53964

58765

73381

93784

93789

94620

100732

125128

181594

194796

50,00,000

40905

40907

47760

58118

67611

87008

106084

106090

106095

108605

125134

188066

203053

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rate for outpatient treatment

Cover Sum (Rs)

2,000

3,000

4,000

5,000

10,000

Premium

1,200

1,800

2,400

3,000

6,000

Family discount of 10%, and Youth discount of 10% are available on the basic premium.
Premium for Critical Illness (each Individual)-

Sum Insured

18-25

26-35

36-45

46-55

56-59

60-65

66-75

76-85

Above
86

2,00,000

372

647

1198

2217

3209

4643

9501

21109

47155

3,00,000

557

970

1796

3326

4813

6965

14251

31664

70733

5,00,000

929

1617

2994

5543

8022

11608

23752

52773

117889

10,00,000

1858

3234

5988

11086

16043

23217

47505

105546

235777

15,00,000

2786

4851

8981

16629

24065

34825

71257

158319

353666

20,00,000

3715

6468

11975

22172

32086

46434

95009

211093

471555

25,00,000

4644

8085

14969

27715

40108

58042

118762

263866

589443

Media