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:

Rate for outpatient treatment –

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