National Mediclaim Policy

Coverage: (For complete details, please refer the policy bond)

Covers Hospitalisation expenses under the following heads.

1. Room Boarding and Nursing charges and others 25% of the Sum Insured any one illness. Sublimit for room charges 1% of SI and for ICU 2% of SI.

2. Medical practitioners surgeons anaesthetist consultants and specialists fees : 25% of the SI any one illness.

3. Anaesthesia, blood, oxygen etc: 50% of the SI any one illness

4. Ambulance charges restricted to 1% of the SI subject to a max of Rs. 2000 in a policy period.

5. Day care procedure for 140 plus procedures

6. Pre and Post hospitalization for 30 and 60 days respectively

7. Ayurveda and Homeopathy treatments restricted to 20% of the SI Some General Exclusions:

a. Pre-existing diseases 48 months.

b. First 30 days waiting period

c. Specific waiting period of one year for 2 named diseases, 2 years 20 named diseases and 4 years 2 named diseases.

d. Some Expenses not covered for reimbursement are specified.

e. Some permanent exclusions, like HIV, AIDs, diseases resulting from drug/alcohol abuses, cosmetic surgery, massage/spa etc.

Cumulative Bonus (CB)

Sum Insured will be increased by 5% in respect of each claim free years upto a maximum of 50% of Sum Insured excluding CB under the current policy period.In case of a claim under the policy in respect of the insured person who has earned CB ,the same will be reduced by 5%

Health Check Up Costs

Expenses of health check up will be reimbursed once at the end of a block of four continuous policy period provided no claims reported during these four years. Expenses payable is a maximum of 1% of average Sum Insured excluding CB for the block of four years. Health check up cost reimbursement should be claimed within 45 days of the 5th policy year.

Eligibility:

Policy can be availed by person between the age 18 to 65 years. Children can be covered between the ages of 3 months to 18 years, provided parents are also covered under the policy.

Policy can be availed for self , spouse and dependent children/brother/sister upto the age of 18 years,. (Upto 25 years in case of a bonafide student and not employed and in case of dependent female child/sister, upto marriage), Parents and Parents in law.

Sum Insured:

a. Sum Insured ranges from Rs. 50,000/- to Rs. 5 lacs in multiples of Rs. 25,000/-

b. Sum Insured for each family member may vary.

c. Senior Citizen having Sum Insured Rs. 15,000/- & Rs.45,000/- in multiple of Rs. 5,000/- may continue with the Sum Insured on payment of revised premium or may opt for higher Sum Insured between Rs,50,000/- to Rs. 5 lacs

Enhancement Of Sum Insured:

Sum Insured can be enhanced only at the time of renewal at the discretion of the insurer. For the increased Sum Insured the waiting period will be as per exclusions 4.1, 2 & 3. Coverage for the enhanced Sum Insured will be available after the completion of waiting periods.

Pre-Policy Check-Up

Pre policy check up is required for the person aged 50 or more for first time insurance including midterm inclusion cases.Investigation reports required are (valid for 30 days from the date of issue)-

1. Physical examination report (to be signed by the doctors with minimum MD qualification)

2. Blood Sugar, Fasting and Post Prandal

3. Lipid profile

4. Serum creatinine

5. Urine routine and microscopic examination.

6. ECG

7. Eye Check up with Retinoscopy

Company will pay 50% investigation cost subject to acceptance of proposal and payment of premium. Pre acceptance check up is not required if the person proposed to be covered is below 50 years, or if the policy is being ported without break, and Senior citizens moving from the old individual mediclaim policy to the National Mediclaim policy.

Payment Of Premium And Renewal Of Policy:

Just call us or write us for a new policy or porting. Help in claim and Renewal is our commitment, therefore don't worry, just knock us for first time only.

Family Discount:

Family discount of 10% is allowed if the policy is purchased for the self and any one of the eligible family members.

Portability:

Insureds are allowed to port from one policy to another within the Company or inter Companies for which application should be made before 45 days of the expiry of the existing policy. In case the person is covered under a Group policy of a particular Company, it is essential that he/she ports to an individual/family floater policy of the same company for one year and then port to another Company if required.

Free Look Period:

The policy has a free look period of 15 days within which the insured may opt out of the same if not satisfied. For details of refund, please refer the policy bond.
 

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