National Insurance Mediclaim Policy Introduction
National Insurance Mediclaim Policy is a health insurance policy which is designed by National Insurance Company for you and your family. National Insurance Mediclaim Policy covers medical expenses incurred for treatment of illness or disease or injury during the policy period. It also covers pre-hospitalization and post-hospitalization expenses and more than 140 day care procedures. Cashless facility and Re-imbursement of hospitalization expenses is allowed under National Insurance Mediclaim Policy. This National Insurance Mediclaim Policy is also available for Senior citizens.
National Insurance Mediclaim Policy Terms conditions and Eligibility
| Entry Age for Proposer/Spouse: |
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| Entry Age for Dependent Children: |
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| Policy Period: |
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| Sum Insured: |
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| Renewal till age: |
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| Pre-policy medical checkup: |
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National Insurance Mediclaim Policy Review and Features
- Cumulative Bonus: It is a No Claim Bonus where Sum Insured will be increased by 5% for each claim free policy year.
- Discount: A family discount of 10% for the premium is available. It covers you and your family members (Spouse, Dependent children and Dependent parents).
- Tax Benefit: You can get tax benefit under section 80 D of the Income Tax Act for premiums paid. For more information regarding Income Tax Benefits, visit www.taxqueries.in.
- Free Look Period: If policyholder is not satisfied with the terms and conditions you can return your policy within a period of 15 days from the date of receipt of policy.
- Portability: If you are insured with another non life health insurance company, you can switch to National Mediclaim Policy, on renewal, without losing any accrued benefits.
- Ambulance charges: 1% of sum insured or maximum of Rs 2000/- are paid for ambulance services in a Policy period.
National Insurance Mediclaim Policy Inclusions
Coverages under National Insurance Mediclaim Policy are,
- Inpatient treatment: It covers expenses for hospitalization for more than 24 hours like Room expenses, boarding expenses, nursing expenses, medical practitioner fees, etc.
- More than 140 day care procedures are covered, which require hospitalization for less than 24 hours.
- Medical expenses incurred for Homeopathy and Ayurveda treatment are allowable up to 20% of the sum assured for Any One Illness.
- Pre-hospitalization expenses – up to 30 days prior to the hospitalization.
- Post-hospitalization expenses – 60 days after discharge from the hospital.
- Pre-existing diseases – covered after a waiting period of 4 policy years subject to continuous renewal.
- Accident Coverage is available from the time of inception of the Plan i.e, there is no waiting period for accident coverage.
National Insurance Mediclaim Policy Exclusions
Exclusions under National Insurance Mediclaim Policy are,
- For first 30 days of commencement of the policy, no claim is payable, expect for accidental claims.
- HIV / AIDS, general debility, Convalescence, sterility, Pregnancy and related problems are excluded.
- Obesity, All psychiatric and psychosomatic diseases, genetic disorders etc. are excluded.
- Cosmetic, sex change, plastic surgery, hormone replacement etc. are not covered.
- Dental, Outpatient treatment, abuse of Drugs or alcohol are not covered.
- Spectacles, hearing aid, contact lens, cochlear implants and also home visit charges are excluded.
For complete information about National Insurance Mediclaim Policy non-coverages please refer National Insurance Mediclaim Brochure or National Insurance Mediclaim Policy Wordings.
National Insurance Mediclaim Customer Care
Assistance:
For any Information or doubts regarding National Insurance Mediclaim Policy, Visit www.nationalinsuranceindia.com or call Toll free: 1800 120 1430 or Fax : (033) 2289 6329
You can also contact National Insurance Company through E-Mail: nic.health@nic.co.in
You can also post or write to the following address.
Address:
Head Office
3 Middleton Street
Kolkata
West Bengal
Pin code: 700071
National Insurance Mediclaim Policy Buying Procedure
- Submit National Insurance Mediclaim prospectus and the National Insurance Mediclaim proposal form to the office or to the agent.
- Proposal form is to be filled with accurate information.
- Additional documents like address proof, medical reports, photographs are to submitted along with proposal form (if required by the company)
- You can also buy National Insurance Mediclaim online at http://niconline.in/.
- Download National Insurance Mediclaim Proposal form and Prospectus here.
National Insurance Mediclaim Proposal Form
National Insurance Mediclaim Prospectus
National Insurance Mediclaim Policy Claim Procedure
| Claim procedure to avail Cashless facility | Information to TPA |
| Planned hospitalisation | At least 72 hours before the insured person’s admission to network hospital/PPN |
| Emergency hospitalisation | Within 24 hours of the insured person’s admission to network hospital/PPN |
| Claim procedure for Reimbursement | Information to Company/TPA |
| Planned hospitalisation | At least 72 hours before the insured person’s admission to hospital |
| Emergency hospitalisation | Within 72 hours of the insured person’s admission to hospital |
Documents Required during Claim Settlement
- Claim form with complete information.
- Original bills, medical history of the patient, payment receipts, discharge certificate from the hospital etc.
- Original cash-memo from the hospital or chemist supported by the prescription.
- Original payment receipt and investigation test reports supported by proper prescription from attending medical practitioner.
- Attending medical practitioner’s certificate regarding bill receipts and diagnosis etc.
- Surgeon’s certificate stating nature of operation performed and diagnosis along with bills etc.
- Any other documents required by National Insurance company/TPA (Third Party Administrator).
Claim Settlement:
- If your offer of settlement is accepted by the company, the payment shall be made within 7 days from the date of acceptance of your offer.
- If, there is a delay in the payment, the National Insurance Company shall pay interest at a rate which is 2 percent above the bank rate.
- If your claim is rejected by the company for any cases, company shall communicate to you in writing & within a period of 30 days from the final document receipt.
National Insurance Mediclaim Claim Form
National Insurance Mediclaim policy Claim Form is to submitted to the company or TPA during claim settlement. It is to be filled completely and accurately.
National Insurance Mediclaim Claim Form
National Insurance Mediclaim Premium Calculator
You can calculate the premium using National Insurance Mediclaim Premium calculator. Personal details, Number of members, Policy period, Age and Sum assured and other details are required to calculate the premium.
National Insurance Mediclaim Policy Premium Rates
National Insurance Mediclaim Policy Premium Chart is shown below,
National Insurance Mediclaim FAQ’s
At what situation National Insurance Mediclaim Policy will get cancelled?
- Company may cancel your policy on grounds of misrepresentation, fraud etc. by sending you 30 days notice.
- You (The Insured person) may cancel the policy at any time during the policy term. In such case the company shall refund of premium.
What are the Services offered by a TPA?
TPA (Third Party Administrator) handles, claim admission and recommend the National Insurance company for the payment of the claim settlement.
What are the reports required for Pre-policy Checkup?
- Physical examination
- Lipid profile
- Blood sugar
- ECG
- Eye checkup
- Urine routine & microscopic examination
- Serum creatinine
National Insurance Mediclaim Forms and Documents
National Insurance Mediclaim Brochure
National Insurance Mediclaim Customer Information Sheet