• National Mediclaim Plus Policy

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    National Mediclaim Plus Policy is a health insurance policy offered by renowned state-owned insurance service provider National Insurance. The policy comes with a range of features to provide affordable insurance service for people in India. It has a range of flexible sum insured options to provide coverage according to one’s requirement and affordability. While the primary cover takes care of the hospitalisation expenses incurred by a patient, the add-on policies provide coverage for critical illness and outpatient treatment expenses.

    Eligibility for Mediclaim Plus Policy

    People who subscribe for National Mediclaim Plus Policy must qualify the following criteria in order to avail successful coverage.

    • Entry age of policyholders must be between 18 years and 65 years.
    • Entry age of proposers must be between 18 years and 65 years.
    • Children between the age of 3 months and 18 years can be covered provided their parents are covered under this policy.
    • Coverage for family includes self, spouse, dependent children, and dependent parents.

    Features of National Mediclaim Plus Policy

    National Mediclaim Plus Policy comes with a range of features to provide benefits for policyholders. Some of the key features of the policy can be listed as follows.

    • Sum insured options for this policy range from Rs.2 lakh to Rs.50 lakh.
    • Pre-existing diseases can be covered after a waiting period of 36 months.
    • More than 140 day care procedures are covered under this policy.
    • Pre-hospitalisation expenses are covered for up to 30 days prior to the date of hospitalisation.
    • Post-hospitalisation expenses are covered after 60 days following discharge from the hospital.
    • Maternity and newborn coverage is offered after 2 years of continuous policy coverage.
    • Premium amount can be adjusted during renewal if a policyholder goes to a foreign country temporarily, and the policy is inactive for a while.
    • Medical second opinion from leading medical centers across the world can be arranged under this cover.
    • The policy comes in three different plans - Plan A, Plan B, and Plan C.
    • Coverage is also available for ayurveda and homeopathy treatments.
    • Organ donor’s medical expenses are covered under this policy.

    Benefits of National Mediclaim Plus Policy

    This policy offers a range of benefits for policy holders. Some of the major benefits offered by this policy can be provided in the following table.

    Expenses Plan A (Rs.2 lakh to Rs.10 lakh) Plan B (Rs.15 lakh, Rs.20 lakh, and Rs.25 lakh) Plan C (Rs.30 lakh, Rs.40 lakh, and Rs.50 lakh)
    ICU and room rent Room rent - up to 1% of the sum insured ICU - up to 2% of the sum insured subject to a maximum of Rs.15,000 Up to Rs.15,000 Up to Rs.20,000
    Maternity Expenses Up to Rs.30,000 for normal delivery and Rs.50,000 for caesarean Up to Rs.60,000 for normal delivery and Rs.75,000 for caesarean Up to Rs.80,000 for normal delivery and Rs.1 lakh for caesarean
    Cataract surgery Up to Rs.60,000 Up to Rs.80,000 Up to Rs.1 lakh
    Daily cash allowance Rs.500 per day Rs.800 per day Rs.1,000 per day
    Ambulance charges Up to Rs.2,500 Up to Rs.4,000 Up to Rs.5,000
    Air ambulance charges Not available Up to 5% of the sum insured Up to 5% of the sum insured
    Medical emergency reunion Not available Up to Rs.20,000 Up to Rs.20,000
    Doctor’s home visit during post-hospitalisation treatment (max. 10 days) Not available Rs.750 per day Rs.1,000 per day
    Vaccination for children Up to Rs.1,000
    Cumulative bonus (No claim bonus) 5% of sum insured per year subject to a maximum of 50% of sum insured
    Health checkup allowance (every two years) Rs.1,000 Rs.2,000 Rs.3,000

    A copayment of 20% is applicable if treatment is taken in a non-network hospital.

    Add-on Covers Available

    This policy comes with a range of add-on covers that can be taken to increase the protection offered. It is necessary to pay some additional premium charges in order to subscribe to these add on covers.

    • Critical illness cover: This pays a lump sum benefit in the range of Rs.2 lakh to Rs.25 lakh following the diagnosis of a named critical illness.
    • Outpatient treatment: This cover pays daily allowance for the outpatient treatment taken by a patient. Benefits are available from Rs.2,000 per day to Rs.10,000 per day.

    Exclusions from National Mediclaim Plus Policy

    This policy comes with a range of exclusions for which coverage will not be provided to policyholders. Some of the key exclusions under National Mediclaim Plus Policy are as follows.

    • Treatment for sexually transmitted diseases, HIV, AIDS, etc.
    • Convalescence, general debility, and run-down
    • Treatment for genetic disorders
    • Treatment for obesity or any weight management programs
    • Treatment for injuries caused under the influence of alcohol or drugs
    • Naturopathy or experimental treatments
    • All kinds of cosmetic or aesthetic treatments
    • Expenses related to spectacles, hearing aids, cochlear implants, etc.

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