National Parivar Mediclaim Policy

• Enjoy options to cover yourself, your spouse, kids and even your parents
• Enjoy access to 10,000+ hospitals for cashless treatment
• Reduce your taxable income by up to Rs. 50,000 deduction under section 80D**

National Parivar Mediclaim Policy is a health insurance cover designed to provide protection for an entire family. As a family floater policy, this cover protects the entire family under a single policy. The available sum insured amount can be used by any member of the family against various ailments or injuries. As per the policy description, a family is limited to self, spouse, and two dependent children. This policy primarily aims to minimise the financial burden of a family during an unexpected illness or accidental injury.

Eligibility for Parivar Mediclaim

Policyholders must fit within the following eligibility criteria in order to successfully avail the Parivar Mediclaim Policy offered by National Insurance.

• The policy is available for anyone between the age of 18 years and 60 years.
• Dependent children between the age of 5 years and 25 years can be covered provided their parents are also covered.
• Dependent female child can be covered till marriage (if not employed).

Features of National Parivar Mediclaim Policy

Some of the key features of National Parivar Mediclaim Policy can be listed as follows.

• Sum insured amount for the policy ranges from Rs.2 lakh to Rs.5 lakh in incremental values of Rs.50,000.
• It is possible to renew this cover till the age of 65.
• Cashless treatment facility as well as reimbursement of hospitalisation expenses is available.
• Policy is typically issued for a period of one year, and it must be renewed every year without fail.
• Premium charges for this policy are based on the age of the eldest member of the family.
• There is a general waiting period of 30 days from the date of commencement of the policy for coverage of diseases. This waiting period does not apply for accidental injuries.
• Pre-existing diseases are covered after 48 months of continuous policy coverage.
• There is a two-year waiting period for certain conditions like cataract, benign prostatic hypertrophy, sinusitis, joint replacement surgery, hysterectomy, hydrocele, hernia, etc.
• Pre hospitalisation expenses are covered for up to 15 days prior to the date of hospitalisation.
• Post hospitalisation expenses are covered for up to 30 days following discharge from the hospital.
• More than 140 day care procedures are covered under this policy.
• Copayment is required for claims arising out of diabetes and hypertension if the conditions are pre-existing.
• A grace period of 30 days is provided for renewal of this policy following the date of expiry.
• The premium amount paid towards this policy is eligible for tax relief as per section 80D of the Income Tax Act.

Benefits of National Parivar Mediclaim Policy

The benefits offered by National Parivar Mediclaim policy can be given in the following table.

Exclusions under National Parivar Mediclaim Policy

National Parivar Mediclaim policy comes with a range of exclusions for which the insurer is not liable for any payment. Some of the key exclusions can be listed as follows.

• Any sexually transmitted diseases, venereal diseases, HIV, and AIDS
• Expenses related to circumcision unless necessitated by an accident
• Expenses related to diagnosis or examinations not related to the primary reason for hospitalisation
• Intentional self-injuries or injuries caused by attempted suicide
• Injuries occurred while under the influence of drugs or alcohol
• Expenses related to vaccination or inoculation
• Congenital diseases, general debility, run down condition, or convalescence
• Cosmetic or aesthetic treatments of any kinds
• Injuries caused by war, warlike activities, or nuclear weapons
• Any treatment related to childbirth, maternity, or pregnancy
• Expenses incurred for vitamins and tonics unless prescribed by the medical practitioner

Claim Process for National Parivar Mediclaim Policy

Cashless treatment facility for National Parivar Mediclaim policy is available only in the company’s network hospitals. It is possible to avail cashless treatment only after prior approval from the third-party administrator (TPA). For planned hospitalisation, the TPA must be informed at least 72 hours before hospitalisation. For emergency hospitalisation, the TPA must be informed within 24 hours of hospitalisation.

For reimbursement claims, the insured must submit a list of documents to the insurance company. These documents include:

• Completed claim form
• Original bills, payment receipts, and medical certificates
• Prescription for medicines and drugs
• Certificate of a medical practitioner for a certain diagnosis
• Certificate from the surgeon
• Any other document requested by the insurer or TPA

Once these documents are submitted, the insurer will check the validity of the claim. All these documents must be submitted to the TPA or insurance company within 15 days after discharge from hospital. Any claims regarding post hospitalisation treatment must also be completed within 15 days after the end of the treatment. The insurer may also assign an agent to enquire with the insured person regarding a claim. The company will inform about the acceptance or rejection of the claim within a maximum of 30 days after submitting all documents. In case of rejection, the reason shall be provided in writing to the insured. Once the claim is accepted, the reimbursement amount will be paid to the claimant within 7 days.