• National Insurance Varistha Mediclaim Policy

    Health Insurance
    • 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**

    Varistha Mediclaim Policy by National Insurance is a health insurance policy designed to meet the requirements of senior citizens in the country. Senior citizens are among the most vulnerable groups when it comes to ailments and injuries. This policy focuses on providing financial security to that vulnerable group against various health risks. This is an individual policy, and it cannot be taken as a group cover or family floater cover.

    Eligibility for Varistha Mediclaim Policy

    As a health insurance policy specifically designed for senior citizens, this cover comes with a set of specific eligibility criteria that must be met.

    • Senior citizens between the age of 60 years and 80 years can enter this cover.
    • The policy can be renewed only till the insured person is 90 years old.
    • This policy can be taken only by individuals.

    Features of National Insurance Varistha Mediclaim Policy

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

    • This policy is available only in two sum insured options - Rs.1 lakh and Rs.2 lakh.
    • Free health checkup is provided after three continuous years of policy coverage without any claims.
    • Copayment of 10% is necessary for all admissible claims.
    • The insured can also opt for 20% copayment and get discount on the premium charges.
    • General waiting period of 30 days is mandatory for all policyholders.
    • Pre-existing diseases can be covered after 12 months of continuous policy coverage.
    • Pre hospitalisation expenses are covered for up to 30 days prior to the date of hospitalisation.
    • Post hospitalisation expenses are covered for up to 60 days after discharges from the hospital.
    • One-year waiting period is mandatory for certain conditions such as benign prostatic hypertrophy, sinusitis, piles, hernia, hydrocele, cataract, hysterectomy, etc.
    • For every claim-free year, a cumulative bonus of 5% of the sum insured is available for policyholders. This bonus is subject to a maximum of 50% of the sum insured amount.
    • The premium amount paid for this policy is eligible for tax relief as per section 80D of the Income Tax Act.
    • A grace period of 30 days is available from the date of expiry to renew the policy. However, coverage benefits will not provided for the period during which there is no premium received.

    Benefits of National Insurance Varistha Mediclaim Policy

    Varistha Mediclaim Policy by National Insurance comes with a range of benefits tailor-made for senior citizens. The policy is designed in such a way that senior citizens get the maximum out of the limited sum insured amount. Some of the major benefits offered by this medical insurance policy can be provided in the following table.

    Room rent 1% of the sum insured per day subject to a maximum of 25% of the sum insured per illness or injury
    Intensive care unit charges 2% of the sum insured per day subject to a maximum of 25% of the sum insured per illness or injury
    Hospitalisation expenses Doctor’s fees, consultant fees, surgeon fees, medical practitioner fees, anaesthetist fees, etc.
    Other medical expenses Blood, anaesthesia, oxygen, surgical appliances, medicines, drugs, x-ray, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, etc.
    Cataract treatment Sub-limit up to Rs.10,000
    Benign prostatic hypertrophy Sub-limit up to Rs.20,000
    Domiciliary hospitalisation Up to 20% of the sum insured amount
    Ambulance charges Up to Rs.1,000 per policy period
    Critical illness coverage Lump sum up to the limit of sum insured is paid for conditions such as cancer, stroke, multiple sclerosis, etc.

    Exclusions from National Insurance Varistha Mediclaim Policy

    There are certain cases for which the insurer is not liable to provide any compensation. Some of the key exclusions from this policy can be listed as follows.

    • Intentional self-injuries or suicide attempt
    • Injuries caused by drugs or alcohol
    • HIV, AIDS, or any kinds of sexually transmitted diseases
    • Congenital diseases, defects, or anomalies
    • Convalescence, general debility, or run down condition
    • Cosmetic or aesthetic treatment of all kinds
    • Dental treatment unless necessitated by an accident
    • Expenses related to vaccination or inoculation
    • Expenses related to spectacles, hearing aids, or contact lens
    • Injuries or diseases caused by nuclear materials or radiation
    • Hospitalisation for the purpose of diagnosis or examination
    • Any war or warlike activities

    Claim Procedure

    Both cashless treatment and reimbursement is available with National Insurance Varistha Mediclaim Policy. In case of an event that may give rise to a claim, the insurer must be notified without any delay. Cashless treatment is possible only after receiving an approval letter from the third-party administrator (TPA). For planned hospitalisation, the TPA must be informed at least 72 hours prior to admission in the hospital. In case of emergency hospitalisation, the TPA must be informed within 24 hours after admission in the hospital.

    For cashless treatment, the TPA will check the validity of the claim and issue the authorization letter. The insured person must submit this authorization letter along with the insurance details and identity card.

    For reimbursement claims, the insured must provide the following list of documents while filing for the claim.

    • Original bills and receipts
    • Medical history of the patient
    • Original test results and other diagnostic certificates
    • Medical practitioner’s certificate about the diagnosis
    • Surgeon’s certificate about the procedure
    • Any other document requested by the TPA or insurer

    Once the treatment is over, the insured must submit all the above mentioned documents within 15 days after discharge from the hospital. After receiving all the documents, the TPA and the insurance company will verify the validity of the claim. The insurance company may also send an agent to check with the policyholder regarding the claim. After verifying the validity of the claim, the reimbursement amount will be disbursed to the insured.

    FAQs on National Insurance Varistha Mediclaim Policy

    1. What are the toll-free numbers of National Insurance?
    2. If you want to get in touch with the customer care executives of the company, you can call the toll-free numbers 1800-200-7710 and 1800-120-1430.

    3. What is a pre-policy check-up and under what conditions is it required?
    4. A pre-policy check-up can be requested by the insurance company to ascertain the physical condition of the proposer of the policy. However, pre-policy check-ups are not demanded always. Pre-policy check-ups are required when:

      • the age of the proposer is 40 years or more
      • the proposer opts for a policy with the sum insured value equal to Rs.6 lakh.
      • the proposer opts for the critical illness cover and is aged between 18 years and 65 years
    5. What kind of reports are to be submitted for the pre-policy check-up?
    6. The reports for the following tests need to be submitted as part of the pre-policy check-up:

      • Physical examination
      • Lipid profile
      • Urine routine and microscopic examination
      • Eye check-up
      • HbA1c
      • Serum creatinine
      • ECG
      • Any other investigation as requested by the insurer

      The date of the medical reports should be within 30 days from the date of proposal of the policy.

    7. What documents can be submitted for proof of identity and address?
    8. The following documents can be submitted as proof of identity:

      • Passport
      • Voter’s ID
      • PAN
      • Driving License

      The following documents can be submitted as proof of residence:

      • Telephone bill
      • Bank account pass book
      • Bank account statement
      • Ration card
      • Letter from a recognised public authority
      • Electricity bill
      • Employer’s certificate
      • Lease agreement with rent receipt
    9. Will the expenses for the pre-policy check-up be reimbursed?
    10. The insurance company will reimburse 50% of the expenses incurred on the pre-policy check-up.

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