Objective

The objective of this policy is to provide for financial support in case the insured member is hospitalised for an illness, disease or accident.

Suited for

his policy can be bought by an individual for self or for family on an individual sum insured basis or as a floater cover.

What does it do?

The policy covers hospitalisation expenses and day care procedures which that do not require an overnight stay in the hospital due to technological advancements. Ambulance charges and hospitalisation expenses of organ donor in case of major organ transplant are also covered. It is up to the policyholder to avail cashless facility. If policyholder doesn't avail cashless treatment, he will be entitled to 6 per cent discount on premium.

Pros

This policy can be bought online.
The policy offers a premium discount if policyholder does not require cashless facility.
It offers an extended renewal period till 90 years of age, if the insured has taken this Mediclaim policy regularly for at least five years prior to attaining 80 years of age.
Premium paid towards the policy is exempt from Income Tax under section 80D of Income Tax Act.

Cons

There are sub-limits on the policy benefits.
The policy can be renewed only up to 80 years of age for those who do not subscribe to it for five consecutive years until 80.

Our View

This basic health insurance policy is good enough as far as its coverage is concerned. The only drawback is the sub-limit imposed on various expenses incurred during hospitalisation.

Eligibility

Entry Age (years)

Minimum

18

Maximum

59

Maximum Policy Renewal Age (years)

80 or upto 90 if policy continued for atleast 5 years prior to attaining age of 80 years with special approval

Coverage Type

Individual/ family on an individual basis/ family floater

Policy Term (years)

1

Sum Insured (Rs)

Maximum

5 lakh

Minimum

50000

No Claim Bonus

5% for each claim free year till it reaches 50%

Pre Policy Medical Check Up

Mandatory for age of 50 years and above. Cost shall be borne by insured.

Policy Termination

Insurance company may cancel the policy by giving a 30days notice. Insurer may also cancel the policy at anytime. In such an event, insurance company shall refund the proportionate premium as agreed in the policy document

Customer Service

Address

Head Office: National Insurance Company Limited
3 Middleton Street
Kolkata
West Bengal
Pincode : 700071

Mail to

website.administrator@nic.co.in

Call to

1800 419 4033

Scope Of Cover

Cashless facility

available if treatment availed in a network hospital

Reimbursement facility

available if treatment availed in a non-network hospital

Pre and post hospitalisation

medical expenses incurred during 30 days prior to hospitalisation and 60 days after discharge from hospital will be covered

Room, Boarding and nursing expenses*

pays 1% of Sum Insured per day subject to maximum of Rs 5000

I.C.U expenses*

pays 2% of sum insured per day subject to maximum of Rs 10000

Surgeon, Anesthetist, Medical Practitioner, Consultants Specialist fees

covered upto maximum of 25% of sum insured per illness

Anesthesia, Blood, Oxygen, OT charges, Surgical appliance, Medicines, drugs, Diagnostic Material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs and cost of stent and implant

covered upto maximum of 50% of Sum Insured

Ambulance charges

pays 1% of the sum insured subject to maximum of Rs 1000

Organ donor expenses

covers hospitalisation expenses of organ donor

Day care procedures such as dialysis, chemotherapy etc.

covers certain treatments which does not require overnight hospitalisation due to advancement of technology

Health check up

allowed once at the end of four continuous claim free years

*Overall limit for these benefits is 25% of sum insured per illness

Exclusions and Waiting period

Pre-existing illnesses

covered after 4 continuous claim free policy years

Waiting period

Certain disorders and surgeries will be covered after first policy yearCertain illnesses such as cataract, hernia, diabetes, hypertension etc. will be covered after completion of first two policy yearsAIDS/ HIV or related diseases