Objective

This is a special policy that aims to cover senior citizens against hospitalisation and critical illness expenses.

Suited for

Any senior citizen, upto 80 years of age, can buy this policy and renew it up to 90 years of age.

What does it do?

A senior citizen policy which will cover hospitalisation expenses, but with sub-limits. It offers additional coverage for critical illness only if policyholder opts for it. Most people in this age group suffer from diabetes or hypertension. This policy offers to cover pre-existing diabetes and hypertension for extra premium. No claim would be paid if the insured member smokes 40 or more cigarettes/ cigars or has an equivalent tobacco intake each day.

Pros

It offers critical illness cover and pre-existing diabetes and hypertension for an extra premium.
This policy can also covers paralysis and blindness for an extra premium.
Premium paid is eligible for tax benefit under section 80D of the Income Tax Act.

Cons

There are sub-limits on the policy benefits.
Policyholder has to bear a pre-specified percentage of admissible claim each time medical services are availed.

Our View

Every senior citizen policy has co-payment clause attached to it. A policyholder cannot escape the co-payment condition while buying insurance at this age. Another useful feature is Critical illness cover which can be added onto this policy as the chances of contracting such illnesses are high at this age.

Eligibility

Entry Age (years)

Minimum

60

Maximum

80

Maximum Policy Renewal Age (years)

90

Coverage Type

Individual

Policy Term (years)

1

Sum Insured (Rs)

100000 and Rs 200000 for critical illness

No Claim Bonus

Insured person can either opt for a premium discount of 5% for each claim free year till it reaches 50% or select to increase the sum insured by the amount of cumulative bonus at the time of renewal

Pre Policy Medical Check Up

Not required if insured was covered under any health insurance for preceding three years. Required for others

Co Payment Clause

Insured has to compulsorily bear 10% of all admissible claims. Insured may also opt for 2% co-payment which will entitle him for a premium discount of 10%.
An additional co-payment of 10% of admissible claim would be required in case claim arises out of a pre-existing disease

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

Section I

Hospitalisation expenses

covered

Room, Boarding expenses as provided by the Hospital/Nursing Home

covered upto 1% of Sum Insured per day. Cover increases to 2% if admitted to ICU. Overall limit is 25% of Sum Insured per illness

Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses

covered upto maximum of 25% of Sum Insured per illness

Anesthesia, Blood, Oxygen, OT charges, Surgical appliances (any disposable surgical consumables subject to upper limit of 7% of Sum Insured), Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs, Cost of stent & implants

covered upto maximum of 50% of Sum Insured per illness

Domiciliary treatment

covered upto 20% of basic sum insured

Ambulance charges

covered upto Rs 1000 in a policy year

Cost of health check up

reimburses the amount upto maximum of 2% of average sum insured once after a block of 3 continuous claim free years

Pre-existing Diabetes and Hypertension

covered from inception of the policy

Section II

Critical Illnesses

Coronary Artery Surgery

covered

Cancer

covered

Renal Failure i.e. Failure for both kidneys

covered

Stroke

covered

Multiple Sclerosis

covered

Major Organ Transplants like kidney, Lung, Pancreas or Bone marrow

covered

Paralysis and blindness at extra premium

requires additional premium equal to 15% in each case or 25% in case of both covers together

Exclusions and Waiting Period

Pre-existing illnesses

covered after 1 policy year from inception of the policy

No claim period

30 days for general cover and 90 days in case of Critical Illness from commencement of the policy

Waiting period

Certain disorders and surgeries such as cataract, hernia, Piles etc. will be covered after first policy year