National Mediclaim Plus Policy
With medical expenses increasing exponentially, the drain on one’s resources can be worrying. National Mediclaim Plus Policy with its comprehensive coverage goes beyond the traditional health covers, as it offers protection against high health care costs and makes health care and related services easy and accessible. The Policy provides for expenses of hospitalisation, pre & post and day care treatment. Expenses of Allopathic, Ayurvedic and Homeopathic treatment are payable up to the sum insured. The Policy covers expenses of maternity, for new born and vaccination for children. Expenses for medical emergency reunion, air ambulance and hospital cash are also payable. In the event of being diagnosed with a serious illness, a medical second opinion from World Leading Medical Centres will be arranged. In addition, optional covers for Critical illness and Outpatient treatment can also be availed.
| Features | Plans | ||
|---|---|---|---|
| PLAN A | PLAN B | PLAN C | |
| Sum insured (SI) | INR 2/ 3 /4 / 5/ 6/ 7/ 8/ 9 /10 Lac | INR 15/ 20 /25 Lac | INR 30/ 40/ 50 Lac |
| Coverage | |||
| Hospitalisation, Pre (30days) and Post (60 days) Hospitalisation, Daycare procedure | Covered | Covered | Covered |
| Pre existing disease | Covered after 36 months | Covered after 36 months | Covered after 36 months |
| Room/ ICU charges (per day) | Room - Up to 1% of SI ICU – Up to 2% of SI subject to max. of INR 15,000 | Up to INR 15,000 | Up to INR 20,000 |
| Limit for cataract surgery (for each eye) | Up to 15% of sum insured or INR 60,000 whichever is lower | Up to INR 80,000 | Up to INR 1,00,000 |
| Allopathy, Ayurveda and Homeopathy | Up to sum insured | Up to sum insured | Up to sum insured |
| Organ donor’s medical expenses | Covered | Covered | Covered |
| Maternity | Up to INR 30,000 for normal delivery and INR 50,000 for caesarean section | Up to INR 60,000 for normal delivery and INR 75,000 for caesarean section | Up to INR 80,000 for normal delivery and INR 1,00,000 for caesarean section |
| Hospital cash per day (max. of 5 days) | INR 500 | INR 800 | INR 1,000 |
| Ambulance (in a policy period) | Up to INR 2,500 | Up to INR 4,000 | Up to INR 5,000 |
| Air ambulance (in a policy period) | Not covered | Up to 5% of SI | Up to 5% of SI |
| Medical emergency reunion (in a policy period) | Not covered | Up to INR 20,000 | Up to INR 20,000 |
| Doctor’s home visit and nursing care during post hospitalization per day, max. of 10 days (in a policy period) | Not covered | INR 750 | INR 1,000 |
| Vaccination for children (up to 12 years) in a policy period | Up to INR 1,000 | Up to INR 1,000 | Up to INR 1,000 |
| Other benefits | |||
| Medical Second Opinion (MSO) for each new diagnosis of any of the major illnesses, in a policy period | One MSO | One MSO | One MSO |
| Good Health Incentives | |||
| Cumulative bonus | Increase in SI by 5% of SI per year up to 50% of SI | Increase in SI by 5% of SI per year up to 50% of SI | Increase in SI by 5% of SI per year up to 50% of SI |
| Health checkup (every 2 years irrespective of claims) | Up to INR 1,000 | Up to INR 2,000 | Up to INR 3,000 |
| Copayment | |||
| Copayment of 20% of admissible claim if treatment undergone in non-network provider | Applicable | Applicable | Applicable |
| Optional covers | |||
| Critical Illness | INR 2,00,000/ 3,00,000/ 5,00,000/ 10,00,000/ 15,00,000/ 20,00,000/ 25,00,000. | ||
| Outpatient Treatment | INR 2,000/ 3,000/ 4,000/ 5,000/ 10,000. | ||
Plans and Sum Insured
The Policy offers three plans with varying covers
Plan AINR 2 lac to INR 10 lac in multiples of 1lac
Plan BINR 15 lac, INR 20lac,INR 25 lac
Plan C: INR 30 lac, INR 40 lac ,INR 50 lac
Eligibility
- Self, spouse, dependent children and parents.
- Entry age of proposer - 18 years to 65 years.
- Children - 3 months to 18 years.
- Entry age of members - 18 years to 65 years.
- The policy can be renewed lifelong.
Pre existing diseases
Covered after a waiting period of 3 years
Treatment
The Policy covers Allopathy, Ayurveda and Homeopathy treatment.
In-patient treatment
- Room charges and intensive care unit charges
- Medical practitioner(s)
- Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances
- Medicines and drugs
- Diagnostic procedures
- Prosthetics and other devices or equipment if implanted internally during a surgical procedure.
Pre and Post hospitalisation
Expenses incurred 30 days prior to hospitalisation and 60 days post hospitalisation
Day care procedure
140+ day care procedures are covered
Organ donor’s medical expenses
Hospitalisation expenses of the organ donor.
Maternity and new born
Hospitalisation expenses for the first two deliveries or termination during the lifetime of the insured or his spouse, provided the policy is in force for 2 continuous years. Expenses for pre natal, post natal and new born baby are also included.
Vaccination
Expenses for vaccination of children are covered.
Hospital Cash
Daily hospital cash allowance is payable.
Ambulance
Expenses for transportation to the hospital, or from one hospital to another hospital are payable.
Air Ambulance
Expenses for medical emergency evacuation to the hospital, or from one hospital to another hospital are covered.
Medical Emergency Reunion
In the event of hospitalisation away from the place of residence, under any life threatening condition, expense for a round trip travel of a family member is payable.
Doctor’s home visit and nursing care
Doctor’s home visit and nursing care post hospitalisation are covered
Adjustment in premium
In the event of the insured or family members going abroad and covered by an Overseas Travel Insurance Policy of any insurer, the policy will be temporarily inactive in respect of the member, and the premium for the inactive period will be adjusted on renewal.
Medical Second Opinion
In the event of being diagnosed with a serious illness, a Medical Second Opinion from World Leading Medical Centre, will be arranged .The Policy provides one Medical Second Opinion for each new diagnosis covering 160 plus diseases.
Optional covers
Critical Illness
Lump sum payment will be made on diagnosis of a named critical illness.
Benefit amount – INR 2 lac to INR 25 lac
Outpatient Treatment
Limit of cover - INR 2,000 to INR 10,000.
Good Health Incentives
Cumulative Bonus (CB)
Sum insured will increase by 5% for each claim free year.
Health Checkup
Health check-up expenses once at the end of 2 continuous years, irrespective of any claims reported.
- Treatment of HIV, AIDS, STD, etc.
- Convalescence, general debility, run-down condition, sterility, etc.
- Treatment of obesity
- Treatment of genetic disorders
- Cosmetic treatment, plastic surgery, change of sex, hormone replacement
- Naturopathy and experimental treatment
- Drug/ alcohol abuse
- Spectacles, contact lens, hearing aid, cochlear implants.
